A VOICE FOR THE VULNERABLE – Irish Examiner Special Investigation – Day 2
THE Irish healthcare system is in crisis. Billions are being cut from its budget, but what will this mean for the elderly, who depend on this system most of all?
This issue is of huge concern. At last month’s Magill summer school, Ombudsman Emily O’Reilly made controversial comments about the new Fair Deal Nursing Homes Scheme and an investigation she is shortly to publish about State provision of care to the elderly.
“I am aware that the new system will make things a lot better for many people,” she said. “But as my investigation will point out, what has effectively happened is that the State believes it has now divested itself of the responsibility to provide nursing homes.”
Is this what is happening? Under the guise of the Fair Deal scheme, which was introduced in October, 2009, is the HSE planning to close its public hospitals and replace them with privately-run care facilities? There are approximately 600 nursing homes in Ireland; 450 are private, and the other 150 public.
These 150 public nursing homes — which care for 10,000 people — are under increasing pressure. Loughloe House in Athlone, Bethany House in Carlow, St Patrick’s in Waterford, Orchard nursing home in Bray; these are just some of the homes that have been closed, or cited for closure, in recent months.
“The HSE announced it was closing Loughloe House in May,” says Lorraine Monaghan, industrial relations officer with the INMO (Irish Nurses and Midwives Organisation). “Of its 39 residents, only 11 are left. The others were transferred to the private sector.”
The reason given for the closure of Loughloe House was the publication of an unfavourable report by HIQA (the Health Information and Quality Authority, an independent body founded in 2007 to enforce standards in the healthcare sector). Lorraine says this was used as an excuse to close a public facility and move the residents into private care.
“The report didn’t call for closure,” she says. “It identified various problems, and listed the actions necessary to bring the facility up to standard. But, instead of investing the funds, the HSE took the easy option and closed the hospital. It took the problem, and the expense of the elderly, off their hands.”
Lorraine says this is a deliberate policy by the HSE, and that their embargo on the recruitment of new staff, which has been in place since April 2009, is another aspect of it.
“Staffing shortages mean that services are curtailed and beds are eventually closed,” she says. “This is an issue in many hospitals all over the country, which means that more facilities will have to shut. If the government doesn’t take responsibility and improve staffing levels now, the privatisation model will slowly creep in.”
The impact that this has on elderly patients is what makes her angry. “Moving elderly people after they have lived in these homes for years and years is ethically and morally wrong,” she says. “These are excellent facilities and they have a lot to offer if the resources are put in place. I worry that soon there won’t be any public service left.”
Would this necessarily be such a bad thing? The INMO says it would place all future generations of elderly people in a vulnerable situation.
“I have nothing against private nursing homes,” says Michael Dineen, another of the organisation’s industrial relations officers. “But they are in a position where they can pick and choose the nature of their patients. Will we eventually find ourselves in a position where those who need the maximum care will not have the facilities open to them?”
David Hughes, deputy general secretary of the INMO, is just as concerned. “We advocate for safe care, and appropriate nursing staff with the necessary skills to cater for the dependency level of the individual,” he says. “In our view, this cannot be guaranteed in the private, non-profit system.”
The INMO aren’t the only ones to be worried. Age Action Ireland is, too.
“We have been contacted by nurses at a number of HSE nursing homes, telling us that they have been informed they will not be filling beds as they become vacant, and they are reducing the number of respite beds,” says spokesperson Eamon Timmins.
“There seems to be a pattern of closing public nursing home beds in recent months, and we are seeking a meeting with the HSE to establish if there is an unwritten plan for them to move away from providing nursing home beds,” he says.
If such a policy does exist, it is one that Age Action Ireland opposes wholeheartedly. They have already come across problems with housing public patients in private facilities, even on a practical basis.
“Public patients in contracted beds in private homes have found it difficult to access public services, such as chiropody and physiotherapy, because, in some cases, HSE staff do not visit these homes,” says Timmins. “Public nursing homes can provide these types of services to older people, who need them in a more cost-effective way.”
When confronted with these concerns, the HSE are quick to deny the insinuated policy of closing public nursing homes by stealth. “The Fair Deal scheme, and the changes that have come about since its introduction, all aim to have all facilities on a par in terms of standards — both public and private — so that people can choose the facility that best suits them,” says Noel Mulvihill, the HSE’s assistant national director for older persons.
He defends the 32 standards introduced by HIQA, and the actions that have been taken following HIQA reports. “Many of our buildings are Victorian in nature and simply not fit for purpose,” he says. “So we are moving people around as we try to meet standards of care. The elderly may not like it. It may be traumatic for some. But they will end up somewhere much better.”
He does not accept the allegation that private nursing homes are being favoured over public options. “In as much as we can, we move people to newer parts of the same facility, or someplace close by. If they are in public residential care, they should be able to stay there, if they want. The more dependent tend to be in the public system, so it’s important we offer people this choice.”
Former patients in Athlone’s Loughloe House, and in Carlow’s Bethany House, would refute this argument. So, too, would the people of Dingle — who are experiencing a problem not with the closure of their local hospital, but with its opening.
“Our hospital, which cares for 42 patients, was built in 1852,” says Breda Carroll, a member of the Dingle hospital support group. “It has needed to be replaced for years. There are only two showers and the patients have no real privacy, even though the staff do the best they can.”
After a decade of campaigning, and after a local landowner donated a site free of charge, the hospital was finally built last year, at a cost of 16.4m. However, the patients have yet to move in.
“They were told they could move on July 27, but, once again, they were stopped, this time by HIQA,” says Breda Carroll. “They won’t give us any answers as to why it was stopped, again. We’re being treated like fools.”
On Saturday, August 16, more than 1,000 people turned out to protest against the situation. “All we’re asking is that the elderly be given dignity at the end of their lives,” says Breda Carroll. “We’ll keep going until they have it.”
Age Action Ireland and the INMO are continuing to campaign, too. Age Action Ireland is asking the public to keep them informed about the scale of cuts nationwide. Details can be sent to info@ageaction.ie.
The INMO are supporting local protests over the closure of care of the elderly facilities, and lobbying the government to take action on under-staffing.
HAVING never visited a residential care home before, all I knew about them I had learned from reading newspaper articles and watching documentary programmes.
I expected to see a building that had seen better days; staff that were caring but pushed to their physical and psychological limits; and residents who were sad to be spending the end of their lives in such a facility. In short, I expected them to be dreary and depressing places.
This is not what I found in Cobh Community Hospital. The building itself may be past its prime but this was the only way in which this care facility for the elderly matched my expectations. My two visits to Cobh were full of surprises.
FUNDING CUTS
The first was just how nervous some of the staff appeared to be. This 110-year-old hospital offers long-term residential, palliative and convalescent care to 38 elderly people and it’s currently under severe financial pressure.
The hospital’s funding has been cut under the National Treatment Purchase Fund and the Fair Deal Scheme. The cuts are so significant that the fear is that it will eventually be forced to close. Staff are worried about their jobs and, as a result, many are reluctant to speak to me.
“Our funding has fallen from 1,240 per person to 960,” explains Toddy Stafford who has come to the hospital to meet me. He is a member of Friends of Cobh Hospital, a group which was originally formed to raise funds for the hospital and now lobbies to keep it open.
“The hospital could barely cope on the previous funding. What is it to do now?”
Toddy is angry about the extent of the downgraded funding. Compared with residents at other residential facilities all over Ireland, those at Cobh receive a below average level of funding.
For example, residents of Kanturk Community Hospital receive 1,415 weekly; those at St Joseph’s Community Hospital in Lifford, Co Clare receive 1,353; and those in St Mary’s Hospital in Chapelizod in Dublin 1,427. The average paid on a national level is above 1,200.
“Everyone is entitled to equality under the constitution,” he says. “But where is the equality in this funding?”
COMMUNITY SPIRIT
If they are unequal in terms of the funding they receive, the residents of Cobh Hospital certainly seem to have an advantage over those in many other nursing homes. I had expected to find isolated old people, looking forward to weekly visits from family members. Instead, I found a facility that is very much a part of its community.
Toddy grew up in a neighbouring house and remembers visiting the hospital as a child. He continues to visit regularly, the proof being just how many residents greet him and ask him for news.
He’s not the only regular visitor. When I speak with Pat Coakley — at 69, the hospital’s youngest resident — he is with his sister Breda Meade. During our conversation, his brother Richard also drops in.
“This hospital is an essential part of town,” says Breda. “Because it’s in town, family and friends can walk up the road and visit at any time. Because it’s so close to the community, it’s a very good place for Pat to be.”
Pat used to have a very active social life before he moved to the hospital last September. Because of the way the hospital is run, this is something he can continue to enjoy.
CLOSURE FEARS
“It’s great here. The staff are brilliant. The food’s excellent,” he says, laughing. “I’ve put on half a stone. And because we’re in town, my friends can come to bring me out to the pub a few nights a week. I’m still waiting for them to come this week though.”
Pat and his family fear for the future of the hospital. “This place is a home from home for Pat,” says Breda. “This hospital allows him to still be part of life in the town. There is nowhere else that could offer that.”
I learn more about life in the hospital when I stop to have a chat to 79-year-old Eileen O’Leary.
She is full of praise for the hospital. She is particularly keen to emphasise just how good the staff have been during the three years she has spent there.
“Nothing is too much for them,” she says. “If you want something, they get it for you. The battery went on my watch yesterday and they got a new one for me. They are also great at telling me the latest news from the town.”
In fact, the only complaint Eileen, a former dressmaker with a keen interest in fashion, has is that she doesn’t have a big enough wardrobe. “I’ve had to get a new chest of drawers,” she laughs.
ANGRY RELATIVES
If Eileen is happy, Máiréad Geary — a local whose 86-year-old father, Edward Foley, has just been transferred from Cobh to the Mercy in Cork for treatment for pneumonia — is fuming.
Staff are constantly stopping to ask how her father is. “Do you see how like a family it is here?” she asks. “You just can’t buy that.”
She is furious that Cobh hospital should be under such financial pressure. “My father worked from the age of 16. He paid his taxes and now he deserves his part of the bargain, a proper level of care and dignity. We are willing to pay for Bertie Ahern’s car and driver but we aren’t looking after our most vulnerable. How can that be right?”
While the families of residents may be angry at the pressure the hospital is under, many of the residents themselves are unaware of the extent of it. However, all of those I speak to hint at a certain anxiety.
Angela Brosnan, 91, was born in the house next door to the hospital and her bed now overlooks her childhood home. “I never thought I’d end my days here but I’m glad I am,” she says, with tears in her eyes. “They make you have happiness here, which is all you want at my age.”
Angela could keep you entertained all day with tales of goings-on at the hospital — the bingo games, the weekly hairdressing appointments and the visits from family members — interspersed with recollections of when she was young.
Other residents and their visitors are keen to have their say, too. One of these is Josephine Walsh, who is visiting her mother Matilda.
“We’d be lost without this hospital and I think it would finish a lot of the residents off if they were moved.”
This seems to be the most commonly expressed fear in Cobh Community Hospital.
The people of the town would miss a facility that has looked after its elderly for decades while the residents themselves would lose their home; a place that proved to be full of unexpectedly positive surprises for me.
MANY elderly people’s lives have been upset by the enforced closures of the wards and hospitals they used to call home. Three family members speak to us about the impact this had on their loved ones.
Paul Horan’s grandfather, Patrick Culleton, (see main picture, above) was a resident of Bethany House in Carlow. This much-loved facility was closed in April 2009, despite a huge public campaign to keep it open. “As a healthcare professional, I could see no realistic reason for its closure,” says Paul, who is a lecturer in the School of Nursing and Midwifery at Trinity College Dublin. “It certainly needed some refurbishing, but that was it.”
Paul had spent years working in the UK, where he had witnessed the impact such closures had on the elderly. “I knew there would be consequences,” he says. “I had seen that when you move people at that stage in their lives, it interferes with their mortality.” His 93-year-old grandfather was happy at Bethany House. He had lived there for eight years and was involved in the life of the home. “He had his own room and a nice routine,” says Paul. “The house was near the centre of Carlow town and he used to pop out and run errands for people. He was still able to do a lot.”
While the residents were being moved to other facilities, Patrick died. “He was the last to die in the home and he left Bethany House in a hearse. I know of at least six or seven others, out of the 25 who were moved, who have since died,” says Paul.
“I can’t categorically say it led to my grandfather’s death, but I know how distressed and disturbed he was by the whole thing.”
“Bethany House was more than a hospital,” he says.
“It was a residential, homely facility. Moving forward, I can see that there will be very few facilities like this open to ordinary people. We won’t have any half way between a residential unit and an acute care facility.”
Paul is angry at the HSE, and feels it is hiding behind HIQA and losing sight of its priority — providing a high level of care to older people.
The HSE has responded to Paul’s claims, saying “The HSE and its staff in its service in the Carlow area had every empathy for residents of Bethany House, in recognising that change can be unsettling. The HSE therefore accommodated the residents' wishes as to where they wanted to be relocated and kept friendships which they had made with others at Bethany House in mind ... The staffing and facilities within Bethany House were no longer able to respond to the needs of residents.”
CHERRY Orchard Hospital, in Dublin’s Ballyfermot, is threatened with cutbacks. The HSE plans to reduce services in a unit that caters for 17 people with dementia and Alzheimer’s disease.
This unit has been home to Patrick Dodrill since last December. His wife, Marie, is worried about the impact such a move would have on him. “Moving from one place to another upsets people like Patrick terribly,” she says. “In fact, it makes them worse. I worry that the man wouldn’t last for very long if he was moved.”
It has taken Patrick some time to settle into his new surroundings, and Marie says that asking him to move again would be too much. “He’s happy there,” she says. “He knows the voices and the faces. It takes a long time to build up that relationship.”
She is also worried about the effect the move would have on the other patients. There are 18 patients left on the ward. “Some are blind and some are in wheelchairs,” says Marie. “Each of them would suffer as a result of the move.”
The reason behind the proposed move is the staff shortage in the HSE. There are 22 nursing vacancies in the hospital that cannot be filled, due to the recruitment embargo. To make things easier for staff, eight patients from the unit will be moved to other beds in the hospital, while the others will remain. While the HSE says this will be done in a way that ensures minimal discomfort to patients, the relatives of those patients worry that this is merely the start of cutbacks at the hospital. Will the unit, and perhaps others, be eventually forced to close?
“I go in every day,” says Marie. “It looks like there are enough staff to me, but I do accept that cuts need to be made. What angers me is that they are targeting people who can’t speak for themselves. That’s why we have been speaking up for them.”
Marie, and others, have been very vocal in doing this. They have staged protests outside the hospital and outside the HSE offices.
“We’re refusing to accept this situation,” she says. “They’ve recruited 60 new people for the passport office and they say they’re about to recruit new gardaí. So why not more in the HSE? This is a very stressful situation for us all, but we’re not going to give up. We are going to keep fighting.”
NORMAN GLYNN is concerned about his father’s future. His father, also Norman, is a resident at St Vincent’s Geriatric Hospital in Athy, Co Kildare, a hospital which appears to be under threat.
“They closed one ward six years ago and now they just aren’t filling any beds as they become vacant,” says Norman. “They aren’t taking on any new staff or patients. We’ve asked the HSE about this but we haven’t got any straight answers. How can we not worry that this means that they are soon going to close altogether?”
Such a move would have serious consequences for his father, according to Norman.
“He has been in the Le Chéile unit for patients with Alzheimer’s and dementia for the past six years,” says Norman. “The care he receives is top-class and he is very happy there. He sees it as his home. It would be a big upheaval for him to move. I don’t think he would understand and he might never come right. He won’t go outside the door of his ward as it is.”
Like many others, Norman believes that what is happening is part of HSE policy.
“It’s all about prioritising private healthcare now,” he says. “But while it may be cheaper for the State, can we really put a cost on people’s health? Why are we taking the element of care out of healthcare?”
Not only is Norman worried about his father, he is also worried about what this will mean for him and other members of his family if they need care in the future.
“What about when I reach that age? I don’t want to be in a private nursing home. There, you are just a number. They don’t look after your specific needs. It’s only about profit for them.”
From what Norman has seen of St Vincent’s during his father’s time there, it is the opposite. “It’s all about care at St Vincent’s,” he says.
Norman is furious that this could be taken away from his father and not even presented as an option to future generations. “The people at St Vincent’s have no voice. They have no say in the matter,” he says. “And yet they paid tax. What was my father’s tax paid for? He paid in good faith, expecting the State to look after him and it is turning its back on him now. We can’t let this happen.”
CONNECT WITH US TODAY
Be the first to know the latest news and updates
