Fergus Finlay: Nursing home sector was utterly unprepared to deal with pandemic

Many of the people who died in the pandemic were those in nursing homes who utterly needed our care and protection, writes Fergus Finlay
Fergus Finlay: Nursing home sector was utterly unprepared to deal with pandemic

Many of the people who died in the pandemic were those in nursing homes who utterly needed our care and protection, writes Fergus Finlay

File Photo: HEALTH MINISTER SIMON Harris has today announced the establishment of a Covid-19 nursing home expert panel, which will examine the national and international measures in response to Covid-19, as well as all emerging best practice to ensure all virus response measures are prepared for. End. Photo/RollingNews.ie

File Photo: HEALTH MINISTER SIMON Harris has today announced the establishment of a Covid-19 nursing home expert panel, which will examine the national and international measures in response to Covid-19, as well as all emerging best practice to ensure all virus response measures are prepared for. End. Photo/RollingNews.ie

The people who lived in those nursing homes – and the people who worked in them – were all badly treated

Despite that, I loved everything about being a trade union official in those days. The dishevelled old building we worked in (I was up under the roof on the top floor). The camaraderie among a tough bunch of colleagues, each of them more hard-bitten and wiser than me. The ungodly hours we worked, because we were expected to be there whenever our members needed us.

But the thing I loved the most was the members we tried to represent.

If they remember at all people think that the 1920s or the 30s were hard in Ireland. But they remember the 1970s as modern. John F Kennedy had come and gone. The Beatles had actually broken up before I began working for the Union.

But even in those “modern” times, ordinary working men and women were not well treated. The ones I worked with were all employed in the health system, most of them in a new organisation called the Eastern Health Board. Pay and conditions were somewhere between poor and lousy. Management was capricious, sometimes bullying.

I didn’t represent the professional grades. My members were the ward orderlies, the cleaners, the women in the laundries and the kitchens, the porters.

There were two categories of employee in the health services then, defined by a single formal name. One category was called officers, one was called servant. I represented the servants.

There were huge distinctions between the two in terms of pension, grade structure and promotion opportunities, and hours of work. If you started your career as a health board officer, you were guaranteed to end it as a higher officer.

If you started as a servant, it was almost impossible to break out. You could count on the fingers of one hand the number of ward orderlies, for instance, who ever managed to secure promotion to any of the nursing grades.

But you know the way, especially in Ireland, that pots love to call kettles black?

Back in those days, there was no group of workers more likely to be looked down on by the rest of their colleagues than the people who worked in nursing homes.

Except they weren’t called nursing homes then. We had a variety of state-run institutions – county homes, old people’s homes, cottage homes. Not only were they run by the state, they were largely reserved for people with no means. They were the places where poor old people came to die.

(I don’t think the word elderly had been invented then. Certainly senior citizens didn’t exist. You were young, middle-aged or old. And if you were old and poor, you were a second-class citizen at best.) The homes provided by the state weren’t staffed by professionals, but in the main by non-nursing “servants”.

The people who worked in the county homes had little enough to do with therapeutic results, and not a lot to do with caring. Their job was to mind the dormitories, to make sure the old people didn’t escape, to deal with any behavioural issues.

 

Dementia was of course the main cause of the behaviour, but back then it wasn’t called that.

The old people in the homes were seen, and described, as “cracked” – that was the nearest they got to a medical term. And very often, the old people were alone. They were there because there was no-one left at home to look after them, or capable of looking after them. Or willing to.

None of that is to say that the people who worked in the homes didn’t care. Most of the ones I can remember were smashing. They’d run little errands for the old people, read letters aloud to them, help them to spruce themselves up if there was going to be a visitor. They were badly paid, and often mistreated themselves, but they treated the old people in their care as if they were their own parents.

I came across one bad apple.

In 1973 an attendant, a member of my branch of the Union, was suspended when it was discovered that he was stealing the ration of cigarettes that was doled out to the old men, and selling them back to them. There was a brief uproar when I refused to represent him, but then some of his colleagues cornered him, and we never heard from him again after that.

But the truth is that the old county homes were bleak, forbidding places. Many of the, especially in rural Ireland, were housed in old workhouse buildings. Their inhabitants lived in dormitories, and there was scant regard for privacy or dignity.

But it was after that period – in the 1980s in Ireland, so less than 40 years ago – that what we now know as nursing homes began to be developed. There was no public policy decision behind that development. Nursing homes were built and developed by private operators for middle class families.

And a new distinction emerged. If you could afford it, and you could no longer cope at home (or if your family could afford it) you spent your declining years in a private nursing home.

Initially, there was little of no state support, so nursing homes were definitely middle-class places.

Gradually, state funding increased to the point where most of the basic costs were covered. The Fair Deal Scheme became a subsidy for the care of the better-off. (I can’t be a hypocrite about this – the Fair deal Scheme paid for my mother’s care when Alzheimer’s took over her mind).

But the policy that diverged in the 1980 – different care provision for elderly poor people and elderly better-off people – never came back together again.

Elderly people who could afford it became consumers of a profitable industry. Elderly people who couldn’t depended on provision that was never anything but a Cinderella of the health system. The only common bit of policy was inspection.

When the coronavirus hit, the owners and proprietors of the private sector, who needed profit to maintain standards of comfort and care, weren’t ready.

Neither was the state. And people died before their time. Some terrified, some alone. All, irrespective of means, vulnerable.

When this is all over, we need to figure this out. We need to look long and hard at both public and private provision, and understand what went wrong.

If we are the ones – the providers, the taxpayers, the families – who are caring for our elderly people – we need to know why they weren’t protected enough.

I’m not an expert, but I’ve been involved in the world of caring for others for most of my adult life. I I’m certain that nobody was at fault this time.

But it we can’t figure out, honestly and clearly, how it is so many of the people who died in the pandemic were people who utterly needed our care and protection, it will certainly be somebody’s fault the next time.

 

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