Terry Prone: Abuse of nursing home patients has been going on for decades

Profit is king when it comes to the running of our nursing homes

'Any of us of the age when we might be “put in a nursing home” due to a stroke or a fall, have been terrified by what RTÉ found.'

The woman who looked to be in her late twenties or early thirties, was sitting at her kitchen table and had telephoned the presenter of Ireland’s most popular radio show. She took a deep breath and explained why.

Some months previously, a stroke had felled her father, leaving him speechless with his movement gravely constrained down one side. This was, she told Gay, a man who loved to walk and suddenly he couldn’t do that. A man with words at will because of his academic background, and now he didn’t have words at all. When Gay asked a question, she shook her head. No, she said. They had tried asking her Dad to write down the words he couldn’t say but it didn’t work.

The family made the decision to get him into a nursing home at least in the short term because he needed so much care. It wasn’t something they wanted to do, but there didn’t seem to be an alternative. They were promised he would get the best of care and sure what else could they do? It seemed okay for the first few weeks, not perfect, but okay, and then Dad just went into himself and wouldn’t look at them when they spoke to him or anything. And then they found out what had happened. Like a journalist, she couldn’t name her source, but the inference was that it was the person in the other bed in the two-bedded room.

On one particular day, her father needed to go to the toilet. Really, urgently needed to be helped to the loo. He could convey simple needs like that, so they were in no doubt as to what he was seeking. But the nurse told him she was busy with other things and to go in his nappy. He made a noise of protest and the nurse got impatient. She was busy. That’s what the nappy was there for. Go in it.

She, the caller, was shocked to find her father, that night, sodden in the bed and so miserable, he had literally turned his face to the wall. She cleaned him up and dressed him in fresh dry clothes and got him into the car somehow and brought him home. But even days later, he had not recovered from what had been done to his dignity, his sense of who he was and she didn’t believe he ever would.

As Gay asked another unheard question, a look of horror came across the woman’s face and she gasped a goodbye. 

It was obvious that the radio was on upstairs in her father’s room and that she’d embarked on the call to Gay without realising her father would have been able to hear her talk about him.

That was what happened in a trigger playlet I wrote about 41 years ago, to train nurses in how to serve the needs of older people who were speech-impaired. It was directed by Linda Cullen, now of CoCo productions which, inter alia, makes the Dermot Bannon programmes. The actor who played the daughter was Eithne Dempsey, now a humanist wedding celebrant. Amazingly — she did the entire thing, a quite lengthy monologue, in one take. It may have lasted only six minutes but it reduced viewers to tears at the thought of what had happened to the fictional father.

Except the father wasn’t fictional. The research that led to the production turned up a young woman who had given up her job — just as the woman in the playlet had — because of how her father had been treated in a nursing home. What was fascinating, at the time, was that during the managed discussion following the viewing, viewers resolutely refused to believe that this horror story could ever have happened in reality. But if it had, they would make sure it never happened again. That it could never happen again.

The VHS recording of that production may still exist somewhere in some HSE storage room. Or it may have been destroyed years ago.

Twenty-five years go, the reality it portrayed was revealed, again by RTÉ, to have been happening in Leas Cross nursing home. Not only were residents left lying in their own urine, but incontinence pads were dried out on radiators and re-used

Action was taken. A watchdog was put in place. It could never happen again. Except we now know it to have been happening in at least two Emeis nursing homes. Other nursing home operators who take pride in the excellence of their service are rightly keeping their heads down lest their nursing home be tainted by the backwash.

Any of us of the age when we might be “put in a nursing home” due to a stroke or a fall, have been terrified by what RTÉ found, while admiring the way they went about it. RTÉ Investigates is public service broadcasting we seriously need.

The Taoiseach described what the covert investigators found as “unacceptable.” Let’s put teeth into that word.

First of all, let’s visit the bottom line. Because that’s where it starts, with big corporations. 

Never mind the individual customers, residents or patients. What the Board of a big multinational like the French one that owns the nursing homes exposed by RTÉ looks at, when the quarterly figures come before them, is the profit line

That’s the Board’s fiduciary responsibility, and the captains of industry who go on corporate boards address that priority right willingly. So if the homes in Ireland owned by this company (which, puzzlingly, changed its name and brand a little while ago) were making a profit, all, as the Board would see it, was cool and groovy.

The chances of changing the rules for corporate boards so that they have wider responsibilities are small. Interestingly, in all the reviews by academics into governance, fundamental questions about the fiduciary responsibilities of such boards never seem to surface.

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Then you have Hiqa. Some years back, when regularly but at random times visiting a resident in a nursing home, I complimented the operator on the constancy of care apparent. She muttered that she wished I worked for Hiqa. Why? Because their inspectors had been in the previous week and had done what she believed they always did: arrived with a nitpick checklist and been less than 100% satisfied with compliance. The checklist, she claimed, was arseways. It included talking to residents, true. But, inevitably, the inspectors could not talk to residents in deep dementia.

“So they can’t check on pain levels,” she told me. “And, even when we know a resident is in agony with back pain, because the resident cannot describe it or agree to painkillers, we can’t administer them. The fear that we’ll drug residents into submission outweighs their self-evident agony.”

 The rules have changed. We have a minister for older people. But the self-same abuse happened 41 years ago, 25 years ago and this year. To victims silenced by age and disability.