says there is a clear need for us to ask whether the care of at-risk across the State people should be for profit.
The crisis has seen nearly 55% of Covid-related deaths occurring in nursing homes, and exposed pre-pandemic systemic flaws of the direct provision system.
What can we learn from last Tuesday’s special Oireachtas Covid-19 response committee meeting on congregated settings?
Privatisation of care and social provision
The difficulties that can arise when the State outsources its responsibilities towards the human rights of vulnerable individuals was evident at the special Oireachtas committee meeting last Tuesday.
Eighty percent of nursing homes are privately-owned and the vast majority of direct provision centres are run for profit by private operators. The frustrations of Nursing Homes Ireland in sourcing PPE, accessing testing, and retaining staff were well ventilated.
Although the Health Information and Quality Authority (Hiqa) clarified this is the responsibility of the care home, confusion over whose role it is to decide the ratio of resident to nurse and care assistant is concerning.
With regard to direct provision, the Department of Justice confirmed that staff requiring garda vetting had not been vetted until last Monday, nor had they undergone adequate training before starting work.
We should all be worried by this. Staff should be vetted and trained to deliver safe and effective services to adults and children.
There is a clear need for us to ask whether the care of at-risk people should be for profit.
Uncertainty around duties and delegation of responsibilities in the context of the provision of vital social and health care is not acceptable.
The HSE did not know this sector
Oversight of institutions is critical. Given our harrowing past in this country, there is acute awareness of the need for robust oversight mechanisms for individuals living in institutions.
However, Ireland remains the only EU country not to have ratified the UN Optional Protocol to the Convention Against Torture, which would require regular independent and unannounced inspections of direct provision centres and nursing homes.
At last week’s committee meeting, we were reminded of the fact that the HSE has no clinical oversight of private nursing homes. In the words of Hiqa, “the HSE did not know this sector”.
Inspections of private homes is left to Hiqa alone, which is in turn dissatisfied with its regulatory powers of enforcement.
Meanwhile, calls for an inspection of the Caherciveen direct provision centre have gone unheeded, despite the serious issues raised in relation to the centre’s suitability during the crisis.
There is a clear need for inspections by statutory bodies with strong powers of enforcement that are encoded in national legislation.
Moreover, Ireland needs to urgently ratify the Optional Protocol to the UN Convention Against Torture, which would include inspections of direct provision centres and nursing homes, as a matter of urgency.
The role of independent advocates
The absence of representation of older people in decision making was also highlighted.
Nursing homes were not mentioned until Nphet’s 12th meeting, on March 10. Nursing Homes Ireland was simply not represented on the Nphet subgroup on nursing homes.
What’s more, the Minister of Health has stated that Hiqa is the voice of the elderly at the Nphet table, yet Hiqa did not visit any nursing home where there was a Covid-19 infection reported during the crisis. How can it represent people it has not met?
Sage Advocacy, a support and advocacy services organisation for vulnerable adults, called for the role of independent advocates to be legitimised through legislation.
It’s obvious that the interests of affected groups should be directly and adequately represented in decision-making processes that concern their human rights. Yet, it’s not happening.
Congregated care model
Longstanding issues with the congregated care model were raised by committee witnesses and deputies alike, underscoring the need for a continuum of care model to be established.
At present, there are little to no community-based options or supports that enable individuals to remain in their own homes when care is needed.
In the direct provision context, a congregated setting is manifestly unsuited to the needs of people seeking international protection and steps should be taken to abolish this system as soon as possible.
Operation in silos
In the words of one deputy, we watched a game of “pass the parcel” at last week’s committee meeting.
A list of high-risk nursing homes, both private and public, was submitted by hiqa to the Department of Health (which was notably not represented at the committee meeting), to which hiqa only received an acknowledgement.
With regards to direct provision, there is a pronounced absence of clarity surrounding who knew what when.
It appears that the HSE did not inform the Department of Justice of the confirmed Covid-19 case in the Swords Travelodge where a group of people seeking international protection were being housed.
Members of this group were then moved to Caherciveen from this affected hotel at the height of a pandemic, with full knowledge of the HSE.
If State bodies, the Department of Justice and the HSE in this instance, had communicated and effectively engaged with each other throughout this time, steps could have been taken to mitigate infection risks and the suffering of residents at the Caherciveen centre could have been avoided.
Reports of residents being locked in the Cahersiveen centre by operators have raised serious concerns regarding where the responsibility for this lies and suggest a lack of effective communication between the Department of Justice, the HSE and private centre operators.
At the core of these deferrals and deflections at the committee meeting was vulnerable individuals living in congregated settings whose rights were not sufficiently safeguarded at the height of a public health crisis.
Responsibility, accountability and transparency should be at the heart of all State responses, especially when it comes to protecting the rights of vulnerable individuals in a public health crisis.
There are some key learnings that require urgent State action.
For-profit care of ‘at-risk’ people should be seriously questioned and the direct provision system should be abolished.
A continuum of care model should be developed to address gaps in health and social care provision. Moreover, there is a pressing need to legitimise the role of independent advocacy and to ratify the Optional Protocol to the UN Convention Against Torture.