Allowing nursing home residents to live with dignity is very least we can deliver

For those of us who work with nursing home residents, the revelations in 'RTÉ Investigates' were sadly unsurprising, writes Dr Joanne Fegan

The Residence in Portlaoise: 'RTÉ Investigates' revealed neglect of basic care needs including toileting, personal care, and mobility management for residents who were actively requesting care.

Recent revelations about serious shortcomings in care in two nursing homes, The Residence in Portlaoise and Beneavin Manor in Glasnevin, as highlighted on the RTÉ Investigates programme last week, were deeply upsetting, yet sadly unsurprising, to those of us who work with nursing home residents on a regular basis.

The programme revealed neglect of basic care needs including toileting, personal care, and mobility management for residents who were actively requesting care. There was evidence of a lack of training, poor staff practices, and lack of availability of staff and basic resources such as sheets and incontinence wear. It speaks to a worryingly poor culture of care within these nursing homes.

As part of their role, consultants in old-age psychiatry routinely visit nursing homes to assess patients referred by their GP. The reasons for referral may be because a resident appears depressed or is agitated or distressed.

The assessment involves an evaluation of the biological, psychological and social factors involved, as well as recommendations that should improve the person’s situation. The recommendations may involve medical investigations or medication, but often will include practical suggestions for nursing home staff to support the resident’s needs.

Despite the provision of very good care in many instances, unfortunately, the grim reality is the model of care in nursing homes in Ireland is utterly broken.

Staffing levels are a particular concern. Anecdotally, many of my colleagues in psychiatry and other disciplines remark on the lack of nursing and healthcare assistant staff on the ground when they visit facilities around the country. 

Indeed, as a consultant old-age psychiatrist who visits nursing homes on a weekly basis, I have never been in one that I felt was adequately staffed.

This can lead to worrying consequences.

For example, psychiatrists are sometimes asked to prescribe sedating medication in situations where the right number of staff with proper training are what is needed.

Instances where this may occur might be if a healthcare assistant needs to bathe a resident with dementia who may become severely agitated because they cannot understand why their personal space is being invaded; or if a resident is wandering a corridor in the night and will not return to their bedroom.

When psychiatrists recommend additional staff or specific non-pharmacological interventions, often there will not be staff available to implement these.

While sometimes the use of medication is appropriate, staff will occasionally request medication in the absence of a properly resourced and staffed nursing home environment. In all likelihood, staff would not look for a quick pharmaceutical fix if they had the right support available to help them to do their job in the correct manner.

Staff training a significant concern

Staff training is also a significant concern. Nursing home residents are among the most vulnerable members of our society. Many are frail, with multiple medical conditions including dementia, that need careful and judicious management. Many, although not all, are older people; some are approaching the end of life.

Some residents will have specific mental health conditions, and many will be impacted by moving to a new home environment. This care profile requires not only the right number of well-trained professionals, but also specific training. 

This means developing competence in older people’s care, including dementia, as well as competence in mental healthcare. Training in end-of-life care is also very helpful. Training in these areas should be mandatory for all staff working in a nursing home.

Overworked and under-trained staff may also not have the time or understanding to accommodate a specific, simple request like how a resident likes their tea made or that they like to go for a short walk at a certain time of the day.

These requests may seem mundane and yet can be critically important, especially for a person who may have dementia and who may become extremely distressed if their request is not addressed.

The vast majority of health professionals working in nursing homes in Ireland are committed, hard-working and full of empathy and compassion for the residents they work with. 

However, when too few are employed and those who are employed are not trained effectively, it can lead to residents being ignored or treated callously, which obviously can be hugely problematic.

Nursing home residents with mental illness can suffer particularly negative effects from living in an unsuitable environment. For example, someone with depression can often feel like they are a burden and may have suicidal ideation. If their needs are not met, it can exacerbate depressive episodes.

Similarly, a resident with paranoia may feel like people are looking to hurt them, and their condition may deteriorate if staff cannot take the time or do not understand how to properly explain why they are washing them or even engaging with them at a particular time.

The combination of, on the one hand, residents who need intensive care and, on the other, inadequate staffing and training is a seriously volatile and worrying one, which leads to appalling situations such as what we saw in Laois and Dublin last week. 

It is unacceptable in 2025 that we are seeing this treatment of nursing home residents and begs the question of what kind of society we want to be.

The solution to the model of nursing home care in Ireland is multi-factorial and complex, and demands a rigorous approach. At a minimum, a holistic care approach is needed which encompasses cultural training, education, and empathy and understanding for residents, with an appreciation that they are not living in an institution, but their home.

Nursing home regulation must oversee the training of all nursing home staff members and staffing levels must be monitored on a consistent basis to ensure our nursing home residents can live with dignity in a suitable and caring environment.

It is the very least we must deliver, and that they deserve.

• Dr Joanne Fegan is a consultant old-age psychiatrist is a member of the Old Age Faculty of the College of Psychiatrists of Ireland and the college’s director of communications