Virus crisis has shone spotlight on pitiful standards in some of our nursing homes
AS THE Covid-19 crisis unfolded, we acquired a new vocabulary to explain what was going on, with terms like ‘flattening the curve’, ‘cocooning’ and ‘test, self-isolate, trace’. We also learned about ‘pre-existing conditions’ or ‘underlying conditions’, like diabetes or coronary heart disease, which make people especially vulnerable to the virus.
There was, however, another pre-existing condition: many of the nursing homes in which people live, combined with residents’ underlying health problems, created the perfect storm and caused a shockingly high rate of fatalities among elders.
Many will recall the Áras Attracta (2014) and Leas Cross (2005) nursing home scandals, but the more pervasive shortcomings of nursing homes in Ireland are less well known.
Last August, a Hiqa report, ‘Overview report on the regulation of designated centres for older persons 2018’, set out the extent of non-compliance among nursing homes with Hiqa’s regulatory standards.
The report paints a sorry picture. For example, on page 23 there is a table showing the percentage of inspections where non-compliance was found, including: 43pc of 278 inspections found regulatory non-compliance with “premises”; 34pc non-compliance with “fire precautions”; and 32pc non-compliance with “governance and management” standards. Other areas of concern were “residents’ rights”, 27pc; risk management”, 22pc; and “infection control”, 18pc non-compliance. Just stop and reflect on the risks posed by these deficiencies.
The report explains that when the premises are inadequate, meaning, for example, poor physical infrastructure and residents with dementia having to share bedrooms, it is more difficult to meet other standards such as fire safety regulations or infection control requirements.
Hiqa reports always acknowledge any progress made in periods between successive inspections and, broadly speaking, there has been progress in the sector, but it is far too slow. So much so, that last July Hiqa warned of a “time bomb” waiting to go off, because 79 centres for people with disabilities and 45 nursing homes were facing closure if they did not meet the specified standards for premises.
Hiqa was concerned that the €2.9m set aside in the HSE’s 2019 budget would be insufficient to meet the Government’s prior commitment to bring all nursing homes up to standard by 2021.
These warnings, repeatedly made long before we ever heard of the coronavirus, signalled an accident waiting to happen, a very big accident. Whatever about underlying health conditions among residents in St Mary’s Hospital in the Phoenix Park, it is not unreasonable to wonder if the poor condition of the physical facilities might have contributed to the 23 virus-related deaths that occurred there.
A Hiqa inspection of St Mary’s last October and published last month said: “The infrastructure was outdated… Although bed-spacing appeared adequate, there were insufficient toilet or shower facilities. The multi-occupancy patient care areas did not have en-suite facilities …No single rooms for isolation were available. Hand-hygiene sinks located in patient rooms were not compliant.” And more of the same.
The really distressing aspect of this situation, for both residents and staff, is that St Mary’s was found to be fully compliant with all standards other than “premises”. It is well governed and managed, staffing levels and training are up to scratch and residents’ rights are respected.
A similar pattern of neglect pervades the mental health services, as reported by the Mental Health Commission (MHC), a
Hiqa for mental health services, as it were, in its July 2019 report: ‘2018 Inspection of 24-hour supervised residences for people with mental illness’.
The grim findings include: “Nineteen percent of residences were in such poor condition that it showed disrespect for residents’ dignity… Another 35pc required improvement”.
The detail is hard to stomach. In one residence, “The garden at the front was overgrown and the windows dirty... some furniture was tattered... all bedrooms smelled musty… there was a general air of neglect internally and externally”.
If these levels of non-compliance with regulations were found in any other sector, say pubs or restaurants, they would all have been closed down long ago. But as a society we have a long history of institutional neglect and abandonment of our most vulnerable citizens, and our tolerance of such cruel treatment persists in spite of endless tribunals and enormous pay-outs to victims.
A separate MHC report in January, on compliance with the pivotal requirement of crafting Individual Care Plans for each person in the care of mental hospitals, found only 38pc compliance. Every racehorse in Ireland has its own care plan, a provision in no small way due to the €67.2m Government subvention to the horse racing industry.
It might be argued that this is not the time to raise such contentious issues when frontline health workers are risking their lives to protect us from the ravages of Covid-19. If not now, though, when?
When the crisis is over and vulnerable people receiving substandard care in substandard premises are once again relegated to the margins, out of sight and out of mind?
In July, Hiqa warned of a ‘time bomb’ as 45 nursing homes faced closure if they did not meet the standards