Our health (and stink!) inspectors
HIQA inspectors lift lid on conditions in some residential centres
THE smell drew the inspector to the disability centre bedroom. When he opened the door, an acrid stink filled his nostrils – when he lifted the mattress, he felt sick.
‘It was just appalling,’ said Gary Kiernan, inspector manager with health watchdog HIQA, adding: ‘People seem to be immune to things.’
Gary and his fellow inspector Mick Keating are two of 47 Health Information Quality Authority (HIQA) inspectors who monitor our disability centres and nursing homes.
Both have visited many centres, but declined to identify or name any particular one while talking to the Irish Mail on Sunday.
Every inspection generates a report, which includes what was seen at the centre but also information given by residents, families and staff.
Mr Kiernan said: ‘As soon as you go in the door, you are sucking in everything. You are using all your senses: smelling, looking, hearing the noise levels.
‘I always say if you are not doing three things at once, you are not doing it right. You use your time, you are in somebody’s home, so you use your time to gather as much information as quickly as you can.’
‘This is a dignity issue at the end of the day’
Only once was the door closed against Mr Keating.
He said: ‘I knocked on the door, this girl answered it. I pulled out the ID and announced who I was, she slammed the door in my face. I didn’t know what to do at first.
‘I could hear her on the phone inside and within another 30 seconds the door opened. That was a panic reaction.’
Inspectors also look at staff rosters for two months before and after their visits. High staff turnover can cause communication issues as some people with significant disabilities are ‘non-verbal’ and rely on gestures.
Mr Keating said: ‘I as an inspector may go into that room and I may not be able to communicate with that person. But a staff member should be able to say to me, “Mick, she’s hungry.”’
Both men expressed frustration at constantly seeing ‘challenging behaviour’ written in medical notes.
Mr Kiernan has seen notes saying someone needs a quiet environment, but that person is spending all day in a sitting-room surrounded by up to 24 people.
He said: ‘I feel very strongly about this. It is used as an excuse. You require a low-arousal environment, but instead you have hugely elevated levels of noise.
‘Then because people are bored, they’ve got challenging behaviour, there is a risk then that you could be assaulted by your peers.’
Mr Keating said at times seeing how people have to live is very upsetting for inspectors.
He has often seen what he calls ‘peer-to-peer abuse’, adding: ‘One of the things that never ceases to amaze me is you have other residents living in that environment, and often they don’t bat an eyelid because that is going on all the whole time.’
One of the most common complaints they see written in logbooks, especially in nursing homes, is that residents are wearing someone else’s clothes.
Gary described seeing an 85year-old man wearing tracksuit bottoms. He said: ‘You’re thinking, “This man never wore tracksuit bottoms before in his life and why is he wearing them today?”
‘But it’s easier for continence management, easier for the staff that is. This is a dignity issue at the end of the day.’
And while they keep the focus solely on residents and staff as they speak, Mr Kiernan does say he joined a 24-hour gym to clear his head before going home.
Mr Keating runs a lot, saying it helps after a tough day.
He explained: ‘To go in and describe and see this, it’s often very not easy. It’s hard to go home and forget sometimes the things that you have seen.’
‘It’s a science. You use your learned life experiences and then
‘Residents were going 14 to 15 hours unfed’
park that. Inspectors make their judgments based on the facts, and that is the key thing.’
Having visited so many centres, they say problems often arise from bad management, rather than financial shortages. In some cases staff were rostered on at night unnecessarily, leaving the centre short-staffed during the day.
Mr Keating said: ‘Real examples would be half the staff taking lunch from noon to 1pm, the others from 1pm to 2pm. So residents were getting their lunches at 11.30 and dinners at 4.30. In one instance, these people were going 14 to 15 hours without meals, between their dinner and their breakfast.
‘And again we heard, “Oh but sure these rosters have been here for the last 20 years.” That has now changed.’
While they said two years is too short a time to overhaul the whole sector, they have seen some changes.
Talking through inspections which left them smiling on the drive home, Mr Kiernan said:
‘I was really inspired to see some people recently who had been born in an institutional setting, who had lived in all kinds of homes, and now to see them in a different centre and the difference that made.’
Even in the worst of the centres Mr Keating visited, he’s met staff doing good work. He described them as ‘banging their heads against the wall’ asking for change.
‘Now they have a report in their hands and they are now saying we are legally obliged to meet these standards. They can go to their manager or their provider and say, “You have committed to this, so listen to me.”’