The scenes broadcast on the recent RTÉ Investigates programme were deeply upsetting. It showed multiple examples of unacceptable care failings and neglect of vulnerable older residents in two private nursing homes. This comes twenty years after a similar expose on shocking conditions and work practices in the private Leas Cross Nursing Home in Swords, which triggered the landmark Leas Cross review by Professor Des O’Neill, and a subsequent programme of reform of the nursing home and home care sectors.
Since then, we have had the creation of Hiqa to set standards, monitor compliance, and inspect all nursing homes. It also has the power to shut down non-compliant facilities.
But it is clear that despite this increased regulation, some nursing home patients are still being failed. As was highlighted in the Leas Cross report, and now again in the RTÉ Investigates programme, staffing remains a core issue; both in numbers as well as training levels and oversight.
The way checks are conducted on nursing homes by Hiqa must also be examined, as underlined by Taoiseach, Micheál Martin this weekend. The organisation has played an important role in improving standards, but there are questions about how these are monitored.
The issues raised are bigger than the specific failings shown in the report. Ireland needs to reconsider its whole system of care for vulnerable older adults in need of longer-term nursing care.
The number of nursing home beds in Ireland increased by 12 per cent between 2013 and 2023, to over 32,000. About 440, or 80 per cent, of our nursing homes are private, or voluntary. Many smaller family run nursing homes, particularly in rural areas, have closed in recent years, with others bought up by large international for-profit companies. There is also a trend towards building larger nursing homes with more beds.
We have a growing, ageing population with projections that we need potentially thousands more nursing home beds in the next two decades. But is our current model of nursing home care provision and significant outsourcing to the private sector really the best way forward? We have largely moved away from congregated institutional-type settings for the care of people with intellectual disabilities and mental health. Is this an option for many older adults needing care?
The Covid-19 pandemic highlighted how isolated and vulnerable those in private nursing homes can be, and the differences in their care and entitlements compared to their public counterparts. While there have been increased supports provided to private nursing homes since then, and a raft of new regulations, it is clearly not enough. It is tinkering around the edges of a system, important parts of which look broken. More comprehensive reform is needed.
