Why do nursing homes have such bad press? "I keep asking myself that question," says Cora McNamara, who established the Greenpark Nursing Home in Tuam, Co Galway, in 1991.
“It’s probably the way people look at it; it’s the last straw. Don’t let me end up in there. It’s a fear of the unknown. And also, the Irish are conditioned to wanting to live in their own houses, and you hear people saying, ‘I’ll only go out of my house in a box’.”
Greenpark, which Cora set up with her late husband Brian, originally had 16 beds. It has now been developed into a 51-bed facility, which she runs with her three children, Brian, Ian and Jane McNamara. Cora is director of nursing; Brian is assistant director of nursing; Ian is the operations and social director; and Jane looks after accounts and administration.
Greenpark is within walking distance of Tuam town, and opposite a large green space that gives the place its name.
“We wanted it to be in town, not out in the sticks,” Cora explains. “So that when kids are coming home from school, they could drop in to see their granny, or if people were on their way to work, they could drop in.”
“You can’t be part of the community if you are in the middle of nowhere,” Jane says.
“A lot of nursing homes at the time had saint’s names, and we wanted to get away from that,” Ian says of the Greenpark name. The family consider the question as to why nursing homes can get such negative coverage.
"Some of it is to do with the word 'home'," Ian says. "In rural Ireland, that always meant the county home; the modern equivalent of the workhouse. Some people have the idea that when you come into a nursing home, you are locked up. Anyone here can go out at any time. This morning, someone went out for tobacco. Someone else went to collect their pension and do a bit of shopping."
“You can understand why people are afraid of the thought of a nursing home,” Jane says. “You don’t know who will be looking after you, and initially, everyone is going to be stranger. When people are vulnerable, this can be a frightening thought.”
“The Leas Cross story [in 2005, RTÉ’s Prime Time uncovered substandard care in a nursing home in Swords, Dublin] did a lot of damage to images of nursing homes, but we can only take responsibility for the care we provide here,” Brian says. “People don’t want to be cared for; they don’t want to think about it. That in itself creates a certain image of a nursing home.”
Greenpark has 55 staff, 34 of whom work part time. The nursing home weekly fee is €920. Most of the residents come from Tuam town, or from a hinterland no more than 15 kilometres distance. Their oldest resident is 96, and the mean age is 80. The average stay is three years. The most common request new residents have is to be pain-free while in the care of the nursing home.
“One time, our occupancy would have been 90 per cent women,” Ian says. “It was women who came into nursing homes, because men died younger. Now men are getting better health care, eating better, and living longer. Our percentage now is about 45 per cent men, and we get more inquiries about male beds than female.”
Over the 28 years of Greenpark’s existence, the McNamaras have noticed a big difference in the point at which residents enter the nursing home. Almost 90 per cent of admissions come straight from hospital.
“Home care now is far more available to people, and people can stay in their homes a lot longer,” Brian says “It means generally that people are admitted after some acute incidence; a broken hip or a stroke. It is more a reaction to a crisis. That is very stressful to people and their families.”
“Years ago, we would have had people a lot more independent coming in, and now the level of dependency has gone way up, and people are coming in older,” Ian says.
“That’s a good thing in a way, as people are staying in their own homes longer. But it makes the nursing home more medically-centred, and group activities become harder to organise.”
There is some activity every day at Greenpark; a film club, or aromatherapy, or arts and crafts . The day before my visit, the Socrates Breakfast Club had discussed the recent appointment of Boris Johnston as the new British prime minister. There is an "imagination gym" on another day, where music is played, and footage of pastoral images play while essential oils scent the room.
“We used to do a lot of bingo and things like that,” Ian says. “We have moved away from that, and more to arts and crafts and discussion. The emphasis on the activity is more about subtly building confidence in the residents. It’s more about a group coming together, telling life stories. It helps people hold on to their identity and express their choices, and tell us what they want. You can only have person-centred care if you know what the person wants.”
The rooms at Greenpark are spread over two floors. In one sitting room, there is a record player, where a vinyl record of Big Tom and the Mainliners is currently on the turntable. There is a small chapel close to the reception area.
There is a smoking room, strictly for residents only. At the centre of the complex is a large enclosed courtyard, with lots of bright flower planting, parasols, and places to sit. I notice a stack of straw sun hats near a door
Most of the communal areas look out on this bright space, including the downstairs dining room, which has a vase of fresh flowers on each table. Residents with memory difficulty, and who need assistance with meal times, have a separate dining room upstairs, “for their dignity,” as Ian says.
There is no strict timetabling for meals.
“We invite people to come for lunch,” Ian says. “We try not to institutionalise things. If you want to have breakfast at 8am or 11am, that’s fine.”
“This place is an extension of people’s homes, so we try to make it as homely as possible. There’s flexibility around meals,” Brian says.
The staff are a big part of your life in a nursing home
Not all residents receive visitors. For those who have nobody to visit them, staff members step in and take them to medical appointments. When their clothes wear out, Ian makes discreet visits to charity shops to buy replacements.
Some residents have regular family visitors, who take what he describes as “an active hands-on role”. “It can go from one extreme to the other,” he says.
There is a whiteboard in the corner of the dining room, and every day, a staff member writes a new quote on it. Today it says: “I never think of the future. It comes soon enough.”
On one of the two days I’m there, the afternoon activity is a group get-together in the dining room to read poetry and reflect. I sit in on it, with activity co-ordinator Cathy O’Brien, joining six residents, all women. They take turns reading poems, and then talk about recent activities.
The staff at Greenpark represent 13 different nationalities, and an “international day” was organised.
“The staff are a big part of your life in a nursing home,” one woman points out. They made flags, and learned the word for thank you in different languages, and sampled some of the food from the various cultures.
One woman volunteers the information to me that there are negatives and positives for her being a resident.
“I don’t have to think about shopping and cooking. I like the activities, but unfortunately there are many people who can’t participate, because of dementia.”
Later, Barbara Carroll (80) invites me into her room, to talk about her thoughts as a resident; she will be at Greenpark a year this September. She was living in Tuam prior to coming to Greenpark.
“My husband died in 2011 and I lived on my own and thought I would be independent, but my health decided otherwise,” she says. “I was in and out of hospital. It became more and more obvious it was getting hard for me to cope and to be alone at night, even with home help, and with my family, who were very good to me. I was prone to falls.
“When I first came here, it was a relief, mentally and physically, that I was being cared for. I needed nursing care as well as care assistants. I did find it daunting, adjusting to life here. It was daunting to go to the dining room for the first time, and see people with varying degrees of mental and physical ability. That is difficult.
“It is very hard to see other people struggling. I always try to just say hello to everyone. There is a small group of us who can communicate with each other, and I find that brilliant.
“It’s not easy to lose your independence. You get used to a routine; there has to be a certain one. Very quickly, I took a deep breath, and thought there is no point looking at the negatives about being here because that will gradually destroy your spirit.
“I know if I press that bell [the one in her room], someone is going to come and ask if I need help. It gives me great peace of mind, and gives my daughter and son peace of mind.”
Barbara has personalised her room by putting up lots of family pictures, and has some pieces she took from her home.
“You do lose independence, but I can still make choices. This is my room, my space, my door that I can close when I want. I can choose what I want to wear every day.
There is peace here and we are safe
“What you need to have in a nursing home is a little more patience. I see care assistants in a very different way perhaps to some other people, because I was a carer to my husband for five years before he died.”
Kathleen and Nora Reapy (91) are twins from Tuam who used to run a bar and grocery business. Neither of them ever married, and they came together into Greenpark, where they share a room.
“We have been together all our lives,” Kathleen says. “There is peace here, and we are safe. We are being looked after well, and we are warm in the winter. And we are together.”
Bridie Higgins (82), who spent much of her adult life in New York, providing teaching support to children in hospitals with cancer diagnoses, was formerly a Dominican nun.
“I have a big sign up in my room here, ‘Don’t look back’,” she tells me.
“Of course you have to adapt, you have to compromise when you come to a nursing home. And be grateful. But I still have some independence; my own room, and my own things, and I have made it as homely as I could. I was in a convent for many years, so I am used to being with people.”
I ask Brian McNamara what people considering nursing home care should look for when choosing a place.
“Call and visit the nursing home, and sit down and talk to the people who are there. You get a feel for the place by being there. You have to be happy in the place, in the environment. And the place has to feel right, because it is a tough decision for people to make, when they have to move into care.”
“It’s about atmosphere too,” Ian says. “A Hiqa report can do a lot of things, but it can’t measure atmosphere. And to the potential resident coming in the door, that is the most important thing.”