Abuse of vulnerable elderly in residential care homes is rife

ANALYSIS:Elder abuse is a common occurrence in Irish residential nursing homes

There is hardly a group in society that is more vulnerable than older people in nursing homes. Many suffer from impaired faculties and most have seen their circle of friends and family diminish over the years. The vast majority living in residential settings depend on paid strangers to provide their food, clothing and shelter needs.

Yet working in a nursing home can be a stressful occupation, with a level of challenge not reflected in staff pay scales. Caring for dependent older people is a 24-hour task and may involve dealing with forgetful, unwilling or even aggressive residents.

It took the Leas Cross scandal in 2005, when an undercover reporter revealed the mistreatment of residents at a north Dublin nursing home for an RTÉ programme, to lift the veil on this largely hidden world.

This was a watershed moment in bringing the issue to the attention of the wider public, and resulted in tighter regulation of nursing homes by a newly established watchdog, the Health Information and Quality Authority.

Since then the issue has largely disappeared from view, apart from occasional controversies that erupt when Hiqa criticises or closes a nursing home.

Staff difficulties highlighted

The report published yesterday by UCD’s National Centre for the Protection of Older People shows the problem of elder abuse in residential settings, far from having gone away, is rife.

In fairness, the study, which is based on a survey of more than 1,300 nursing home staff, also highlights the difficulties these workers face in their everyday work.

And it points out that levels of abuse reported in studies in other countries are generally higher than those contained in this Irish survey.

Elder abuse matters not just because of the vulnerability of the victims but also because of the numbers of people involved.

Some 535,000 people are aged 65 years and over, and this number is set to rise to more than 900,000 by 2026 as the population ages. At present, about 6 per cent of this age cohort is in residential care, but the proportion is likely to rise as we live longer and more of us suffer lifestyle ailments. So while it might be an issue for “mam and dad” today, it will be “you and me” in a few years.

Demographic time bomb

A number of recent reports have pointed to the challenges posed by this demographic time bomb.

One of the most immediate challenges relates to the condition of our State-run nursing homes, many of which are in dilapidated, unsuitable premises that urgently need renovation or replacement. With international research showing the physical state of a home has a bearing on abuse levels, it behoves the Department of Health to make an early decision on whether to invest in State homes or encourage the private sector to take up the slack.

The UCD report tells us physical abuse of older people is more likely to happen in smaller homes and is more likely to involve “other-European” staff rather than Irish workers.

Low job satisfaction, an intention by a staff member to leave and high levels of burnout were other factors associated with abuse.

For staff, the most stressful part of the job was caring for residents who are aggressive, and the difficulty in communicating with residents.

Earlier this year, Hiqa expressed disappointment both at the inadequate arrangements in place in residential care centres to prevent abuse and at the relatively poor follow-up by institutions to implement recommendations.

This latest report suggests there remains scope for considerable improvement.