THE GRIM roll-call of nursing homes subject to allegations of mistreatment has been growing in recent years. Leas Cross may have grabbed the headlines, but many others have been under the spotlight over their standards of care and welfare for residents also.
St Mary's, a public nursing home in the Phoenix Park, is the subject of an inquiry into the mistreatment of patients, where it is alleged that a patient suffering from dementia had tape put across her mouth by a staff member to keep her quiet.
The Tara Care Centre in Bray, Co Wicklow, was fined for breaches of care and welfare which led to the disappearance of one of its residents.
Health authorities tried closing another nursing home in Dublin over fears that residents were at risk because of improper administration of drugs and staff shortages.
These cases have highlighted the gaping flaws in our current system of inspections and the urgent need for stricter standards of enforcement so that the most vulnerable of older people are protected.
Now, years after it was first promised, a new regime of minimum standards and inspection is due to be unveiled.
Under the new system, all nursing homes, both public and private, will be subject to independent inspections by teams attached to the Health Information Quality Authority (Hiqa). A set of minimum standards will apply to all residential settings where older people are cared for and for which registration is required.
The 32 draft standards set out the rights of residents and include their entitlement to protection, safe and respectful care. They include requirements such as ensuring that a minimum of 50 per cent of care staff have acquired further education or training; that individual care plans are in place for all residents; allowing each resident to choose meals and meal times; and are aimed at keeping residents safe from physical, financial, material, psychological or sexual abuse and neglect.
The person responsible for enforcing the new standards will be Hiqa's chief inspector of the Social Services Inspectorate, Dr Marion Witton, who has worked at a senior level with inspection authorities in Britain.
She says nursing homes which offer a good level of care will have nothing to worry about, although she warns there will be no place for nursing homes which do not provide a satisfactory level of service.
"We're not here to try to catch people out. The standards will be there to promote good practice and stop bad practice," she says. "In a sense, we are the only people in the system who are working solely in the interests of residents. Often, relatives feel guilty about putting a loved one in a home and what someone does for an older mother isn't necessarily what a mother wants. Being independent, we are here firmly for the residents. We are here to report without fear or favour."
In many ways, the political pressure to establish a better inspection system in Ireland mirrors what occurred in the UK.
It took a series of serious cases of abuse and mistreatment of nursing home residents in Britain before legislation was enacted to provide for greater protection and higher standards of care for residents in the home care sector.
Similarly, it has taken a public outcry over the rights of nursing home residents to get the forthcoming inspection regime up and running. Witton, however, cautions that a new system will never prevent all cases of abuse or mistreatment.
"Any amount of regulation can't stop abuse. Even if we were there every single day of the week, the standards can't prevent every bit of bad practice. "But we can do an awful lot by ensuring that people registered to run homes are suitable.
"If someone knows there are good regulations, they'll think twice about setting up a home. I want everyone to have confidence that we have a rigorous process which will stop inappropriate people from running nursing homes."
The flaws in the current system are also similar to those that applied under the old UK regime, with HSE officials being asked to inspect the same nursing homes which another part of the health service funds.
"How can you place someone in a nursing home on Monday and say it's inadequate on Tuesday. You can't. It's an absolute conflict of interest. The HSE is both provider and inspector. This is exactly the problem that led to the establishment of the national inspectorate in the UK."
At the heart of the new standards will be a deeper focus on the individual needs of patients.Instead of one-size-fits-all staffing ratios, for example, the emphasis will be on evidence that patients themselves are being looked after properly and that individual needs are being met.
Witton gives an example of how a simple issue, such as policies relating to fluid intake for residents, can have serious consequences down the line.
"A nursing home might offer residents a cup of tea in the morning, at lunch-time and in the evening, and then nothing from six that evening until the morning.
"If you or I are out and about, we need fluids at different times of the day. If you don't get enough fluid, you get constipated. If you get constipated, you get confused.
"Then you get agitated and maybe you're put on medication. Once you're on medication, you might fall over and end up in hospital, all for the want of a glass of water," she says.
It may still be several months before the new inspection system is up and running. The draft standards for nursing home care have been finalised by Hiqa and are due to be published by the Minister for Health.
Recruitment to the new inspections teams is ongoing and new regulations to accompany the new standards have yet to be published.
Witton and others are using this period to work with nursing home owners to help raise awareness of their new obligations. Nursing homes which consistently fail to meet the new standards may lose their registration status.
For less serious breaches, nursing homes will be given a conditional registration for a set period of time, during which the home will be expected to meet the regulatory standards.
Overall, Witton is confident the new regime will win the confidence of residents and service providers alike.
"I believe the vast majority of nursing home owners want good, robust standards because it separates them from the cowboys," she says.
"So we'll be looking for evidence of good practice, as well as for signs that need to be improved. If you're just looking for failings, it gets very demoralising . . . But everyone should be aware that what we are expecting is not unreasonable."
New draft standards on nursing home care aim to ensure protection and respect. Dr Marion Witton will be responsible for enforcing them
New nursing home standards: main aims
Give each resident a contract setting out what they should be able to expect regarding accommodation, care and services.
Allow each resident to choose meals and meal times.
Provide residents with a physical and social environment to ensure their independence is preserved.
Ensure that residents have a flexible daily routine which can be varied to suit their needs.
Facilitate and encourage links with family and friends.
Give residents a say in room-sharing arrangements.
Keep residents safe from abuse and neglect.
Provide at least one toilet for every five residents and one handbasin for each resident. En-suite toilet and handbasins are to be provided for all residents in new nursing homes and extensions from 2008.
Desist from using physical or chemical restraints to compensate for inadequate staffing levels, or in the routine management of residents.
Ensure that specific healthcare needs of all residents are allowed for, including nutrition, wound management, continence and oral health.
Ensure that residents' wishes regarding religious and cultural practices concerning death are recorded and implemented, and that upon death, time and privacy is allowed for family and friends.
The person in charge should be qualified to run the residential-care setting and should have at least three years' experience in a senior management capacity.
Clear guidelines must be in place on the management of the residents' accounts to ensure that they control their own money, except where they state they do not wish to.
Medical, nursing and the organisation's records should be secure and up to date.
All qualifications for staff must be checked and nurses' registration should be verified with An Bord Altranais and references sought.
New staff should be confirmed only following completion of a satisfactory Garda clearance.
Nursing home buildings should comply with various standards, including fire regulations, as set down in the new code.
All residents must have access to information held about them by the registered service provider.