Reported 16,000 elder abuse cases in five years ‘the tip of the iceberg’

Safeguarding group says HSE figures do not cover abuse in nursing homes and hospitals

Almost 16,000 cases of elder abuse have been reported within Health Service Executive-funded services for older people over the past five years.

The number of abuse concerns relating to over-65s increased from 3,029 in 2016 to a peak of 3,412 in 2020, the first year of the Covid-19 pandemic.

The number of cases reported strongly underestimates the true level of elder abuse, according to Sage Advocacy, a group that campaigns on safeguarding issues.

"These figures are just the tip of the iceberg," according to Sage deputy chairwoman Patricia Rickard Clarke, who pointed out that they do not cover abuse in private nursing homes, hospitals or other services such as homeless units or addiction centres.


The most common type of concern reported to the HSE over the period involved psychological abuse, which accounted for 35 per cent of reports in 2020.

Physical abuse accounted for 23 per cent of cases in that year, while 19 per cent involved financial abuse, according to the HSE’s national safeguarding office. Neglect was involved in 15 per cent of cases, and self-neglect in 4 per cent.

A total of 4,379 cases of physical abuse of older people was reported over the five years, and 665 of sexual abuse.

The figures were provided to Fine Gael TD Fergus O'Dowd in response to a question about the number of investigations carried out within HSE older person services.

Ireland is "a disgrace" when it comes to ensuring at-risk people are properly protected against abuse, said Ms Rickard Clarke. "We don't have safeguarding legislation in place, as many of our European neighbours have. It's a big black hole, with no assessment of risk or needs, and no obligation to provide services."

Failed to progress

An adult safeguarding Bill, which proposed the creation of an independent national safeguarding authority, was introduced in the Seanad in 2017 but it has failed to progress.

Ms Rickard Clarke said the most common form of abuse suffered by older people was psychological abuse, often practised as coercive control. Although legislation on coercive control was implemented in 2018, it only applies to people in an intimate relationship, she said, and does not therefore apply to many situations in which older people are abused.

A lack of data sharing between agencies, caused by the way GDPR legislation is interpreted, is also impeding efforts to tackle elder abuse, she said.

Standardised procedures for screening and protecting vulnerable adults at risk of abuse were put in place in 2014. The procedures cover older people and people with disabilities within HSE and HSE-funded services.

Preliminary screenings are held into concerns of abuse about adults at risk, with the result determining whether a safeguarding response is warranted.

“Where there is an outcome of reasonable grounds or further information required, each service would also submit a safeguarding plan which is then also oversight-reviewed by the HSE safeguarding team,” according to the HSE.

Meanwhile, a new survey has found that about one-quarter of patients attending hospital emergency departments (EDs) are being admitted promptly.

Waiting time

Just 29 per cent of patients were admitted to a ward within the HSE’s target waiting time of six hours, according to the 2021 National Inpatient Experience Survey by Hiqa (Health Information Quality Authority).

Over 300 people, or 4 per cent of the 10,743 respondents to the survey, said they had waited 48 hours or more to be admitted.

Overall, most patients report having a good experience in hospital, with 83 per cent rating their hospital care as “good” or “very good”. The majority said that they were always treated with respect and dignity, and that they were given enough privacy when being examined or treated.

Patients also gave very high ratings of cleanliness, pain management and confidence and trust in hospital staff.

This is the fourth year the survey has been carried out by the HSE; it began in 2017 but was cancelled in 2020 due to the pandemic. The 2021 survey went ahead but the month it was conducted was switched from May to September due to the cyberattack on IT systems in the HSE.

Patients admitted to small and specialist elective hospitals tended to report more positive experiences than those admitted to medium and large hospitals.

Cappagh orthopaedic hospital in Dublin (9.5 out of 10) and Bantry hospital (9.3) scored highest for overall experience; St Vincent’s in Dublin and Kerry University Hospital in Tralee scored lowest (both 7.7).

Paul Cullen

Paul Cullen

Paul Cullen is Health Editor of The Irish Times