Analysis: Leas Cross was not an isolated incident, writes Eithne Donnellan, Health Correspondent
'It would be a very major error to presume that the deficits in care shown in Leas Cross represent an isolated incident. Rather, given the lack of structure, funding, standards, and oversight, they are very likely to be replicated to a greater or lesser extent in institutions throughout the long-term care system in the country".
Those are the startling words of the consultant geriatrician Prof Des O'Neill in his report on Leas Cross published yesterday.
They will send a shiver up the spine of anyone with a relative in long-term care. Up to 18,000 older people are in long-term care in public and private nursing homes in this country.
The O'Neill report points to many shortcomings, not just in one large private nursing home in north Dublin, namely Leas Cross, but also to deficits in policy, legislation and regulation of this sector in the Republic which have left all older people in nursing homes vulnerable.
He says there are, for example: no set nurse-to-patient ratios in nursing homes inthe State; too few nurses have been exposed to specialised knowledge about care of older adults; there is an almost complete absence of systematic monitoring of deaths in Irish nursing homes, and the nursing home inspection process has also proved to have been deficient.
In many cases in the past nursing homes were informed when inspections would take place. Little surprise then that Prof O'Neill says what happened in Leas Cross could be happening elsewhere. But this is not just a theoretical possibility. We know from nursing home inspection reports released under the Freedom of Information Act that other homes across the country have also had problems.
In May 2000 an inspection on a nursing home in Co Wicklow found "there was no doctors signature for medications given" and one resident had not had his prescription renewed since November 1999.
An inspection on the Bedford House Nursing Home in Balbriggan, Dublin, in February 2004, found it to be "very run down" and it said patients were only getting a bath or shower "every 10 days".
Inspectors who visited Mowlam Nursing Home in Ballinakill, Waterford, in April 2005 found hygiene "a huge area of concern". In many instances residents had not been seen by a doctor since admission and a total of 14 accidents, mainly involving patients falling out of bed, had been recorded in April 2005.
Meanwhile, a coroner heard last year that two patients who died at the nursing home at Stocking Lane, Rathfarnham, were buried before death certificates were issued, even though they were believed to have died of natural causes.
Details of inspections on this home show inspectors had concerns that the home had insufficient staff, that there were more patients in the home than were registered and that the local health board had not been notified of all deaths.
In May 2005 the inspectors recommended the home not be reregistered, as they had in February 2005. But it was allowed to continue to operate subject to certain conditions.
Age Action Ireland confirms it also regularly receives complaints about issues in nursing homes. These vary from complaints of physical and verbal abuse, patients being left on wet beds for long periods, high levels of restraint being used, to people who can't feed themselves being given dinner but not given any help to eat it.
The HSE claimed yesterday it was doing everything possible to ensure that nothing but the highest quality services were available in nursing homes.
But Aidan Browne, who is responsible for older people's services in the organisation admitted "care in nursing homes is variable from day to day, and even the very best nursing homes will from time to time have incidents . . . which are unacceptable and where the care standard drops".
He revealed the HSE has taken steps in recent times to halt admissions to a number of unnamed private nursing homes. But it is unclear what it has done for the people already in these homes.
There has been a mushrooming of private nursing homes in this country in recent years, at least some of which have been built with generous tax breaks. And while many are likely to be providing a high standard of care the reality is that they are essentially there to make money.
Nationally there has been a shift from 55 per cent public long-stay beds and 45 per cent private to 45 per cent public and 55 per cent private in just four years from 2000 to 2004.
This shift from the public to the private sector, which has occurred without any real public debate, may have important consequences for the health of older people in residential care. Why? A recent study by the National Council on Ageing and Older People found the ratio of registered nurses to resident was significantly lower in the private sector than in public sector homes.
The O'Neill report also says the US government agency for quality in healthcare has funded research showing that for-profit nursing homes have lower operating costs but higher hospitalisation rates than non-profits.
This should be of concern to the Minister for Health Mary Harney because if more people end up in hospital from private homes, the more it will contribute to hospital overcrowding.
Therefore there needs to be a complete rethink on how we care for our growing population of older people. Steps need to be taken to ensure proper safeguards are put in place to protect in particular those who have to live out their final years in nursing homes, regardless of what part of the country they are in.