Sir, – Dr Jonathon Roth (December 17th) correctly highlights the root problem of abuse in nursing homes as the inadequate structure of the Fair Deal scheme which only provides funding for “bed and board.”
As I have a parent in a private nursing home, who is also a beneficiary of the Fair Deal scheme, may I share some observations and ideas on possible remedies to improve the situation.
Although highlighted in Paul Cullen’s report (Front page, December 7th), nursing home abuse or less than adequate or below-expected levels of duty by entrusted care staff, is in my opinion, but one form of abuse.
Both public and private nursing homes are charged with long-term care for the frailest group with a reduced life expectancy of which 85 per cent of residents are female. Adequate management and care of these residents takes an enormous physical and emotional toll on the most dedicated staff. Thus it is too easy to blame staff alone. Where performance is less than adequate, we must as a society ask whether sufficient back-up – including financing long holidays and counselling support – is made available to care workers. Also it can be argued that stern regulation on minimum competency and professional requirements those entrusted with direction and supervision of nursing homes, has been, and to some extent still is less than adequate.
A contributing, albeit unintentional, factor behind the lack of reporting or notification of abuse by residents, may be the traditional and perhaps liberal use of mood-calming medication. While such prescriptions are at the sole discretion of the practising GP, it may be a factor which reduces any given resident’s ability to make an assertive complaint when warranted. An independent review of such medication within nursing homes may produce surprising results.
Irish nursing homes have become totally dependent on foreign and non-EU nursing staff. Unfortunately, the driving factor is cheap labour and minimum wage practices. Such a regime may drive down costs, but it also forces low expectations upon its staff, and naturally will feedback negatively into the day-to-day care culture endured by nursing home residents.
Thus there is an argument for the HSE or other statutory agency to examine employee motivation, fairness in employment and remuneration, and review how a serious abuse reporting structures can foster fear-free expression. Excellence in care requires us to go beyond the last-ditch provisions of whistle blower’s legislation.
Perhaps allowing non-EU-staff to be awarded “time credits” for every year of service which could assist in fast tracking citizenship applications would be an honest trade-off and a good incentive for all staff to feel safe in reporting abuse. – Yours, etc,