Outdated laws and rules govern all aspects of our nursing home care, writes Martin Wall.
Senior health service figures readily accept that the current legislation and regulations governing the operation of private nursing homes are outdated and were drawn up for a different era.
The legislation was enacted in 1990 and the subsequent Department of Health regulations were drawn up three years later.
The legislation and regulations govern all aspects of nursing home care. These include who should run centres and the staffing numbers and facilities that must be provided to the level of inspections by the health authorities.
The regulatory framework pre-dates the growth of large-scale commercial nursing homes in recent years and were introduced at a time when there were not as many elderly people with high-dependency needs in the population.
There has also been a surge in the number of nursing homes opening in recent years, up 135 per cent over the last two years. This has been fuelled in part by Government tax breaks as well as demographics.
Under the current rules, the Health Service Executive (HSE) can seek to close or to take over the management of a nursing home which it believes is failing to comply with the regulations.
However, unless the proprietors agree voluntarily to such moves, sanctions can only be put in place on the orders of the District Court, processes that can take some time.
Both the legislation and the regulations specify that all private nursing homes must be visited by inspectors twice a year.
However, a report released last week by the HSE to Fine Gael deputy Fergus O'Dowd indicates that in some parts of the country a large number of centres are only being examined once. The report, for example, indicated that in Cork, 26 out of the 49 private nursing homes were only inspected once. HSE sources said the inspection process in some areas had been affected by industrial action by public health doctors.
Another criticism of the current system, which has been raised by Minister of State at the Department of Health Seán Power among others, was that health authorities gave nursing homes advance notice of their inspections.
This was strongly denied last night by a HSE spokesman, who said all inspection visits were carried out without warning. Subsequent or follow-up meetings to discuss the findings of inspection visits are, however, pre-arranged.
Under legislation, all nursing homes must be registered with the number of patients to be accommodated set out in agreement with the health authorities. It is a criminal offence to operate an unregistered home.
In most cases, the person in charge of the home must be an experienced nurse. There also must be a nurse on duty at all times and a "sufficient number of competent staff having regard to the numbers of persons maintained therein".
The regulations require that nursing homes provide patients with sufficient space, heating and lighting. Kitchens have to have suitable facilities, with food prepared in a hygienic manner.
Bed linen, disposable sheets and incontinence pads must be changed as frequently as required for the comfort of patients.
Nursing records of a patient's health as well as details of drugs administered must be recorded daily. A log of any accidents or falls must be maintained.
The regulations also allow for a patient in a nursing home or a person on his of her behalf to make a complaint to the local health authority.
Critics of the regulations say many of the current problems stem directly from the legislation and regulations themselves.