Vulnerable adults in care may have experienced ‘significant’ abuse during pandemic

Vulnerable adults in HSE-run and private care may have been exposed to “significant cases” of abuse during the pandemic, including “harmful institutional practices, domestic violence and increased exposure to financial abuse”, a HSE report warns.

There have been more “complex cases” requiring “greater engagement” by the HSE’s safeguarding and protection teams (SPTs) and entailing “legal proceedings and liaison with An Garda Síochána”.

The annual report from the executive's National Safeguarding Office (NSO) notes 10,216 concerns about abuse of vulnerable adults were reported to the HSE last year, involving 11,847 abuse types.

“The most frequent type of abuse alleged is psychological followed by physical. This is the position across all the age groups,” it says.

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There was “a particular drop in notifications” in the first half of last year, it says however, coinciding with the pandemic and restrictions on visits to residential care settings.

“International studies have shown that the restriction in access to services and external support creates increased safeguarding risks. The restriction in home and residential visits, enforced as a consequence of Covid-19, has led to reduced contact with adults at risk.”

It continues: “The SPTs have conveyed that while the number of concerns declined for the second quarter of 2020, there have been indications of hidden abuse during lockdown.”

Adults aged 18-65 had the highest proportion of psychological (42 per cent of notifications for this age group) and physical abuses (38 per cent) alleged.

Among the 65-80 year olds, psychological abuse accounted for 38 per cent of concerns; 25 per cent concerned physical abuse; and 16 per cent financial. Among those aged 80 and older, 32 per cent of notifications concerned psychological abuse; 23 per cent financial abuse; and, 21 per cent physical abuse.

The NSO leads implementation of the HSE’s 2014 policy, Safeguarding Vulnerable Persons at Risk of Abuse, which is operated at local level by nine SPTs.

The NSO, however, has no legislative power and reiterates its warnings that SPTs have no power to access services or to talk to people considered to be at risk of abuse. In addition: “Services without a HSE contract have no legal obligation to share information and/or co-operate in safeguarding,” it says.

The vast majority of notifications of abuse (78 per cent) last year concerned people in older persons’ care or the disability sector, with the number of reports highest in the southeast, at 3.63 per 1,000 population, and lowest in west at 1.88 per 1,000.

“For those under 65, the person allegedly causing concern is most likely to be another service user. In contrast, for those over 65 the person allegedly causing concern is likely to be an immediate family member,” says the NSO.

Under-reporting

It remains concerned about under-reporting of elder abuse, saying while there are consistently about 2,000 reports a year, given the population of older people “the number of older people who have experienced elder abuse is estimated at 14,026… There is a need for... programmes that enhance recognition and response to all forms of elder abuse.”

The report calls for primary legislation to underpin and strengthen its work.

“There is a requirement for primary legislation in the area of adult safeguarding as well as the commencement of the provisions of the Assisted Decision Making (Capacity) Act 2015. These legislative provisions when commenced will significantly enhance the HSE’s ability to safeguard,” it says.

Safeguarding Ireland echoed the call for primary adult safeguarding legislation. Its chairwoman, Patricia Rickard-Clarke, said the organisation's research indicated actual levels of abuse were "much higher than what is reported annually to the HSE teams".

"We need to greatly speed up the enactment of primary adult safeguarding legislation, to begin planning for a National Safeguarding Authority, and to see the effective rollout of the long-awaited Assisted Decision-Making Capacity Act (2015) from June 1st, 2022."

Sinn Féin spokesman on Health, David Cullinane TD, called for mandatory reporting of suspected vulnerable adult abuse.