Much is rightly made of the statements of intent and idealism that characterised the foundation documents of this Republic. These included the Democratic Programme unveiled at the meeting of the first Dáil in January 1919, in which “The Irish Republic fully realises the necessity of abolishing the present odious, degrading and foreign Poor Law System, substituting therefor a sympathetic native scheme for the care of the Nation’s aged and infirm, who shall not be regarded as a burden, but rather entitled to the Nation’s gratitude and consideration”.
At the centre of that poor law system established under British rule was the workhouse, which was feared and detested in equal measure. While independent Irish governments subsequently sought to develop a more humane and empathetic social contract, the care of our elderly population has for far too long been compromised, sometimes egregiously.
There is excessive reliance on nursing homes, a dependency more alarming given the shortcomings in Ireland’s history of institutional care. There has also been a dramatic shift towards the privatisation of these homes. In the 1980s, public nursing homes accounted for roughly 60 per cent of total beds nationally, but a report from the ESRI last year highlighted that in 2022, “83 per cent of all Long-Term Residential Care (LTRC) home beds were provided by voluntary/private sector LTRC homes, with private for-profit operators alone contributing 74 per cent”.
Considering the recent revelations by RTÉ Investigates, the Minister of State for Older People and Housing, Kieran O’Donnell, has said he has “concerns” about the scale of privatisation and has ordered officials to study this issue. The Health Information and Quality Authority (HIQA) has highlighted the need to give it more power in relation to private nursing homes and their corporate owners.
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The current controversies are all the more disturbing given it is 20 years since distressing images of the use of Buxton chairs to restrain elderly nursing home residents at the Leas Cross home in Dublin. A subsequent report by consultant geriatrician Desmond O’Neill described the care shortcomings at the home as “institutional abuse”. As was often and remains the case, various concerns had been raised but it took journalistic exposé to bring matters to a head.
In 2022, our population aged 65 years and over was 781,400 and is set to reach over one million by 2030. The number aged over 85 is projected to rise to 301,000 by 2051. What has been uncovered must generate an urgent dynamic to address the care of our elderly, who now, no more than when their needs were voiced by the architects of Irish independence, need to be treated with the dignity, gratitude and respect they deserve.
