ANALYSIS:Abuse was rife in Leas Cross nursing home and others because it was facilitated by a dysfunctional regulatory system, writes CARL O'BRIEN.
AS YOU look through the 400 or so pages of the commission of investigation into Leas Cross nursing home, a pattern quickly emerges.
It isn’t so much the serious gaps in care and neglect of vulnerable elderly people by the owners of the nursing home but the inaction of health authorities confronted with repeated and overwhelming evidence that the health, safety and welfare of residents was in jeopardy.
At the heart of this scandal is the fact that health authorities were not only inspecting nursing homes, but were also funding them to care for exposed older people. This created an environment where a blind eye was turned to serious care failures.
This circumstance placed residents in Leas Cross at risk. Moreover, the gaping flaws in care standards and the conflict of interest within the regulatory system may well have facilitated the abuse of untold numbers of older people in nursing homes across the country.
Firstly, let’s take Leas Cross. For several years – from its opening in 1998 to 2003 – there were a number of complaints, but no sustained pattern of inadequate care at the home.
The key to the home’s deterioration in care standards was its decision to expand services from a 38-bed facility to a 111-bed nursing home in 2002. Health authorities – in this case the northern area health board – expressed support for the extension to the home before it was even built. Indeed encouragement was forthcoming before there was any application for registration of the new beds.
When it was built, the health board swiftly registered the facility. It did so without any evidence that it gave sufficient consideration to the staffing levels needed or the dependency level of residents. Moreover, the health board took the opportunity to purchase contract beds from the home so it could transfer a number of high-dependency patients from St Ita’s Psychiatric Hospital.
These were the most vulnerable of patients, suffering in most cases from dementia and Alzheimers; they required the most intensive and qualified kind of nursing care available. But it was not forthcoming.
When a series of complaints were made in 2004 – including one very serious complaint – the nursing home was re-registered by the health board without adaquate investigation of these concerns. Consequently, the inspection process was seriously undermined posing serious risks for residents at the home.
In fact, during the period when the health board contracted out beds in the expanded care home there were no spot checks to ensure compliance and only one routine inspection.
When the failings of the home tumbled into the open, health authorities acted quickly to assume management of the centre and eventually close it down.
But Leas Cross wasn’t alone. There are many others which have been subject to serious concerns or investigation, but never received the same glare of publicity.
St Mary’s, a public nursing home in the Phoenix Park, Dublin, has been the subject of allegations of mistreatment of residents. One such allegation concerns an older person suffering from dementia who had her mouth taped by a staff member to keep her quiet.
The Tara Care Centre in Bray, Co Wicklow, breached care and welfare standards, which led to the disappearance of one of its residents. Health authorities tried closing another nursing home in Dublin over fears that residents were at risk because of improper administration of drugs and staff shortages.
These are just a handful of homes. In an environment where a shortage of nursing home beds existed, in conjunction with a tax incentive-fuelled rush to build new homes, an issues like standards were relegated to one of minor consideration.
Leas Cross was just a symptom of institutional abuse and the State’s laissez fair attitude towards the area. With the exception of some figures, this was a systemic failure by Government, health authorities and other groups to address the issue of appropriate quality of care for older people.
This month, five years after Leas Cross, a new regime of independent standards and inspection finally came into force. On the face of it, at least, it represents a significant improvement.
Under the system all nursing homes, public and private, will be subject to independent inspections by teams attached to the Health Information Quality Authority (Hiqa). A set of minimum standards will apply to all residential settings that care for older people and for which registration is required.
While the standards will help deliver better quality care, it would be naive to think they will rid the system of abuse. In the UK, where tough independent standards and inspections have been in place for several years, there are still shocking cases of abuse. But it will help minimise scandals like Leas Cross occurring again.
We still have a long way to go, though. There are tens of thousands of vulnerable adults and children living in institutions or residential centres for the disabled which are not subject to any form of independent inspection or standard. This is despite dozens of reports of abuse in these places and research which shows that disabled people are at a higher risk of abuse than the general community.
Funding for inspections for disabled people has been refused by the Government because it says it doesn’t have the funds. Minister for Health Mary Harney also warned yesterday she could not guarantee that money for inspections for nursing homes will not be cut.
The question, in light of the Leas Cross report, the Ryan Report and others, is not whether we can afford to resource more robust care standards and inspections – it is can we afford not to?
Carl O'Brien is Social Affairs Correspondent with The Irish Times