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Nursing home residents were denied family life with no recourse

Government readily acknowledged lockdowns increases risks of domestic violence and child protection rates in private homes, yet refused to recognise the risks of increased institutional abuse while nursing homes operated behind closed doors

Imagine you are a nursing home resident. Cocooned away from family and friends since March 2020, you have lived in the near total care and control of care staff, reliant on them to ensure your rights are respected and protected. You live on an island within an island, it appears; for while the Government says one thing, your nursing home does another. 

Health Minister Stephen Donnelly repeatedly urged nursing homes to facilitate safe window visits, yet in your home, you were barred from looking out your window at the faces you love most for months on end. The Government issued visiting guidance, but neither monitor compliance nor sanction your home when they refuse to comply with it. You need support from staff to use a phone or tablet and feel unable to have private conversations.

You then experience an episode of poor care, abuse, or neglect. Perhaps support around your personal hygiene dwindles. Perhaps you are left in bed, all day, every day. Perhaps a pressure sore receives less attention than it should and deteriorates. Perhaps you have dementia and an impatient staff member shouts at you, handles you roughly or assaults you. Perhaps your sense of dignity is lost, as you are left sitting on a commode, with your room door open, visible to anyone who passes. You are sick and frightened and though national guidance states compassionate visits are allowed, nursing home management say you’re not sick enough to warrant time with your family. How do you seek help or support from inside the cocoon?

These are not fictional accounts. As a volunteer family led advocacy group, Care Champions work with families who have shared their experiences of infringements of rights, abuse, neglect and unnecessary separation from residents during Covid-19.

While Tusla provides a statutory, independent response to children experiencing abuse and neglect, residents in nursing homes have no such service when similar incidents arise. 

Bounced between multiple services

Instead, families are bounced between multiple services trying and failing to seek a satisfactory response from the State. Hiqa only investigates systemic failures, the Ombudsman only deals with non-clinical concerns, the Office of the Confidential Recipient only supports residents in HSE nursing homes, Safeguarding and Protection social work teams lack legal right of entry to private nursing homes, where over 80% of residents reside. 

Residents and families quickly learn that when harm is experienced, there is no ‘one stop shop’, or effective response.

These inherent weaknesses in our sector were well known to Government in March 2020. Stung by criticism for delayed action to protect nursing home residents in wave one of Covid-19, the Government pursued a single and ultimately harmful approach in 2020 and much of 2021 – prolonged cocooning. 

Government readily acknowledged lockdowns increases risks of domestic violence and child protection rates in private homes, yet refused to recognise the risks of increased institutional abuse while nursing homes operated behind closed doors. 

Harrowing stories

Despite the harrowing stories from Dealgan House in wave one, despite the Department of Health’s own research which shows people do not know how to report abuse, despite the known trends of underreporting of abuse by staff in nursing homes and despite the successful prosecution of the rape of a cocooned resident by a staff member, the Government still had no objection to cocooning residents without a single additional safeguarding measure in place. 

The Irish Association of Social Workers advocated for a range of measures, including a family liaison service, focused safeguarding training to support staff to specifically recognise and identify institutional abuse during cocooning and proactive monitoring of safeguarding trends. The Government did not listen.

While the Dutch parliament outlawed blanket visiting bans last summer, and using visiting spaces, education and infection control measures, re-established safe, managed indoor visiting without any increase in Covid-19 transmission, the Irish Government continued to frame the loss of family life for residents as an unavoidable policy choice. Family visits, which are a vital protective support, were facilitated not on rights to family life, but on compassionate grounds. 

Compassion often entirely lacking

As evidenced in last night's RTÉ Investigates, in many homes compassion was subjective and often entirely lacking. Many residents died alone, after months of avoidable separation from family and the grief and loss group formed by Care Champions is a testament to the lasting devastation experienced by grieving families.

The RTÉ Investigates programme provides a valuable opportunity for all stakeholders in and outside Government to reflect on their role. 

Where was the leadership on the risks and response to increased institutional abuse during cocooning from the HSE National Safeguarding Office? Or Safeguarding Ireland? 

Why did some professional advocacy groups publicly welcome visiting guidance which provides visits on the grounds of subjective compassion, rather than the rights to family life the rest of society enjoyed when restrictions eased? 

There is little point in using rights based language, while welcoming paternalistic policies which infringe rights. Why did the Expert Panel on Nursing Homes fail to make a single reference to safeguarding in their 86 recommendations? 

Why with the exception of social workers, was there a complete professional silence from health professionals on the possibility of abuse and neglect occurring in nursing homes, despite Hiqa reports showing repeat failures? 

Why has it been left to families and residents themselves to expose these failings, when registered professionals have a leadership role in every nursing home? Why aren’t resident and family councils in every home meaningfully contributing the management and functioning of each home?

The Workplace Relations Commission identifies social work as the lead profession in adult safeguarding and social workers have demonstrated why this is the case during the pandemic. 

The Irish Association of Social Workers repeatedly briefed Government of the safeguarding risks associated with prolonged cocooning, concerns which have since been validated by the staggering 71% increase in public concerns about nursing home care reported to Hiqa in 2020. 

Deafening political silence

Social workers proposed solutions and campaigned for political action. They, like Care Champions, have encountered a deafening political silence. 

Care Champions and the IASW now jointly call for legislative and regulatory reform, for the introduction of an independent safeguarding ‘one stop shop’, for legal protection of visiting rights, for a public inquiry into both the deaths which occurred and the experiences of surviving residents and for a root and branch reform of our nursing home sector.

Care Champions are clear – nothing will change until the law changes. It is also clear political action will only take place with sufficient media attention and public pressure. 

Majella Beattie is chairperson of Care Champions, a family led advocacy group

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