Elderly neglected since 1968

For the last thirty years, numerous reports have attempted to provoke Government action on nursing homes, but to no avail. By Hilary Curley

Long-stay care facilities for the elderly are home to our most vulnerable people, and the failings of institutions and the Government to protect them have been documented in a series of reports since 1968.

The Human Rights Commission reported in 2002 that long-stay care residents were particularly vulnerable to human rights abuses. They said the absence of inspections, the lack of standards, the unequal treatment between public and private patients and the absence of proper protections and complaints procedures infringed on the rights of older people in long-stay facilities – rights which are supposed to be protected under Irish and EU law.

Five per cent of the older population are in long-stay facilities, and these are, for the most part, the most vulnerable people in need of care. The vast majority of people in long-stay care suffer from chronic physical and mental illness, according to the most recent large-scale survey of long-stay units, which was carried out by the Department of Health in 1996.

This five per cent does not include those who are resident in mental hospitals. The most recent report from the Inspector of Mental Hospitals recorded that the majority of patients (almost 55 per cent) were long-stay and most of these were over the age of 65.

The first detailed report on services for older people was published in 1968, complete with commitments from the Government. Subsequent reports and strategies referring to older people and long-term care were also issued in 1988, 1994, 1997 and 2001. Very few of the recommendations from any of these documents were implemented, according to the Human Rights Commission report.

In that report, Ita Mangan identified key areas where older peoples' rights were being neglected, or violated.

• Older people are not treated equally in the health care system. Differences in treatment exist between people who are cared for in the home and community and people who are looked after in long-term care. There are also significant differences between those who are accommodated in public care and those in private care.

• The shortage of long-stay care beds raises important equality and equity issues about how these beds are allocated and to whom they are allocated to. Minister for Health Mary Harney has opted to provide more beds through the public-private partnership approach, that is, bringing in the public sector to design, build and maintain the facilities. Nine 50-bed community nursing units are to be built in the eastern region and eight are to be built in the southern health board region.

• Critics of the public-private partnership approach have argued that it results in public services being privatised. The primary concern of private investors is getting the highest rate of return for their investment, so the quality of care may be compromised.

• There is no effective mechanism for the protection of vulnerable older people, with no complaints procedure in place and a scarcity of advocacy services.

• Older people are at particular risk of "inhuman and degrading treatment" of older people, and there is a lack of research on how older people in care are treated. There are also issues about how they are involved and consulted about the decisions that affect their lives.

• Access to clear and precise information is a basic human right but the quality and quantity of information available to the public on long term stay is poor. This prevents people from firstly making informed decisions and secondly from pursuing complaints.

• The absence of an external inspection system for public long-stay care means that there is no mechanism whereby the service providers can be held accountable. Conflict of interest also arises given that the provider of the public facilities ie the health boards, is the inspector of the private sector. Given the shortage of facilities, the health service has an interest in ensuring that the private facilites remain in place even if they do not accord with set standards.

• There is a lack of clarity between who is entitled to avail of long-stay care and who is obliged to contribute to the cost of the care provided. This has been on the Government's radar since 1994 but has not been resolved. This confusion is part of the reason the State now faces a €2 billion bill because older people were illegally charged in long term care.

The Human Rights Commission posed the following questions about how older people are treated in these facilities:

– What element of choice is exercised by the older person who goes into long-stay care?

– Are decisions being made by the individual, the families or the medical professionals?

– What control do residents have over their immediate environment?

– Are there ways in which residents can influence the policies of the institution?

– Is there genuine consent to medical treatment?

– Is force being used to administer treatment?

– Instances of restraint – are they property documented?

– Who makes the personal care decisions in cases of residents who are unable to make them?

None of the recommendations in this report have been acted upon. The Human Rights Commission has now commissioned a further report to examine how the legal instruments of the Constitution, the European Convention on Human Rights and the UN coventants can be used to guarantee the rights of older people in long term care.

The report is due out in the autumn and the Commission will make recommendations to the Government at that stage.