the tip of the iceberg

A single incident, however momentous, does not guarantee that concerned individuals will view the event as an example of a larger problem, and organise to solve it".*

The response to the Prime Time Investigation on the quality of care in Leas Cross is one of shock and outrage. National attention is now focused, even for a short time, on the quality of care of older people in long-term care in Ireland. The hidden camera has illuminated a dark corner but in this case the picture cannot tell the complex story of the individuals behind it or the organisation that allowed it to happen.

There are approximately 25,000 older people in institutional care in Ireland, which is a small proportion of the total population (what proportion). People in long-term care have very high levels of dependency due to complex medical problems and many suffer from dementia. The societal focus on successful and active ageing, brings with it a risk that those who suffer such losses in old age will be seen as less than human. We distance ourselves and react with emotional responses of avoidance and even disgust.

There have been reassurances that such examples of mistreatment are exceptionally rare. It is sobering, however, to read the historical accounts of life for the aged and infirm in the workhouses and asylums with overcrowding, squalid conditions and mistreatment. In the 1960s, reports of abuse and neglect in long term care were met with denial. There was huge resistance, evident in Dáil debates to the introduction of inspection of nursing homes.

The report of the ombudsman into the operation of the Nursing Home Subvention scheme by the health boards revealed little regard for the human rights of older people and even more disregard in the delays in refunding the money owed. The recent Travers report into the illegal charging of older people in long-term care for over 30 years is chilling evidence of financial exploitation.

In the last few years' accounts in the media include reports of lack of adequate nursing cover, delay in attending to patients' need for help with toileting, overcooked and unappetising meals, very small helpings of food, patients with pressure sores, lack of privacy or place to store personal possessions, lack of call bells, no sluice rooms, lack of supervision for patients who wander, sexual assault of residents, overcrowding and poor hygiene. This is far from reassuring.

Little effort has been made break the silence about the life of those, who live and work in nursing homes. This silence is shared. It is a form of forgetting and a sense that talking about the abuse, either experienced or witnessed, is not worth it – nothing can be done.

Elder abuse is becoming increasingly familiar in Ireland. It is an umbrella term for a wide range of behaviours, which cause harm to an older person and is confined to physical abuse, verbal abuse such as swearing, shouting, threats or financial exploitation.

Some less recognised and controversial aspects of elder abuse include the over-use of medication such as sedatives, the use of "restraints" such as seat belts, furniture, medication and electronic tagging devices, which restrict movement; a wide spectrum of sexual abuse of women and men, often targeting those most dependent; ignoring an older person; deprivation of social contacts with friends; forcing the older person to sign over money, houses, change wills; and neglect- lack of care of the person, their living environment, inadequate health care and malnutrition.

There is also a growing recognition that abuse and neglect can occur in a variety of settings such as the person's own home, day centre, hospital or nursing home.

There is a danger that the public outcry following the Prime Time programme will be shortlived and collective apathy will set in once more. The path from private trouble to public issue is a long and complex one but it must be taken.

One of the most important factors is willingness to accept the problem – a readiness, shared by a group of individuals to do something to change the situation and recognition of this by the wider society.

Anne O'Loughlin is a social worker, researching the role of inspection in the detection of elder abuse in institutional care

* This quote is from Barbara Nelson who carried out a detailed study in the 1980s of how child abuse became a public issue in America. The point of her research was that although examples of the brutal and neglectful treatment of children were found as far back as records had been kept, child abuse had not become a social problem.