Highest standards must be expected in care centres

Serious shortcomings at St Joseph's Community Nursing Unit in Trim have been uncovered by the Health Information & Quality Authority (HIQA) following a two-day inspection carried out last September. The findings give rise to concern on a number of levels. HIQA found that allegations of elder abuse against a nurse at the hospital were not adequately investigated in accordance with HSE procedures. The nurse concerned remained on duty until two further allegations of alleged abuse were made. Age Action Ireland has said the report is a cause of serious concern and undermines so much of the good work being done by staff at St Joseph's and other nursing centres throughout the country. A number of other issues are raised by HIQA that will leave relatives of the 147 residents of St Joseph's uneasy. Quite apart from the matter of the alleged abuse and the fact that the investigation was inadequately handled by management at the hospital, attention has also been drawn to to management practices at the hospital which did not come up to the required standard. The most worrying of these relate to fire safety. The authority found that bedroom doors were wedged open and that several units which make up the complex could not be isolated to prevent the spread of fire. Staff had not attended fire drills and the number of staff on night duty was insufficient should there be a need to evacuate in the event of a blaze. Indeed, no plan was in place at all for an emergency evacuation of the centre. Inspectors also identified that a number of complaints had not been investigated and that the management of complaints in general was unsatisfactory. However, it was the failure of the senior manager to investigate the allegations of abuse that is the most serious. They found that the investigation had not been initiated in a timely manner and there was a lack of robustness in the approach. Relatives were not informed and no immediate protection measures for residents were introduced. The nurse in question remained on duty and was not placed on administrative leave until last November following two further allegations of alleged abuse. HIQA has now initiated a complaint with An Bord Altranais around fitness to practice of the nurse concerned. Questions inevitably must be asked not only of the senior management at the nursing unit concerning the ineffectual response to the allegations of elder abuse, but also of the HSE, which is ultimately responsible for the operation of St Joseph's. In particular, there are questions surrounding the fact that no training on elder abuse had been provided to staff. Since 11th November last, management at St Joseph's has put in place a policy that now records complaints and ensures they are addressed, actioned and reviewed for learning by the management team. The Leas Cross scandal in 2005 opened the country's eyes to the neglect and systems failures that seem to be endemic in our dysfunctional health system. Systems certainly failed in Leas Cross and were shown to be inadequate but systems are only as good as the people who operate them. Almost five years on, we should be able to say that everything has changed for the better in Ireland's nursing care homes, but can we? Leas Cross underscored the need for independent investigations of elder care centres and HIQA has proved its worth with the work it has engaged in. Giving elder loved ones an environment towards the end of their days where they can be properly cared for, such as long-term care facilities, involves families placing their absolute trust in others to care for their family members who are no longer able to look after themselves. Many facilities provide excellent care, both State-run and private, but those that do not - where residents may be neglected, abused or threatened - give the entire sector a bad name. The excellent care afforded to thousands of patients who have passed through the doors of St Joseph's in Trim since 1921 should not be forgotten as a result of this failure. But clearly, lessons need to be learned in this case if reputational damage to this essential local facility is to be minimised. Indeed, it is worth noting in the HIQA report that the views solicited from both residents and relatives by the inspectors were positive in all aspects, with residents in particular praising the St Joseph's staff for their commitment and kindness. Notwithstanding the goodwill there is from all quarters towards the Trim nursing unit, there is now widespread recognition of the need to protect the rights of those in residential care. The new national quality standards provide a baseline for those with the responsibility for providing care to ensure proper planning, developing appropriate resources and ensuring a good quality of life for those in their care. The hope must be that the failures in St Joseph's outlined in this report have now been addressed adequately and that the lessons learned have been taken on board and implemented. Everything possible must be done in the future to ensure that both residents and their relatives will have confidence that such cases are very much the exception and that the very highest standards will apply from now on.