Neglect came from our choices on private for-profit care for the elderly
Published in the Irish Independent, Saturday November 11 2006
THE abuse and neglect of older people in Leas Cross did not happen to them by accident. Nor did it occur in a policy or a political vacuum. It happened in a modern, super-rich democracy that has made choices about how public money is spent and what are our priorities. Des O’Neill’s report is very important in many ways; in its detail of the abuse experienced by older people in Leas Cross; in its identification of the total failure of health services management to respond to very serious concerns raised by relatives of residents, senior medics and its own inspection teams; in its recommendations for better care for older people in the future. O’Neill also highlights another important aspect – the growth in private care for older people and the failure by government and the health services to regulate standards and quality of care for older people living in private nursing homes. O’Neill cites unease in relation to the growing use of private care and how it has occurred without any public debate. The percentage of older people living in private nursing home care has changed from 45pc in 2000 to 65pc in the most recent Irish research, published in May 2006. O’Neill’s investigation found that in North County Dublin in 2004, where Leas Cross was situated, there were disproportionate numbers resident in private nursing home care, with 75pc of older people in private care, compared to 25pc in public care. This increased use of private care is a direct result of current government policy. Since 2001, there are significant tax incentives favouring the building and refurbishment of private nursing homes. This is in line with PD policy that the solution for all of society’s problems is in the market. The 2001 incentives were strengthened by commitments made by Mary Harney as minister for health in 2005, with her 10-point plan to resolve the crisis in A&E. In order to free up beds in public acute hospitals, patients in public hospitals, known as ‘bed blockers’, needed to be moved into long-term care. As there was no increase in the provision of public long-term care beds for older people between 2000 and 2004, beds had to be found in the private sector. Private homes were unable to provide the high level of care needed, so low-dependency patients were moved from public hospitals to private homes so that public institutions could offer more high-dependency places. A 2001 Review of Services for Older People published by the ERHA, the health services executive for the Eastern Region at that time, found that private nursing homes refused up to three quarters of patients referred to them from general hospitals because they were unable to manage high levels of care these older people needed. International research shows that private for-profit care may not always be the most appropriate place for older, high-dependency nursing home residents. By their nature, the primary concern of private nursing homes is profit, not the care and well-being of the older person. Private nursing homes may not have the access to essential services such as speech and language and occupational therapy – essential services for this group of vulnerable people. O’Neill refers to American research which shows “that for-profit nursing homes have lower operating costs but higher hospitalisation rates than non-profits. This trend has also been noted in the private sector in Northern Ireland. In general, the quality of care in not-for-profit (voluntary and public) homes in the US is higher than in for-profit (private) homes.” Irish research has shown that private homes have fewer nursing and non-nursing staff to patients than those in the not-for-profit sector. Privatisation of long term care for the elderly has occurred by stealth, with no public consensus that it might be the best option. Perhaps, O’Neill’s report may make us stop and think.