Tony Mullins hoped the day would come when his mother’s needless death in a private nursing home would be acknowledged, and care standards improved. Mullins and others who had relatives and friends in the Leas Cross nursing home in Swords, Co Dublin, thought the publication of the investigation into the home would close this terrible chapter in their lives. But they were wrong.

Questions remain

Unanswered questions form the inquiry trouble advocates of aged care reform. But the decision to release the report on July 16, within hours of the huge publicity over Colm McCarthy’s ‘Bord Snip’ recommendations, left a bad taste in the mouth for many across the board.

Leas Cross nursing home closed in August 2005 after an undercover RTE television programme had identified serious concerns over the level of treatment, and evident neglect, of people living there.

An initial report, done in July and August 2005 on behalf of the Health Services Executive (HSE), found there had been ‘systematic’ institutional abuse at the nursing home, and that this had been a factor in the deaths of some residents between 2002 and 2005.

In April 2007, Health Minister Mary Harney commissioned a full investigation in to the management, operation and supervision of the home. The report of this inquiry, led by senior counsel Derry O’Donovan, was published more than two years later.

This inquiry found that inspections and complaints should have alerted the HSE to the home’s problems. The Commission of Investigation said that the standard of care at the home fell below acceptable levels. It also criticised staff at Beaumont Hospital in north Dublin or not raising concerns about Leas Cross.

Lack of accountability

But the families of those who died at Leas Cross were disappointed by the report’s failure to hold anyone accountable.

Tony Mullins, spokesman for the Leas Cross Death Relatives Group, said that the report doesn’t go far enough. “The Commissioner’s report has confirmed that the HSE was aware of the conditions in Leas Cross, and what I find most remarkable is that this has all taken place and nobody is to blame. There seems to be nobody involved in the HSE who will take responsibility for the decisions taken in Leas Cross.”

Mullins cautiously welcomed the new independent inspection system, suggesting that time would tell whether it was effective.

New inspection system

This system was established in 2006, in the aftermath of the Leas Cross scandal, and is administered by the Health Information and Quality Authority (HIQA). HIQA is now responsible for the registration and independent inspection of all residential care services for older people. Under the new system, private, voluntary and HSE-run nursing homes will, for the first time, be inspected under the same criteria.

Head of communications with HIQA, Marty Whelan, explained that the newly developed criteria work on the principle that the nursing accommodation is the person’s home. ‘As well as considering personal safety, care standards and the physical environment, we will also seek to establish the social and emotional well-being of the residents,” he says.

Public accountability

HIQA has 32 standards covering the rights of residents, health and social care needs, quality of life, staffing, the care environment, management and governance. ‘The same standards will be applied throughout the country. Our inspections reports will be publicly available and, as relevant, recommendations will be made to improve the quality of service available in a home,” Whelan says.

He adds that, “while some inspections will be announced in advance in order to schedule interview with management and staff, we clan inspect unannounced at any time, day or night.” Inspectors will also be concerned with talking to residents, whether in groups or individually.

Under HIQA’s new approach, panels of relatives will be formed. These will provide a forum for relatives of nursing home residents to get support and information and to communicate any concerns.

‘Fair Deal’ funding

This year has also seen the introduction of the Fair Deal Scheme, which replaces the existing nursing home subvention arrangements. Private nursing homes can cost about €50,000 a year.

The new scheme provides for the HSE to carry out a medical and financial assessment of all individuals to determine their care requirements and the contributions they will make towards the cost of long-term nursing home care. A person will contribute to their care costs up to 80 per cent of their assessable income, which includes pensions, and 5 per cent of any assets in excess of €36,000. If these assets include land and property, the contribution can be deferred during a person’s lifetime, and that of any dependants, and collected from their estate in the future.

The State will meet the balance of costs over and above the individual’s contribution in approved facilities. If a person is already resident in a home they can continue their present arrangement or choose to avail of the new scheme.

Practical tips

1. Research homes in your area: speak to your GP – ask for advice and recommendations. There has been a considerable increase in the number of nursing homes opened in recent years, giving patients the option of a wide range of homes and retirement villages across the country.
2. Create a short-list of homes, and visit them to compare quality, care, team and facilities.
3. Talk to the HSE about a medical and financial assessment to determine care needs, eligibility for the Fair Deal Scheme, and the costs to be paid for care.

Questions to ask

• What is the ratio of staff to patients (night/day)?
• Who determines the amounts of medication patients receive?
• What recreational activities are available?
• What opportunities are there for physical exercise?
• Are there restrictions on visiting times?