Thursday, 8 February 2007
Nursing Home Placements.
Over the past few days a number of constituents have come to me to complain that their close family members are about to be moved to nursing homes outside the Dublin area.
A 34-year-old man, who is brain damaged and has been hospitalised for many months, is one of the cases in question. His elderly mother visits him every day in a local hospital. Not long ago she was told that he was on a waiting list for a long-term care place in Dublin. His mother thought this would have been great because she would then be able to take him home regularly. Over the past few days, however, his mother has learned that there is some debate going on in the HSE about whether he was ever on that waiting list. She was then told he would be moved to one of two care homes in County Kildare. It would take his mother, who does not own a car, much time and effort to reach either of these homes. She is understandably very upset by this development. At a case conference yesterday in a hospital in my constituency, his mother and family were apparently told that regardless of whether they consented, the patient was about to be moved to County Kildare. She is expecting him to be sent there tomorrow.
A second case involves an 82-year-old woman whose husband suffers from Alzheimer's disease. He is to be transferred to a nursing home in Kildare. I understand that this nursing home is two miles from Kildare railway station on the Athy road. My constituent, who is 75, had to walk this two miles with no footpaths to see the nursing home. This elderly woman would not be capable of making this journey on a regular basis. The family will find it impossible to visit. It is very expensive to do so. This lady is afraid that she will never see her husband alive again. I am being told about the family's unwillingness to consent to this man's removal to Kildare, but the HSE has stated that he would be moved regardless of whether they consent.
Each of these patients, for one reason or another, has a limited capacity to make decisions about his own welfare. In each of these cases, family members have been told their loved ones are going to a nursing home outside Dublin. In each case, family members would be incapable of visiting their loved ones if they are moved outside the Dublin area. Each family has been told in a variety of ways that, regardless of whether they like it, their loved ones will be moved.
Why are Dubliners in need of long-term care being moved out of the county, far from their loved ones? I understand and appreciate that there is much competition for beds in the HSE. I also understand that hospitals are not necessarily the most appropriate places for those in need of long-term care. What I cannot understand is how we can countenance dispatching people in need of long-term care far away from where their close family members live.
The second issue that arises is one of consent. What is wrong with the law that in such cases, where non-minors are incapable of giving consent, there is no obligation on doctors contemplating medical operations or procedures to obtain the consent of those who love the incapacitated ones most? My suspicion is that these two cases are merely the tip of the iceberg and that we are entering an era where, in order to cover up for chronic incapacity in the Dublin hospitals and care homes, we are exiling people from one area to another where their family members cannot visit them. Article 8 of the European Convention on Human Rights guarantees the right of every person to a private and family life and these patients are being denied that right.
I want the Minister to investigate not necessarily these two cases, but the broader issue surrounding them, that is, the movement of these people away from an area where they can be visited by their families and to take account of the need of those people to get such visits on a regular basis.
I am replying to this Adjournment matter on behalf of my colleague, the Minister for Health and Children, Deputy Harney, and I thank Deputy Upton for raising it.
The issues raised are appropriate to the Health Service Executive working in conjunction with the hospital concerned. The Deputy's question centres on the movement of patients from acute hospitals to nursing care at an alternative location and on the issue of consent by families to the placement of their relatives. The Deputy will appreciate that this is a complex issue and one which requires sensitive management in all cases.
Every effort is made by the executive and individual hospitals to ensure that patients are placed in a care setting which is appropriate to their individual needs. This involves interaction both at hospital and community level and the input of a number of care disciplines, for example, clinical, nursing and allied health professionals.
Hospitals are encouraged to commence discharge planning with patients and their families as early as possible in all cases. Patients may be discharged to a range of settings. Hospitals engage extensively with patients and families to ensure that the post-hospital requirements of the individual are comprehensively assessed and that as much choice as possible is made available. It is not always possible to place a patient in a facility close to the family.
In certain circumstances, a family may be offered financial support to cover travel costs where a specialist placement may be some distance from the family home. At all times, the hospital strives to advise patients and their families and to ensure that the best solution is agreed.
The Department of Health and Children is advised by the HSE that a reply has issued to the Deputy regarding the two specific cases raised. The HSE advises that in both cases a place was offered in a nursing home but was refused. Alternative places have been identified and these are the subject of ongoing contacts between the HSE and families. Every effort will be made by the executive to accommodate the wishes of the families concerned. The HSE advises that, regarding the third case, the hospital is engaged in ongoing consultation with the family with regard to suitable placement of the patient.