Rónán Mullen (Independent) | Oireachtas source

We had a debate recently on nursing home care, to which I contributed. I would like us to continue that debate on the care of older people in nursing homes and home care settings early in the new year. Yesterday, the Oireachtas Life and Dignity Group welcomed Trinity College Dublin's Professor of Medical Gerontology, Desmond O'Neill. Many people will remember Professor O'Neill for his excellent work on the Leas Cross report and his continued advocacy for the need to respect the dignity of older persons, particularly and not exclusively in the context of nursing home care. He provided us with a very challenging and revealing overview of things yesterday, including the fact that we have gone from having 20% of nursing homes in the private sector in the 1980s to around 70% in 2017. While like others, Professor O'Neill does not have a problem with a mixed public-private system of nursing home care, he is rightly sceptical of the ability of regulation alone to guarantee the kind of standards that older persons deserve. He has warned of the minimum standard required becoming the maximum that is available. Yesterday, he noted that the national nursing home regulations have nothing to say about the need for proper linkage with secondary healthcare settings. There is a hands-off approach out there to nursing homes which is not acceptable, given the particular needs of many residents. There was supposed to be a review of the deaths of older persons in nursing homes during the Covid crisis. Where stands that review now? Many people died, and many died in an unacceptable way that left others traumatised. There have been calls for inquiries. There seems to be very little about it now.

There is no person with gerontological expertise in the National Treatment Purchase Fund, which is the commissioning body for nursing home services. The people at HIQA who regulate are not clinicians; they are administrators. I wish them good luck, but they are not clinical people. One striking point that Professor O'Neill made yesterday was on the absence of social and recreational spaces in many of our nursing homes. I am sure it is something that we have all noticed. When we contrast that with the kind of space and amenity that we expect from hotels, which we contract privately for services, we see how a lack of public expectation of quality in our nursing homes is perhaps part of the problem. Professor O'Neill warned against the kind of negative characterisation of being in a nursing home, and the thinking that we would hate to go there. Maybe that is leading to lower expectations and standards.

In conclusion, we need to look at clustered accommodation of perhaps between 12 and 15 residents, referred to as the greenhouse model. We should perhaps ask ourselves about nursing homes. In how many of them are people expected to share a room where they would otherwise like to be in a room of their own? In how many of our nursing home settings do residents have the space they need for their own furniture, for pictures, photographs and mementoes? Those are the kind of questions that I think could be used as indicators to us in respect of the ongoing issues of quality that we need to investigate.