"That Dáil Éireann:
- due to the Covid-19 pandemic, guidance on visitation to long-term residential care facilities was issued by the Health Protection Surveillance Centre, which included requirements to facilitate window visits during all levels of pandemic restrictions;
- this guidance was not placed on a statutory basis and there was no authority which could compel its implementation, monitor compliance, or sanction a non-compliant
- nursing home residents, their families, advocates, and social workers have been raising concerns since the beginning of the pandemic that this created an unsafe environment, and warned of high risks of neglect and abuse, and that residents would suffer heavy consequences from isolation;
- concerns were raised by nursing home representatives regarding the testing protocols and procedures around discharging hospital patients to care facilities, staffing levels, and ability to comply with regulations;
- nursing homes received financial assistance from the State to aid with pandemic protection measures;
- more than 2,000 nursing home residents have died due to Covid-19, equating to more than 40 per cent of Covid-19 related deaths in the State; and
further notes that:
the Health Information and Quality Authority (HIQA) has warned successive Ministers for years that the regulatory, governance, and safeguarding framework for the older persons residential care sector was insufficient;
the Department of Health has yet to advance safeguarding legislation despite years of mounting evidence for its need;
there is no designated independent authority with powers to investigate individual complaints of neglect or abuse in the social care sector, and that Health Service Executive Safeguarding and Protection Teams are not empowered or resourced to investigate; and
social workers are the regulated professionals who are trained for safeguarding and the protection of vulnerable people; and
calls on the Government to:
- commence a full public inquiry into the deaths of residents and quality of care in nursing homes during the Covid-19 pandemic, and systemic failures in the sector;
- place Long-Term Residential Care Facility (LTRCF) visitation guidance on a statutory footing and give interim authority to HIQA to enforce it;
- expedite adult safeguarding legislation, including legal right of entry and powers of investigation for appropriate authorities;
- ensure all residents are treated as community clients with direct access to safeguarding social work services and all primary care services, including an independent social worker liaison attached to each Covid-19 cluster in LTRCFs;
- empower a State agency to independently implement, monitor, oversee and enforce safeguarding legislation and investigate individual complaints in the social care sector;
- fast track reforms to empower HIQA with improvement and compliance notices and improve social care sector regulations in line with HIQA advice;
- mandate reporting of neglect and abuse of residents by all staff in nursing homes to both An Garda Síochána and social worker Safeguarding and Protection Teams; and
- introduce accountability at an organisational level, in terms of penalties and criminal offences, where failures to govern safely in accordance with HIQA regulations result in loss of health or life for residents in care of the service."
I am sharing time with a number of colleagues.
The pandemic restrictions, combined with poor oversight of the nursing home sector, gave rise to a perfect storm that led to neglect and abuse. Our starting point has to be to acknowledge what happened. There is a responsibility on the State and the sector to acknowledge and deal with their failings before and throughout the pandemic. To protect the vulnerable, severe restrictions on access to nursing homes and long-term residential care facilities were put in place. In truth, this was an afterthought and there is more than enough evidence to suggest the State did not have sufficient knowledge of the sector it was dealing with. The pandemic exposed major and fatal flaws in our health and social care system that should have been known. Even by the third wave, many nursing homes were overwhelmed when outbreaks caused major staff shortages, as homes competed with each other and the HSE for staff.
The crisis exposed a sector that was fragmented, neglected and poorly governed, without adequate clinical governance and based on a weak regulatory framework. For years, HIQA, the regulator responsible for the sector, made recommendations to address these deficits and strengthen sectoral governance and regulation.
The Irish Association of Social Workers, IASW, and family advocates, such as Care Champions, have for years been pointing to flaws in the State’s governance of nursing homes and the lack of safeguarding legislation to prevent abuse and neglect. Indeed, safeguarding legislation was introduced in the last Seanad by Senator Colette Kelleher. However, the previous Minister for Health, Deputy Simon Harris, did not accept or advance it. The advice fell on deaf ears and avoidable deaths, abuse and neglect were the consequences. In the last 18 months, more than 2,000 nursing home residents and staff sadly passed away from Covid-19, in instances related to outbreaks in their care homes. That was more than two-thirds of the deaths linked to outbreaks, and it does not factor in the quality years lost due to isolation and neglect. While the restrictions were necessary to reduce mortality, the prolonged isolation they caused for many was not. When visitation guidance for nursing homes was introduced, it allowed window visits at all levels of the plan. However, families and social care workers raised the alarm in this regard. It was not enforceable and this plan would lead to isolation and harm. The guidance was not the law. Nobody was given the authority to implement it, monitor compliance or sanction non-compliant nursing homes.
I have engaged in recent weeks with many families who lost members in nursing homes. They are not seeking to apportion blame, but they are seeking justice and the truth. Many of us will have seen the "Prime Time Investigates" programme several weeks ago which again set out harrowing accounts of people who could not see their loved ones before they died in nursing homes. Included were the stories of people who could not even watch their loved ones from a window of the nursing or care home. There were difficult and harrowing accounts, in some cases, of neglect or what could be described as abuse. This was all because of systemic failures in the sector. Many people working in the public and private nursing home sector did their absolute best, but we must also acknowledge that many of them were let down, as were the families and residents.
The starting point here must begin with establishing the truth and the facts of the situation. That is why this motion calls for a public inquiry, and it is necessary. We also want to see the visitation guidance for nursing homes immediately put on a statutory footing and the Health Information and Quality Authority, HIQA, should be given the interim authority to enforce it. Adult safeguarding has been promised time and again. It is a commitment in the programme for Government. It must be delivered and it must include the expediting of the legal rights of entry and power of investigation. No statutory authority or State agency has a right of entry into private nursing homes to investigate individual cases of neglect. That is wrong and it is a wrong that must be put right. We must fast-track reforms to empower HIQA, which has been stating for some time that its powers are blunt instruments. The organisation needs the ability to issue compliance notices and to improve social care sector guidelines in line with its recommendations. We also need accountability at an organisational level in situations where the failure of a nursing home to govern safely results in a loss of health or in death for residents in their care.
Therefore, serious issues must be dealt with concerning nursing home care and care of the elderly. We all know we need a new strategy and plan in this regard. It will only happen, however, if the political will is there to make it happen. The starting point for that must be a public inquiry to establish what happened in those nursing homes at that time. We must also put in place adult safeguarding measures, empower HIQA to be able to do its job and make more prominent the role of social workers and social care teams and the work they need to do to keep people safe in care homes.