I move:
That Seanad Éireann calls on the Government, as a matter of urgency, to institute legislation to control, register and otherwise keep under close supervision, premises described as nursing homes, convalescent homes or some such analogous term or purporting to be institutions, homes or rest centres for infirm and/ or aged persons in some of which premises conditions of neglect amounting to cruelty have been discovered by professional and other persons when visiting inmates.
At this stage in our civilisation, it fills me with sorrow and shame that anyone should have to move a motion such as this. It is some years since I first got a slight inkling that there were places where the aged and sick, more particularly the incurable cases, were taken in, dumped in deplorable conditions and then forgotten. On that occasion, I felt that the case mentioned to me was an isolated one and would soon be put in order as at that time I was under the impression that all such places were considered to be nursing homes, were registered and, therefore, subject to inspection. I also felt that, in her distress, my informant was exaggerating the conditions she had found in trying to find accommodation for her young husband—an incurable cancer case—whom she had been advised not to try to nurse at home.
This motion has been on the Order Paper for a long time. It was tabled following approaches made to my colleagues and myself on the subject of these places. The facts made known to me by those who asked me to help were so shocking and revolting that I felt it my duty to report the matter. I sent the facts I had to the Minister for Health who informed me that he had no function in regard to what he described as, "alleged nursing homes". The Minister very kindly indicated that it might be useful if I discussed the matter with the officers of his Department and I arranged to do so.
Feeling, however, that I had perhaps approached the wrong Department, before talking to the officers of the Department of Health, I contacted the Dublin Health Authority and discovered that unless the premises housed a patient for whom the Authority is called upon to make a payment from its funds, there is no inspection and no control of any kind. It is possible, according to my information, for anyone who has a house with spare rooms, with even an attic, a basement, or outbuildings, to take in persons discharged from hospitals as incurable, the aged or the sick, and literally dump them into beds and leave them there, while collecting fees from relatives for their keep. I subsequently discussed the problem with an officer of the Department of Health and learned that the situation was as I feared—that it was considered to be impossible to do anything to control such places or to register or supervise them in any way.
I know all this sounds like the incredible statement of a crank but I assure you I am no crank; neither am I likely to be misled by wild statements. The information I have comes from reliable sources, including relatives, professional persons who have actually seen the conditions and in some cases have removed, with much difficulty, people who were consigned to these places before their relatives had made a proper investigation as to the conditions obtaining in them.
In the interval since the motion was tabled, I have spent much time interviewing persons, professional and otherwise, who have had experience of the conditions existing. I have been given facts that have confirmed the necessity for supervision of these places and I have been besought to do everything in my power to have some form of inspection introduced.
As I have already informed the Minister, some of the conditions discovered were: room doors tied with stout cord to prevent any escape; numbers of beds crowded into very small rooms; bed clothes very sparse —this is in icy weather; no floor coverings and no heating arrangements of any kind—in one case, four elderly patients were found locked in a room and one of these unfortunate souls was quite insane—no attendance on bedridden patients and many of these found suffering from bedsores. Sanitation in practically all these places was bad, linen dirty and food inadequate. I could elaborate much further on this aspect on the neglect of patients, but ordinary delicacy prevents me from doing so.
These are but a few of the complaints about these money-making premises but a more serious aspect is the fact that there seemed to be no difficulty whatever in these unregistered, uncontrolled establishments obtaining huge supplies of sleeping tablets. I have given the Minister full details of the careless way they are kept and the immense quantity on hand.
I have read carefully the replies given by the Minister to questions in the Dáil on the registration of these places and I realise that it might require new legislation to confer a right of inspection of nursing homes generally. I hope he will now change his views as expressed in June, 1961 in Vol. 190, No. 7, of the Dáil Debates:
I am compelled to the conclusion that the case for doing so is not proven.
I would impress on the Minister also that these places are not nursing homes in the accepted sense but merely money-making establishments that have sprung up because of the difficulties that can arise in relation to incurably ill persons discharged from hospital or people through age becoming bedridden and relatives having no way of caring for them, no place to keep them, or indeed not wishing to undertake the task.
It has been pointed out to me against my arguments that the unfortunate sick people would themselves complain if their treatment were such as I have described, but if the owner of the premises or some other person is present at a visit or if the patient is kept in a doped condition, a vigorous protest is very unlikely. In many of these cases, however, it is a sad but true fact that once the relatives have got rid of the burden, there is very little visiting. Again, as mentioned at the beginning, many of these people have been discharged from hospitals incurable. They are weak and some of them are even in their dotage. They do not require medical or nursing care in the ordinary sense and when a doctor requires to be called in, it is easy to put on a show of care and comfort for a time. These helplessly sick or old people can do nothing for themselves.
The Minister has said it would be impossible to provide in legislation for minimum standards of care and skill, that it would require the imposition of minimum standards which would impose additional hardships on the persons whom registration is intended to benefit. I do not think this is so. I would agree with the Minister that minimum standards should be fixed and that he should draw up a suitable scheme, but what the motion deals with is a problem of urgency where something must be done now to control a deplorable situation which exists, even if it is only an interim measure until the Minister and his Department can proceed to build a proper scheme to deal with this problem. We cannot delay. Something must be done at once.
I might be disposed to tolerate the Minister's approach if the establishments catered for persons for whom there was hope of a cure and a return to normal life, but in the main this is not the case. Many of these places could better be described as resting places for those who are dying and all that would be required would be cleanliness, warmth, the provision of proper meals, an occasional check on their comfort and safety, a kind word from time to time and, when necessary, something to ease the pain administered in accordance with a doctor's instructions—as would happen in their own home if they had one. I would describe the treatment and care I am seeking for these poor invalids as what one might expect in a very ordinary Christian home, a home where all that was possible would be frugal comfort. I want the Minister to put some control on the existing establishments, while he and his officers think out a proper scheme to meet the present needs which would give us a system under which these establishments would be under control and open to inspection. It seems reasonable also to expect that a trained nurse should be in charge of such places.
I believe it is possible for the Minister to do this and to put an end to the hardships and cruelties which these unfortunate souls are enduring by the introduction of a Bill or an amendment of existing legislation which will, in the words of the motion, "control, register and otherwise keep under close supervision, premises described as nursing homes, convalescent homes, et cetera.” I believe that if registration and inspection are made compulsory for all establishments of the kind of which I speak, many of the abuses will cease because the owners will not risk the publicity of a prosecution.
If we can afford an inspection staff to examine hotels and guesthouses to ensure that they provide certain amenities for healthy people who are well able to fight for their own comfort, then we can surely afford a small staff with power to examine homes where infirm people are taken for reward. It is, however, essential if the Minister agrees to an inspection and that system is to give satisfactory results, that it must be what is known as "spot inspection" such as takes place in local government audits, with no opportunity for the owners to cover up abuses and so defeat the purpose of inspection— which it to protect the old and infirm from those who are willing to make money out of the helplessness of invalids and the difficulties or indifference of those to whom they belong.
I know the Minister is aware of, and sympathetic to, the needs of the infirm aged and the chronic sick. When opening the new geriatric unit attached to Our Lady's Hospice in July last he said—and I quote from the Irish Press of 19th July, 1962:
Provision of services for the elderly and the chronic sick must command more concern and practical public effort than it has in the past.
He further stated on that occasion that:
Among the European States our country was one of those which had a very high proportion of people aged over 65 years in the national population and even with a downward trend in emigration, it was likely that this position would continue for many years.
As I have said, I believe the Minister is sympathetic to the needs of those on whose behalf I am now appealing to him to take action. However, his reference to the fact that the position is likely to continue for many years should drive him to support my plea that those who are making money from the needs of these people should be made to run their premises in a proper and humane manner.
I am certain that if the Minister would, pending the setting up of a proper scheme to meet the problem, introduce a Bill to register places such as are described in our motion, which take infirm or aged persons for reward, he will not find as many obstacles as he fears, and the horrible practices I have mentioned will diminish and eventually cease altogether. I make this very sincere appeal to the Minister to take strong action without further delay.
