Mar 042015
 

I’ve been visiting a public nursing home very frequently, and I’ve been shaken by some of the things I’ve noticed and some of the things I’ve been told.

The clue is in the name.

Nursing home.  That’s Home.

I can see nothing homely about the public nursing home I’ve come to know so well.  What I’ve seen is an institution, a place where everybody — staff and residents — are institutionalised.  But what’s tragic is that it wouldn’t have to be like that if only attitudes were different.

Ireland has a strong authoritarian streak, limited only by our membership of the EU that forced us to comply with certain basic norms, whether we liked it or not.  One of those norms is this: people are entitled to their essential human dignity.  This is not something in the gift of any other human being.  It is not to to be offered or withheld at the whim of a ward manager, a cleaner, a nurse, a doctor, a kitchen assistant or a clerk.

And yet, from what I can determine, human dignity is withheld all the time in nursing homes under the control of the HSE, though in a more subtle way than the days when a staff member felt comfortable threatening a resident: take your pills or I’ll bust your jaw.  Legislation and the fear of the HR department have changed that, but neither law nor HR administrators can change mindsets.

That”s why there’s no more overt bullying, or at least not when anyone is watching.  Instead, it’s covert and insidious.

Let me give you a few examples.  Would you, as a grown adult tolerate anyone addressing you as Good girl or Good boy?

Would you, if your mobility became reduced due to an injury,  tolerate anyone berating you for dropping food on the floor?

How would you react if somebody constantly spoke to you in an exaggeratedly loud voice?

If you had diarrhoea and vomiting, how would you like being told you’ll have to wait?

How would you feel about a uniformed authority figure assuming you have  some cognitive disability even though you know you are far better read than they are?

How would you, as a grown adult, like it if you had no defensible space, no privacy and no say in the decisions made about your living conditions?

How would you like it if you had nowhere to keep your personal possessions or the little luxuries that a grandchild might bring?

How would you feel if those little treats mysteriously disappeared in the middle of the night?

How would you feel if you had no entitlement to a key for a locker?

How would you like it if your clothes went to a common laundry  and if they returned stretched, shrunk or not at all?

I know that a nursing home is not a hotel.   I realise that all residents have health problems of one sort or another,  but a nursing home is not a hospital.  It’s a home.  It’s the only home the residents have or will ever have, and yet, the regime in public nursing homes is all about authority, at the expense of the residents’ dignity.

Let me ask a few questions.

Why does a nursing home physically need to look like a hospital?  Why is it painted in the soulless hospital cream?

Why can’t there be semi-private spaces that people can retreat to when they feel the need?

Why do staff need to wear uniforms?

Why can’t staff address residents in a normal conversational tone of voice as equals, unless they happen to know the resident is deaf?

Why can’t staff assume that a resident is compos mentis unless they have evidence to the contrary?

What would be wrong with basic courtesy towards another human being?

Why are staff given to understand that they have authority over residents when in fact they do not?

Why do some staff think they have a right to discipline residents verbally, as they might do to a child?

Here’s a revolutionary idea: what would be wrong with asking residents how they’d like their homes to be organised?  How about consulting the people who live in public nursing homes, listening to them with respect, and doing what they request, as far as practicable?

It’s all about respect in the end.

It’s all about dignity, and most of it would cost the HSE nothing, since basic courtesy is free.  In all likelihood, the staff would never think of treating their own family or friends the way they treat their vulnerable, powerless residents, unless they wanted a strong reaction.  A very strong reaction indeed from those of us who aren’t impaired in one way or another.

There is nothing worse than being rendered powerless, but sadly, as with all Irish institutions, the only way this will change is through fear, and in that regard, we can only welcome the appointment of the Confidential Recipient, Leigh Gath.

I might just get in contact with this admirable woman.  And I might just install a hidden  video camera that operates even when I’m not there.

What do you think?

Failing that, I might get legal on their ass.

 

 

 

 

  17 Responses to “Residents of Public Nursing Homes Are Deprived of Human DIgnity”

Comments (17)
  1.  

    I was between jobs in 1982 and took a few weeks work doing some maintenance in a public residential home for the elderly in Limerick city. In those few weeks I never once saw anything like you have described Bock. Having said that, I was only there between 8 and 5 Mon – Fri but I clearly remember one elderly man being up and dressed in an old 3 piece black suit with a fedora like hat by the time we arrived for work. He spent the whole day sitting in a chair beside his bed only moving for toilet or meals. As a young cocky 20 year old it made a huge impression on me. I thought that if I ever got to that stage I wouldn’t like to continue with life. The only other thing I can remember from time is the smell of disenfectent and urine, if I close my eyes now I can clearly smell both. It’s no way for vunerable people to be treated.

  2.  

    You did some maintenance in a nursing home and you never saw anything like this?

    I see.

  3.  

    Was working on a fire alarm system and no, I never saw any patient/ resident spoken to without respect and I never saw any staff stealing anything. I did notice the colour of the paint but reading your post I thought that less important.

  4.  

    You reckon installing a fire alarm would put you in a position to assess the quality of resident care?

  5.  

    No Bock. Never suggested I was qualfied to do anything more than wirk on a fire alarm. If you think I was defending the nursing home, may I draw your attention to the part where I stated that being in that situation would make me questiom whether I would want to continue with life !

  6.  

    I’m sorry that that is your experience of a HSE nursing home. I visit a HSE home in East Cork two or three times a week where my mother is a resident and one of my sisters visits it almost once a day. It is, thankfully, utterly unlike the home you describe. The residents are treated with respect and dignity and nor is this a subjective impression – it is based not only on observation but on conversations I have had with several of the residents as well as with my mother. Any time I visit – and there are no set visiting hours – I enjoy the banter and the craic and the often very interesting stories that people have to tell. I invariably leave energised and never depressed. It is a place I would willingly live out my final days in. So, it is not fair to make a blanket statement that “the regime in public nursing homes is all about authority, at the expense of the residents’ dignity.” That may well be the case in the home you have experience of; it does not apply to the one I know.

  7.  

    That’s good to hear, but the issue still needs to be aired.

    Your personal experience has been positive, for which we all give thanks, but of course, that doesn’t mean everyone’s experience is equally good.

    Do you have any views on any of the issues raised, such as uniforms?

  8.  

    I think the single most important factor in ensuring that a nursing home is a good environment for the residents is carefully selected staff, staff who are employed for their empathy as much as their efficiency. The day-to-day interaction between residents and staff needs to be, as much as possible, like the informal and friendly experience of a good family home. As you say, the emphasis needs to be on the word “home”. Training is key – as you say, making sure that staff respect the dignity of residents and not to talk down to them is very important.

    I agree that relatively minor changes like not having a soulless institutional colour scheme can have significant positive effects. In the home that I have experience of there are large murals of farm life of another era – horses and ploughs and that sort of thing – on the corridor walls as well as paintings by residents (current and deceased). It all helps to lessen the institutional feel of the place.

    It also has an alcove where residents can go to be on their own or to discuss private matters with family and friends out of earshot of the other residents. (Residents are free to bring visitors to their rooms and residents are also encouraged to display family photographs and such like – which they do.)

    I suppose it has the advantage of not being a very large home – I’d guess there are about 40 residents – and so the atmosphere is much more intimate than might be the norm in larger places.

    Uniforms? The nurses and the catering staff wear uniforms whereas the Matron, her deputy and the admin staff do not. I suppose there is a practical reason for nurses and catering staff wearing them – to protect their own clothes – but, yes, ideally, the less uniforms the better.

    I have never seen any residents being disciplined verbally but then again it is unlikely to happen when visitors are present. But neither have I heard of any such incidents and some of the residents are robust personalities who wouldn’t be shy about criticising a member of staff were such behaviour to occur.

    There is also a meeting of residents and staff once a month to discuss relevant issues e.g. staff changes, menus, entertainment, etc., and a newsletter is produced detailing what was discussed.

    I think what might be useful for you to do (assuming you haven’t done so already) is perhaps discuss the issues you have raised with the management of the home in question. You have very good ideas and suggestions and I would be surprised if they weren’t listened to sympathetically. Then again, it all depends on the relevant Matron or Manager – if he/she doesn’t want to know then it might be worth considering talking to other relatives and take it from there.

  9.  

    It’s not easy seeing a loved one being treated in any way less than what you’d like them to be treated… I’d be getting very snarky indeed if I felt staff were being in any way rough, or disrespectful or condescending in talking to my relative.
    Some people are in the wrong professions completely.. You wouldn’t let them near dogs, never mind children or the those in need of some assistance.

    I think I’d prefer to be sent out on an iceberg as the eskimos do, when the times comes.
    It’s probably more humane than how we treat our elderly.

  10.  

    You hit the nail on the head with this article. I have seen for myself an elderly patient being abused verbally, mentally and physically in a hospital. It was horrible, 2 nurses and 1 doctor were the culprits. They were very smug and covert. I never thought it would happen to me until it did some years later when I was too ill to find the breath to speak up for myself. At that same hospital. What a wonderful article and so true.

  11.  

    For me a core issue is privacy. I have assisted a person in their own home and the realisation that they and only they could decide on who could or could not enter their home was I felt of huge importance. Understanding that and the dignity it preserves should I feel be at the centre of the design and running of an institution such as a nursing home.

  12.  

    I would go with the camera every time.You know what they say,a picture is worth a thousand etc.Then I would take the miserable shits apart.

  13.  

    Changing mindsets is viewed as one of those impossible things by those of set minds.
    History shows such views to be false entirely.

  14.  

    Firstly, these homes are mostly run as a business and the “inmates” are referred to as “clients”, as in customers ? .
    The non professional staff are recuited from a pool of uneducated people that will work for very little, are not evaluated as to their ability to have sympathy towards other people, are given almost no training, The most important questions these people are asked is “how soon can you start ?” & “have you any objections to working night & weekends”.
    If you ask them (I have !) why they are so rough with some of the “clients” they invariably say ” that one is always giving us trouble ” pay peanuts, get monkeys……

  15.  

    Norman,you might have failed to notice the title of this post. I recommend reading it again before commenting.

  16.  

    I am fully aware of where this thread is going, I am merely adding to the pattern within the weave, relating my own obversations like the other contributors. It truly is a sad end for some of the older generation.

Leave a Reply