Irish public nursing home standards are delusional

Flaws in care of the elderly

Since the State oversees standards, one might expect that HSE-managed nursing homes would represent the gold standard, because otherwise the State would have no moral authority when imposing standards on private operators.  But, as anyone with an elderly relative living in a HSE nursing home knows, these standards are beyond delusional.

Here’s one sample extract from the HIQA standards for nursing homes.



Standard 2: Consultation and Participation

Each resident’s rights to consultation and participation in the organisation of the residential care setting, and his/her life within it, are reflected in all policies and practices.

2.3 The resident contributes ideas to and participates in the day-to-day activities of the residential care setting.

2.4 The person in charge facilitates the establishment of an in-house residents’ representative group for feedback, consultation and improvement on all matters affecting the residents. At least one nominated person acts as an advocate for people with dementia/cognitive impairment. Issues raised by the residents’ representative group are acknowledged, responded to and recorded, including the actions taken in response to issues raised.

2.5 Feedback is actively sought from the resident on an ongoing basis on the services provided. The residential care setting clearly demonstrates how the impact of the resident’s feedback informs reviews and future planning.


Let’s look at these rights, as laid out by HIQA.

The resident contributes ideas to and participates in the day-to-day activities of the residential care setting.

I can tell you from personal experience that there is absolutely no consultation with residents.   If you suggested to the staff of these units that an in-house residents’ representative group is required you would not be laughed at.  You’d be met with a blank stare of incomprehension, because this notion is so far removed from the culture of these institutions that it would be inconceivable to the staff who, in many ways, are just as institutionalised as the residents.

The resident contributes ideas to and participates in the day-to-day activities of the residential care setting. 

The reality is that nobody asks the residents’ opinion about anything.  Where residents are routinely blamed and challenged for minor infractions such as dropping food on the floor of their bedrooms, where some staff raise their voices as if talking to an idiot, there is no possibility of this.

The regulations also require that people should, as far as possible, be able to lead a normal domestic routine, as close to their home-life as possible, independent of staff rotas, but the reality is that often, elderly residents are woken at 6 am to be washed, because that’s what suits the management, even at the expense of personal dignity.

The regulations require that residents should be able to meet visitors in a private space.  In reality, there is no private space because such a thing would be anathema to those who believe the residents require supervision rather than care.

The regulations require that residents should have a lockable, secure space to store their personal belongings.  The reality is that any staff member, from nurses to cleaners, can, at any time, go through residents’ personal effects.

The regulations require a presumption that residents are fully compos mentis unless evidence to the contrary emerges.   The reality is that all residents are treated as subordinate to the management.

Feedback is actively sought from the resident on an ongoing basis on the services provided.

Nobody asks the residents anything.  The reality is that elderly residents are afraid even to report snappy comments or sarcasm for fear they might be further victimised.

The reality is that some (though not all) staff think of themselves as being in authority over the residents, instead of being responsible for their wellbeing, and that is a culture permeating the entire HSE nursing-home structure.  Until that culture is rooted out, there’s no point issuing well-meaning but hollow regulations reflecting a non-existent elder-care Utopia.


3 thoughts on “Irish public nursing home standards are delusional

  1. Nursing homes are one of those facilities that you hope you will never need to use, but it is good to know that they are there if you need them.

    But as you say HIQA only seems to be able to wield any power over private nursing homes. If the private nursing is not up to standard HIQA can shut it down, however the same power either isn’t used or can’t be used on HSE run nursing homes. A prime example of this powerlessness is the constant findings by HIQA that hospitals are not up to standard, but we have never seen a hospital closed down for failing to meet certain standards.

    Maybe it is time for the staff to ask themselves how they would like to be treated if they ever needed to make use of the facilities. Maybe it highlights the fact that many of the people involved in the so called “Caring professions” are not very caring.

  2. There are so many possible levels to this. One is the problem of the HSE which, like many institutions in this country, is dysfunctional.

    Taking it to another level, in Samuel Beckett’s play Endgame one of the characters, Hamm, keeps his parents in two dustbins. Some critics castigated Beckett’s unflattering portrayal of human nature, of which they saw this as an example. But as Anthony Cronin said in his biography of Beckett, why would anyone question this, ‘…since the practice of putting old people in institutions which are little more than refuse bins has grown to be almost the norm in our civilization…’ (p. 467)

    And one could take it a step further. Human rights, dignity and respect are incompatible with the exigencies of an overpopulated world in which the organising principle is hierarchy rather than equality.

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