Michael Collins recently told his wife Peggy he might be better off if he had Alzheimer’s disease.
The 89-year-old man had just been moved from Castleturvin House nursing home in Athenry and his wife Peggy was telling him about another resident who no longer knew where he was or who he was.
“And Michael looked me straight in the eye and he said, ‘Peggy, maybe I would be better off not to know where I am,’” recalls Peggy.
Their daughter, Eileen Jackson, says the hardest thing she has ever done in her life was “walk my father out of his home and put him into a nursing home”.
That was in August 2021, and little did the family know that just over a year later Castleturvin House would close, one of 17 such facilities that will be deregistered before the end of the year.
Tadhg Daly, chief executive of Nursing Homes Ireland (NHI), which represents the private and voluntary sector, says he has recently been told of an 18th facility in Dublin which intends to shut its doors once its registration expires. Blaming “discrimination in funding” – with HSE-run facilities getting almost €700 more per resident per week under the Fair Deal scheme than private facilities – he says he is “very fearful” that the new year will bring more closures. “There is an inevitability around it unless something is done.”
After six decades sharing a home with a woman who not only buttered his bread but, according to their daughter, answered for him if anyone asked what he’d like for his dinner, the family believe the latest move has traumatised Michael Collins further.
His daughter believes he deserves better. “My father comes from a generation where they worked from a very young age and got very little education,” says Eileen. Michael, one of 14 children, 13 of whom survived, had his first job on a milk round at the age of nine. “He left the country in the 1950s and he sent money back, to keep this country going,” she adds.
Shed a tear
After working for 20 years with Digitial in Galway, Michael went to work as a groundsman and a security guard in Dunnes Stores in Terryland in the city, eventually retiring at the age of 70.
“He has contributed and contributed and contributed, and never took time off. I don’t remember my father ever being sick until he had a stroke at 81 years of age,” says his daughter.
She thought her father would cry the day he went to Castleturvin but she saw him shed a tear there just once when she popped in unexpectedly to see him.
Knowing his love of flowers, and because he had a ground-floor room with his own entrance, she established a garden outside the door and regularly pushed his wheelchair out there when she popped in on her way from work.
“I had just got used to swinging around on my way home because going to Athenry wasn’t a big deal. It was meshed into our lives,” she says.
“We made the best of the situation. He made the best of the situation but this has upset him.”
She says it’s hard when “everything changes” for an 89-year-old and once more he has to get used to a new room, new faces, and different day-to-day interactions. He also misses his garden.
Instead of a 15-minute drive to see her husband, Peggy, who is nearly 82 “and not very quick on my feet”, now has a 40-minute journey to his new nursing home and the drive makes her anxious.
“I have to keep my wits about me,” says Peggy, who dreads one spot where she has to exit a quiet country road and cross over a much busier route where “they are flying past me”.
When her husband had a fall a few years after a stroke, his health deteriorated and Peggy and the family could no longer provide the 24-hour care he needed.
‘Rollercoaster of emotion’
“We exhausted every possible route. It was not an easy decision for us to make,” says Eileen.
“I am very close to my father. He looked after me when my kids were small.”
She says staff in Castleturvin House, “having come out of two years of a nightmare” during the pandemic, did everything they could to make the father-of-four content.
Peggy says it had been “a rollercoaster of emotion” for the past year but Michael had just settled when they had to move him again. “That upset Michael, it upset me and it upset our three daughters,” she explains.
Eileen says her mother is nervous about driving to see Michael, “but she will do it because she wants to see her husband. She misses him terribly.”
Castleturvin House, a 42-bedroom nursing home, said in September it had notified the State’s nursing home regulator, the Health and Information Quality Authority (Hiqa), of its intention to cease trading as a nursing home after 21 years in business. The owners of the care facility said that it, like many other smaller, family-run and local community-based nursing homes, had “struggled against increasing cost pressures, including regulatory cost pressures, to continue to provide the best model of care for our residents”.
Anthony Kelly (Tony) had been in Stella Maris nursing home in Athlone for 11 years when it closed and even though he’s closer to his daughter, Charlene McCormack, in his new care home in Moate, she believes it was unfair that he had to leave what had become his second home.
Both Charlene and her dad were crying on the day she had to move him. She says some staff were crying too. “He did not want to go. That was his home and it was like our second home. They made us so welcome.”
When Anthony (71) was moved into the new nursing home, he told his daughter he would give it a day or two and if he didn’t like it he was going “home” [to Stella Maris]. “He wasn’t happy. He could not understand why he had to move and he asked the same questions over and over.”
While the staff in Moate have been “very kind”, sourcing, for example, a bigger television for Anthony, much to his delight, his daughter is concerned that the loss of familiar surroundings has set him back.
“His speech is a lot worse since he moved. Sometimes I don’t understand him so I just say ‘yes’. He asks the same things over and over. I think he seems a little more confused.”
Series of mini-strokes
Charlene believes families and residents should have more say.
Like Michael Collins’ family, Anthony Kelly’s family believe he has made a difference in his life and should be treated with more consideration now when he is vulnerable. He raised five children, who were aged from seven to 17 when his wife died suddenly in 1990 at the age of 36. Five years later, Anthony’s son died at the age of 20.
Anthony, who was in the Army and did a few tours of duty in Lebanon, was also a painter and decorator.
He had a series of mini-strokes and started to develop dementia when he was about 60.
Charlene feels there is nobody considering the impact on people like her father when it comes to the nursing home regime.
Stella Maris, another of the family-run nursing home, closed in August. The reasons were manifold, among them it pointed to strict and costly regulatory demands to improve its building continuously. One of the owners Clare McNally said in August: “We have no desire to finish – even now we don’t – but the only ones that can survive are the big nursing homes with big investors. The worry is where will all the local people go. There doesn’t seem to be much forward thinking on the care of older people.”
Brian Jones’s wife, Catherine (75), recently had to move out of a nursing nome in north Tipperary when it closed and she is now 10 miles from home in a facility in Roscrea.
“There is nothing wrong with Roscrea but it’s further away and she just hasn’t settled there yet,” says Brian, who has been visiting every day to try to reassure his wife. Catherine has vascular dementia. “I could not handle her. She needs 24-hour care,” he says.
‘Set her back’
He has tried to explain the move to her.
“It went in one ear and out the other. She knew it was a new environment. She did not know any of the faces. Definitely it set her back.”
Brian says he and other relatives were very sad to see the home close. “That is economics for you. Nobody had a bad word to say about the place. I was very disappointed when it closed. The move has distressed Catherine.”
Daly of NHI agrees that the “robust and regulatory framework” overseen by Hiqa has caused problems for some nursing homes. “The interpretation of the regulations is an issue,” he says. “Even though the legislation has not changed, the interpretation does change.”
He says that if the funding issue were addressed, it would help.
With the housing crisis impacting many families, the NHI chief executive says that in the next year or two, availability of nursing home accommodation will be “a massive issue”.
“The consequences of inaction will be very grave. My concern is that do Government really understand the crisis or are they not fussed about it? We know what the solution is – additional resources.”
Peggy Collins believes her husband was already fearful. Once when she asked him why he never rang for assistance, he told her: “Peggy, they might throw me out.”
‘Living with that fear’
She says that fear has doubled since the move. “So my husband, an old man, is living with that fear. And that, to me, is very hard on him and it is hard on the family.”
Meanwhile Minister for Health Stephen Donnelly and Minister for Older People Mary Butler have written jointly to their Cabinet colleague Roderic O’Gorman expressing concern about “a small number” of active nursing homes which have chosen to convert their facilities to host Beneficiaries of Temporary Protection (BOTPs).
The two Ministers in the Department of Health say regulations preventing some nursing homes from adapting their accommodation to host displaced persons is “to avoid unintentionally incentivising active nursing homes to leave the market”.
In a statement, the Ministers said that “given the challenges currently being faced in the nursing home sector”, they have written to their Cabinet colleague detailing their concerns and setting out the guidelines which prevent nursing homes still registered on or after September 1st last from providing accommodation for those seeking temporary protection.
NHI has repeatedly urged the Government to act given that at least 17 nursing homes are expected to have closed by the end of this year. NHI maintains that the main reason for the closures is that the private sector does not get the same level of funding as HSE-run facilities.
In a statement, the Department of Health said the drivers for nursing home closures are multifaceted. “It has become apparent since late August that a small number of active nursing homes have chosen to convert into accommodation centres for Beneficiaries of Temporary Protection [BOTPs],” said a spokesman. “Other active nursing homes were known to be in official negotiations or to be considering this approach,” he added.
The department said it has engaged on this issue “as a matter of urgency” and that, given the challenges faced by the nursing home sector, the two Ministers have written jointly to Mr O’Gorman to express their concerns.
“Neither the Minister for Health nor the Minister with special responsibility for Mental Health and Older People have any direct role in procurement of any individual accommodation centres for use by displaced persons, or the approval of same,” the department spokesman said.
‘Appropriate notice’
While nursing homes still registered with Hiqa on September 1st are excluded from providing accommodation for BOTPs, former nursing homes that had already ceased operation and were deregistered prior to this date are not precluded from doing so.
According to the Department of Health spokesman, they would not be affected if they wished to enter into contracts as accommodation providers.
The Department of Children, Equality, Disability, Integration and Youth and the Department of Health has indicated it will apply this position.
In a statement, the Department of Health said: “The Government is aware that a number of nursing homes have closed this year. The closure of nursing homes can put pressure on other local health and social care facilities.”
The department said it was aware this can be a time of stress and worry for residents, their families and the service providers. “It is essential that when nursing homes are intending to close that appropriate notice is given and residents given time to find appropriate accommodation.”
The department also pointed out that there is a legal requirement that providers give at least six months’ notice to Hiqa if they intend to close.
“This provides residents, their families and public health authorities appropriate time to respond effectively,” it said.
