ÁINE CAMPBELL says that when the subject comes up, her 70-year-old father just closes his eyes. So she no longer talks about the threat to his “home” of four and a half years. Michael Campbell, who has had below-the-knee amputations in both legs, expected until last week that he would spend the rest of his life in the Abbeyleix Community Nursing Unit.
He can’t speak and is very dependent since his most recent stroke, but he is a sociable man and usually engages enthusiastically with his daughter on her almost daily visits. But she has noticed that if the proposed closure of the nursing home is raised, her father closes his eyes and switches off.
“I don’t talk about it anymore because I don’t want to upset him,” says Campbell who cared for her father at home for eight years after his first stroke, until a hoist became necessary to get him out of bed. “I realised then that I just wasn’t able to care for him anymore.”
She believes her father, who had his stroke at 58, has endured enough upheaval in his life and should not be forced out of his familiar surroundings once more.
If the Government really is flying an array of kites and has no plans for increased prescription charges, a €50 medical card fee or widespread public nursing home closures, it should realise that elderly people are paying a high price for its keep-them-guessing exercise.
“Some residents are crying themselves to sleep at night,” says Karen Shiel, secretary of the recently formed Abbeyleix and District Hospital Action Group who met Minister for Health James Reilly last Wednesday to air their concerns.
But all the signs are that the Minister means business when it comes to overhauling the community nursing unit system and those who have been speculating about the end of the public sector may not be that far off the mark.
The Minister told the Oireachtas health committee on Thursday that a rationalisation of community nursing units was “unavoidable”, blaming three factors – money, the moratorium on recruitment and the standard of some public facilities.
HSE chief executive Cathal Magee told the meeting that only about 2,000 of the 5,800 long-stay public nursing home beds were up to the required standard in relation to their physical environment. It would take between €600 million and €900 million to put them right.
But campaigners in areas such as Abbeyleix and Athy, where community nursing units have been earmarked for closure or a reduction in bed numbers, say that a lot of money has been spent in bringing these facilities up to Hiqa standards and they are asking whether that money is now to go down the drain.
The fact that Abbeyleix was included in a HSE document leaked to a newspaper last week, listing dozens of units earmarked for complete shutdown or bed closures, has made people sit up and take notice.
The HSE had already confirmed that it intends to close the Abbeyleix facility, home to 28 permanent residents, but it is not known how many other closures are also on the cards.
Similar announcements have recently been made in respect of the 80-bed St Brigid’s home at Crooksling in Brittas, Co Dublin, and St Brigid’s Hospital, Shaen, Portlaoise, a 28-bed residential Community Nursing Unit with two respite beds.
The leaking of the HSE memo, suggesting that 842 beds in dozens of facilities around the State are set to close, has added to the uncertainty and fear among elderly residents and the Minister appeared to confirm that he does intend to wield the axe.
Eamon Timmins of Age Action Ireland thought it ironic that at around the same time as the Minister was confirming to the Oireachtas committee that “rationalisation” was on the cards, his organisation was addressing the Seanad public consultation committee on Thursday about the rights of older people.
Among the issues raised by the advocacy group was the Fair Deal funding crisis this year, which prevented many older people from accessing nursing home care.
A survey of six hospitals by Age Action on August 18th found that a total of 266 elderly people were stuck in acute facilities because there were no nursing home beds available for them.
According to Timmins, it’s a “no-brainer” that a mass shutdown of nursing homes without proper planning will exacerbate this problem.
“The private sector just won’t be able to magic the beds,” says Timmins, who predicted that waiting lists on the east coast will grow, given the demand for places in this region.
“A lot of people may think the nursing home issue has nothing to do with them, but this affects everybody who may need a bed in an acute hospital because something like this causes the entire system to back up,” he says.
He also stresses that acute hospitals are not appropriate places for anyone to live. “People who can’t get into nursing homes will always get a bed in a hospital, but that’s not appropriate and may not even be safe if people are exposed to infection.”
Tadhg Daly, chief executive of Nursing Home Ireland which represents private nursing home operators, estimates that there are up to 2,000 empty beds in the private sector now.
Daly says his members have the expertise and capacity to accommodate many of those who will be displaced if public facilities close.
But he agrees with Timmins that such a mass upheaval in how elderly people are accommodated should be done with consultation and proper planning.
“We are saying to the Minister to come and talk to us,” says Daly, who confirms that no approach has been made by the department to his organisation, to plot a way forward if hundreds of public nursing home places are to close.
Daly is keen to stress that in a 2010 report, the Comptroller and Auditor General gave the average cost of care in a public nursing home as €1,245 a week compared with €865 in private homes.
The private nursing home sector now caters for close to 21,000 residents,compared with the 5,800 figure for the public sector quoted by the HSE chief executive.
Timmins points out that this is the absolute reversal of the ratio not too many years ago. His organisation does not take a view on whether public or private is best but believes that a mix is necessary, not least because some residents are very highly dependent.
“Private operators can obviously decide who they want in their facility and can pick and choose,” he points out.
Sinn Féin health spokesman Caoimhghín Ó Caoláin has accused the HSE of “cutting a swathe through the State’s care facilities for older people”.
“The Minister and his colleagues may hope that this softening up process will lead people to say on budget day, ‘Well, it wasn’t as bad as we thought.’ Don’t count on it, Minister,” he says.
His party colleague, Cllr Michael Dunne from Athy, says that there is much uncertainty about how many beds are to close in St Vincent’s Hospital in the town, with management suggesting that just eight of the 128 beds there will go, while the Irish Nurses and Midwives Organisation has said 24 are to get the chop, bringing the number of closures to 47 since 2009.
The memo leaked last week suggests that 10 beds are to go at St Vincent’s. It is a former workhouse which might give pause for thought, given that Daly has pointed out that private facilities are purpose-built with such attractions as en-suite single rooms.
Dunne does not accept the not-fit-for-purpose argument. “A lot of money has been spent there since 2009, bringing it up to Hiqa standards.”.
Shiel says the Abbeyleix community has enough funds to re-roof and refurbish the local public facility, with the Friends of the Hospital having raised €90,000 in the past 18 months.
At its meeting with the Minister last week, the action committee demanded to know the rationale behind the planned closure and asked for a six- month delay.
“It was a very positive meeting,” says Shiel, who points out that the residents themselves are determined to fight for their home with three of them involved in a legal action.
“I’m a celebrity – you won’t get me out of here,” one 90-year-old resident declared on a placard during the recent protest in Abbeyleix.
Campbell does not know whether the residents who, like her father, know what is happening are better off than those who don’t realise their loved ones may soon find it harder to visit them.
“It’s getting to the stage where you would be afraid to get old in Ireland as God knows how you will be treated,” she says.
“My dad is only 70, but one of the residents in his ward will be 100 next month and the other is 90-something. They have surely earned a bit of peace and security.”
- Only about 2,000 of the 5,800 long-stay public nursing home beds were up to the required standard in relation to their physical environment. It would take between €600 million and €900 million to put them right
