Hundreds of nursing homes and elderly care institutions are not being inspected by health authorities despite evidence of abuse and neglect in some.
Around 25,000 older people are accommodated in nursing homes. However, there are no inspections of the State's 500 public nursing homes, and there are not enough staff to regularly inspect all private homes. While health professionals say standards of care are good in most homes, inspection reports released under the Freedom of Information Act show a litany of failures by some owners to provide basic standards.
The reports show some homes have failed to wash patients regularly, heat homes adequately in winter or provide hygienic food preparation facilities.
However, homes are often escaping censure because legislation governing standards of care is vague, according to senior health officials.
A survey of health boards around the State by The Irish Times shows just one private nursing home has been the subject of legal action in the courts over the last five years.
And although legislation requires that all private nursing homes be inspected "not less than once in every period of six months" health boards admit this frequently does not happen. The Western Health Board, for instance, says inspections are carried out "six-monthly to 10-monthly".
More than 60 complaints have been made to boards about nursing homes in the past year. The South Eastern Health Board, with 17, has had the most. The Northern Area Board in the eastern region has had 13 complaints about nine homes in the past year.
The physical condition of some public institutions has also come in for criticism, with one senior health board official saying that as many as half of them should be closed down.
Prof Des O'Neill, a geriatrician at Dublin's Tallaght Hospital, said that while the majority of nursing homes maintained high standards, underfunding was the main cause of abuse or neglect.
"Abuse in institutions occurs where people are overstretched and under-resourced, where there are not quality markers and where staff aren't trained," he said.
"Until we have good care standards, universally and transparently available, it is going to be harder for the system to prevent abuse."
A study commissioned by the Government in 1998 estimated that between 12,000 and 20,000 people in the community could be suffering from abuse, neglect or maltreatment.
However, the Government has not acted on the main recommendations of a series of reports which have called for safeguards such as mandatory training for careworkers and independent inspections of nursing homes.
The Minister with responsibility for older people, Mr Ivor Callely, said the Government was committed to addressing this area, and pledged that there would be independent inspection of all nursing homes and institutions for older people.
"The inspection of public homes is very much on the cards. It is a question of finding the right mechanism to ensure meaningful inspections," he said.
He did not think it appropriate that health board officials should inspect boards' homes and said he envisaged an independent inspectorate along the lines of the Social Services Inspectorate which inspects children's homes.