I did not watch last night’s RTE “Prime Time Investigates” special on Irish nursing homes. I did not need to, for we have all seen the story before. My mother watched it, and was horrified, and a little bit frightened. My parents are at that age now where the deprivations of advanced age are not yet a reality, but loom uncomfortably close on the horizon. I got another flavour of it from the press release sent out to me this morning by Peadar Toibin, who is calling for “safeguarding legislation” to be enacted:
Deputy Tóibín continued: “The findings of RTE Investigates are extremely distressing. Old people left lying in urine, being pushed and pulled around by their clothes. Across the board the number of nursing home patients appears to be rising, but not the number of staff. Some of the residents were at high risk of malnutrition and did not have access to medical professionals. In some cases there was only one staff for every nine residents which presented a serious challenge if one resident required the bathroom, the other eight would have to be left alone. Cases of residents falling, and being lifted by their clothes, residents left in pain ringing the assistance bell for up to twenty-five minutes. This is abuse, it is neglect, and it cannot be tolerated”.
I do not doubt the good intentions of Deputy Toibin or those of the many other politicians who will be out today, calling for some sort of legislative response to the scenes of older people being abused. That is the job of legislators – to legislate. They can do no more than that.
But this is not a legislative problem. A decent and compassionate society should not require laws and regulations to make sure that its older citizens are treated with dignity and compassion. That should be the default standard.
But it is not the default standard in our country. It is not the default standard in any segment of our country. Over the winter, I wrote about the case of an elderly man known to me left on a trolley in a busy Irish hospital. He was there for over 48 hours, soiled himself, and his family were left in a state of immense distress.
I do not think this is a legislative problem. I think of it as the airport problem.
When you go through airport security – something most of us do at least once a year – you surely cannot escape the feeling that to the staff, you are something less than human. Thousands of people winding their way through a long queue to all do the same thing must, over time, to the staff, become more akin to cattle at a mart. A friend, a very nice person, used to work in that area and confirmed as much to me. People lose their individuality when they are simply another creature going through a scanner. Another person to be “processed”.
Taken to its absolute extreme, historians have long wondered how it could be that people went to bed and slept soundly after a day of shuttling Jews and other undesirables into the gas chambers at Treblinka. The answer I suspect is the same: Familiarity breeds indifference. At times it breeds casual cruelty and callousness.
With the best will in the world, there will always be those who succumb to seeing the old people in their care as something less than human. This is also, tragically, true of childcare. Just as it is of hospitals. Just as it was of Mother and Baby homes. I do not write that last bit to exonerate the Church, by the way. But this kind of indifference to the people in one’s care is a repeated and observable problem that crops up time and time again.
The response to the nursing home scandal – this latest one – will probably at a political level take the usual form. Some people will want the nursing homes nationalised. Others will want them regulated. Others will demand more funding and resources. But none of those responses, meritorious though they may be, solve the real problem: Nobody will ever care about your dad, or your mum, as much as you do.
I do not write that to condemn those families who feel that they can no longer cope with an elderly parent or relative who has, say, advanced dementia and is in a state of constant distress and unrest. Those families often feel as if they have no other choice but to seek residential care.
I write it to say that the idea solution to this problem is not more regulated nursing homes, but fewer nursing homes. The state to its credit does some stuff in this area already: There are grants available for in-home improvements to bedrooms and so on.
The best thing we can do for older people, I would argue, is to do everything in our power to make sure they don’t end up in long-term residential care in the first place. The focus should be on those families who feel like they have no other options. The focus should be on making sure that they do have the support, and the options, they need. I for one would have no difficulty in vastly increasing the financial supports for carers, for example, or investing in far more district nurses and support staff to come and aid families in their homes with a declining relative.
I can’t think of a single person who wouldn’t agree with the statement that older people deserve dignity and care in their golden years. That is something people right across the political spectrum can get behind. The problem is that in Ireland, we’ve gotten this idea into our heads that the state can deliver dignity and compassion, when those are the very things that the state cannot do.
Without wishing to sermonise, dignity and compassion are first derived from love. To be invested in somebody’s well being, it is often, usually, a prerequisite to actually care about them as an individual. The state does not love us. It is not capable of it. The state is a soulless institution without feeling. What it is capable of doing, with the right political direction, is supporting people who do love their elderly family members, and wish to care for them themselves.
That, not nursing homes, should be the primary focus of state policy.