Abuse in care homes: if nothing changes, then nothing changes
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This week, harrowing details of the sexual abuse and rape of a former nursing home resident, ‘Emily’, came to public attention, following the publication of details from a report of the National Independent Review Panel (NIRP), which investigates such serious incidences for the HSE.
While the details in Emily’s case are horrific in themselves, that impact is further compounded by the fact that this is far from the first time we have woken up to such terrible news. Disclosure of the content of this NIRP report follows similar previous publications in the Áras Attracta, ‘Grace’ and ‘Brandon’ cases, among others, for example.
All these scandals reflect not just deep systemic problems in our adult safeguarding systems and structures, but indicate a glaring lack of will to put these deficits right, so as to ensure no recurrence in the future. All our citizens deserve as much. The time for hand-wringing and sincere statements is long past. We need action now and unfortunately, as long as nothing changes, nothing will change.
Top of the list for action has been renewed calls for adult safeguarding legislation. This is acknowledged in principle as a glaring gap by all concerned and all political parties support the need for such new laws. Yet despite a bill being drafted five years ago, and various discussions and explorations since then of what is needed from a legislative point of view, we seem no closer to achieving enactment of this ‘priority’ statute.
New legislation aside, many commentators are now asking yet again: How can such horrific crimes be perpetrated in nursing homes and similar settings? How can it be that even when residents report abuse, in so many cases they are not believed and allegations are not followed up? Why can’t this offending be prevented?
To begin with, under-reporting of abuse is a well-recognised problem. Following the NIRP report, and another on the same home by the Adult Safeguarding and Protection Social Work Review Team, a number of other previously-reported incidents of sexual and other abuse were shown to have been recorded there. These were not apparently reported when they were recorded to An Garda Síochána nor the appropriate safeguarding team.
On a wider scale, there is widely-recognised under-reporting of abuse. The National Safeguarding Office has completed a report which shows that out of 131 older persons' homes, 68 homes failed to make a single report of abuse or neglect to safeguarding and protection social works teams in 2021. In addition, some homes have never made a single report since 2015. This is stark evidence of under-reporting from such centres, despite policy, having a national office and the provision of online training.
There are clear links here regarding why the voices of brave and strong residents like Emily can and often do go unheard and ignored. Simply put, they are frequently not recorded or not reported, much less followed up.
Serial perpetrators of various types of abuse tend to be skilled at overcoming barriers to achieving their goals and easily identify and take advantage of any gaps in policies and practices designed to protect residents. Social workers do not have legal right of entry to private nursing homes, where approximately 80% of residents live.
The latest NIRP report highlights deep systemic, structural and cultural issues, which do not have to wait for legislation to be addressed. NIRP explicitly recommends — not for the first time — a move to a more social model of care, which sees the care setting as a resident’s home, rather than as a medical facility. The current medical model of care contributes to the NIRP finding that allegations of sexual abuse in a number of instances were ‘explained’ in the context of medical diagnoses of dementia and urinary tract infections, among others.
We also need to debunk widely-held myths regarding sexual and other abusive behaviours, which are more about power, control, and aggression, and the availability of potential victims, and much less about age, ability, and appearance, as is often believed. Ultimately, ageism and ableism at a societal level play a part. Older people and persons with disabilities are too often ‘out of sight and out of mind". They are not seen as a priority, they are patronised and their independence, human rights, and even their personhood itself are frequently not recognised or vindicated.
The response to the NIRP report by HSE ceo Bernard Gloster, including his statement that he will appoint an appropriate international expert in safeguarding, to examine our structures, policies, and practices, and to make recommendations, gives cause for some optimism that now matters will be taken more seriously and concrete and effective steps taken.
Clearly, safeguarding legislation needs to move to the top of the reality of legislative priorities. There is an urgent need for homecare legislation too, to ensure that those who need care in their lives can avail of it in their own homes, and for as long as possible, rather than having to move to congregated care settings.
The voice of social work, as the lead profession in safeguarding needs to be heard more with more accountability built into our system. Safeguarding social workers currently report to more senior administrators with much less safeguarding knowledge and expertise. We need mandatory reporting of abuse and the appointment of a chief safeguarding social worker, with ultimate responsibility for ensuring safeguarding standards and practice, and ultimately we need an independent adult safeguarding agency.
All of this should be supported by appropriate legislation. But we do not have to wait for legal change to make real changes that will make a real difference – for the better.