'Have a go' attitude helping people with disabilities in Cork move out of nursing homes

The Ombudsman has described this as “wasted lives” and is actively encouraging the HSE to change this. He has called for this project in Cork to act as a model for other areas.

The programme is a collaboration between charity Headway Ireland and the HSE in Cork and Kerry. While Headway are involved with many different projects across the region, this programme is specifically focused on these young people. 

Some wish to move out while others want to have more independence while still living in a nursing home. However, on the ground, the team is finding re-locating people is not as straightforward as they would like.

The situation is not helped by the housing crisis, so it could take around two years to re-locate someone once they and their family are ready for it. This project is new with 24 clients in the system but only one person fully re-located when they spoke to the Irish Examiner before Christmas.

Aisling Corcoran, a rehabilitation worker based in Ballincollig, described how that person faced down the concerns of people around him when the time came to move.

“I just remember the comment that person made, when family and staff were coming at him saying ‘what if this goes wrong?’ and he was saying ‘at least just let me try, let me give it a go’”, she said.

Ms Corcoran said brain injury is traumatic for people of all ages with her clients ranging in age from their 30s to 60s.

She said:

The biggest thing really is the lack of confidence. They might go from being a father and working full-time to having to be cared for.

People might need to get used to money and shopping again following memory loss. “In the early stages they are unsure about how much money they have or how much things cost, that can be gone so it has to be learned,” she said.

She visits nursing homes where young people are living and, in co-operation with the nursing home staff, begins rehabilitation.

The clients wishes and needs vary too. Some do want to move home or to supported housing. Others will always need 24-hour care but could be more independent than a typical nursing home resident. Others may not have a home as homelessness sadly is not unusual among people with brain injuries.

Angela O’Neill, HSE head of disabilities for Cork and Kerry said the recovery journey starts in a hospital. “There is the imperative of moving people on from acute hospital settings, because you have the pressure of trolleys and wanting to move people on from there,” she said.

Options for the next step are limited for people who may be in no shape to return to their old lives immediately, if ever.

“You’ve residential centres for people with disabilities which is usually for intellectual disabilities, so the person with acquired brain injury doesn’t fit there. We have some residential services for people with mental health disorders so they don’t fit there,” she said.

“They don’t really fit in a service for older people either but it is the least worse situation.” 

While outsiders might be shocked at sending someone in their 30s to a nursing home, many families and clients welcome this option. Location, location, location is often behind this.

Paul O’Callaghan, Headway Day Programmes Manager for the Southern Region, said their clients find being sent to the national rehabilitation hospital in Dublin quite isolating.

“You have to take into account the concerns of the family. You have a lot of people who have been in the nursing home for a long time, and the family is secure in knowing they are safe,” he pointed out. “They can still visit and they’re involved.” 

It takes time to have a house or apartment adapted for wheelchairs in just one example. A parent with young children might worry about caring for their newly-injured partner as well.

Setting up wrap-around homecare help is complex particularly in rural areas of Cork. “To move someone back home is a major positive risk. You have to look at rehabilitation in that light, you reduce the risk as much as you can but you can’t clear every possible situation,” he said.

Both he and Ms Corcoran have found working with nursing homes a positive experience. However, they highlighted some sector-specific challenges.

He said:

It can get very difficult for nursing homes because they change staff, they have constant changes. 

“Headway offers training for the staff in acquired brain injury. But our frustration is we go back six months later and you are looking at a set of brand new faces.” 

Clients struggling with memory loss and trying to find a routine might suddenly find ‘their’ carer is gone whether to a new job or on maternity leave, for example.

Ms O’Neill said the project arose directly from a critical 2021 Ombudsman’s report titled “Wasted Lives: Time for a better future for younger people in nursing homes”.

The current Ombudsman, Ger Deering, highlighted the Cork project in his September update to that report.

He said “the outcomes have been very encouraging” there already. He described how Headway Ireland could “be agile and operate in a personal and local manner” compared to the more unwieldy State system.

“This is an approach that I strongly support,” he said. “And I would encourage the HSE centrally, as well as through individual community health organisations, to work with capable NGOs to harness their specialist expertise and local knowledge.”