You should care about the state of our care homes – you just might end up in one – The Irish Times

“I never want to end up in a nursing home” is the most nerve-wracking phrase I encounter in my work as an aging expert.

In other areas of health, we aspire to have any disease or disability we acquire treated in a way that allows us to thrive as much as possible. Yet despite the many positive aspects of late aging, the welcome increases in healthy life expectancy, and the greater availability of home support, there comes a time when the complexity of illness and disability will be such that living in a communal setting will be necessary for a significant minority of us as we age.

Yet if we turn our heads away from this possibility, we create a political vacuum and even a negativity towards nursing in nursing homes that eventually finds its way into political, societal and even professional negligence. A shocking example was provided by a former mediator when he denounced the position of young people in retirement homes leading “wasted lives” with a lack of dignified treatment, self-determination and independence, but did not no reference to the fact that these deficits also applied to more than 20,000 elderly residents in nursing homes.

The minimum space for a resident’s bedroom according to National Care Home Standards is less than the minimum size of a parking space mandated by Dublin City Council

This neglect is reflected in the absence of a proactive policy on care homes by the Ministry of Health where large scale privatization of the sector has taken place without debate or consideration of how this affects care delivery, no indication of a vision of high quality service by the sponsoring organization (the National Treatment Purchase Fund), the low priority given to engagement in nursing homes by health professional bodies, the lack linkages to public health and secondary care services and over-reliance on a reactive regulatory system which alone cannot address the broader absence of a proactive framework that promotes fulfillment and independence.

Regulation alone will never suffice, the minimum becoming the maximum in the absence of other inputs such as popular will or virtuous thinking. For example, the minimum space for a resident’s bedroom by National Care Home Standards is less than the minimum size of a parking space mandated by Dublin City Council – how can we expect to fit an armchair and furniture and personal effects in such a small space?

This reflects international concerns, with a recent book, The Gravediggers (The Gravediggers) made waves during the last French presidential election by detailing allegations of poor care in French nursing homes run by Orpea, a major provider of commercial nursing homes.

The standards we expect in hotels and restaurants in terms of decoration, service and satisfaction are not only due to the regulations in place, but because we have generated an expectation of what they should be. It’s time we started to identify nursing home nursing as an important possibility for our own future and create a vision of what it could be.

There is some urgency to this – Ireland has done relatively well overall for the Covid pandemic, but had one of the worst death rates among nursing home residents in Europe. While the Ministerial Committee on Care Homes was an important interim solution, it is deeply troubling that the implementation of its recommendations has fallen far behind the proposed timelines with an alarming lack of political, popular or media concern. , and the Implementation Committee ceased in June with virtually all substantive objectives not met.

If deaths had occurred to this extent in children’s homes, there would have been an outcry and almost certainly a public inquiry. After undertaking the review of the Leas Cross scandal in 2005, I wrote to past and previous health and justice ministers that such a review should take place, and that a public inquiry is needed to radically review how our future care and life provisions are planned, as well as a legal framework for the provision of high quality health care.

The next time you say or think, or hear someone say, “I would hate to end up in a nursing home,” consider an alternate version.

Rethinking care home design and design policy should be an immediate start, and our research group in Trinity Haus in TCD has issued guidelines on how we move forward. Rather than large units of more than 200 beds located at a distance from neighborhoods, it is necessary to focus on relatively small units located in localities close to dwellings, designed in the form of small sub-units on the scale and domestic atmosphere, including kitchen, lounges and private spaces. Single rooms should have space for personal effects and furniture. This model, known by names such as the “Green House” or the Taghlach model, has proven to be more effective in terms of protection during pandemics, as well as promoting a better quality of life.

It is clear that there needs to be a radical increase in HSE and voluntary provision of nursing home care to achieve this kind of more sophisticated care setting, the kind we would like to be in.

So the next time you say or think, or hear someone say, “I would hate to end up in a nursing home,” consider an alternate version. “As I have a high likelihood of needing nursing home care in my future, I want it to be a supportive and liberating environment in a national and local setting that will allow me to thrive to the fullest extent possible. possible.” We all need to make this shift in mindset to translate this momentum into a better present and future for all.

Professor Desmond O’Neill is a consultant geriatrician at Tallaght University Hospital and undertook the Leas Cross Care Home Review in 2005

About Antoine L. Cassell

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