Safeguarding concerns in the spotlight after RTÉ exposé
On Thursday, families of nursing home residents and those in disability services protested outside Leinster House in pouring rain.
One by one, daughters, sons, nephews and nieces, mothers and fathers addressed those gathered about abuse and neglect of their loved ones in care, including in nursing homes.
The event was organised by Care Champions.
It is an independent advocacy group which was established when nursing home deaths and visiting restrictions were to the fore during the Covid-19 pandemic.
Since then, a small team led by Majella Beatty has been fighting for the rights of so many families nationwide who feel they have no one else to turn to for support and empathy.
For years, concerns have centered around safeguarding in nursing homes.
Since the transmission of the RTÉ Investigates programme, Care Champions has been inundated.
When he watched the programme, Minister for Older People Kieran O'Donnell rang Health Service Executive CEO Bernard Gloster to ask that the HSE put safeguarding teams into the two nursing homes in question.
However, families claim they were told by local HSE safeguarding teams that they could not go in and assess private nursing homes under current legislation.
In a statement, the HSE said that while safeguarding and protection teams do not have a legal right of entry to private nursing homes without the owners' permission, under the current statutory framework, they can and do, when required, enter private nursing homes with the owner's consent to respond to allegations of abuse and harm to residents and work with providers.
Which led to the question, are safeguarding teams in the homes as requested by the minister, or not?
The Department of Health said that the HSE had confirmed that the directors of nursing from both local HSE Community Support Teams had been onsite in the nursing homes and "are continuing to engage with them".
Almost two weeks from the transmission of the programme, Majella Beatty says the families of residents feel abandoned.
The HSE said that Department of Health policy "will provide legislative underpinning to strengthen governance across all parts of the health and social care system, including private nursing homes".
That policy, due to be published this year, has moved at snail's pace in the last number of years and in the meantime, there have been repeated calls for adult safeguarding legislation following the Brandon case, the Grace case and the Emily case, to name but a few.
Many are astonished that it has not been dealt with more urgently, considering the proliferation of private nursing homes in Ireland.
As the older population increased in the 1990s, so too did the privatisation of nursing home care, with approximately 80% of beds now privately owned.
In 2005, undercover filming by RTÉ's Prime Time resulted in the establishment of the regulator, the Health Information and Quality Authority.
There has been much criticism of the watchdog in the wake of the latest RTÉ Investigates programme and it has been invited before an Oireachtas Committee to provide answers.
In this case, there is a body to be held to account, but there is growing concern about the privatisation of other forms of care, including the care of children and those who are in disability services - some of the most vulnerable in society.
During the week, there was a briefing on the issue organised by The Wheel, which represents charities and community organisations.
It expressed concern over the increase in people with disabilities receiving essential care from profit-driven providers while voluntary service providers decreased.
In April, the independent think-tank Social Justice Ireland pointed out that the Government continues to look to the market and engage private enterprise to provide the public services that should be part of "a basic floor" that everyone in the State should expect.
"They do this notwithstanding continuous evidence that it is more expensive and less effective.
"The rationale given is that the private sector can provide more, faster and cheaper, but again and again, this is not borne out in the evidence," it stated.
The National Association of Voluntary Residential Childcare and Aftercare providers CRAVA have also been vocal about children in the care of the state being sent to 'privates'.
It has pointed to the "phenomenon" of growing privatisation in residential childcare in other jurisdictions, including the UK, where it has been sharply criticised by the Children's Commissioner and the Markets and Competition Authority as the primary cause of the increasing dysfunction in children's social care in England.
CRAVA has said that the dominance of private for-profit provision is viewed as being directly responsible for spiralling costs and poorer outcomes for children in residential care and aftercare.
Many children are being placed in residential care centres, often hundreds of kilometres from their own family, community, social networks and left more open to exploitation.
There are similar concerns about residential care for children with disabilities in Ireland, which has been working on an emergency basis for many years.
Many of the protesters outside Leinster House on Thursday, some of whom were very raw from the RTÉ Investigates programme, spoke about their loved ones being "warehoused".
They spoke of their helplessness in witnessing what they did on screen and yet two weeks on they continue to feel helpless.
The families want transparency, they want safeguarding reviews completed on their loved ones, and for the HSE to take over the home or that residents will be moved into an HSE-run home with one-to-one care.
A former staff member who worked in one of the homes featured in the RTÉ Investigates programme wrote to Care Champions following its transmission.
The letter, seen by RTÉ News, began by describing the hope, excitement and enthusiasm for their work with the residents.
However, that staff member left, unable any longer to deal with inexperienced colleagues, overwork and poor management.
Covid-19 and Leas Cross were failures and should have ignited far more action by the Government, which will point to initiatives like Healthy Age Friendly homes which provides support packages to people to remain at home, but this is not possible for everyone.
Therefore, policymakers need to think about what care looks like in Ireland.
It should look like "warehousing", nor should it be solely about shareholders.
It should be about offering a quality of life which includes physical health, psychological support, a level of independence, social relationships, and a relationship with the environment, with sufficient staff to offer support and care.
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