Abuse of Elderly Won't Stop Until Funding Starts

Independent

September 9, 2008

Ireland

From Leas Cross in 2005, when the warning bells started ringing, to Falcarragh recently, where two nurses admitted to tying an elderly man's hands together to prevent him from removing his incontinence wear, there can be very few of us who are unaware that abuse of the elderly occurs. 

I don't feel that anyone -- nurse or relative -- would deliberately commit abuse. However, I do feel that through frustration, overwork and lack of resources, abuse does occur. 

If most of the care staff in nursing homes were told their care constituted abuse, they would be shocked and horrified. Yet, tying residents to chairs, causing dehydration due to insufficient fluid intake, causing pain from rough handling, verbal and psychological abuse, demeaning toileting procedures, etc, can and do happen on a regular basis where there are insufficient staff to cater for the residents.

After 20 years of working in the acute hospital setting, I decided I needed a career change. Care of the elderly has always held great appeal to me, so the obvious move was to work through a nursing agency to gain experience. This was in 2006, after all the elderly abuse stories had broken, and the HSE had issued guidelines for improvements. 

My first night was, coincidentally, in an HSE-run facility in which I had worked as a newly-qualified nurse 22 years previously. I went back into a time warp -- nothing had changed. Twenty-four beds were pushed together with barely room to move between them. The paint on the walls was stripping in places, and the curtains surrounding the beds gave a suffocating, claustrophobic and depressing feel to the whole unit. I had one care attendant (CA) to help me for the night. The staff: resident ratio in most of the nursing homes, both HSE and private, was 1:14 for nights, 1:7 for day care.

While I administered the medications, the CA's job was to give out drinks to the residents. With 18 of the 24 dependants needing help to drink, I had my doubts that they all got fluids, as within three quarters of an hour the CA had started to change incontinence wear on her own. A few yells from the residents alerted me to the fact that, because she was doing it alone and with limited time, the incontinence wear was being pulled off quite roughly. My suggestions that we work together were met with a stoic, "We need to get the work done."

Unless two people work together on lifting, turning and changing adults, undue force is going to be used. This causes pain, bruising, at times lacerations and, if the resident has had a stroke, can lead to dislocations of the hip or shoulder joints.

Another night, and another nursing home (this time, one carer to 28 residents), and the same repetition of drinks given out at breakneck speed, with quite a lot of coughing by some of those I did see being helped. I was to see repeated evidence of dehydration. Also, in one particular HSE care home, the GP in question had voiced his concern that the majority of residents were showing evidence of dehydration in their blood results.

Another oft-repeated practice I came across -- tying residents to their chairs -- has been a generally-accepted means of restraint "for resident safety" for years. This is where the staff -- well meaning, but nonetheless incredibly lacking in good practice -- had tied a broken belt around a resident's waist to secure them to a chair to try and prevent them from standing up and sustaining injury. Besides being demeaning, the obvious danger of strangulation stunned me. I couldn't get the ties off quickly enough. 

At 5.30am, I was informed that we had to get some of the residents out to give them their breakfast. When I argued against this on the grounds of cruelty, I was told it had to be done as the day staff didn't have time.

One particular night, I was working with a male CA -- a good-humoured, level-headed type. One of our male residents was very handy with his fists, and it was rare to go any shift without getting a painful wallop. On hearing furious yelling at about 3am, I rushed into the "walloper's" room to find my CA up on the bed with his knee on the man's chest, nose bleeding profusely. The CA had his arm drawn back, with fist clenched, and to this day I don't know if my intervention stopped him, or if he would have hit the resident.

Incidents where the staff are pushed to the limits of their patience by repetitious anti-social behaviour of the elderly and confused do lead at times to verbal abuse. 

Education of staff on what constitutes abuse is paramount -- and, where it does occur, it must be reported. It's also a qualified nurse's responsibility to educate her/himself in any area that they're working in.

The State response to the initial expose was to introduce new guidelines of inspectorate and care under the Health Information and Quality Authority (HIQA). This process started back in 2005 and has so far failed to make any meaningful impact. 

In order to implement the HIQA guidelines -- on staff: resident ratios (the amount of staff should be based on residents' dependency levels, not numbers), greater education of staff, more individualised care (eg. the resident can choose their own meal times), provision of stimulating activities, etc -- there needs to be significant improvement in funding. 

To date, while the HSE has invested hugely in investigations, reports and recommendations, there has been little investment in what really matters: staff education and improved ratios. And the postponement of 'Fair Deal' funding ensures that there will be little improvement for some time to come.

Care of the elderly is seen as the Cinderella of the healthcare profession. The work is physically and mentally very demanding and can have very few rewards. 

Nursing management must be seen to be at the forefront of resident care, educating their staff, and protecting their residents from poor practices.

Let's face it, this particular bell is tolling for all of us.

The author of this piece is a registered nurse who wishes to remain anonymous 

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