STAFF SHORTAGES ARE significantly impacting charitable and nonprofit residential disability service providers, with centres across the country failing to meet care standards.
The Journal Investigates reveals the pressure placed on staff — with some working up to 60-70 hours a week to plug gaps in the system — leading to burnout, low morale and retention issues.
A family of a former resident told us that a constant change of staff had a “huge knock-on effect” on the standard of care received by their relative.
Our investigative unit examined more than 900 inspection reports from the Health Information and Quality Authority (Hiqa) in 2023. We found that charitable-run disability centres were significantly less compliant than those managed directly by the HSE.
According to the Regulation Handbook published by Hiqa, “a judgement of not compliant means the provider or person in charge has failed to comply with a regulation and that considerable action is required” to improve standards at the centre.
These regulations, set out under the Health Act 2007, cover a wide range of areas, including governance, staffing, health and safety as well as individualised support and care of residents.
We can reveal that 92% of inspections of residential centres run by Ability West found breaches in at least one regulation in 2023 – the highest of any provider. A similarly high number (86%) was recorded in inspections of COPE Foundation centres.
A spokesperson for the COPE Foundation said the organisation acknowledges the findings of Hiqa inspections from 2023 and is working to address them “as a matter of urgency”.
Ability West also acknowledged “a range of significant challenges facing the organisation in 2023” and that there has been a “marked positive turnaround in 2024” following a “comprehensive review of operations in consultation with Hiqa and the HSE”.
There are approximately 1,600 residential disability centres in Ireland, with only 168 of these directly managed by the HSE. The rest are run by charitable or nonprofit organisations.
However, as our investigation exposes, many of these providers struggle to meet their obligations under the regulations to maintain safe and effective residential disability services.
Hiqa is responsible for monitoring, inspecting and maintaining the registration of these centres, ensuring that providers meet the national standards for residential service for people with disabilities.
Concerns over slipping standards of care were raised by Hiqa in their 2022 annual report, with the regulator stating “there was a notable deterioration in the levels of compliance across services”.
A spokesperson for Hiqa said “it is the providers’ legal responsibility” to ensure services are delivered in-line with the assessed needs of residents and that it is “the responsibility of the Chief Inspector of Social Services within Hiqa to monitor this”.
A HSE spokesperson also added that “the vast majority of the voluntary entities are compliant or substantially compliant with regulations and deliver services to a standard at least comparable to HSE’s directly delivered services”.
The HSE also acknowledged that “voluntary organisations are an essential and valued element of Ireland’s public health and social care system.”
Our investigation shows how a lack of staff is contributing to these poor standards and impacting the delivery of care and quality of life received by residents.
The staff that worked at all of these centres were often praised by inspectors, saying they displayed care and kindness towards residents.
However, inspectors were also sharply critical of the providers for not allocating enough staff and resources to run these centres.
At one Ability West centre, inspectors found that staff were working up to 60 and 70 hours a week and that they sometimes had to work full days following being on duty during the night.
Agency staff from four different external agencies were being used to cover other gaps at this centre, but inspectors found that some of these agency staff did not have adequate training to deal with the complex care of some residents.
At another centre run by the COPE Foundation, one or two staff members regularly supported 11 or more residents, significantly elevating the risk at the centre.
A spokesperson for the COPE Foundation said it is working within its limits of funding when it comes to staffing, and added:
The recruitment of staff is an issue affecting organisations right around the country.
A spokesperson for Ability West told The Journal Investigates that staff shortages have created “protracted challenges” that are “difficult to overcome” but are “constantly being worked on”.
The Journal Investigates spoke to current and former staff at these providers about the pressures faced due to a lack of staff.
They told us it was putting current staff under immense pressure, leading to burnout and high turnover.
One staff member at the COPE Foundation with more than 10 years experience said retention of staff has always been an issue, with low morale prevalent across different sectors of the organisation.
They said the lack of staff numbers sometimes meant they were unable to provide adequate care to residents that had more specialised needs and that their ability to take residents out for activities was hampered by a lack of resources.
The staff member told us that while there was an acknowledgement from management of the lack of staff, they were told “there was always an area that was worse off than us, there was always an area that had less staff” when requests were made for more staff.
“Everybody there wants to give the best care to the residents,” they continued, adding that the frustration at not being able to provide this care due to staffing constraints led to low morale among staff and a high turnover rate.
A spokesperson for the COPE Foundation said that “staff welfare is always a key priority” for the organisation, and encouraged staff experiencing difficulties to contact HR. They also added that staff wellbeing teams have been put in place to assist staff.
We also heard from staff working at Ability West who said the lack of staff was leading to a feeling of pressure to take on extra shifts. One staff member said they had heard of staff covering each other’s annual leave.
This reliance on staff taking on extra shifts has led to low morale, higher stress and burnout, with resentment also creeping in when “some are seen as helping out more than others”.
A spokesperson for Ability West said “resourcing issues are being actively managed, and any related discussions are with employees and not through the media”. They added:
“If any employee has a particular issue, they know we have robust and fair processes in place, to address such issues as they are presented to us.”
The lack of continuity of staff, as well as the carousel of agency staff used to plug gaps in the system also has a substantial knock-on effect on the care received by residents.
One family told The Journal Investigates the constant change of staff at a centre run by the COPE Foundation had a “huge knock-on effect” on the standard of care received by their relative, as waking up to a new face every morning caused distress.
They told us their relative had always been very independent, but “in later years, they got older, their needs got greater”, and this variety in staff was a huge issue.
Whenever agency staff were brought in, the family told us, residents would have to build trust over the day, expecting the same staff member to be there the next day but when they were greeted by someone different, the whole trust process had to start again.
There was also a decline in the number of activities and trips residents were taken on due to the lack of staff, which significantly reduced the quality of care provided.
The family told us residents used to take trips to Killarney or Dublin but these outings were substantially cut back with management saying there wasn’t sufficient staff available.
We asked the COPE Foundation about this family’s experience, but it did not respond to these specific questions having already indicated that they are working to address concerns raised by Hiqa “as a matter of urgency”.
Staff at Ability West also told us that the use of agency staff was leading to increased anxiety among residents.
The inconsistency in staff numbers meant “service users sometimes miss out on outings and appointments due to staff shortages”. This was having a “detrimental effect” on trust between staff and residents “as they are unsure if staff will turn up to facilitate their appointments or outings”.
Ability West has said they have had a “marked positive turnaround in 2024” in consultation with Hiqa and the HSE.
Over half of all inspections (474) of residential centres in 2023 failed to meet the standards set by Hiqa and while the vast majority of these recorded minor or limited breaches of the regulations, significant breaches were found at some centres.
Almost 200 centres were found to be in breach of three or more regulations and 28 inspections recorded breaches with seven or more regulations last year.
A COPE Foundation centre in Cork City had 12 breaches of health and safety regulations, the highest number of any centre.
A spokesperson for the COPE Foundation did not provide any further response when we put this to them. They did say that the organisation is addressing the findings of Hiqa inspections “as a matter of urgency”.
By far the most common breach by providers last year was in relation to Regulation 23: Governance and Management.
This regulation ensures that sufficient resources, such as staff, have been provided by the service provider so that the centre is able to provide safe and quality care for residents.
It also covers the leadership structures of residential centres and looks for evidence of improvements made following previous inspections.
Over 170 breaches of this regulation were recorded by Hiqa last year.
Staffing was also identified as a significant issue across residential disability centres, with over 100 breaches recorded.
There were also issues surrounding the premises residents live in, fire safety precautions and notification of incidents to the Chief Inspector of Social Services.
These five regulations made up almost half (48%) of all breaches recorded with the other 24 regulations making up the remainder.
Our investigation also exposes how some charitable and nonprofit providers are failing to maintain centres to the required standard.
We did this by combing through each inspection that took place last year and calculating how many found at least one breach in the required regulations. Our team focused on large disability service providers – those with 15 or more centres inspected in 2023.
Ability West in Galway and the COPE Foundation in Cork came out highest in our analysis, with 92% and 86% of the inspections at their centres, respectively, failing to meet at least one Hiqa requirement.
In response to a query from The Journal Investigates a spokesperson for the COPE Foundation said it “has in place a Quality and Continuous Improvement Programme to improve quality in several designated centres and assist in improving compliance with regulations and standards”.
Ability West also said that it now “has an evidence-based Hiqa compliance rating of 90%”.
This compliance rating measures the total number of regulations complied with but does not show the number of inspections that found regulation breaches.
However, they were not the only providers that didn’t meet Hiqa standards. The Brothers of Charity (70%), Aurora (75%) and Sunbeam House Services (79%) were also found to have a significant number of inspections that found at least one regulation breach last year.
A Sunbeam House Services spokesperson said, “staff and management continually strive to improve on our levels of compliance”. They added that there have been some recent challenges with recruitment, but that they “are continually striving to address vacancies as they arise”.
A spokesperson for the Brothers of Charity pointed to the organisation’s compliance rate of 85% with the regulations last year and said “where a non-compliance is identified we put in place a compliance plan and monitor the implementation of the plan closely”.
Aurora CEO Annette Ryan told The Journal Investigates that compliance with the regulations this year was high, with 108 regulations inspected at over 95% compliance.
These findings are in contrast to centres managed directly by the HSE, where just 27% of inspections of centres found regulations were breached in some way, despite the second-highest number of inspections of any provider last year.
In response to a query from The Journal Investigates, a spokesperson for the HSE said “there is an interdependence between the state and voluntary sectors in providing health and social care services”. They added:
Voluntary organisations are an essential and valued element of Ireland’s public health and social care system.
Disabled people should be supported to live outside of these residential centres or congregated settings, according to many advocates.
The HSE has implemented a policy to move away from congregated settings – where 10 or more people live together. Many of the centres inspected last year did have smaller numbers living there. However, Hiqa recently told the Joint Committee on Disability Matters that the pace of this transition was disappointing.
Shelly Gaynor, a disability rights activist and peer mentor with Independent Living Movement Ireland (ILMI) told The Journal Investigates “with the appropriate support any disabled person can live a life of their own choosing”.
Shelly lives in her own home with the support of a personal assistant and says there should be more awareness of the services available so that at the very least, people have a choice on how they want to live.
She said that it’s sad so many people are living in residential centres in 2024, and added:
I think everyone should be looked at as an individual and given the same opportunities as their non-disabled peers.
“The amount of people that don’t know about independent living in the way that I live is shocking.”
Shelly said one of the problems with the lack of awareness of personal assistants is that parents of young disabled adults assume that there aren’t any other options out there.
“If you’re not aware of this, how do you know where to go and get it,” she added.
The ILMI told the Joint Committee that disabled people should “have the right to a personal assistant over residential care”. The Committee has since recommended the government establish “a needs-based Personal Assistance Service on a national statutory basis”.
For now, the need for more staff to care for those who continue to live in residential centres was highlighted in numerous inspections.
In 2023 both Ability West and the COPE Foundation were placed on targeted inspection programmes by Hiqa due to repeated poor inspection results.
Our investigation shows how these poor results continued through much of last year, with staffing highlighted as a major issue at both providers.
A spokesperson for Hiqa said “the Chief Inspector continues to monitor and inspect Cope Foundation services. The provider has demonstrated their commitment to meeting the needs of residents through their compliance plan responses.”
“With regard to Ability West designated centres,” the spokesperson continued, “the compliance levels for 2024 show that the provider has made steady progress in addressing the areas of non-compliance and continues to implement changes and improvements.”
However, they added that “the Chief Inspector continues to monitor and inspect Ability West services with an emphasis on ensuring that the provider is in compliance with the regulations and that the progress made is sustained and embedded across all centres.”
According to the HSE’s 2023 Annual Financial Report, Ability West received just over €32m in funding, while the COPE Foundation received close to €79m.
While this was roughly in line with other disability service providers, some larger organisations received significantly more.
Macotar Lodge Services, a centre run by Ability West located in a village in Galway, was inspected four times last year with inspectors finding “significant failings” by the provider.
The registration for this centre was ultimately cancelled by Hiqa and the HSE took over the management of the centre.
The first inspection under new management took place in late 2023 and it was found to be in complete compliance with all regulations inspected, with “significant improvements” noted in relation to staffing, risk management and residents’ social care.
Other issues at Ability West centres included one person managing ten centres, which inspectors said significantly impacted their ability to oversee the inspected centre. Another worked overtime as, in addition to their management duties, they were working 36 hours a week as a social care worker due to the lack of staff.
Ability West did not reply to specific questions about these centres saying “we are not going to further engage on questions in respect of 2023 Hiqa inspections”, citing the organisation’s “great progress” this year in compliance with Hiqa regulations.
Staffing issues were also evident in a number of centres run by the COPE Foundation in Cork, with concerns raised over their ability to evacuate residents in an emergency.
There was also regular use of agency staff, with one inspection finding that an average of 10 agency staff were required at a COPE Foundation centre to cover gaps in the roster each week.
A COPE Foundation spokesperson did not reply to questions about these centres, beyond indicating that all Hiqa concerns are being addressed.
Centres run by Ability West and the COPE Foundation were also among the top five centres with the most breaches during a Hiqa inspection in 2023.
The highest, a COPE Foundation centre in Cork City had 12 breaches of the regulations, with Hiqa inspectors finding “poor oversight in many areas of the service” including residents’ rights, fire safety, risk management procedures and safeguarding.
One resident had been living temporarily at the centre since 2016, with no plan in place to move them to a permanent living arrangement.
When asked about this resident, the COPE Foundation said it does not comment on individual cases but indicated that it is addressing the HIQA concerns.
Another COPE Foundation centre with a large number of breaches, again located in Cork City, was found to have significant staffing issues, with one or two staff regularly supporting 11 or more residents.
This severely impacted the care they received, with inspectors finding their opportunities to participate in everyday experiences were severely limited.
A spokesperson for the COPE Foundation did not respond to questions relating to these centres, beyond indicating that all Hiqa concerns were being addressed.
A centre in Waterford run by the Brothers of Charity had the second-highest number of regulation breaches (11), with inspectors finding it failed to meet standings in every regulation inspected.
“Very poor practices in relation to residents’ rights” were reported by inspectors, with decisions and choices of residents dependent on the number of staff in the centre, which was also found to be inadequate.
A spokesperson for the Brothers of Charity said “we acknowledged the shortcomings in the quality of service provided to the individuals residing in the centre”.
They added that “a subsequent report in January 2024 found that, while some areas still required improvement, there had been improvements in a number of areas”.
Riverside Services, a centre located in a town in Galway and run by Ability West, failed to meet a large number of Hiqa standards with 10 breaches recorded.
Living arrangements for one resident were found to be unsuitable due to their changing needs and prevented them from using shower facilities within their own apartment.
Inspectors said that the centre had failed to address these changing needs, which had been ongoing for over a year and was harming residents’ rights and quality of life.
Ability West did not reply to specific questions about this centre.
A fifth centre, Tús Nua, located in an urban area of Kilkenny and managed by nonprofit Aurora, was the final centre to have ten or more breaches recorded upon inspection.
Hiqa inspectors found management was unable to ensure residents were safe at all times and regular use of agency staff had an impact on the continuity of care received by residents.
A second inspection of the centre in 2023 found significant improvements had been made, but some issues remained, particularly around residents’ access to their own finances.
Having told The Journal Investigates that compliance with the regulations this year was high, with 108 regulations inspected at over 95% compliance, Aurora said it had no further comment to make when asked about this centre.
Staff at some providers, like Ability West, are not classified as public servants, despite the vast majority of funding for these providers coming from the HSE.
Historically, their pay was linked to HSE staff, but during the economic crash, these organisations, known as Section 39 organisations in legislation, were instructed to impose pay cuts in line with those made on HSE staff.
However, during the recovery, HSE staff pay was restored, but additional funding to restore the pay of Section 39 organisation staff was not provided. This meant workers often left to work directly with the HSE.
Not all disability organisations fall into this category, however, with some, such as the COPE Foundation classified as a Section 38 organisation, meaning its workers are considered public workers.
Unions representing Section 39 organisations have campaigned to realign pay with HSE staff and on the eve of strike action last year, were awarded an 8% pay rise at the Workplace Relations Commission (WRC).
Despite the government acknowledging that the lack of funding had led to a significant recruitment and retention challenge in the sector, a binding realignment of pay was not agreed, leaving some still worse off than their HSE counterparts.
Further discussions at the WRC this year have not resulted in an agreement, with Fórsa’s health and welfare division head Ashley Connolly telling The Journal Investigates the union is consulting with its members.
In response to a query from The Journal Investigates, a spokesperson for the Department of Equality said it was committed to overcoming the “workforce challenges in the disability sector” and that it remains optimistic that a deal can be reached to “appropriately benefit workers, service users and families”.
Reporter: Conor O’Carroll • Editor: Maria Delaney • Social Media: Sadbh Cox • Main Image Design: Lorcan O’Reilly
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