ALLEGATIONS HAVE BEEN made regarding an incident of sexual assault, unexplained injuries and poor hygiene standards in nursing homes in Ireland, according to documents released to TheJournal.ie under the Freedom of Information Act. 

The documents show that since January of this year specific concerns were raised about staffing issues, nutrition, residents sustaining injuries and fire and safety issues. 

In one piece of correspondence sent to the health watchdog Hiqa, it is alleged that a person received an anonymous letter stating that a resident “suffered physical and sexual assault by another resident”. 

In that same entry, it is claimed that staff were “instructed not to record the incident”. 

Hiqa Hiqa

Another piece of information from a concerned person claims that a resident “was naked from the waist down” and “standing at the head of the bed” in their relative’s room. 

This person also claimed “another resident previously entered relative’s room and urinated all around it”. 

The documents concern unsolicited information received by Hiqa in relation to older persons’ services from 1 January to 4 June 2019. 

Hiqa is responsible for the monitoring, inspection and registration of designated centres for older people, such as nursing homes, in Ireland.

The information comes from anyone concerned about something in a nursing home. 

The concerns are heavily redacted in places and are undated. All identifying material relating to the centres and people involved is removed, in order to respect their privacy. Despite this, the concerns give a real glimpse into the issues in residential care centres and nursing homes across Ireland.

The issues raised with Hiqa sent through unsolicited information over the course of the period range from personal belongings being misplaced, lack of supervision, staffing issues, concerns over food provision, to an overall lack of care. 

Report

Earlier this week, Hiqa published an overview report for regulation activity in designated centres for older people during 2018.

The report detailed findings from 542 inspections and outlined that while the quality of care and support provided in nursing homes is improving, a number of centres have more to do to comply with the minimum requirements. 

“Over 31,000 people live in nursing homes in Ireland. They should expect to receive safe care that meets their specific needs, and should be assured that their home is being well managed,” Hiqa’s director of regulation and chief inspector of social services Mary Dunnion said. 

Our inspections found that this was the case for a large number of people, but many vulnerable older people continue to receive care in a physical environment that is not conducive to providing care in a dignified, safe and personalised manner. 

On 2 August, Hiqa published 35 inspection reports on nursing homes in Ireland. Evidence of good practice and compliance with regulations and standards were found in 23 centres. 

However, evidence of non-compliance was found in 12 centres. In these centres, the provider failed to ensure that the service delivered to residents was effectively monitored in line with the regulations and standards.

Inspectors identified non-compliance in areas including governance and management, risk management, fire precautions, personal possessions, healthcare and infection control, among other issues. 

Injuries and assault 

In the FOI documents, multiple instances of injuries such as bruising are detailed.

A recurring theme within the documents is residents experiencing bruising. 

In one instance, a concerned person (CP) claimed that a resident “suffered a number of assaults by another resident who has challenging behaviour”. 

In another instance in the documents, it is claimed that a resident had “significant bruising on a number of occasions”. 

“Medical attention was not received by resident until 3 days after a fall,” it was alleged.

One concerned person claimed a resident “suffered unexplained bruising on the face”. 

Hiqa Hiqa

Another piece of information outlined that a relative visited a centre to find a resident “sitting in their bedroom very upset and crying”. 

“Resident has Dementia but could not communicate what was wrong. Relative lifted the resident’s clothing to find bruising on their arm,” it was claimed. 

Hiqa Hiqa

In another instance, it is alleged that a resident “banged their head” and that the family were not informed. 

“When another relative visited they noticed the bruising and also that the resident was in soiled, wet clothing in the activity room,” it was claimed. 

It continued: “The following day when relative visited again they noticed blood on the bandages used to cover [redacted] ulcer and discovered that the blood was not from ulcer but from a fresh cut.

When relative touched resident’s arm to try hold her whilst investigating the fresh cut they were in pain. Resident transferred to [redacted] hospital and tests confirmed they had two fractured bones in their arm and a lot of bruising under their arms. 

The concerned person alleged that “staff cannot give an explanation as to how these injuries occurred”. 

Other complaints

Other common issues raised within the documents include hygiene issues, concerns over building standards and staffing worries. 

One document alleges that “residents are left in soiled incontinence wear for long periods of time”. 

Another piece of information claims that a person found their relative “cold, hungry, soiled and upset” when they visited. 

In another complaint, concerns were raised over a resident “not being encouraged to eat or drink”. 

In relation to staffing, Hiqa received numerous pieces of unsolicited information. 

One person raised concerns regarding staffing levels, “especially at night time”. They claimed that staff are “constantly rushed off their feet”. 

The person said they had “witnessed call bells ring constantly without being answered”. They claimed this was because they were “attending to residents who need constant monitoring”. 

Another complaint alleged that there is a “lack of supervision” in the day room in the nursing home in question. 

One person complained that “there was a lack of appropriate care to meet the needs of the resident”. 

The document outlined that the concerned person brought the resident home and discovered they had been “given medication that was prescribed for another resident”. 

There were also concerns raised about the standards of the nursing home buildings. 

It was alleged in one document that a lift was “not operational” and another person raised concerns regarding “fire and safety” at a nursing home. 

Hiqa’s role

Hiqa does not have a remit to investigate individual complaints. However, all unsolicited information, which can be received from anyone concerned about a centre, is used to inform the watchdog’s monitoring of each residential centre.

Noting this fact, Fine Gael TD Fergus O’Dowd said: “I’d be very concerned that [the complaints] never trigger, as far as I understand, an immediate investigation of the individual. 

[Hiqa] can go in [to a nursing home], but they can’t as for the file of the individual which doesn’t make sense and you need a lot more accountability from Hiqa as to what they are actually doing. 

As noted above, the concerns are heavily redacted in places and are undated. All identifying material of the centres and people involved are removed, in order to respect their privacy. 

“I think that the [identity] of the individual should never be disclosed but I don’t see why there shouldn’t be as little redaction as possible because you need to know the full detail of what culpability or what are the responses of the actual institution to the complaints that are made,” O’Dowd said. 

Hiqa monitors and inspects designated centres for older people, such as nursing homes, against regulation and standards.

Where there are risks to the safety of residents or where the provider has failed to address areas of concern repeatedly, Hiqa can take escalated action, up to and including court action to cancel the registration of a centre.

“The aim of the Health Information and Quality Authority is to advance high-quality and safe care for people accessing health and social care services in Ireland,” a spokesperson for Hiqa said.

“Where Hiqa has concerns related to the safety of residents and the quality of care that they are receiving, providers are required to take immediate action to address this.

“Hiqa inspectors follow up with providers to ensure that the actions are being implemented and are resulting in improvements for residents.”