As we plan to commemorate a centenary of independence, the woefully inadequate investment in facilities to cater for the end of life needs of older people since independence justifies a bold initiative to make amends urgently, argues Denis Doherty.
The HIQA inspection report on St. Patrick’s Hospital, Carrick on Shannon seemed to come as a surprise to many. The two main problems identified were, firstly that the building is not fit for purpose and is not capable of being made fit, and secondly that it is not adequately staffed.
Why did it come as a surprise to anyone that a workhouse building, constructed 175 years ago, is not a fit place to accommodate and care for sick, older people at the end of their lives? The workhouses were built to a standard plan said to have been copied from the design of American prisons. They were intentionally forbidding, gloomy and repulsive. They were intentionally narrower than their English counterparts. When building regulations were introduced here, in the 1990s, it quickly became apparent that workhouse buildings were incapable of being adapted to conform to the regulations. The narrowness of the buildings could not be overcome. They should have been replaced then, but many of these buildings are still in use.
The Welfare Home concept was not a success. In practice they found themselves catering for more highly dependent residents than they were either designed to cater for or staffed to cope with.
In 1968, ‘The Care of the Aged Report’ was published and led to improvements in the accommodation used to care for frail and sick elderly people. A number of workhouse buildings, were replaced by purpose built hospitals for the sick elderly and by welfare homes for the frail elderly. In some counties, former workhouses were adapted to better meet the accommodation needs of sick elderly patients. Progress was sporadic and uneven.
Take County Leitrim as an example. In times of prosperity, Leitrim has always struggled to obtain a fair share of the benefits that were going, and in times of recession, the county has not been granted any special favors. In the 1970s, new, 40 bed, Welfare Homes were built in Manorhamilton and Mohill. The intended purpose of welfare homes was to cater for the needs of frail elderly people. Like the workhouses of more than a century earlier, they were built to a standard plan. The workhouse building in Carrick on Shannon was adapted with the intention of fulfilling the role of a geriatric hospital recommended in the ‘Care of the Aged Report’. In hindsight, it would have been wiser to build a new hospital for that purpose, had the money to do so been available. Nevertheless, under the leadership of Dr. Bill McGarry, as Medical Officer, and Sr. Maureen, as Matron, St. Patrick’s Hospital soon became a greatly admired provider of services for older people. A Day Centre and Day Hospital were established that contributed greatly to maintaining older people in their own homes for as long as possible. The emphasis placed on rehabilitation in the hospital meant that many patients could be discharged back home with the support of community-based services. In Ballinamore, a scheme of supported housing for older people was remarkably successful. Led by a local curate, Fr. John Young, the local community took ownership of it and demonstrated that, with the support of community services and the Day Hospital at St. Patrick’s Hospital, the vast majority of those who were allocated a house there were able to live out the rest of their days there, semi independently.
The Welfare Home concept was not a success. In practice they found themselves catering for more highly dependent residents than they were either designed to cater for or staffed to cope with. In time, they became public nursing homes. The standard plan design does not lend itself well to affordable or suitable adaptation.
There are now five nursing homes in Leitrim; three public and two private. Four of these, the former welfare homes at Manorhamilto and Mohill and the two private nursing homes, did not attract any significant adverse findings in the most recent HIQA reports. However, the fact that when inspected most recently, public nursing homes at Manorhamilton and Mohill were catering for only 24 and 32 patients respectively must raise serious questions about the financial viability of homes of that size.
Beginning in 1840, there were 130 workhouses capable of accommodating 100,000 inmates completed in less than four years.
The report of the fifth home, St. Patrick’s, Carrick on Shannon, gives cause for serious concern. The building needs to be replaced and more staff need to be employed. On the positive side, it appears to be the only home in Leitrim that caters, in a structured way, for convalescence, respite care, assessment, rehabilitation, palliative care, continuing care and dementia care. It also appears to be the only home in Leitrim that employs Physiotherapists, Occupational Therapists and Speech and Language Therapists.
It is being suggested that St. Patrick’s is one of the public nursing homes at risk of losing its licence. What a shame it has come to that. The 2011 census report shows the population of Leitrim is only 31,798, 15% of whom are over 65 years of age and according to the HIQA inspection reports only 5% of that number are in residential care in Leitrim. If St. Patrick’s was to close, a third of the residential care beds in Leitrim would be lost along with the range of services listed in the previous paragraph that are unique, in Leitrim, to that home.
The late John Healy would no doubt proclaim – ‘and no one has shouted stop’! The older people of Leitrim and I expect the older people of other counties deserve better.
Beginning in 1840, there were 130 workhouses capable of accommodating 100,000 inmates completed in less than four years. That was a belated response to centuries of neglect and is perhaps one of the few aspects of the history of workhouses in Ireland worth admiring. As we plan to commemorate a centenary of independence, the woefully inadequate investment in facilities to cater for the end of life needs of older people since independence justifies a bold initiative to make amends urgently.
