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Nursing home complaints: Allegations of poor hygiene standards and staffing issues

The allegations are contained in documents released to under the Freedom of Information Act.

MULTIPLE ALLEGATIONS HAVE been made regarding poor hygiene standards within nursing homes in Ireland, according to documents released to under the Freedom of Information Act. 

Since June last year, the documents show specific concerns were raised about staffing issues, living standards, nutrition and residents being left unattended to.  In one piece of correspondence sent to health watchdog Hiqa, it is alleged that “soiled clothing were left on the floor”. 

In that same entry, it is claimed that there is was “no assistance with meals”, however, as the sentence is heavily redacted, the full context of both instances are unclear. 

Soiled clothing Hiqa Hiqa

Another piece of information claims that “toilets don’t work correctly and general hygiene is very poor”. 

The documents concern unsolicited information received by Hiqa in relation to older persons’ services from 21 June to 25 October 2018. 

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 of the centres and people involved are removed, in order to respect their privacy. Despite this, the concerns give a real glimpse into the widespread issues and failings in residential care centres and nursing homes across Ireland.

The issues raised with Hiqa sent through unsolicited information over the course of the period outlined above range from call bells being left unanswered, inadequate staffing, concerns over food provision, to an overall lack of care.

On Thursday, Hiqa published 49 inspection reports on nursing homes in Ireland. Evidence of good practice and compliance with the regulations and standards were found in 29 centres. 

However, evidence of non-compliance was found in 20 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-compliances in areas such as staffing, governance and management, infection control, health and social care needs, personal possession, residents’ rights, and individual assessment and care plan.

Hygiene issues

In the FOI documents, multiple instances of poor hygiene are detailed.  In one instance, a concerned person (CP) outlined that they feel “there is little regard to infection prevention”. 

Another complaint outlines that “clothes and bed linen are soiled frequently”.

Meanwhile, another complaint alleges: 

Residents received no assistance with hygiene and oral care.

Another writer claimed that “toilets are blocked and overflowing” – again, the scale of this issue is unknown as the information is redacted. 

toilets Hiqa Hiqa

Another recurring theme within the documents is food standards.  One concerned person claims that there is “no choice” of “when to have breakfast” and another claims that the “food is not nutritious”.

Meanwhile, another concerned person claimed that one resident receives “no assistance at meal times”. The same entry claims that “the records are indicating the resident had a full meal” and that “staffing levels are inadequate to ensure the care and wellbeing of the residents”. 

Another entry claims that someone (it is unclear who as the information has been redacted) tested the food served to a resident and “confirmed it was not according to the diet plan”. 

Other complaints

Other common issues raised within the documents include staffing issues, concerns over building standards and dignity worries.  One entry alleges that “call bells are ignored”.

Another claims that “the alarm bells are not responded to in a timely manner”. The same entry emails that “staffing issues [are] impacting on care and wellbeing of residents”. 

callbell Hiqa Hiqa

A number of other complaints surround concerns over accommodation standards.  For example, concerns are raised over lifts being out-of-order, lack of heating and lack of ventilation.

Meanwhile, numerous concerns were raised regarding staffing issues, such as shortages of staff.

Speaking about the general types of complaints that arise within unsolicited information received by Hiqa, Fine Gael TD Fergus O’Dowd told “I think staff issues are huge. A lack of proper staff, lack of trained staff, lack of staff at weekends, a lack of trained staff on holidays. This is a recurrent, constant theme for years.

“Depending on the dependency level of patients … there should be adequate and appropriate nursing staff and care staff for the level of dependency.” 

He added that many nursing homes around the country have “over 60 beds, and many of them have very high-dependent patients”. 

Adding that he believes these sorts of complaints are “quite common” across the country, he said that “it’s very distressing for family members and family members, in a lot of cases, are very vulnerable themselves”. 

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. 

O’Dowd said that it is a “disgrace” that such FOI documents can be heavily redacted, because “the public need to know exactly what is going on in these care homes”. 

“It’s deeply frustrating that people who want to know the truth and are entitled to know that truth … that the facts are hidden from us,” O’Dowd said. 

He went on to say: “There are some excellent staff, really dedicated, committed staff and they’re done a disservice by this redaction of critical data which doesn’t personally identify anybody but which will greatly help people make up their minds about their care.” 

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, O’Dowd added: “The key problem is that Hiqa is the agency who inspects, but they don’t have the power to go in on an individual complaint. If I make a complaint about my father or brother or whatever, they can only take that on board when they go in there.” 

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 centre the registration of a centre. 

“The aim of the Health and Information 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.

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