HEALTHCARE ASSISTANTS in private nursing homes are carrying out medical procedures such as catheterisations and taking bloods, which they are not qualified to perform, according to reports received by the HSE’s national safeguarding office. 

Teresa Cronin, who became the first Director of Nursing in the National Adult Safeguarding Office in 2022, told The Journal that she is increasingly concerned that lower-paid staff are having to provide a level of care to nursing home patients that they are not qualified to give. 

She said this raises risks for nurses who work in these homes as well as patients as the nurses could be held responsible if something goes wrong. 

There are adult safeguarding teams in each of the HSE’s community healthcare areas, made up of mostly social workers.

Posts were funded for a nurse to be hired into each of these teams in late 2022, but only two were hired before the HSE recruitment freeze was put in place. 

The HSE’s adult safeguarding and protection teams are tasked with assessing allegations of abuse or neglect within older persons services. 

• There are also hundreds of disabled people under-65 living in nursing homes in Ireland. The Noteworthy team want to investigate why. Support this work here. 

“We know that 74% of nursing homes in Ireland are privately run for profit now.

“We are hearing concerning reports about healthcare assistants being trained to perform medical procedures they are not qualified to carry out, such as catheterisations on older women,” Cronin said. 

“That involves a tube being inserted into the bladder of a woman who is unable to pass urine.

“It is a complex nursing intervention that you need four years of undergraduate training to perform. There are risks involved in the procedure, a risk of infection, and a need for aftercare.”

Teresa Cronin, the Director of Nursing in the HSE's National Adult Safeguarding Office.

Healthcare assistants need to have completed a QQI Healthcare Support Course to work with older people in residential facilities. 

They are not registered to any particular body, and HSE safeguarding policy at present does not pertain to private nursing homes. 

Cronin said that increasingly these workers are being hired in place of nurses, as it saves privately run homes money.

Nurses on community safeguarding teams at present do get reports concerning residents in private and voluntary nursing homes, but they are limited in the action they can take, as they aren’t given access to these facilities under the current legislation. 

“If it is a report about potential physical or sexual abuse, the team will go back to the reporter to encourage them to go to gardaí,” Cronin explained.

She further said that the National Adult Safeguarding Office is calling for safe staffing and skill mix legislation, which is in place for emergency departments, to be implemented for residential facilities. 

“We hear reports of one nurse being in place for 30 residents. The issue is, those nurses are delegating to the healthcare assistants, so if they carry out a medical procedure and something goes wrong, the nurse is ultimately responsible,” Cronin said. 

The Health Information and Quality Authority does inspect private and voluntary nursing homes, but Cronin said there is some concern that staff don’t feel free to speak openly about their experiences.

A Cork-based nurse in a private residential facility told The Journal that there is a risk of nursing becoming”obsolete” in healthcare settings like the one that she works in. 

Healthcare assistants are brought in as they cost less to hire. They are tube feeding residents, preparing food in the kitchen and then working with the residents. The risks seem to be enormous to me.

“We will be the ones held accountable if something goes wrong, and it’s our registration that is at risk, but mainly, we’re concerned about patient safety, and about the healthcare assistants who are under pressure” she said. 

Cronin said that there have been modern slavery cases in the UK connected to private nursing homes, but that there have been no reports of similar situations arising here. 

“But we certainly hear about healthcare assistants being on low pay, being brought over by recruitment agents, and then being discouraged from joining a union.

“These people will be terrified to report incidents related to residents,” she said. 

Cronin said that nurses are an essential part of adult safeguarding, and that the nurses that join the teams already set up in Ireland will give workshops to other nurses in their localities on the physical and psychological signs of abuse.  

Elder abuse can be physical, sexual, financial, emotional, and highly complex. It can be perpetrated by relatives, peers, staff members, and others. 

It can happen in people’s homes, in healthcare settings, and in other situations.

Cronin said that Irish research shows that 1 in 10 older people in Ireland experience some form of abuse each year, but that incidents are underreported. 

“We have a population of around 800,000 older people in Ireland, so we should have 80,000 referrals, but in reality, we get roughly 4,000 to 5,000 a year. 

“Part of the issue is that adult safeguarding is embryonic in Ireland, and it’s years behind child protection. Abuse happens to older people, so it is up to everyone to be on the lookout for it, to do something about it,” she said. 

The HSE information (1850 24 1850) can give contact details for HSE workers in your area that you can talk to if you have concerns related to elder abuse. Gardaí can also be contacted. 

If you would like to share an experience related to the issues raised in this article you can contact eimermcauley@thejournal.ie.