Gareth O'Callaghan: Ageism is the last permitted prejudice - that's why nursing home scandals continue
As the architect Frank Lloyd Wright once said: 'The longer I live, the more beautiful life becomes.' I didn't feel that sentiment in the horrors I watched that evening on RTÉ, mixed with a sense of déjà vu.
In the days that followed, from the anger and distress I heard on both radio and television, and the jaded self-serving platitudes of high-ranking politicians, it was starting to sound as though residential abuse of the elderly had never happened here before. And then – as usual – it all went silent.
Perhaps that's because people have shorter memories these days; if the subject matter doesn't impact their lives, they move on unaffected. Critical stories have become little more than morbid curiosities in recent times.
Maybe it's because a critical story relevant to everyone becomes inconsequential faster, reaching its 'best-by-date' because scrolling through hundreds of different topics everyday has left us emotionally numb to the plight of the most vulnerable – namely our elders.
I found myself shouting at the radio as I listened to one man blaming covid for the shocking treatment of elderly individuals in these homes. 'This all started during lockdown,' he said. It didn't.
Leas Cross closed in 2005 several weeks after a damning RTÉ Primetime Investigates – Home Truths programme revealed that 105 residents died there between 2002 and 2004, many from grave neglect, dehydration, and malnutrition. File photo Garrett White / Collins
Ireland has a catalogue of residential abuse that dates back to the days of the asylums for the mentally ill; and with each shocking revelation over the years comes the same clichéd reactions from the politicians.
Perhaps the most publicised was Leas Cross, near Swords in Dublin, which closed in 2005, several weeks after a damning
RTÉ Primetime Investigates – Home Truths
programme revealed Dickensian living conditions. 105 residents died at the nursing home between 2002 and 2004 – many of the deaths resulted from grave neglect, dehydration, and malnutrition.
In response to the scandal, the Health Information and Quality Authority (HIQA) was established in May 2007, charged with setting and monitoring standards at private nursing homes to ensure there would never be a repeat of Leas Cross, with the power to seek a District Court Order that could close or suspend the running of these homes if continued operation posed a risk to a resident.
Mary Harney, minister for health at the time, said: 'An independent organisation with teeth is now being created.' In the years that followed, it became clear the teeth weren't doing much biting.
Six members of staff had criminal charges brought against them after revelations of residents with intellectual disabilities being abused by workers at Áras Attracta. File photo: Shay Fennelly
Roll on seven years to December 2014 when RTÉ Investigates – Inside Bungalow 3 was broadcast, featuring harrowing undercover footage of residents with intellectual disabilities being abused by workers at the Áras Attracta facility in Swinford, Co Mayo. Again there was national uproar. A garda investigation later led to criminal charges being taken against six members of staff.
As far back as 40 years ago, residents at the 'plush' Rostrevor House nursing home, which opened its doors in 1984 in Dublin's upmarket Rathgar to mostly wealthy elderly locals, were complaining of ill-treatment at the hands of some staff, including allegations of sexual abuse. It would take decades for the home to be shut down.
One of the many abuse cases at Rostrevor to be later read out in court was of a female resident, aged 101, who had been forced to sleep every night for a year in a Buxton chair – the same type of tilting chair so heavily criticised after the Leas Cross scandal.
Judge Victor Blake, in making the final order of closure of Rostrevor House at Dublin District Court in June 2011, told the court that elderly people had to be protected in their hour of need. Hiqa cited 'an alarming history of falls, injuries and incidents' at the home in their report.
These cases are just a short refresher in how many elderly parents have been treated – at their own or their families' expense – in residential homes that guaranteed that old aphorism of 'tender loving care' down through the years.
I watched with a mix of horror and déjà vu on RTÉ the revelations about The Residence Nursing Home in Portlaoise. File picture: Collins Photos
Let's quickly remind ourselves there are many excellent facilities, whose owners and staff were appalled by what they watched on RTÉ just over a week ago. But there are also homes that, for many of their residents, are nothing less than a living hell.
How many television investigations does it take to show us that there's something both wrong and evil with the system of governance in many of these places that has gone unchecked and remains unchanged for decades?
Ageism - the last permitted bias
Ageism is a stubborn prejudice – a topic very few people want to discuss. It's one of the last socially acceptable discriminations. In 2021, the World Health Organisation (WHO) released the results of a survey which found that one in every two people – half the population – were either moderately or highly ageist.
Ask anyone about global warming, or immigration, or the effects of smartphones on pre-schoolers, and they'll have an opinion and a solution. Ask them about ageism and watch their eyes glaze over because of the widespread stigma associated with it.
From a very young age, we have secretly feared becoming old. It's so engrained in our culture that we don't even notice it – but we should; because one day each one of us will be old, and a target for ageism; the last permitted bias.
It's endemic in society. So why would it not exist in nursing homes that care for elderly people? Prejudice and discrimination are two key dimensions associated with ageism, so it begs the question why are people who exhibit these traits allowed anywhere near fragile ageing patients?
If nursing home workers such as those in the recent investigation display negative assumptions about their patients' value as vulnerable human beings, or their capacity or level of understanding, then why are they working there?
Why aren't staff subjected to a psychometric test at the job interview stage that could be specifically designed to measure behavioural patterns and personality traits to see if they hold any bias against ageing patients?
And what about the language barrier? If workers in Irish nursing homes can't make themselves understood to an elderly patient, or can't understand what the patient is asking for, then what hope is there for a healthy happy environment?
It's anticipated that 135,000 people aged 65 and over will potentially be in need of nursing home care by 2031. That's less than six years from now. According to Hiqa, as of 2023, there was a total of 32,314 nursing home beds in Ireland. It's painfully obvious that as our population gets older, successive governments – including the current one – have continued to ignore a ticking time bomb.
As geriatrician Professor David Robinson said on the recent RTÉ Investigates exposé: 'This is going to shorten people's lives, and their lives will be more miserable.'
So who will mind us when we get too old to mind ourselves; and, more important, how will we be treated? Will the changes to nursing home regulations that took effect at the end of March make any difference? Most important, how will the new governance measures tackle ageist prejudices and abuse from staff?
In the aftermath of Leas Cross 20 years ago, Mary Harney said: 'I can't guarantee this won't happen again, but I can guarantee that it would be picked up on quickly.' She got it badly wrong on the latter. Nothing has really changed, so it will happen again.
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