“The Irish Republic fully realises the necessity of abolishing the present odious, degrading and foreign Poor Law System, substituting therefor a sympathetic native scheme for the care of the Nation's aged and infirm, who shall not be regarded as a burden, but rather entitled to the Nation's gratitude and consideration.” – Democratic Programme of the First Dáil, 1919
While not on the same scale or of the same type as that of the shocking treatment of children recounted in the recent Ryan report, the neglect of older people cited in the report into abuse and neglect at the Leas Cross nursing home makes for difficult and disturbing reading.
The litany of ill-treatment highlighted in both reports stands as a shocking indictment of a system that condemned tens upon tens of thousands of young and old alike to a life characterised by abuse and neglect instead of the love, care and appreciation they should have been treated with.
The ill treatment of older people in the privately-run nursing home in Swords, County Dublin first surfaced in 2005 after an RTÉ Prime Time undercover investigation into allegations of neglect of residents. It was shut down in August of that year after investigations showed the level of care provided in the nursing home to be sub-standard.
It subsequently emerged that there were 105 deaths at the nursing home during the period 2002-2004, a figure well above the average death rate for a similarly sized nursing home. A report by professor Des O’Neill described what happened in Leas Cross as the “systematic abuse” of residents. Many of the dead had telltale signs of severe ill treatment at their time of death, including bedsores, dehydration and malnutrition.
Amongst its key findings, the Report of the Commission of Inquiry into the Leas Cross Nursing Home identifies the inadequacy of state inspections of the facility. It also identifies the fact that no one in the Health Boards or Beaumont Hospital either noticed or reported the high rate of admissions to the hospital of unwell, dehydrated, wound-infected and malnourished residents from Leas Cross. No one from either the Twenty-Six County Health Service Executive [HSE] or Beaumont Hospital is identified by name in the report, something which prompted relatives to denounce the report as a “whitewash”.
The most interesting aspect of the report, however, is that which links the registration by the state of 73 new beds, on top of the 38 already in use in Leas Cross since the business’ establishment in 1998, and their subsequent filling by high-dependency dementia and Alzheimer’s disease suffering former residents of St Ita’s Hospital in Portrane, County Dublin with a decline in levels of care. The report states that the registration of these beds occurred in the absence of due consideration being given to the quality of care that residents might subsequently be liable to experience.
Although the report’s author doesn’t make this point [and he should have], it is a fact, nonetheless, that a decline in standards of this type is a feature of what happens to health and social care services when they are ‘outsourced’ to private business interests. It goes something like this: it costs money to take care of residents. Businesses are concerned with making profit. The less money expended on the care of residents equals more profit. The tendency, therefore, is for the standard of care to be less where there is a profit motive. This is the logic of the market.
It is an iron law of capitalism that profit must be made if a business is to remain ‘viable’. Making profit from crucial social services is facilitated where you have a government that believes in the neo-liberal agenda. In effect, what you have, in this instance, is a situation where the state turns over crucial social services to private, for-profit business interests and, in the process, abdicates its responsibility to provide for the care of its infirm senior citizens. This is exactly what happened in Leas Cross.
One of the main findings of the report is that there was nowhere near enough qualified staff in Leas Cross to meet the needs of residents [qualified staff cost money] and no-one from the HSE to notice this because inspections weren’t prioritised – a case of ‘out of sight, out of mind’.
Rudolf Rickes could very easily have been writing about Ireland when, in his book Social Justice Yesterday – Today – Tomorrow, A Critical Reflection, he notes how, “If one considers the observation that the worth and dignity of a civilization is judged by the way it treats its weakest members, we cannot help but look back in shame at our past.”
However, Rickes didn’t need to refer to Ireland specifically. In noting the tendency in some ‘civilized’ societies to mistreat its weakest members, he was, in fact, referring to a characteristic that is a relatively constant feature of care systems in capitalist countries.
As callous as it might seem, the reality is that those who find themselves in the care of the state are, by that very fact, no longer contributors to the economy. Their age or infirmity makes them superfluous to the needs of the economy, unless that is, they can be sent out to work as slaves, which is exactly what happened in many state institutions. Their powerlessness means that they are liable to be and, often are, deemed a burden on the system.
As the recommendations of the McCarthy Bord Snip report clearly demonstrate, in bourgeois societies it is the health of the economy which is deemed to be far more important than the health and welfare of human beings. Where this is the principle that governs social and economic life, it doesn’t take a great leap of imagination to see how the young and old in care might not be seen as a priority for those in control of society.
Mr Tony Mullins of the Leas Cross Deaths Relatives Action Group found it “ironic to note that the abuses highlighted in the report happened at a time of plenty and not cutbacks”. In the context of a capitalist state, however, there is, unfortunately, no irony at all in this fact.
In the final analysis, the abuse and neglect that occurred in residential care institutions derived principally from the fact that the people who inhabit them have traditionally been seen as a burden on the state and society. It has ever been a case of ‘out of sight, out of mind’, and, once out of sight and out of mind, there has always existed the real possibility that a society that views the vulnerable and powerless this way will treat them accordingly. Thankfully, this is changing somewhat. Certainly, the ability of the authorities to keep secret what happens behind the high walls of its institutions is becoming less and less tenable. Hence, the Leas Cross report, although the best that Twenty-Six County minister for health and children Mary Harney could offer in the aftermath of its findings was that she couldn’t “guarantee this won’t happen again”, but could “guarantee that it would (if it happened again) be picked up quickly”.
The publication of the Leas Cross report does not for a second suggest that abuse and neglect does not still occur and will not occur in future in state institutions and the private companies to which the state has increasingly outsourced its responsibilities. Given the nature of government in the Twenty-Six County state, it is highly possible that this type of scenario will occur again in the future.
According to Age Action Ireland’s spokesperson Eamon Timmins: “The arms of the state responsible for protecting these people let them down, and let them down in a major way. It is unclear if the systemic failures would have hidden the problem if it had not been for the media.”
In an article entitled Respect for the elderly, Jim Clarke states that “a study into elder abuse by the National Council for Ageing and Older People estimated that as many as 12,000 older Irish people might be suffering from some form of abuse at any given time. The report, 'Abuse, neglect and mistreatment of older People' found that the reluctance of society to recognise the problem of elder abuse is merely following a pattern of how such abuses come to be accepted.”
As with all others forms of abuse and neglect, the institutionalised abuse and neglect of older people will continue as long as we have an economic system based upon the profit motive. We will continue to see the vulnerable suffer so long as the profit motive and outsourcing of social services is supported by a government that cherishes the market and is content to rule in a society where greed triumphs over need.
On a daily basis, we are reminded of the reality that the vision of the 1916 Proclamation remains just that, a vision. We are constantly reminded that the most important aspect of the liberation of Ireland, i.e. the liberation of its people, is impossible under capitalism. We are readily reminded of the chasm that exists between the intent, spirit and letter of the 1919 Democratic Programme of the First Dáil and that of every subsequent programme for government.
The more the state abdicates its responsibilities towards the young, the old and the infirm, the more it loses its right to govern. The more government surrenders to a neo-liberal agenda with its guiding notions of the ‘small state’ and the ‘government-as-facilitator for private business and profit’, the more it moves away from the citizen-centred principles at the heart of the 1916 Proclamation and the 1919 Democratic Programme.
The more it does so, the more it demands others to depose them and institute a system where the population and not profit margins are cherished.