Elderly residents at a HSE long stay hospital are spending a large part of their day in their beds at the hospital’s two largest units because they have nowhere else to go.
That is according to counsel for Health Information and Quality Authority (HIQA), Remy Farrell SC who was addressing Ennis District Court yesterday where the HSE is appealing a HIQA order that will effectively close St Joseph’s hospital in Ennis to new admissions until 2021.
The senior HIQA inspector who carried out the two inspections that resulted in HIQA imposing the order, Mary O’Mahony told the court: “Isn’t the night very long if you go to bed at 4pm and you are in bed until 8am the next morning?”
Ms O’Mahony said that in one unit at St Joseph’s Hospital it wouldn’t be unusual if 18 of the 24 residents were in bed for tea at 4pm or 4.30pm or to have 15 out of 24 residents were by their bed for their dinner.
She said: “Their whole life revolves around their bed. One carer said to me that that residents become territorial about their space and they don’t want to leave their space because they themselves are being institutionalised.”
She added: “The old people there think ‘this is it. This is the best that can be done for me’ and don’t realise that there should be better there for them.”
Ms O’Mahony said that there is an institutionalised culture at the hospital.
In the first case of its type, Mr Farrell said that the case goes beyond the HSE not complying with building regulations and that is how the HSE incorrectly characterised this in their opening statement.
Senior HIQA official, Susan Cliff said: “We have concerns about the quality of life of the residents at St Joseph’s. We have concerns about the culture that prevails in the centre.
She said: “The residents accommodated there have become institutionalised. They are now in a situation where their daily routine is getting up in the morning, sitting in a chair by their bed and remaining there until 4.30 in the afternoon when they go back to bed.
She added: “When you move from that practice, it generates anxieties in the residents and they don’t feel safe. What you don’t want is new residents going in there and becoming part of that culture as well.”
Ms Cliff said that you want a culture where staff encourages residents to go see their visitors in the sun room in the afternoon and have lunch outside their unit.
She said: “When I was at the centre in April, I spoke to one woman who was afraid to leave her bed space because she was afraid that her bed would be gone when she comes back. That is not the space we want these residents to move into.”
Henry Dowling BL for the HSE said that the HIQA action in effectively closing down the two largest units at the hospital to further admissions is “using a sledgehammer to crack a nut”.
He said: “There are other ways of dealing with this.”
In reply, Judge Patrick Durcan said: “That is my thinking on it.”
Mr Dowling said that the effect of the order by HIQA would have a debilitating effect on the provision of health services for Co Clare.
Mr Dowling said that the order that will result in St Joseph’s long stay hospital being no longer able to admit residents for its two largest units, the Hazel and Alder units which accommodate a combined 84 patients as being “unreasonable, unnecessary and disproportionate”.
Senior HSE official, Bernard Gloster told the special court sitting that the HIQA action “would effectively close down the county home”.
Mr Gloster said that last year, the hospital had 308 short stay admissions; 78 long stay admissions along with 216 rehab admissions.
Asked where the residents who availed of short stay admissions would go if the HIQA order was to be affirmed, Mr Gloster said: “I don’t know what options they would have.”
Mr Gloster said that if the HIQA order was to be affirmed by the court, it would also impact on the numbers lying on trolleys in acute hospital as the hospital provides a very important step down facility for recovering patients.
Under cross-examination from Mr Farrell, Mr Gloster admitted that non-compliances in relation to the building have been highlighted by HIQA since 2010.
Mr Gloster said that the economic climate since then didn’t afford the State to carry out those works to address the non-compliances.
Mr Gloster said that the Government has committed €12 million for the development of 52 new beds that will result in the reconfiguration of the two large Hazel and Adler units.
He said that the new works will address the HIQA concerns in relation to privacy and dignity of patients.
Mr Dowling said that a design team will be appointed for the project next year and that the project will be delivered by 2021.
Mr Gloster said that in 2015, €79,000 was spent on refurbishment works at St Joseph’s; €105,000 in 2016 and €195,000 is set aside for the spend on refurbishment this year.
The case before Judge Patrick Durcan will continue on Tuesday.