Woman forced to stay in psychiatric unit due to nursing home uncertainty

An elderly woman with dementia, who cannot go home for safety reasons, is to remain inappropriately placed in a hospital acute psychiatric unit after 15 nursing homes were unable to admit her.

High Court president Mr Justice Peter Kelly said on Thursday the main problem appears to be due to an absence of updated national guidelines, in the context of Covid-19, for admission of new patients by nursing homes.

Fifteen nursing homes in the woman’s area had said they could not, as of now, admit her, he noted.

It appeared government protocols would be issued “in the near future” to address admissions but he did not know if that meant “days or weeks”.

While understanding that precautions have to be taken, the sooner the situation is addressed, the better, he said. He was sure this woman was not the only person medically fit for discharge from hospital for whom a nursing home place was wanted.

He was reviewing the case of the woman, aged in her 80s, who was admitted to the psychiatric unit last last year after suffering delusions.

She was admitted under the Mental Health Act and, after those orders expired last month, said she would remain in the unit voluntarily but also indicated a number of times a wish to go home.

Because it was considered her dementia and home situation made a home return unsafe, the HSE initiated wardship proceedings.

On Thursday, Paul Brady, for the HSE, told Mr Justice Kelly the woman's doctors and family agreed a nursing home was the most appropriate place for her at this time although her son hoped she would be ultimately able to return home.

The woman unrealistically believes that supports previously available to her, including from her family and elderly neighbours, will continue to be available but that is not so due to Covid 19, he said.

It is proving very difficult to get a nursing home place because of the Covid-19 situation and waiting lists, he said.

Pending a place, counsel sought orders for the woman’s continued detention in the psychiatric unit.

‘Very challenging’

Joan Doran, a solicitor appointed as the woman's guardian ad litem, said the woman was very agreeable and pleasant but was also easily alarmed by events.

She wants to go home and does not want to remain in the psychiatric unit which presents a “very challenging” situation for someone with her personality, Ms Doran said. While staff were doing their best, it is not an appropriate place for someone ready for discharge to a nursing home.

In his ruling, Mr Justice Kelly said the evidence was a home return would represent a risk to the woman’s life and health.

The current medical evidence was to the effect she is of unsound mind and lacks capacity and doctors believe she would not take medicines as required or follow pubic health guidelines in the context of Covid-19.

The evidence is she has real difficulty with daily tasks and maintaining her home and personal hygiene and had not availed of “meals-on-wheels” services. There were safety concerns for reasons including she had put dish towels on a toaster, there had been flooding incidents and she previously expressed a desire to harm herself when she felt stressed.

An acute psychiatric unit is not appropriate but it is in the woman’s best interests to remain there until a nursing home place is found, he said. The situation will be reviewed in four weeks, he directed.