Age-old problems remain

Heart Beat: Global warming took a few days off around here in Kerry last week

Heart Beat:Global warming took a few days off around here in Kerry last week. So much so that upon waking on Friday morning the surrounding hills were snow capped.

The water in the bay was leaden coloured and choppy, driven by a restless, harrying, probing, cold wind. Most definitely it was a day for the fire and the books.

Nevertheless, I felt it necessary to leave my snug cocoon, unwilling as I was. The bad thing about exercise is that you actually have to do it if you are to derive any benefit.

Talking about it doesn't count. Even Robert Hutchin's solution - "Whenever I feel like exercise, I lie down until the feeling passes" - was not admissible. Accordingly wrapped up, muffled, booted and accompanied by the Highest Authority, I set forth.

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Miles of deserted beach, steadily pushed back by the incoming tide lay ahead. Some frozen-looking oystercatchers and an odd duck were the only creatures to share our solitude.

It was a wonderful free feeling and a feeling that I think is readily in the reach of all.

There is hardly anybody in this island who is beyond reach of some beautiful place to walk. I feel strongly that this is something we ought to do while we are able and thus perhaps postpone the melancholy days when such exercise may be beyond us and dependency, to some degree or other, looms.

This is a far cry from my going for a walk in the freezing cold other than to justify my palpable insanity. My thoughts, however, had strayed in that direction following the furore occasioned by the belated, dare I say reluctant, publication of the Leas Cross report and the problems faced by senior citizens in this and some similar establishments.

Advancing years are but part of the human condition and mean for many the loss of independence. They should never, in so far as it is possible to prevent, lead to the loss of dignity.

Leas Cross and subsequent events have shown us something unacceptable in the way we look after our older folk. I am not saying in the way Leas Cross looked after folk. I am saying in the way, we, all of us, allow such situations to develop.

The extended family, in which we all look after our own, is the admitted ideal. Despite the belated recognition of carers, this desired situation is in an increasing number of cases simply unobtainable.

It took a shock like this and Prof Des O'Neill's factual, uncompromising and, above all, uncompromised report to focus our attention away from ourselves and on to some of the most vulnerable elements of society.

In times past, many such homes were run by religious orders or by denominational guilds and foundations. Many still are and, by and large, are well administered with acceptable and good standards. They were often overseen by boards of visitors who reported regularly on their status. Many were private.

For the less fortunate and financially dependent, conditions were generally less favourable even with the illegal sequestration of the occupants' funds. It did not impinge on most of us and was a low priority. Now we have to think of it, hopefully altruistically for the benefit of all; if not selfishly because maybe that is where we are headed ourselves.

There is no "one size fits all" solution. Different folk have different needs. Some are totally dependent, some less so.

Many have physical illnesses such as heart failure, diabetes and neurological conditions. All of these require dedicated care and intensive nursing. It is no easy job to look after a melange of such conditions in the enfeebled, and instead of simply condemning and reaching yet again for the lawyers, let us rather see what can be done to help.

We must take a hard look at the motivation of the people who run such institutions and private hospitals. Most have something to give and are beyond reproach, some are well intentioned but the task is simply beyond them. Some sadly are in it to make money, their interest stimulated by tax breaks and a seemingly endless supply of clients. You make money if staff costs are pared and if heating, lighting and maintenance are below par.

Let nobody tell me this doesn't happen and hasn't happened. Of course it has and we are only now waking up. Those charged with representing our interests as citizens once more failed their duty and led us to this point.

They knew for years about some of these problems and did nothing. Now they are foremost in sending doctors and nurses' names to the gardaí. How about going yourselves, boys and girls, you are as much and more to blame?

Yes, of course, we need an independent inspectorate; we needed it years ago. The trouble is that such inspectorates rock boats and turn over flat stones. Heads down until it all blows over. In the meantime, blame a few nurses and doctors.

The real problem is that infrastructural and manning deficits are endemic in this sector and the will to face the problem is not there. On safety and manning grounds, a case could be made to close many. What do we do then? Where do the senior citizens go? Can we offer them nothing but Goethe's "no skill or art is needed to grow old; the trick is to endure it".

As usual, nobody is responsible for another health debacle. The Minister said it was a matter for the HSE. The HSE said it pre-dated its inception. We have heard this circular nonsense before. You take the job, you take the trouble.

Dr Maurice Neligan is a cardiac surgeon.