By Jonathan Diebold
Do you ever have those dreams when you are in a situation where something awful is happening and you are screaming into the abyss? That’s what it felt like, that’s how desperate I was, because I knew the real human suffering that was happening… As a professional, I was shocked, I was ashamed, I was angry. As a human being I was heartbroken.
-Claire Doyle, nurse, on the inaction of health regulatory body HIQA after she and others made protected disclosures about the nursing home chain Emeis. HIQA took 17 weeks to investigate.
Emeis, the largest provider of nursing homes in the country, was the subject of a recent, harrowing RTÉ investigation which found severe instances of neglect. As one staff member put it, secretly being recorded by an investigator, “This is abuse”. Emeis formerly operated under the name Orpea, until a 2023 rebrand after widely publicised revelations of abuse and accusations of embezzlement, and a subsequent bailout by the French state, where it is headquartered. They operate 27 care homes in Ireland, for a total of 2,700 beds across the country, nearly 10% of the total number, as part of a portfolio spanning 20 countries.
Breathtaking neglect
RTÉ sent undercover investigators to two Emeis locations, Beneavin Manor, Dublin 11, and The Residence, Portlaoise. In Portlaoise, HIQA investigations found, among other things, low staffing levels, residents at high risk of malnutrition, in reports written as recently as this February. By the time RTÉ’s undercover investigator was on scene, nothing had been done and, indeed, the number of residents had increased from 55 to 70. In one instance, a resident was found abandoned on a toilet, desperately pulling a call bell which staff knew was broken. In another instance, the investigator was left caring for 30 people at once, alone, unable to even help residents go to the toilet for fear of breaking safety protocols and abandoning the others. In one particularly nightmarish sequence, the investigator walks down a corridor calling for help with one residence, and is met only with the chiming of bells from all directions, from other residents calling for help.
In the Beneavin Manor location, the latest HIQA review found “little concern”, with residents “happy” and the facility “well managed”. The RTÉ investigation painted a very different picture. After a 12 minute interview, an undercover investigator was hired on the spot. Finding similar instances of dangerously low staffing. Residents who requested help using the toilet were instead repeatedly forced to rely on incontinence pads. Supplies were chronically short, with management seemingly just not signing off on necessary equipment. Records of recreational activities were seen being routinely falsified in order to deceive family members into thinking such activities took place, when virtually none were provided. One staff member said “I wouldn’t put my mother here if it was my last breath”.
Rise of for-profit nursing home care
Staff in these facilities are given impossible choices. Resources they need to do their jobs are just not there. “I was like you when I was younger, but then I saw how the system is fucked” said one staff member when an undercover investigator tried to intervene in the low standard of care provided. Short staffing means workers rush to provide minimal levels of care to as many as possible, rather than adequate care levels to everyone. The for-profit ethos of these facilities means having the maximum number of beds filled and the lowest number of staff to pay. After taking into account financial assistance from the Fair Deal scheme, residents of the Portlaoise location are charged €1,200 per week, and in Beneavin, €1,400.
The switch to for-profit nursing homes has been a trend only of recent years. Previously, they made up 20% of the sector, with the state and a small number of nonprofits making up the remaining 80%. In the last decade and in particular since the pandemic, this ratio has switched, with the nursing home sector identified by large financial institutions as an underexploited market. During the pandemic, 20% of small, independent nursing homes closed. Now, 14 large private operators, including Emeis, control 40% of nursing home beds- indeed, 2020 was the year Emeis entered the Irish market. Small, independent operators make up a further 35%. The HSE closed a further 800 beds during the pandemic as the government increasingly shifted beds to the private sector. A HIQA report highlighted that increasingly nursing homes are owned by Real Estate Investment Trusts (REITs) and operated by separate companies which “are increasingly funded (at least partially) by private equity funds” and “Currently the majority of medium/large providers receive partial or full funding from private equity, many of whom rely on financing from France, Belgium, Germany and the Netherlands”.
The for profit ethos of these homes does real, quantifiable harm to the lives of residents in these homes. One expert told the RTÉ team that the abuse experienced will shorten peoples lives. Studies have found that having a REIT owning a nursing home correlates with lower nurse-to-resident ratios as firms seek to maximise profit by replacing more skilled and experienced staff. A 2024 ESRI report, Long Term Residential Care in Ireland, found that:
“There is now increasing evidence from the US (Gupta et al., 2021), England (Patwardhan et al., 2022) and other countries that the introduction of private equity has changed the landscape of health and social care, and often results in poorer outcomes for residents. For instance, Gupta et al. (2021) show that private equity ownership increases the short-term mortality of Medicare LTRC [Long Term Residential Care] residents by 10 per cent; while in England, private equity funded LTRC homes (and independently operated homes) have lower quality and regulatory compliance scores (Patwardhan et al., 2022).
A different yype of model needed
Throughout RTÉ’s investigation, small glimmers of what nursing care could look like shone through, with staff who genuinely cared and fought for their patients. With adequate resourcing and staffing, as well as real democratic input from staff, families, and residents, proper care is possible. But it isn’t possible to do so while also maximising profit. Care should be brought back into public ownership, as it was only a few years ago. But under a neo-liberal government of Fianna Fail or Fine Gael, underfunding or a return to the market will always be a threat. That is why we need a socialist transformation of society which puts people’s live first, ahead of profit and greed.
