A Look at HSE Elder Abuse - Origin and History

During most of Dolores' life, the HSE (Health Service Executive) did not exist. Public health services were delivered through the local government systems. Their funds came through lotteries known as the “hospital sweepstakes.” Attempts by the Irish Government to provide universal health care were ferociously opposed by the Catholic Church and medical profession, leading to the two-tier system in place today.

The Years Ahead Report, 1988 In 1970 the public health services were fundamentally re-organised under the the Department of Health. Health services were removed from the local authority system. The Department of Health was structured with eight regional health boards.

In June of 1981, Ireland's first body concerned with Elder Issues was formed. It was called “The Council for the Elderly.”

During this time of the Health Boards a “Working Party on Services for the Elderly” was formed in 1986. This was the first study of Elder health care issues. Their report, named “The Years Ahead – A Policy for the Elderly” was published in October of 1988. Although there were studies in other countries from as early as the 1970's raising the issue of Elder Abuse, there was no mention of it in any form in the 233 page report.

Shaping A Healthier Future Report, 1992On April 21 1994 another study of Irish healthcare was published. Called Shaping A Healthier Future, it was a four year comprehensive plan to reshape and improve health services in Ireland.
It identified over 200 targets in 17 areas of healthcare to be met and accounted for. It addressed healthcare issues concerning the Elderly, but did not mention Elder Abuse.

The report described the policy: “The Health Strategy is underpinned by the key principles of equity, quality of service and accountability.” It had very little, if any effect on the quality of care provided to the Irish people. See this for a 2001 review of the effectiveness of this policy. It has been described as being more about image than substance.

The first known use of the word “abuse” in an official report or publication about the Elderly was published in 1993. It mentions abuse one time in the context of reiterating the UN Principle on Ageing. “Older persons should be free of exploitation or abuse and be treated fairly.” It was a report on the conference proceedings called “Measures To Promote The Health And Autonomy Of Older People In Ireland.” See it on page 99 here. A position paper with the same name also mentioned Elder Abuse in 1994. See that one here.

A preliminary briefing about Elder Abuse was submitted to the Health Minister in 1996 from the National Council for the Elderly. The National Council on Ageing and Older People was established by the Minister for Health shortly after this in March 1997, and was dissolved in September 2009. It was the third National Council for elder issues; the first was the National Council for the Aged, begun in June of 1981, followed by the National Council for the Elderly, begun in Jaunuary of 1990.

It was agreed that a further study was needed. This study about Elder Abuse in Ireland was published in November 1998, mainly drawing on Canadian, American, and British studies, policies and literature. Called Abuse, Neglect and Mistreatment of Older People: An Exploratory Study, it offered many recommendations about the policy and infrastructure to deal with Elder Abuse in Ireland. National Council of Ageing and Older People In October 1999, on the foot of the above study, the Minister of State with special responsibility for Older People established the Working Group on Elder Abuse, under the aegis of the NCAOP. In September 2002, the Working Group published the report that informs much of Ireland's response to Elder Abuse today:

Protecting Our Future
More than twenty years after some other nations made Elder Abuse the subject of study and policy decisions, Ireland now had a framework in which to deal with Elder Abuse. Protecting Our Future gave a clear picture of the level of existing support for Elders suffering abuse: little to none, depending on a variety of arbitrary and random factors. Because of that, the Working Group made many recommendations about the structure that needed to be put into place to be able to offer an adequate response to Elder Abuse. From the report: “While we set out wanting (but not able) to place the response to elder abuse in the context of an adequate system of services for older people and have found that this is indeed where it should be, such a system does not currently exist. For our recommendations to be effective in addressing elder abuse, it is essential that such a system be put in place.”

They considered their recommendations to be merely an absolute minimum: “It is important to point out that we see the policy and procedures as representing a minimum change, a first step in tackling the complex issue of elder abuse in Irish society. The resources required to support the initiatives outlined here represent an absolute need.”

The report made recommendations in thirteen areas: the link to wider policy; policy on elder abuse; staff structure; legislation; impaired capacity; carers; awareness, education and training; financial abuse; advocacy; implementation; research and education; reporting abuse. It also recommended that progress in implementing Protecting Our Future should be reviewed.

The policies and framework contained in Protecting Our Future were the focus of the Elder Abuse National Implementation Group which was formed in December 2003. It drew on the talents of a wide spectrum of individuals in the areas of health, law, education, management, the Gardai, etc. They were charged “To plan, advise on and monitor, the implementation, on a phased and consistent basis, of the recommendations contained in the Report of the Working Group On Elder Abuse entitled ‘Protecting Our Future.’”

The Health Service Executive was born on January 1, 2005 as a result of the Health Act of 2004. The Health Boards were no more. In their place, the country was divided into four regions, with a total of 32 Local Health Offices:

HSE Regions and Local Health Offices

The Elder Abuse National Implementation Group was on the forefront of implementing the government's policy concerning Elder Abuse. One of the main problems they faced was funding. As such, when the EANIG published their first annual progress report in June 2006, (which detailed the progress made in 2005), they could report on only a few areas of progress. Two of the thirty-two Senior Elder Abuse Caseworkers needed were hired, and one of four Dedicated Elder Abuse Officers. No public awareness campaign was done. No studies on prevalence or collection of statistics were done.

In 2006, the Government finally provided some funding, and the implementation of Protecting Our Future had more robust progress. By the end of 2006, twenty one Senior Elder Abuse Caseworker positions had been filled, and two Dedicated Elder Abuse Officer positions had been filled.

There were 927 referrals to HSE Elder Abuse Services in 2007. The information on these is incomplete, as statistics were only starting to be gathered during the latter portion of 2007. In 2008, the first full year of data collection, there were 1,840 referrals, with 859 from HSE South, where Dolores lived. On average each Senior Elder Abuse Caseworker in HSE South handled nearly 100 referrals. The workload of the Senior Caseworkers was rapidly growing.

By the end of 2008, EANIG reported there was further progress from the HSE concerning Elder Abuse, although EANIG was disappointed: “It is with some disappointment, however, that the group reports little progress in the recommendations outside of health, perhaps resulting from the non-adoption of Protecting Our Future as overall government (as opposed to health) policy.”

Elder Abuse Steering Committees on the national and four regional HSE areas were established. This would be instrumental in gathering hard data. Twenty eight Senior Elder Abuse Caseworker positions had been filled, and three Dedicated Elder Abuse Officer positions had been filled. Approximately 4,000 HSE staff were given training in elder abuse awareness along with some voluntary agencies also receiving training. A Public Awareness Campaign was planned for the following year. The National Centre for the Protection of Older People In addition, a National Research Centre on Elder Abuse was established at University College Dublin, called the National Centre for the Protection of Older People in October 2008 (and officially launched just over one year later by the Minister for Health and Children, Mary Harney TD in November 2009).

The Elder Abuse National Implementation Group was disbanded in 2009. Many of the duties of EANIG were at that point taken over by the HSE Elder Abuse Services. EANIG was instrumental in driving many of the recommendations of Protecting Our Future, and forming the infrastructure in Ireland for responding to Elder Abuse.

In 2009, as reported in the HSE Elder Abuse Services report Open Your Eyes 2009, the number of Senior Elder Abuse Caseworkers had fallen by one, to 27, and the regional Dedicated Officers for Elder Abuse remained static at three.In this first full year of data reporting, the number of referrals for Elder Abuse jumped to 1,870. Once again, HSE South had the most referrals. Although the 65 and older population in HSE South is 27% of the total in Ireland, it saw 43% of the Elder Abuse referrals. That translates to 798 cases for HSE South. Furthermore, from the previous year, there were 33 open cases.

In 2010, although the Dedicated Elder Abuse Officers varied between two and three, the Senior Elder Abuse Caseworker number had risen to 30. Referrals to Elder Abuse were numbering over 2100. HSE South once again received hundreds more referrals than other regions, and accounted for 38% of total referrals. It was in this year that HSE Elder Abuse Services were looked upon to help Dolores.