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Home where golden years were tarnished

IN 2005, Mrs Therese Lipsett left Dublin District Court with an €8,000 fine for breaching the nursing home regulations, claiming that she was the victim of a malicious campaign.

An elderly woman was found sleeping on a chair; the dressing on an elderly man's bedsore wound was contaminated with feces, and there were concerns over the safe-keeping of drugs. Mrs Lipsett, owner of Rostrevor nursing home, pleaded guilty to 10 breaches of regulations but still left court claiming no one had been wilfully neglected and that her innocence had been established. Soon afterwards, she wrote to the HSE: "As you know, I was the victim of a malicious campaign. The only sin I am guilty of is being too good and kind."

When the health watchdog, the Health Information and Quality Authority (HIQA), moved to close Rostrevor last week because of allegations that elderly patients had been assaulted, claims of malice surfaced once again. This time they were made by Therese Lipsett's daughter Sarah, who took over the nursing home after her mother was struck off the nursing register for professional misconduct. Sarah, a 30-year-old solicitor, claimed a "personal vendetta" between three staff members and a care assistant was behind the "unfounded" allegations of elder abuse. This was "a total revenge situation", she said.

Sarah Lipsett claimed the nursing home has 23 happy residents, whose families have nothing but good to say about the care they provide to their loved ones. But Rostrevor does not have the gleaming record that its owners would suggest.

Therese Lipsett, a qualified nurse and mother of three glamourous daughters, set up her nursing home in 1985. It is in a Georgian building, with its own gardens, in the leafy Dublin suburb of Rathgar. She once described it as an "intimate and beautiful" establishment catering for no more than 23 elderly residents. Sarah said last week that a retired doctor, a retired priest and a former company director are among their clients.

But behind the scenes inspectors found plenty to concern them at Rostrevor, as revealed in internal reports published by the Sunday Independent in 2004. Some concerns dated as far back as 2000, when health board officials wrote that the home was "in a very bad state hygienically" and that Mrs Lipsett had been "strongly advised" that this was "totally unacceptable." Other reports said a relative complained that her mother was often dressed in someone else's clothes and, on more than one occasion, was given her meals while sitting on the commode. Another woman had "numerous unwanted visits" from a disturbed, confused male patient, who urinated on her meal table.

In December 2002, an elderly resident fell from a window of the nursing home. Staff found him standing at the front door looking shocked, pale and sweaty. They noticed that his clothes were damp, he had grass on his feet and that the window in his bedroom was wide open. When they asked had he jumped out the window, he said he had. He was brought to hospital only the following morning, when nurses noticed that his stomach was distended. He had in fact sustained serious injuries, including a number of fractures. These facts emerged at the inquest into his death some time later, which found that he died after contracting pneumonia and an MRSA infection while in hospital.

In 2004, health board inspectors moved to shut Mrs Lipsett's operation down amid concerns over the standards of care and hygiene, and when that failed she was prosecuted in the District Court in 2005. Two months after pleading guilty to 10 breaches of nursing regulations and being fined €8,000, Mrs Lipsett wrote to the health authority making claims of a "malicious campaign" against her and pleading that they remove conditions on her nursing home's registration so that she could register with private insurer VHI.

She wrote that letter in November 2005. The same year, an elderly female resident in her care had allegedly been subjected to sexual abuse by one of her nurses.

Details of the abuse surfaced years later and only because of a subsequent investigation by An Bord Altranais, the nursing regulatory body, which published its damning findings last December.

The allegations, upheld by the nursing body, were as follows: between February and July, 2005, the male nurse worked nights at Rostrevor. During that time, staff noticed that he regularly hugged and kissed patients in an inappropriate manner, one elderly woman in particular. On one occasion, the nurse lay on the bed of an elderly female patient, who was naked. He was "partially undressed and/or" his "trousers were lowered". On another occasion, he lay on the same elderly woman's bed, both of them were partially undressed, "and her hand or hands were on (his) genitals", the nursing board inquiry found. It found that he also drank while on duty and brought alcohol into the nursing home with him.

Staff raised their concerns about him in June 2005. But Mrs Lipsett did not adequately investigate the complaints or inform the authorities, according to the inquiry. At one point, the then matron allegedly saw the nurse lying in bed with the elderly woman but the nursing board inquiry found that she failed to take appropriate action and failed to protect the patient when care staff informed her that the nurse had engaged in "physical and/or sexual contact" with her.

The allegations were reported to the HSE only in 2008 by a care assistant who had left the nursing home. Gardai investigated but the staff said to have witnessed the alleged sexual abuse of the elderly woman stated they only saw the male nurse lying on a bed. The nurse was arrested and also denied the allegation of sexual abuse. The Director of Public Prosecutions directed that he should not be prosecuted.

The nurse had left Rostrevor by then, but not without a reference from Mrs Lipsett, something which later drew harsh criticism from An Bord Altranais. Mrs Lipsett furnished "verbal or written references" to a hospital and a nursing agency, which she "knew or ought to have known" were "untrue, inaccurate, false or misleading". "You thereby exposed other patients or potential patients . . . to the risk of inadequate, or inappropriate or abusive patient care."

Following a two-year investigation, An Bord Altranais published its findings in December. The nurse was struck off for professional misconduct, as were Mrs Lipsett and the then-matron, for failing to act on the allegations when staff reported them.

When HIQA was informed of the finding, Mrs Lipsett was pressured to stand down from her role. In March this year, Mrs Lipsett resigned and her daughter, Sarah, took over as director of Kitelm Ltd, which operates the nursing home, along with her sister, Avilla. HIQA inspectors were dispatched in force to the nursing home as concerns began to mount. During two inspections on May 26 and 27, three staff indicated to Hiqa officials they had concerns about another care assistant.

They were all foreign workers, apparently afraid to talk fearing they could lose their jobs, and insisted on meeting inspectors off-site.

The allegations of abuse they subsequently divulged prompted the health watchdog to go straight to the High Court to seek a court order to shut the home down the following day.

They claimed the care assistant -- who was identified as 'P' -- had assaulted a number of patients, targeting one elderly female resident and a man, who has since died of unrelated causes.

'P' was accused of banging an elderly man's head off a door jamb and ordering staff to say the man had fallen. He allegedly kicked the same elderly man several times while he was on the ground, and refused to stop when his colleagues intervened.

He allegedly grabbed another patient so violently that he was bruised. 'P' was also accused of regularly taking an elderly woman into the bathroom on his own, having told staff that only he was allowed to do this. They claimed that the woman could be heard screaming from the bathroom.

In an affidavit, Hiqa boss Dr Tracey Cooper said that the staff who complained were "clearly frightened and concerned that any report or mentioning of these incidents would possibly lead to them losing their jobs".

"They are dependent on the home for their livelihoods as they understand that their working visas entitling them to remain in Ireland are tied to the home."

Furthermore, she said in her affidavit, they believed nothing would be done if they complained and that they could be putting their own jobs in jeopardy by reporting the abuse.

Dr Cooper's affidavit also questioned the care qualifications of Mrs Lipsett's daughter, Sarah, who took over from her mother, and suggested that Mrs Lipsett was still involved in running the nursing home.

She had "serious and immediate concerns regarding the life, health and welfare" of the 23 residents, all of whom appeared cognitively impaired to some degree and some of whom were wards of court.

The HSE took charge of Rostrevor nursing home last week following Hiqa's court application and arrangements are being made to move the residents elsewhere, despite a legal bid by the Lipsetts to stop them. The nursing home has 24 days to appeal.

Gardai have launched an investigation into the care assistant over allegations that he perpetrated five assaults on three residents.

The extent of Dr Cooper's concerns for the lives of the residents of Rostrevor stands in stark contrast to the defence mounted by the Lipsetts.

According to their version of events, the impression given is that the State body in charge of regulating nursing homes had been hoodwinked by disgruntled staff, intent on settling a score.

Sarah Lipsett did not respond to my calls this weekend, and her sister, Avila, a co-director of the company, said the family would be making no further comment. However, Sarah Lipsett claimed to one newspaper that the nursing home had never received complaints about the care assistant in question. As for bringing an elderly woman to the bathroom alone, she said "she has dementia" and she "screams sporadically".

In any case, the bathroom was beside the nurses' station and they had heard nothing. As for the elderly man whose head was allegedly banged in a door jamb, surely his GP who visits regularly would have noticed if the patient was bruised and bleeding, she suggested.

The events of the past week are a reminder that elder abuse can often be shrouded in secrecy and silence, and have led to calls for tougher legislation to protect whistleblowers.

On Friday night, Therese Lipsett called to Terenure Garda Station and made a formal complaint of fraud against one of the three staff who reported the alleged elder abuse. She asked gardai to investigate, triggering a criminal investigation into staff, who were last week hailed as heroes for blowing the whistle.

Sunday Independent