The National Independent Review Panel issued nine recommendations in its report into a governance review into a HSE-run nursing home, where a resident was sexually assaulted three years ago.
It suggested the establishment of a working group to examine and reform the management and model of care in residential facilities for older people in line with international best practice models.
It said that movement towards a more social model of care would emphasise the fact that it is the residents' home rather than a 'nursing facility'.
"This would reduce the likelihood of allegations and incidents of sexual abuse being viewed through the lens of [the residents'] medical condition," it said.
Such a working group should have a wider professional representation and include a user representative and a family representative.
It recommended that the HSE implement a staff awareness campaign (including senior staff - the Community Health Organisations), to ensure older people who are victims of sexual abuse are believed and that safeguarding allegations are taken seriously.
"This should include awareness raising on the traumatic impact of sexual abuse, and ... compassionate care for victims, to support residents, staff and families."
It said all staff working in HSE community facilities caring for vulnerable people should receive face to face/group training on the signs and symptoms of elder abuse and should include direction on how to respond appropriately to allegations that are brought to their attention.
This recommendation is in response to the HSE’s National Safeguarding Office informing the NIRP that since September 2020 awareness raising training had been moved online.
The NIRP said that learning and sharing provided "a valuable way of ensuring untrue myths around the sexual abuse of older people are debunked in a supported environment and inappropriate cultures and inaccurate staff beliefs are challenged".
It also suggested the development of a crisis response plan to ensure that there is an appropriate management response to staff, residents and families when a serious traumatic event occurs within a facility.
The HSE was asked to review the resources that are available to the local safeguarding and protection team to ensure staff are equipped with the time and energy to deal with allegations of sexual abuse in residential facilities.
It said the review should examine the availability of senior experienced social work staff in the HSE to provide strategic advice on the management of safeguarding allegations to ensure each and every allegation is reported to the appropriate authorities and immediate actions are taken to prevent reoccurrence.
It called for a memorandum of understanding or a joint protocol between the HSE and An Garda Síochána on the roles and responsibilities of both organisations (including a communication plan) when allegations of sexual abuse of a vulnerable adult are being investigated.
It also said the HSE should review the record keeping or file policy in residential facilities to ensure files are fit for purpose.
"This should include responding to the difficulties identified in this review, particularly in relation to contemporaneous note-taking in the event of an untoward incident," it said.
There were a number of incidents highlighted in the body of the report where a lack of contemporaneous records proved problematic.
There were different recollections by staff members and Emily's family of the exact time that certain steps were taken.
The Director of Nursing told the NIRP review team that she recalled contacting the former head of older persons' services at 4.30pm on 3 April 2020 to report the assault.
However, the recollection of the former head of older persons services was that the information came on the morning of 4 April 2020.
In other records reviewed by the NIRP, the time of the communication was recorded as 3.45pm.
Similarly, Emily's family member told the NIRP of going to the nursing home at 2.30pm on 3 April 2020, however the Director of Nursing's timeline stated that the arrival time was 4.30pm.
The NIRP review team acknowledged the multiple difficulties that management experienced on the day and that the timely response of the nursing home staff to inform the gardaí and Emily's strength and consistent evidence resulted in the conviction of the perpetrator.
"Nonetheless, the need for contemporaneous notes in a crisis at a crime scene cannot be overstated," it said.
The HSE responded to the NIRP in March last year acknowledging that it was the practice in the nursing home to complete contemporaneous notes.
However, it said that due to the nature of the crisis, the demands that day were to urgently respond to Emily, to the residents in the unit in the midst of the beginning of a pandemic, the staff, the gardaí, the SATU, the HSE Public Health Department, HSE management and Emily's family.
"The prompt action of the staff of the nursing home resulted in a swift response and a swift conviction."
The final recommendation suggested that the HSE review the policy of rotating HCA staff to other units to ensure vulnerable residents such as Emily get the personal, intimate care they require from a trusted individual following a trauma.
The Rape Crisis Centre can be contacted on its freephone national helpline at 1800 77 8888, at any time of day or night.
