Nursing home care: If Ranulph Fiennes can disappear, what about everyone else?

Dr Suzanne Crowe

WIDESPREAD CONCERN ABOUT the welfare in the UK of renowned explorer Sir Ranulph Fiennes reflects a growing awareness of the vulnerability of older people in residential care settings.

Fiennes, now aged 82, was the first person to completely traverse Antarctica and reached the summit of Mount Everest at the age of 65. British and international media have been focused on finding him in recent days, as he hasn’t been seen in public for two years.

Fiennes has reportedly been living in nursing homes since 2024 and has been moved between facilities in England and Wales. Recent reports say he has at times been living under an assumed name, while members of his family and friends have raised concerns about their ability to visit him. There have also been reports that Britain’s King Charles, a friend of Fiennes, was also unable to make contact with him. Cheshire Police have said that Fiennes is in an appropriate setting and receiving suitable care.

Whatever the fate of Fiennes, this high-profile case has served to once again remind us of how important it is that we have effective oversight in our nursing and care home systems. 

The decision to move an older family member into a nursing home is one of the hardest anyone will ever make. Learning to trust others to care for a loved one is a very difficult place to be, and at the very least, we deserve assurances that systems are in place to make sure that no harm can come to them. Declining cognitive capacity or physical frailty often mean dependency on trained carers – but it ought not to mean a new worry about institutional abuse.

We have had our fair share of controversies over residential care in this country. It’s 20 years since the revelations of the Leas Cross nursing home scandal. The fallout from that was a major turning point for the care of older people in Ireland against a wider backdrop of health-service reform. It fed into the establishment of the Health Information and Quality Authority (HIQA), a healthcare regulator set up to independently inspect nursing homes. 

The current picture

Despite two decades of regulation and reform, stories of the mistreatment of nursing home residents still emerge. Rather than any indication that staff have become more cruel, the increase instead reflects greater public awareness and a rise in reporting. But regardless of regulation or legislation, the picture continues to be of a small number of humans mistreating weaker humans.

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This summer, in the first case of its kind in Northern Ireland, one former healthcare assistant was convicted of ill-treatment of patients. The person took and shared degrading photographs and videos of non-verbal patients with advanced dementia on Snapchat, along with mocking commentary on their plight.

Poking fun at weaker members of our society for likes on social media is deeply offensive and wrong. The obvious misuse of the power imbalance between a healthcare worker and patient is disturbing. We ought to be even more worried about exploitation occurring off camera.

Episodes of abuse have a ripple effect. They harm the relevant person, of course, diminishing their human dignity. But the abuse of a vulnerable person also betrays the trust that a family and their community have placed in the service. It damages the wider health and social care professions, where trust and respect for human life are a vital part of our work.

In the Republic this year, the Mental Health Commission investigated Bloomfield Hospital in Rathfarnham, a long-stay facility caring for individuals with dementia, mental health issues and neurological conditions. An internal report found that vulnerable residents were verbally abused, slapped and left in soiled clothing. A number of staff resigned or were dismissed after the revelations. 

Supporting vigilance

People who cannot live independently may become isolated and are at risk of being abused by health and social care staff. This ought to make us ashamed but also want to understand the circumstances in which this occurs.

Ill-treatment of vulnerable people is not inherent to human nature; we are tribal and grounded in protecting others. The health and social care professions generally attract people who want to care for others. But it appears that when individuals are systematically devalued or confined, cruelty is more likely to emerge.

Going into a nursing home shouldn’t mean disappearing from family and friends. In fact, a social circle is a key element in protecting vulnerable people, by noticing subtle care failures and in advocating for patients’ needs.

In his book Asylums, sociologist Erving Goffman described the segregation and loss of identity which could develop in institutions such as nursing homes. When patients are seen as a burden to be managed, or bodies to be cleaned, rather than unique individuals with a value that is independent of their cognitive ability or physical capacity, the psychological barrier against mistreating them collapses.

When you place the various cases of neglect or abuse that have hit the headlines alongside one another, the underlying issues will often match, despite two decades of safeguarding awareness, mandatory reporting and regulation. Ultimately, these cases demonstrate that the social and healthcare system remains overly reliant on whistleblowers to expose the abuse of patients who cannot speak for themselves.

Another important factor in why abuse continues, is that regulation does not seem to be sensitive enough to detect depersonalisation in an institutional setting. Regulation assists a service in meeting standards of care, but it is too high-level and intermittent to pick up the early signs of compassion fatigue, moral distress and devaluing of patients by staff. Detecting these signs must occur close to the service by managers continuously attuned to their staff and patients.

Related Reads

Older people are fighting to stay out of nursing homes as legal costs soar

Almost 200 allegations of abuse of residents at nursing home in RTÉ programme were made since 2022

Opinion: After Leas Cross and Aras Attracta, how are we still failing people in nursing homes?

Is ‘just OK’ good enough?

There are also wider questions about the growing role of private companies in providing care, and about whether financial pressures can sometimes sit uneasily alongside the highly personal needs of vulnerable residents.

Even more broadly, treating essential disability costs as a political football suggests a frightening societal willingness to dehumanise care. We do not need another healthcare regulator. We need a fundamental reclamation of right from wrong and an ironclad guarantee that when whistleblowers speak up, their voices are respected, not silenced.

To address the structures that breed institutional abuse, we must enforce safe staffing ratios with an appropriate skill mix. And we ought to champion engagement with friends and family as it helps to keep vulnerable people visible, connected and safe. Our older people shouldn’t disappear when living in care. Which brings us back to Ranulph Fiennes…

The reports and concerns over his care have raised difficult questions about what happens when an older person becomes dependent on others. But if reports that even Britain’s King Charles was unable to visit his old friend are correct, then isn’t there a problem? Not because a famous person deserves greater access than anyone else, but because if someone as well-known as Fiennes can become invisible to the outside world, then what safeguards exist for the thousands of others whose disappearance from public view would attract no headlines at all?

Going into residential care should never mean disappearing from family, friends or society. Our older people deserve to be visible, valued and connected. Not because they are famous, but because they are human.

Dr Suzanne Crowe, consultant in paediatric intensive care.