Safeguarding Older People in Ireland: Preventing Abuse, Neglect, Financial Exploitation and Institutional Harm

Safeguarding concerns rarely arrive in a neat form. An older person may appear increasingly withdrawn during home-support visits. Money may be disappearing from an account without an obvious explanation. A relative may begin controlling access to the person, speaking on their behalf and discouraging contact with professionals. In a nursing home, poor practice may become normalised gradually rather than appearing as a single dramatic incident.

These realities make safeguarding a central part of Ireland’s wider ageing and long-term care system. Across the Ireland Ageing, Long-Term Care & Community Support Knowledge Hub, many of the pressures affecting older people also influence safeguarding risk: dependency, cognitive impairment, family stress, workforce shortages, isolation, institutional culture, financial reliance and fragmented service responsibility.

Ireland entered 2026 with a significantly stronger national policy direction. The National Policy Framework for Adult Safeguarding in the Health and Social Care Sector, published in December 2025, establishes a broader rights-based approach across public, voluntary and private health and social care services. It strengthens the emphasis on prevention, accountability, service-provider duties, reporting, oversight and coordinated intervention. Government has also committed to legislation intended to underpin key elements of that framework.

That distinction matters. Ireland now has a clear national policy direction and an established HSE safeguarding infrastructure, but not every proposed statutory power or duty is yet fully enacted and operational. The practical challenge is therefore twofold: improve safeguarding today through existing responsibilities, while preparing services for a more comprehensive statutory framework.

Safeguarding is broader than responding to proven abuse

Safeguarding is sometimes understood too narrowly as the process that begins after somebody reports abuse.

In practice, it starts much earlier.

The HSE describes safeguarding as protecting the safety, health, wellbeing and human rights of adults who may be at risk, reducing the likelihood of harm, empowering people to protect themselves and responding appropriately when concerns arise.

That creates three connected responsibilities:

• prevent abuse and neglect where possible;
• recognise and respond when concerns emerge; and
• protect the person without unnecessarily removing autonomy or control.

The final point is particularly important.

Safeguarding is not synonymous with stopping older people from taking risks. Excessively protective practice can itself restrict independence, privacy, relationships and decision-making.

A mature safeguarding system therefore balances protection with autonomy. That principle is closely connected to safeguarding, capacity, consent and human rights in older people’s services.

Ireland’s safeguarding architecture is moving from service policy towards a sector-wide framework

For many years, adult safeguarding within HSE older-person and disability services has been organised around the HSE’s Safeguarding Vulnerable Persons at Risk of Abuse policy introduced in 2014.

That policy created a structured approach within relevant HSE and HSE-funded services, including Designated Officers and specialist Safeguarding and Protection Teams.

The 2025 National Policy Framework for Adult Safeguarding marks a significant broadening of that approach.

Its intention is that adult safeguarding should operate across the full health and social care sector rather than remain associated primarily with particular HSE social-care services.

The framework sets a direction in which:

• public, voluntary and private health and social care providers are brought within the safeguarding architecture;
• the HSE leads and coordinates adult safeguarding across the sector;
• service-provider safeguarding duties become more explicit;
• risk evaluation, safeguarding statements and training become stronger organisational expectations;
• mandatory reporting is intended in specified circumstances;
• HIQA oversight of safeguarding arrangements is strengthened; and
• serious safeguarding incidents can contribute to formal learning and review.

Some of these elements depend on further legislation and implementation. They should therefore be understood as the direction of reform rather than assumed to be fully operational statutory duties in every setting today.

The HSE Safeguarding and Protection Teams remain central to practice

The HSE has specialist Safeguarding and Protection Teams staffed by social workers with responsibility for responding to concerns involving adults at risk.

Within relevant older-person and disability services, Designated Officers act as an important first point of coordination when concerns arise. Staff are expected to raise safeguarding concerns through the appropriate service process and relevant concerns may then involve the Safeguarding and Protection Team.

This creates a practical escalation route that is different from ordinary complaint handling.

A complaint might concern food quality, communication or delays. A safeguarding concern involves possible abuse, neglect, exploitation or harm to an adult who may have difficulty protecting themselves.

The distinction is not always clear at first sight.

For example, repeated missed care visits may initially appear to be a service-quality complaint. If those missed visits leave a person without essential personal care, nutrition or medication support, the issue may also raise safeguarding concerns.

This is why safeguarding incident response and escalation should be integrated with quality governance rather than treated as a separate specialist process.

Abuse can occur in private homes as well as regulated services

Safeguarding older people cannot focus only on nursing homes.

Many older adults live in their own homes, where abuse may be perpetrated by family members, acquaintances, neighbours, paid carers or others with access to the person.

HSE safeguarding data have repeatedly shown that concerns involving older people often arise in community settings and that immediate family members can be prominent among persons causing concern, particularly for people in older age groups.

This does not mean family care is inherently unsafe.

It means safeguarding systems need to recognise that dependency can alter relationships.

A son managing his mother’s shopping may gradually begin controlling all of her money. A spouse providing intensive care may become exhausted and neglect essential needs. A relative may prevent professionals speaking privately with the older person because they fear losing control over decisions.

The operational challenge is that the same person may be both an essential source of support and a source of risk.

Scenario: concern develops around an older person living at home

An 84-year-old man in Limerick receives home-support visits several times each week. A worker notices that he has become quieter and has stopped talking about his usual trips to the local shop.

His adult son has recently begun staying in the house. During visits, the son answers questions for him and becomes irritated when staff try to speak to his father alone.

The worker also notices that there is less food in the house despite the older man previously managing his own shopping independently.

No single observation proves abuse.

But the pattern warrants attention.

The worker records objective concerns and raises them through the provider’s safeguarding process rather than confronting the son or making assumptions about what is happening.

The older man is given an opportunity to speak privately. He explains that his son has taken his bank card “to help with things” and is withdrawing money. He is worried about challenging him because he depends on him for transport.

The response now needs to balance protection, family relationships, financial risk and the man’s own wishes.

The safeguarding process may involve the HSE Safeguarding and Protection Team and, depending on the circumstances, An Garda Síochána or other agencies. The important point is that early frontline observation created the opportunity for the older person’s voice to be heard.

Financial abuse is often hidden behind legitimate assistance

Financial abuse is particularly important in older-person safeguarding because many people rely on others for some level of financial support as health or cognition changes.

That assistance may be entirely appropriate.

A daughter may legitimately help manage bills. A trusted person may collect a pension or buy groceries. A decision supporter may have formal authority within Ireland’s supported decision-making framework.

The safeguarding question is whether money or property is being used in accordance with the older person’s wishes and legal rights.

Warning signs may include:

• unexplained withdrawals or transfers;
• changes to property ownership or financial arrangements that the person does not understand;
• pressure to provide money, gifts or loans;
• somebody controlling access to bank accounts, cards or correspondence;
• unpaid bills despite apparently sufficient income; or
• financial decisions inconsistent with the person’s known preferences.

Financial abuse can be difficult to identify because exploitation often occurs within trusted relationships.

Digital banking creates additional complexity. Older adults may share passwords or devices with relatives because online services are difficult to navigate, increasing both dependency and opportunity for misuse.

Capacity cannot be used as shorthand for vulnerability

An older person does not lose the right to make decisions simply because professionals believe those decisions are unwise.

Ireland’s Assisted Decision-Making framework is built around a functional and decision-specific approach to capacity and places strong emphasis on supporting people to make their own decisions.

This is highly relevant to safeguarding.

A person may decide to remain in contact with a relative who has previously taken money. They may choose to return home despite some environmental risk. They may refuse a service that professionals believe would improve safety.

Those decisions cannot automatically be overridden.

At the same time, apparent consent should not be accepted uncritically where there are concerns about coercion, undue influence or exploitation.

Decision Support Service guidance recognises that where a decision may have been influenced by abuse or undue pressure, the issue should be treated as a safeguarding concern.

The operational skill lies in distinguishing an autonomous decision involving risk from a decision distorted by coercion.

This is why capacity, consent and safeguarding decision-making need to be understood together rather than through separate processes.

Neglect may be deliberate, accidental or systemic

Neglect does not always involve an individual intentionally withholding care.

An exhausted spouse may become unable to meet increasingly complex needs. A provider with insufficient staffing may repeatedly miss essential support. Poor communication between services may leave nobody responsible for a task. A nursing home may allow continence, hydration or mobility support to deteriorate because weak routines have become normalised.

These situations differ in intent but can produce similar harm.

Safeguarding therefore needs to examine context.

The key questions are not only who failed to act, but why the person was left unsafe and whether the circumstances could recur.

That makes neglect closely connected to prevention and early intervention.

Repeated small failures often appear before serious harm becomes visible.

Institutional harm develops when poor practice becomes normal practice

Institutional harm is different from an isolated act of abuse by one worker.

It develops when systems, routines, leadership or culture consistently place organisational convenience above residents’ rights and wellbeing.

Examples might include people routinely being woken according to staff schedules, restrictions being used without adequate individual justification, residents having little meaningful choice over daily life, concerns being dismissed, poor staffing becoming accepted or staff using disrespectful language without challenge.

None of these patterns should be assessed only as an individual conduct issue.

If several workers behave similarly, leaders need to ask what the organisation has taught, tolerated or failed to see.

This is particularly significant in residential care because people live within the service twenty-four hours a day.

HIQA’s regulation of designated centres for older people under the Health Act 2007 provides an important external layer of oversight. Inspection can identify non-compliance in areas including governance, staffing, training, care planning and residents’ rights.

But inspection cannot be the first point at which a provider discovers that its culture is deteriorating.

The nursing-home safeguarding question is bigger than compliance

Recent scrutiny of Irish nursing-home regulation has intensified the focus on how poor practice is identified, escalated and acted upon.

Following serious public concerns about practices within parts of the nursing-home sector, an independent review of regulatory inspection processes for designated centres for older people was published in 2026.

The wider lesson is not that Irish nursing homes are uniformly unsafe. HIQA continues to report many centres that are fully or substantially compliant and where residents receive appropriate care.

The important governance question is how services detect the minority of settings where serious problems persist.

Regulation should be supported by internal intelligence including:

• complaints and concerns from residents and families;
• safeguarding notifications;
• staff turnover and agency dependence;
• injuries and incidents;
• restrictive-practice patterns;
• staff training and supervision; and
• resident experience and advocacy feedback.

Organisations examining similar oversight questions can use the Quality Dashboard Builder to structure safeguarding, quality and workforce indicators into a coherent governance view. It is not an Irish regulatory framework, but the principle of connecting multiple weak signals before serious harm occurs is widely applicable.

Scenario: poor culture is mistaken for isolated staff behaviour

A nursing home in the east of Ireland receives a complaint from a resident’s daughter that her mother is regularly told she cannot get up until staff have finished breakfast rounds.

The manager initially treats the issue as a communication problem involving one healthcare assistant.

Further review shows that several residents are being encouraged to remain in bed because mornings are difficult to staff. Employees describe the practice as normal and say they have never been told otherwise.

The issue is no longer about one worker.

It involves staffing, culture, residents’ rights, leadership and potentially safeguarding.

The provider reviews staffing deployment, speaks privately with residents, examines care plans and identifies other routines designed primarily around staff convenience.

Managers also review whether previous complaints or family comments contained similar signals that had been addressed individually rather than thematically.

The corrective action therefore goes beyond retraining one employee. It includes rota redesign, clearer expectations about choice and dignity, supervision, resident feedback and governance monitoring.

This is a critical safeguarding principle: repeated poor practice should trigger examination of the system that allowed it to become ordinary.

Restrictive practice requires particular scrutiny

Restrictions may sometimes be considered where there is a genuine safety concern, but they should never become routine substitutes for staffing, environmental adaptation or individualised support.

Bed rails, locked doors, restricted movement, surveillance technologies or other interventions can have significant implications for liberty, privacy and autonomy.

The safeguarding question is whether restriction is necessary, proportionate, individually assessed and reviewed.

This connects with positive risk-taking in older people’s care.

A zero-risk institutional environment is neither realistic nor necessarily desirable. Preventing every possibility of harm by restricting ordinary life can produce other forms of harm through loss of mobility, choice, privacy and identity.

Strong safeguarding therefore seeks the least restrictive reasonable response.

Home support creates distinctive safeguarding risks because work occurs behind closed doors

Home support has a different safeguarding environment from residential care.

Workers often operate alone, without direct supervision, inside a person’s private home.

This can create risks in several directions.

The older person may be exposed to poor practice, theft, coercion or neglect by a worker. The worker may encounter domestic abuse, unsafe environments or family conflict. They may also become the only professional regularly seeing somebody who is being abused by another person.

The forthcoming regulatory framework for home support will therefore have an important safeguarding dimension.

The Health (Amendment) (Home Support Providers) Act 2026 creates the legislative basis for registration and regulation of home-support providers, although the new regime is not yet fully commenced.

As regulation develops, safeguarding assurance will need to extend beyond policies to recruitment, supervision, incident reporting, training, lone-working controls and how concerns raised by frontline staff are escalated.

Training needs to build judgement, not merely awareness

Staff working in relevant HSE older-person and disability services are required to complete adult safeguarding training, and Designated Officers receive additional role-specific training.

Training is necessary, but knowing the categories of abuse is not enough.

Workers need judgement.

They need to recognise that a sudden change in behaviour may be significant. They need to know how to respond if a person discloses abuse without promising confidentiality they cannot maintain. They need to understand when immediate safety or Garda involvement may be required.

They also need confidence to raise concerns about colleagues or managers.

That is why safeguarding competence connects directly with safeguarding training and competency.

A workforce can be technically trained and still remain unsafe if workers fear speaking up.

Reporting culture is a leadership issue

Safeguarding systems depend on information reaching the people able to act.

That sounds obvious, yet organisational culture can suppress reporting in subtle ways.

Workers may fear disciplinary consequences, damage to team relationships or being labelled difficult. Managers may unconsciously prefer explanations that preserve the organisation’s reputation. Families may worry that complaining will affect the care their relative receives.

A strong safeguarding culture therefore needs leaders to make concern-raising ordinary rather than exceptional.

Employees should understand that reporting a concern is not an accusation of guilt. It is a mechanism for ensuring that possible harm is examined appropriately.

This connects safeguarding directly with safeguarding culture and leadership.

The best evidence of a safe culture is not necessarily a low number of safeguarding reports. Very low reporting can sometimes mean concerns are not being recognised or escalated.

Scenario: a frontline worker challenges a respected colleague

A healthcare assistant in a community nursing unit notices that an experienced colleague speaks harshly to one resident with dementia and occasionally handles her roughly during personal care.

The colleague is popular with the team and has worked there for many years.

The healthcare assistant initially doubts herself. Nobody else has complained and she worries that raising the issue will damage working relationships.

However, the behaviour continues.

She raises the concern through the service safeguarding process. Management immediately ensures the resident’s safety, records the concern and follows the appropriate safeguarding and employment procedures.

Other staff are spoken to separately. Several describe similar behaviour but had interpreted it as the colleague being “strict”.

The case reveals two risks: the conduct itself and a team culture that had gradually normalised it.

The provider responds to both.

The safeguarding process addresses the resident and alleged behaviour, while wider review examines supervision, leadership visibility, staff confidence and how concerns are discussed.

This illustrates why reporting systems must protect residents without presuming the outcome of an allegation and why organisations need to look beyond individuals when several people have witnessed the same behaviour.

Making safeguarding personal keeps the older person at the centre

A safeguarding process can become highly procedural.

Referrals, screening, risk assessments, meetings and action plans may all be necessary, but the process should not displace the person it is intended to protect.

The HSE has adapted Making Safeguarding Personal resources for Irish practice, reinforcing the importance of understanding the person’s views and preferred outcomes.

An older person may want the financial exploitation to stop without wanting their son prosecuted. They may want help managing a relationship rather than complete separation. They may want to stay at home despite some continuing risk.

Professionals cannot promise every preferred outcome, particularly where other people may also be at risk or a criminal offence is suspected.

But the person’s voice should shape the response wherever possible.

This is closely aligned with Making Safeguarding Personal and Ireland’s wider supported decision-making direction.

Advocacy becomes especially important where power is unequal

Older people involved in safeguarding processes may face several powerful actors at once: family members, providers, professionals, financial institutions and public agencies.

Independent advocacy can help the person understand options, communicate preferences and challenge assumptions.

In Ireland, advocacy support is available through organisations including Sage Advocacy, while other statutory and independent mechanisms also operate in specific settings.

The Law Reform Commission’s 2024 work on adult safeguarding highlighted gaps in consistent statutory access to independent advocacy and recommended strengthening provision across settings.

The 2025 national safeguarding policy direction further reinforces the importance of empowerment and voice.

This matters because safeguarding decisions made without meaningful participation can become another form of control.

Safeguarding does not end when somebody moves service

Transitions can create safeguarding gaps.

An older person moving from hospital to a nursing home, from a nursing home back into the community or between services may have an active safeguarding plan, known risks or restrictions on contact with another person.

If that information does not transfer appropriately, the receiving service may unknowingly recreate the unsafe circumstances.

The HSE has specific guidance addressing transfer and discharge of adults at risk of abuse between services.

The principle is wider than documentation.

Responsibility must move with the person.

This means identifying what the receiving service needs to know, who remains responsible for ongoing safeguarding actions and how the person’s confidentiality is protected while necessary information is shared.

Safeguarding therefore depends on proportionate information sharing and confidentiality, not either unrestricted disclosure or excessive secrecy.

Safeguarding data should expose patterns, not simply count referrals

National safeguarding data are important because they reveal where concerns arise and who may be most affected.

But headline referral totals need careful interpretation.

An increase can reflect greater incidence of harm, improved recognition and reporting, service expansion or a combination of factors.

Equally, a reduction does not automatically demonstrate improved safety.

Useful safeguarding intelligence examines:

• type and location of concern;
• relationship of the alleged person causing concern to the adult;
• repeat concerns involving the same setting;
• time taken to respond and complete safeguarding actions;
• whether reasonable grounds for concern were established;
• outcomes sought and achieved by the adult; and
• themes requiring organisational or policy change.

The strongest analytical question is not “How many safeguarding cases did we have?” but “What are these cases telling us about preventable risk?”

Serious incidents should produce organisational learning

The 2025 National Policy Framework places stronger emphasis on learning from serious safeguarding incidents, including strengthening the National Independent Review Panel process and moving towards a more formal statutory basis.

This is important because safeguarding systems can become focused on case closure.

A case may be resolved for one person while the same organisational weakness remains.

If a financial-abuse case arose because nobody checked a questionable change to account access, other people may face similar risk. If neglect resulted from persistent understaffing, addressing the individual incident without workforce action will not remove the cause.

Organisations considering comparable issues can use the Governance Maturity Assessment to test whether accountability, escalation and organisational learning are functioning together. The tool does not replace Irish safeguarding requirements, but it can help structure the question of whether repeated concerns are reaching decision-makers capable of changing the underlying system.

Scenario: financial abuse reveals a wider control weakness

A residential provider discovers that an employee has persuaded a resident to provide repeated cash gifts.

The immediate response addresses the resident’s safety, reports the safeguarding concern and initiates the appropriate employment process.

At first, management treats the incident as misconduct by one employee.

A later review reveals that staff have frequently helped residents access cash and banking services without clear documentation of boundaries. Managers had relied on general honesty expectations rather than specific controls around gifts and financial transactions.

No evidence emerges that other staff have stolen money, but the safeguarding case exposes a structural vulnerability.

The provider therefore strengthens guidance, introduces clearer recording of financial assistance, reinforces restrictions on accepting gifts and trains staff on financial exploitation and undue influence.

Residents are also given accessible information about their financial rights and how to raise concerns.

The organisation then reviews whether similar controls are needed across its other homes.

The value of the safeguarding process is therefore greater than resolution of one incident. It identifies a weakness that could have affected many people.

Governance should connect safeguarding, quality, workforce and complaints

Safeguarding information should not sit in isolation from other service intelligence.

Repeated complaints about rushed care, high turnover, medication errors, unexplained injuries and low resident satisfaction may each be manageable separately. Together, they may indicate a deteriorating service environment.

This is why safeguarding audit and assurance need to connect with quality and workforce governance.

Senior leaders should be able to understand:

• where safeguarding concerns are concentrated;
• whether particular services generate repeated concerns;
• whether staffing or leadership problems correlate with safeguarding risk;
• whether action plans are completed and effective;
• whether residents and families feel safe raising concerns; and
• whether learning is shared beyond the service where the incident occurred.

This is the difference between processing safeguarding cases and governing safeguarding risk.

The new national framework shifts more responsibility towards prevention

The most significant direction in Ireland’s current reform agenda is the move from a predominantly responsive model towards one that places clearer duties on organisations to prevent harm.

The National Policy Framework envisages safeguarding statements, risk evaluation, workforce training, clearer provider responsibilities, stronger HSE safeguarding functions and greater independent oversight.

The Government has also approved the development of legislation intended to provide additional statutory duties and powers, including stronger intervention mechanisms and mandatory reporting in defined circumstances.

As of August 2026, those legislative proposals should still be described as reforms being developed rather than a fully commenced comprehensive Adult Safeguarding Act.

That implementation distinction will matter operationally.

Providers should prepare for stronger obligations while continuing to meet existing duties under current HSE policy, regulation, professional requirements, criminal law and wider health and social care legislation.

International learning lies in balancing empowerment and protection

Countries organise adult safeguarding differently. Some have long-established statutory adult-protection duties held by local or regional government. Others rely more heavily on health services, criminal justice, regulation and sector-specific mechanisms.

Ireland’s emerging model reflects its own institutional structure and cannot simply be transferred elsewhere.

Its experience nevertheless highlights several widely relevant principles:

• safeguarding needs a preventative as well as investigative function;
• older age alone should not be treated as incapacity;
• financial exploitation requires cooperation beyond health and social care;
• frontline workers need safe routes to raise concerns;
• institutional harm requires organisational rather than purely individual responses;
• independent advocacy strengthens participation where power is unequal; and
• serious incidents should generate system learning.

The transferable lesson lies in building safeguarding around rights and accountability simultaneously.

The future challenge is implementation, not policy intent

Ireland now has a stronger national framework for adult safeguarding than it had only a few years ago.

The next test is whether that framework changes everyday practice.

Legislation can provide powers and duties. HIQA can provide independent oversight. The HSE can strengthen Safeguarding and Protection Teams. Providers can introduce policies and training.

But the lived quality of safeguarding will still depend on whether a home-support worker feels able to report what they have seen, whether a nurse challenges coercive family behaviour, whether a nursing-home resident is believed, whether financial concerns are investigated promptly and whether senior leaders recognise patterns rather than isolated events.

That is where policy becomes protection.

Conclusion

Safeguarding older people in Ireland is moving into a more mature phase. The 2014 HSE safeguarding system created important structures for older-person and disability services, while the 2025 National Policy Framework now establishes a broader sector-wide direction built around rights, prevention, intervention, accountability and stronger oversight.

The most important challenge is to avoid reducing safeguarding to reporting procedures. Abuse, neglect, financial exploitation and institutional harm often develop gradually through dependency, poor culture, workforce pressure, family dynamics or weak organisational controls. Effective safeguarding therefore begins before a formal allegation exists.

For older people, protection must also remain compatible with autonomy. Ireland’s supported decision-making framework reinforces the principle that safeguarding should help people exercise rights rather than remove control simply because risk exists.

The strongest future system will connect frontline observation, Designated Officers, HSE Safeguarding and Protection Teams, providers, HIQA, advocacy, Garda involvement where necessary and emerging statutory duties into one coherent architecture. Just as importantly, it will use safeguarding intelligence to change the environments in which harm occurs.

Ireland’s policy direction is becoming clearer. The harder work now lies in implementation: ensuring that older people are heard, concerns are acted upon, organisations learn and protection becomes part of everyday care rather than something activated only after serious harm has already happened.