On Friday morning, in Larchfield nursing home in Naas, Co Kildare, one elderly lady is enjoying a cigarette in the smoking area. Her fingernails are painted candyfloss pink. The staff do things like that at Larchfield, because it makes the residents happy.

Down the hall, two ladies are making use of the visiting hairdresser. Annie Burke, who is 79 years old, is already sitting under the dryer while her friend, 86-year-old Sheila Farrell, is having her grey hair coaxed into curlers.

Sheila is dressed, has her make-up on, has had her breakfast and is now beaming brightly at everyone she sees.

"I love it here, " she says. "I moved from Portlaoise to be near my son and I've been here two years. I was dying when I came in and they brought me back to living.

Honestly, I couldn't say a bad word about it."

"Except for the piano man, " says Annie, referring to the musician who entertains residents once a week. "He's a bit heavy on the piano. I'd never say it to him, though." She chuckles conspiratorially.

Sheila and Annie are among a small minority of mobile, independent residents in Larchfied. The rest of the room is not empty, but it's quiet. Full of high-dependency residents, some who can't speak, others who can't swallow, others who can't do anything but watch the world.

High-dependency residents are more common in nursing homes all over the country now, as people live longer and become more fragile. In Larchfield, 90% of residents are in this category.

"Fifteen years ago, this was a totally different business, " says Ellen Dillon, administrator of Larchfield, and vicechairperson of the Federation of Irish Nursing Homes. "People would come and go and lead active lives, and be generally very independent. Now, we're like a fortress trying to keep people in. We look after 50 really wonderful old people here, but they are also 50 very vulnerable people."

Larchfield could easily do with double the number of staff it has at the moment, but they can't afford it, according to Dillon, and they can't find the willing bodies to fill the positions.

"Four new staff had agreed to come in yesterday for training, " she says. "Then there was this new wave of bad publicity and only one person turned up. I just wonder by next week, will half our nursing homes be empty of staff?

It's incredibly demoralising at the moment."

Dillon's nursing home has had its own code of conduct and strict policies for years now. Among these is a policy of not using any restraint mechanisms unless it has been discussed at length with the resident's family.

"The word 'restraint' seems so awful and negative, " says Tania Chidgey, the nursing manager at Larchfield.

"But sometimes, it is needed for the safety of the resident.

For example, you could have a patient who can't walk, but is confused, and thinks that she can walk, and she stands up and falls. We don't use any belts or Buxton chairs, but we have a 'comfy chair', which works well."

This chair is out in the hallway in plain view. It's large, cushioned, bucket-shaped and tilted backwards, so that . . . while there is nothing tying you down . . . it is difficult to get out of.

Eager to promote ideas such as this, and to learn from others, Larchfield cooperated with around 40 other nursing homes in the east to form best-practice policies in relation to such issues as restraint, falls and how to deal with uncooperative patients.

"We want to expand this so that there is a set, high standard of care for all nursing homes, " says Sara Dillon, medical director at Larchfield. "We don't accept residents unless we are sure we can offer them the best possible care."

No matter how dedicated the staff are, accidents happen at Larchfield, as they do everywhere. Residents have in the past sneaked out of the home, only to be found on a busy road waving at traffic.

Larchfield staff are not saying this is acceptable. They are saying that they try everything to stop it happening. "A patient can turn over in bed at night, and break a hip, " says Tania Chidgey. "You can't stop people falling, you just have to pick them up. We can only minimise the risk as best we can."

These sentiments are echoed by the staff of Pointe Boise Nursing Home in Salthill, Galway. "Everybody makes mistakes, " says the director of care, Carol Preisler. "It's not because we're bad, it's because we're human. However, if anyone so much as cuts their finger, we tell the family. We are in constant communication with the family and that is so important. It stops small issues becoming big problems."

Liasing with the family is also emphasised by staff nurse Finnuala Curran. "Family involvement is so important, " she says. "It's not as simple as checking in your relative to a nursing home and then walking away. Families must take a certain amount of responsibility too.

"If you were putting your child in a creche, you'd check it out properly first. If you were booking a hotel, you'd make sure it had all the facilities you wanted. If you weren't happy with the service, you'd leave. It's the same with nursing homes. If you saw your mother in a nursing home and you were unhappy with the care she was getting, then you should take her home and complain about it immediately.

"We love the residents we have. We treat them like our own family. It can be an incredibly rewarding job, if you like it."

The frustration and hurt of the staff in Galway and Naas is obvious. In Galway, the nurses had spent their time off on Thursday night organising a painting exhibition for one of the patients with Parkinson's disease in the home. They wanted to do it, for the residents. They do things like that all the time. Because they care.

But that's good news. Who writes about that?