Time to start planning for our demographic time bomb

Inaction in respect of care requirements will have huge implications for older persons

Over 22,000 people call private and voluntary nursing homes ‘home’. Photograph: Getty Images

Over 22,000 people call private and voluntary nursing homes ‘home’. Photograph: Getty Images


Some years back, Ireland had a boom in births. Part of the response and planning for that, while not always perfect, was to provide for new schools, creches and other services to meet the challenges of that demographic.

Another “boom” is forthcoming, and is also worthy of celebration. The CSO is projecting our population aged 85 and over will more than double in 15 years. While debate surrounding our ageing population has focused on funding pensions, little of the discussion has focused on the over-85 category who, by virtue of the levels of frailty and complexity of care needs, may require residential care.

Current research demonstrates that the demand for long-term residential care doubles for those aged 85-plus when compared with those in the 80-84 age group.

Unlike when we had the baby boom, as a country we have made little or no preparations for the care requirements of our older old – those aged 80-plus.

The reality is we are ill prepared for it and, like with many other solutions in Ireland, the focus has been only on the short term. Inaction as a policy is popular in Ireland as we have seen to our cost over the years, and inaction in respect of care requirements will have huge implications for older persons.

The social cost of failing to plan for the over-85s will prove far more distressing than the financial cost. Imagine a family having no option but to care for a loved one at home, even though the older person has complex care needs they are not in a position to meet.

The other outcome in that scenario would be for the person to seek care within an acute hospital setting, an inappropriate setting, at a much higher cost to the State – eight times higher than that of a nursing home. In that situation, for every 1,000 additional people who can’t access nursing homes, there will be an additional annual cost to the Exchequer of €273 million.

Potentially, as a society we may have up to 8,000 people unnecessarily in this situation, adding another €2 billion to our severely strained health budget.

Social or emotional cost
None of this takes account of the social or emotional cost for the older person or society and we simply cannot bury our heads in the sand.

For that reason, Nursing Homes Ireland (NHI) commissioned an independent report called Health’s Ageing Crisis: Time for Action which is available on our website, nhi.ie. People often accuse anyone who commissions a report of having a vested interest. Yes, NHI does, but our members are engaging on a daily basis with families seeking care for loved ones and they are witnessing an emerging crisis.

As an organisation we are committed, in partnership with others, to solutions.

The reality for our sector – and we are just one of many stakeholders – is that we don’t know what the future strategy of the country is in relation to this demographic time bomb that awaits us all. We commissioned the report to ensure that the debate commences now.

So what do we want to see happen? First, we must plan appropriately for the seismic requirement. The Government cannot continue to ignore this. The Department of Health must lead the way and bring all stakeholders around the table and ensure a sustainable and viable action plan is developed and agreed.

Appropriate framework
Our sector must be supported by an appropriate framework to meet this requirement. Worryingly, the State has sought to dismiss our proposal, stating such a gathering would be anti-competitive – but this is bunkum.

When the State is faced with a further €2 billion in health spend and requirement is as stark as that outlined, why refuse to engage with nursing homes already providing care and a “home from home” to more than 22,000 persons in our local communities?

This year the State has significantly reduced the resources to enable older persons requiring the dedicated care of nursing homes to avail of it. It cut the allocated spend for the Fair Deal scheme by €35 million.

This will see almost 1,000 fewer persons supported for nursing home care in 2014. The purpose of Fair Deal is to make nursing home care affordable and accessible without anxiety.

At the end of 2013, 23,007 persons were supported by Fair Deal but 1,236 were awaiting its support. The cut to Fair Deal is an imprudent and irrational move.

The appropriate planning must focus on the complexities and holistic care requirements of those requiring the specialist care provided by nursing homes.

An appropriate framework in this regard would support nursing homes in expanding to meet the significant growth for the care they provide.

This debate is not about money; it is about strategy. We aim to celebrate ageing but must embrace the responsibility that comes with a population that is growing older and living longer. We must plan and act appropriately.

As a society we must be informed if the State will continue to provide nursing home care, if the immense investment required for public homes to meet Hiqa’s 2015 physical environmental standards deadline will be forthcoming and, crucially, how the required 8,000 new beds will be provided.

Over 22,000 people call private and voluntary nursing homes “home” and equivalent staff are employed. Our sector has a key role to play in strategy planning and implementation.

We want the Department of Health to lead the required engagement and planning involving NHI, HSE, National Treatment Purchase Fund, Hiqa, Age Action and other key stakeholders.

The time for inaction is over. Prevarication has never got anyone anywhere and the State should strike while the opportunity is still there. NHI and our members are ready to play our part.

Tadhg Daly is chief executive of Nursing Homes Ireland, the representative organisation for the private and voluntary nursing home sector.

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