Major reform of the care of the elderly should concentrate on keeping people out of nursing homes and in the community, a new report for Government recommends.
A review of the nursing home subvention scheme suggested that a new model for funding the care of older people should favour home-care over residential.
"There seems little justification for the continued public subvention of low and medium dependency residents in either public or private long-stay care without first of all attempting to care for these people in the community," it stated.
The current system of subvention for long-stay care in private nursing homes needed reform, but it should be part of a wider strategy of keeping older people out of all types of long-stay care.
The review, prepared by Prof Eamon O'Shea, of the National University of Ireland, Galway, recommended a community-based subvention scheme.
"An essential part of any new strategy should be a community-based subvention scheme for the most vulnerable older people living at home.
"For that reason, there is a need to develop a pilot scheme for community-based subventions immediately to evaluate the optimal approach to planning and developing such a scheme on a national basis."
It proposed that up to a maximum of £120 per week should be available to support older people living at home but at risk of admission to long-stay care.
It said the best way to reduce public expenditure on private nursing homes was to ensure that fewer older people were forced to leave their homes.
Some older people had nowhere else to go. These so-called "social cases" often ended up in care for the rest of their lives because of the absence of any alternative community-based facilities.
The review recommended curtailment of access to residential care by more stringent and consistent dependency assessment across the State.
It also suggested a common approach to dependency assessment and means testing between public and private long-stay care, and an increase in the subvention for people in private care.
Currently, 47 per cent of long-stay beds were located in the public sector, 33 per cent of beds were subvented beds in the private sector, while the remaining 20 per cent of beds were private non-subvented beds.
Approximately 13,000 high to maximum dependency older people lived at home. "The key to maintaining the commitment of families in the face of changing economic and social circumstances is to further ease restrictions on eligibility for the carer's allowance," the review said.
Expenditure on the scheme increased from £12 million in 1994 to an estimated £52 million in 2001. Over 6,000 people are in receipt of a subvention.