Second Opinion: Older people are still blamed for acute hospitals’ ills

The new report from the Emergency Department Task Force can be summed up in two words: blatant ageism. It seems that older people are to blame for all that is wrong with acute hospitals. They are hogging beds that could be occupied by more deserving (younger) people.

The report lists the six “key contributory factors” to the “trolley waits” in the emergency department. The top three specifically refer to older people and the bottom three relate to staff shortages, including “loss of corporate experience”, “challenges in attracting and retaining senior clinical decision-makers” and “reliance on agency [nursing staff]”.

The top three factors are “growth in the wait time for NHSS [Nursing Home Support Scheme] from four weeks in January 2014 to 15 weeks at the end of November 2014”, “growth in the total number of delayed discharges [lack of NHSS beds and home care packages] of the order of 30 per cent during 2014”, and a “20 per cent increase in the proportion of over-65s admitted on an emergency basis”.

People getting jobs are also blamed: “high levels of unemployment were experienced between 2008 and 2014, which led to higher levels of family and carers support being available”.

Older people are not responsible for the dogs' dinners that are Ireland's emergency departments. Successive governments and health managers are to blame. It is almost 50 years since the first report on caring for older people, Care of the Aged, was published in 1968. This was followed by 33 further reports, including The Years Ahead in 1988 and the National Positive Ageing Strategy in 2013.

Remain at home

All reports acknowledge that older people want to remain in their own homes and must be facilitated to do so through comprehensive, coordinated and accessible community services. Few of the recommendations in any of the reports have ever been implemented. According to the

Positive Ageing Strategy

, “Government policy is to support older people to live in dignity and independence in their own homes.” Despite this, another €44 million will now be spent on nursing- home beds.

Not only is the Government going against its own stated policy, it is relying on the private sector to provide the residential facilities needed by a few older people. Vital services for younger age groups are not privatised. Children from age four up are entitled to State-funded free education which is regarded as a public good. Well- educated children will grow up to be productive members of society, so are deserving of taxpayers’ money. Older people are not.

Services for children under four are also privatised. Apart from one free preschool year, parents are expected to pay the equivalent of a mortgage to childminders and creches if they want to work. This is blatant discrimination driven not only by ageism but by sexism.

Ireland does not have State-funded childcare or comprehensive community supports for older people because women are supposed to do these jobs for nothing. Nothing else can explain why, nearly 50 years after the first report on older people’s health, the same problems exist.

Achievable goal

It does not have to be this way. Facilitating all older people to live in their own homes is achievable. Norway and Sweden are the best countries in which to grow old, according to the 2014 Global Age Watch Index, which ranks 96 countries.

Sweden’s allocation to older people’s services is nearly five times the EU average and its policy is that older people can “receive assistance around the clock” in their own homes and “severely ill people can also be provided with care in their own homes”.

Only 2 per cent of older people in Sweden are in a nursing home. Ireland is in 17th place in the index, and 34th for “capability” (involvement in employment and education). Nearly 5 per cent of older people in Ireland are in a nursing home.

Over 40 years ago the Pulitzer Prize-winning author Robert Butler said, “Those who think of old people as crones, old fogies . . . garrulous, unproductive and worthless, have accepted the stereotypes of ageing, including the extreme mistake of believing that substantial numbers are in or belong in institutions.”

The taskforce report is hard evidence that ageism is still driving how health services are planned and delivered. It is well past time to provide enough community supports to all who need them. And can health managers please stop calling older people stuck in hospitals “delayed discharges”? It sounds like a sexually transmitted disease. Almost worse than bed blockers – the 1980s word for older people who needed home supports.

drjackyjones@gmail.com Dr Jacky Jones is a former HSE regional manager of health promotion and a member of the Healthy Ireland Council.