How about some mature discussion on ageing?


SECOND OPINION:It seems it’s open season on older people in this country, writes DES O'NEILL

WE IRISH have a contrarian and subversive streak. Our innate desire to run in the opposite direction to the pack is reminiscent of Brer Rabbit in the classic children’s tale pleading with Mr Fox not to throw him into the briar patch, when that was exactly what he wanted.

The choice of 2012 as the European Year for Active Ageing and Solidarity between the Generations seems to have been a particularly effective stimulus for this reflex, and certainly the rest of Europe might just be scratching their heads at the negative political and public discourse about generations and ageing in Ireland over the past 10 months.

On the other hand, they could not fault us for inconsistency. The only group from whom we removed statutory health entitlements in the past decade was older people, with the removal of the over-70s medical card and the entitlement to nursing home care at a cost of 80 per cent of the non-contributory pension (replaced by the so-called “Fair Deal” with much higher levies on property and income).

The debate in the Dáil at the time of removing the medical card signalled an erosion of the understanding that when illness strikes in later life, it is more likely to be complex, associated with disability, and often with several illnesses occurring at one time.

Regardless of whether you are from humble origins, or a former High Court judge (one of the examples used by the then Tanáiste to justify the removal of the over-70s medical card), the range of services needed can be very wide, from the public health nurse, through dressings, pads, equipment and appliances, to a range of therapies and home care supports.

Without the medical card, access to all of these can be hugely problematic, and add considerably to the stress, worry and challenge of continuing to live at home, a scenario that geriatricians increasingly encounter.

This European year has seen some increasingly colourful and divisive rhetoric, particularly from economic pundits, suggesting that older people are gaining at the expense of younger people, almost as if having paid off one’s mortgage (often at interest rates many multiples of today’s rates) was a form of antisocial behaviour.

The title of a recent piece by David McWilliams in The Irish Independent – “Only One Side Wins as the Generation Game Plays Out” – is typical of a wider phenomenon. Many of the apocalyptic articles appearing in the press seem not only unaware of the wider range of intergenerational transfers and supports, but their tone and temper would not be tolerated if discussing women or minority groups.

Older people and their advocates will not shy away from robust and fair dialogue about how the whole of society should respond to the enormous burden the cavalier behaviour of banks, property developers and politicians has laid at our doorstep: but to be caricatured in such a negative and simplistic manner will not facilitate such discussions.

A further source of concern is the creation of the artificial construct of a Social Insurance Fund, which is then found to be in “deficit”. Since Bismarck’s time, pensions have been provided on models of intergenerational transfer, and current generations of pensioners have provided in their time for the pensions of others. Attempts to double-load one generation – both providing for their parents’ pension and also “investing” for their own pensions – appear to be happening without appropriate debate, apart from the very helpful Tasc report on pensions strategy.

But perhaps the saddest development is the introduction of accelerated intergenerational conflict, a rolling back of the interface to a much earlier stage of life, with a much closer age gap. In school staffrooms around the State in coming years, we will find the scenario of a 24-year-old teacher and a 28 year old doing the same task, but one earning almost a third less than the other, a pattern of inequality that will create bitterness and life-long strife.

Ironically, while the trope of Berlin or Boston often features when discussing our social strategy, usually to the detriment of the United States, it is their model of social security and Medicare that provides one of the most meaningful models of intergenerational solidarity for us in Ireland.

Prof Des O’Neill is a consultant physician in geriatric and stroke medicine and professor of medical gerontology, Trinity Centre for Health Sciences at Tallaght hospital

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