SECOND OPINION: An alternative to nursing homes has yet to be suggested
STAY IN your own home and be abused by relatives and carers or go into a nursing home and be abused by the staff. These seem to be the stark choices offered to older people in Ireland, according to recent reports. A Total Indifference to our Dignity from Age Action shows that older people would prefer to stay in their own home and endure abuse rather than go into a nursing home. Is this the best we can do?
The news that Fair Deal, our latest attempt to deal with the “problem” of older age, has run into financial difficulties is the best news ever as it will force health planners to completely review services for older people in Ireland. Although the need for more community services is widely recognised, no one has so far suggested that there is an alternative to nursing homes. The reason for this is ageism.
Over the past 50 years, the planning and delivery of services for older people has been driven by ageist attitudes. These attitudes stereotype older people as dependants and in decline or marginal members of society. Ageism generates relationships with older people that are characterised by patronage, neglect and abuse.
Ageism has led to a situation where the Irish government’s own policies have not been followed in practice. These have always asserted the desirability of enabling older people to live independent lives in their own homes and yet most resources are spent on residential care.
In 1966, the White Paper which led to the formation of the old health boards stated: “The general aim is to encourage old people to stay at home and . . . ensure that assistance is available when needed.” Prevention was emphasised in this paper and it was recognised that debilitating conditions should be nipped in the bud. The development of these preventive services and home assistance programmes was supposed to reduce considerably the number of older people needing nursing home care. These aspirations were never realised and even when I joined the old Western Health Board in 1976, community services were the poor relation. Budgets were constantly being taken from community services to prop up overspending in the acute hospitals. This is still happening today.
In 1988, The Years Aheadreport recommended re-orientating older people's services away from nursing homes and into the community, yet very little changed. The Nursing Homes Act (1990) massively increased the numbers of people in institutional care even though that was not the intention of government. The 2009 Fair Deal scheme has led to even more older people going into nursing homes even though they have consistently said they dread the idea and want to stay at home.
The Equality Authority argues that older people are not given real choices to stay in their own homes and communities, and the practice is to segregate them from the rest of society. Implementing Equality for Older Peoplepoints out that there is no legislative entitlement to the community services required. Older people are entitled by law to medical services, such as GP and acute hospital services, but they are not entitled by law to the basic services that will enable them to stay at home, such as home-help, night-sitters, housing grants and therapies that keep them mobile. At present, the provision of these services is subject to local decision-making, whereas if an older person attends an acute hospital they must receive a service. There should be a clear legislative entitlement to community services and the fact that there is not is due to ageist attitudes.
The Equality Authority notes the risk of nursing homes becoming “warehouses” for old people. This fits in with the findings in the Age Action report where older people lose their “personhood” and are seen, among other things, as having no future.
In 30 years, we will look back with horror and wonder how we thought nursing homes were an acceptable model of care in the same way we are now looking back at orphanages, industrial schools and Magdalene laundries. Some Nordic countries have decided to phase out nursing homes altogether as they are no longer considered appropriate.
HSE managers who are now planning older people’s services should bear in mind that whatever they prioritise will apply to themselves in 20 or 30 years’ time, so what do they want? Not a nursing home bed that’s for sure. We need a new Fair Deal which provides funding direct to the older person so that they can buy the community services they need to live independent lives. Older people must become more assertive and exercise their human right to participate in society as equals.
Dr JACKY JONESis a former regional manager of health promotion with the HSE