Many in nursing homes could live at home if supported - report

Provision of care disorganised, fragmented and underfunded, say social work groups

Many nursing home residents could live at home if the appropriate supports were available, according to their social workers.

More than 50 per cent of older people awaiting, or sent to, long term care from hospital wished to remain at home and could have done so, a report by a number of social care organisations says.

The most commonly needed supports to allow them to stay at home were night-time care and intensive home care packages, according to social workers surveyed for the report.

Access to lower levels of support, such as respite care, flexible daycare, supported housing and home adaptation, could also help more people remain at home.


One in three of the older people covered by the survey were medically ready for discharge from hospital but waiting for supports to be put in place. In half of these cases, the delay was caused by an inability to access home supports.

Lack of consistency

The report points to a lack of consistency across geographic areas and professional disciplines in the provision of services and the way older people are involved in decisions about their care.

The provision of care is disorganised, fragmented and underfunded, according to the organisations that produced the report, the Irish Association of Social Workers, Age Action, the Alzheimer Society and UCD's school of social work.

"Home care in Ireland is in crisis. Acute hospitals and nursing homes are being prioritised over the kinds of community services that enable older people to stay home," says Dr Sarah Donnelly of UCD, one of the report's authors.

“Waiting lists for home helps and home care packages are growing. Community care is grossly underfunded and people are simply not getting the care they need. This means more people in hospitals who don’t need to be there. It means more people in nursing homes who don’t need to be there.”

The report says assessments are “deficit based, so where a person had family members providing care, they were less likely to get any support”.

Decisions on care are regularly influenced by considerations of the risk involved, and professional practice is defensive, often to the detriment of the older person who wants to live in a manner deemed “risky” by others.

“In such cases, the rights of the older person were often ignored and pressure brought to bear on the older person to, for example, move into long-term care where it was viewed they would be ‘safer’.”

Social workers reported regularly having to advocate for the right of the person to live “at risk”.

Lack of transparency

There is a lack of transparency about older people’s entitlement to services in different areas and discrepancies between the number of hours of care they have been assessed as needing and what is approved.

Fifteen per cent of older people were not involved at all in decisions about their care, according to their social workers, and among those who were involved, this was at times “tokenistic”.

The HSE is spending less on home support care services than it was in 2008, despite the increase in the numbers aged 85 years and over, and those with dementia, the report points out.

It criticises the fact that some nursing homes “cherry-pick” residents by refusing to accept people with more advanced symptoms of dementia.

The report recommends the provision of an annual ring-fenced budget for community care, measures to ensure the dignity, rights and autonomy of older people are respected and the development of a single and fair national standard for needs assessment.

Paul Cullen

Paul Cullen

Paul Cullen is Health Editor of The Irish Times