The phrase "wasted lives" haunts us with its echoes of irrevocable losses and unused talents. The concept has been in the news this week in the context of an important report by Ombudsman Peter Tyndall. He has investigated people under the age of 65 with disabilities who have been inappropriately placed in nursing homes.
Sadly, the concept of a wasted life can probably also be applied to many more over the age of 65 in similar facilities.
This is not in any way to detract from the particular tragedy of younger people or the need to find them better alternatives as quickly as possible. But the fact remains that there are people over 65 inappropriately placed in nursing homes whose potential is being wasted, too.
There are some 1,300 people with various disabilities under the age of 65 in nursing homes, many of whom feel abandoned and as if their potential is withering away. Some do not recall giving consent to living in a nursing home while others believed it would only be a temporary measure.
There are all sorts of bureaucratic obstacles preventing people from accessing the services they need. For example, a man called Jack aged 44 suffered a brain injury after being assaulted. He has been more than a year in a nursing home. He passes his time repairing computers.
Jack’s nursing home cares for his well-being but cannot meet his needs. The home put in an application to an acquired brain-injury training course for Jack but was told that, not only had the rehabilitation window passed, but also that Jack was not eligible as he is in a nursing home and the service is for people in the community. He is on a waiting list for specialised accommodation for people with brain injuries but there are no vacancies.
While cases like this are shameful, many people over 65 could also be living fulfilling lives in their own community if they were given adequate support. The problem is not nursing homes, per se, provided that they are well run and resourced.
The problem arises when there is a mismatch between people’s needs and capabilities and their accommodation. Most of us have seen older people deteriorate rapidly, too, when they are placed in accommodation with no stimulation and no opportunity to use their abilities to contribute to society.
Peter Tyndall is far from ageist and is very aware that there are older people in similar situations.
There are important social, psychological and physical benefits to being supported to remain living within one's community
But there is a great deal of ageism in Irish society, with perhaps the most egregious example being the slowness with which we moved to protect those in nursing homes last year. Ageism was at the root, too, of last year’s blanket requirement for over-70s to cocoon, which many were deceived into thinking was a legal requirement.
Ireland has always had a propensity to institutionalise people who present difficulties or do not fit neatly into categories. That propensity is just applied to different categories of people today.
Even though there has been a significant policy shift in Ireland towards providing a spectrum of alternatives when it comes to housing for older people and people with disabilities, policy changes are slow to be translated into best practice.
If we were just looking at cost-saving, in 2019 the Housing Agency found that by supporting older people to live in homes suited to their needs, an average annual Government saving of €4,650 per person can be made.
The agency’s report looked at purpose-built housing where people have their own front door and an ability to live with a degree of independence with tailored levels of support. Even at the higher levels of support, there are significant savings to be made in comparison to nursing-home care.
More importantly, there are important social, psychological and physical benefits to being supported to remain living within one’s community, whether that be at home or in purpose-built accommodation.
Policy needs to be translated urgently into practice. The Economic and Social Research Institute projects that those aged 65 and over will number one in six of the population by 2030 while the number of people aged over 85 will double.
I have written before about innovative schemes such as McAuley Place in Naas, a residential development of 53 self-contained apartments and 60 residents, dedicated to older people living independently and with engagement in their local community. It relies on a network of 85 volunteers and the efforts of the residents themselves. Even during Covid-19, with most of the residents cocooning, it managed to organise car-park concerts, a hot dinner every day, and contact via virtual meetings with friends and family.
Originally, it was envisaged that people would transition from McAuley Place to nursing homes, but the vast majority have been able to go on living there when provided with HSE support.
The cases outlined by the Ombudsman of people aged under 65 are shocking and dispiriting. It would seem a no-brainer, however, when researching younger people who are inappropriately placed in nursing homes, that the same kind of research should be carried out concerning those over 65.