THE INVOLVEMENT of the Health Service Executive, the Irish Hospice Foundation, Age Action and other agencies in a conference in Dublin today on residential care for older people provides an opportunity to bring some clarity to the emotive and intermittent debate on how citizens are cared for in later years.
Although only 4 to 5 per cent of us will avail of a community hospital, nursing unit or nursing home, these facilities are an essential cog in our social and health services. There have been some positive developments in recent times, including the introduction of new standards for residential care settings, efforts to develop a household model in community hospitals, the encouragement of personalised care and the continued, although tardy, provision of new facilities.
But there are real concerns. Residential care is rarely seen as one element in a continuum of service provision and much of its role has not been defined. In many cases there is little clarity on how individual nursing homes and community hospitals relate to acute hospitals, GPs and community services. Older patients resent being rushed to AE departments because their residential unit cannot provide intravenous procedures or because weekend doctor services are scarce. There is persisting worry about reduced budgets. Public confusion also abounds about the Government’s Fair Deal to finance nursing home care and there has been little push to develop sheltered housing as an alternative.
A major concern is inappropriate placement. Nursing Homes Ireland members have empty beds, although not always with the required supports, while clinically cured elderly patients occupy more costly acute facilities. The trend is for nursing home residents to be more dependent but there are about 9 per cent of older people in residential care for social reasons. Research in 2006 found that nearly 30 per cent of all long-stay residents have low to medium dependency. Why should many of these not be in their own homes?
The purpose of residential care should be clarified. The role of community hospitals deserves scrutiny too. Are they homes or hospitals? If they are the latter, is there sufficient access to doctors? Absenteeism needs to be discussed, as does the reliance on agency nurses with the concomitant effects on care continuity. Non-Irish health employees contribute magnificently but their ability to communicate with patients is not always adequate. This can worry older people. These and other sensitive issues should not be ducked.