Are we ready for an older Ireland?


Sir, – Your Weekend Review article “Are we ready for an older Ireland” (August 24th) raised questions about the sustainability of the Nursing Home Support Scheme (“Fair Deal”), the adequacy of funding for home support, the need for new models of support and care and a comprehensive approach to regulation and safeguarding.

It is important to stress that a minority of older people – probably one in five – requires some form of support. While at any one time less than 5 per cent of older people live in some form of congregated setting, such as a nursing home, a third of women and a quarter of men are likely to spend time in a nursing home before they die. With appropriate supports many older people can live, and die, in the place of their choice which, for the majority of older people, repeated surveys indicate is their own home. However, lack of resources and supports for people in their homes means that long-term care is now almost synonymous with nursing-home care.

Under current financing arrangements, people with specific conditions (such as stroke victims) receive free care within the acute hospital system but are subject to significant cost-sharing if they move to a nursing home or are cared for in their own homes. This means people are treated differently because of their care setting.

A 2016 public opinion survey for the Forum on Long-Term Care for Older People found that the greatest overall preference for funding long-term care was through general taxation. In contrast, the Citizens’ Assembly in 2017 reported that a compulsory social insurance payment was the preferred source of overall funding for long-term care. In May of this yearn Sage Advocacy published A New Deal, a discussion document on funding long-term support and care. It outlined the main features of an insurance-based social care model.

1) At national level, an additional earmarked social care insurance contribution would be introduced, to which employers would also contribute. This could be as an addition to PRSI or could be introduced as a replacement for the USC.

2) In the short to medium term, revenue from inheritance tax could be allocated to the fund in order to build it up to the level required for sustainable functioning.

3) Following the principle of fairness between generations, it is suggested that those aged under-40 should be exempt from the scheme for a renewable period of five years.

4) To ensure the accountability desired by the public, the funding derived from such premiums must be ring-fenced for long-term care.

Older persons in need of support and care require an integrated continuum of provision, including accommodation, assistance with daily living, nursing and medical responses. The current separation of funding for community-based and residential nursing home responses runs counter to this and any plans for a separate statutory system of home care provision will only add to the funding silos problem which has up to now incentivised use of the NHSS because it has been easier to access than adequate homecare.

In recent years, Ireland has shown the world that it can maturely deal with sensitive issues through structured public consideration and debate. It is now time to debate and then decide on a system for financing long-term support and care in an ageing society. – Yours, etc,


Sage Advocacy,

Executive Director,

Ormond Quay Upper,

Dublin 7.