Why should nursing home residents carry the can for failed housing policy?

One indicator of the Irish summer is the appearance of colourful kites along our wonderful beaches, lazily probing and capitalising on the often fickle direction of the wind. A parallel occurs in the world of politics, with summer the peak season for political kite-flying, probing the possibilities for flying as close to the wind as possible when the general population and commentariat are in a more relaxed mode.

In a complex world where change is challenging and powerful interests such as bankers and developers are entrenched and enmeshed with the political process, there is a temptation for politicians to take moral and civic short cuts through what might be seen as paths of least resistance. These generally impact on those with the least voice and power in society, and this year was no exception.

The particular kite flown was whether those among us in nursing homes might be encouraged or incentivised to rent out our houses while resident in the nursing home. Rather like crime in a multistorey car park, this is wrong at so many levels that it is hard to know where to start.

At its most fundamental it raises further troubling questions about the attitudes of the Irish State and ourselves to the integrity of citizenship of older Irish people.

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So-called Fair Deal

Older people were the first group in our population to have a major health eligibility removed from them through the so-called Fair Deal scheme – up to that point all who required nursing home care on health grounds were eligible for it at a cost of 80 per cent of the State pension.

Now they pay 80 per cent of income, 7.5 per cent per annum of the value of their assets, and up to 22.5 per cent of the value of their home for this care. The lack of insight and critical thinking at the time of the launch of the scheme was troubling in terms of not only solidarity and the realisation that not only will most of us become old, but also that a dangerous precedent had been set for differing eligibilities based on age-related diseases such as stroke and dementia.

Sadly, the patronising renting scheme positions the older person in the nursing home as a passive element

The politicians may have been emboldened by the lacklustre outcomes of the Citizens’ Assembly’s two weekends of talking about ageing. These focused on ageing in terms of perceived demands and burdens rather than the wonder of the longevity dividend, and yet again opted for new fundraising for standard services rather than including them in general eligibility.

Depressing

It is, therefore, depressing to see politicians using this vulnerable and relatively voiceless group as a distraction from the failure of successive governments to invest in social housing and to hold developers to task in developing social housing.

Even worse in terms of fostering ageism against our future selves is the diffusion of the sense of older people blocking access to housing for the homeless, a process we have already seen for “bed-blockers” and “delayed discharges” where the very genuine unmet needs of our older people have been distorted to suggest obstructive or unreasonable behaviour.

There are a range of other reasons why this scheme is highly insensitive and impractical, including that older people and their families may change their mind about nursing homes and return home, the ability to make outings to one’s own home, the wish to accommodate visiting family members from the typical Irish diaspora in the family home, the residence of other family members in the home among many others.

Equally, the state of maintenance of the homes of cash-poor older people is often compromised in terms of adequacy of renting, and the complexity of renting is already deterring solo landlords, let alone those with disabilities.

Also troubling is the issue of determining who is benefiting from this incentive to gain rental income, and ensuring that the wishes and interests of the older person are protected.

We have been here before with the financial sharks and equity-release schemes. Despite the noble intentions of the Assisted Decision-Making (Capacity) Act – which still requires considerable work to match clinical realities – it is unlikely that it will resolve this problem on its own.

Perhaps the most challenging element is the denying of the individuality and emotional richness of later life and the multifaceted nature of attachment to home. A 2016 report from the ESRI on encouraging downsizing for older people should have helped to dispel simplistic thinking about ageing and housing.

Sadly, the patronising renting scheme positions the older person in the nursing home as a passive element.

The older person is seen as a user of resources rather than a valued member of our community with desires, wishes, embedded in personal history and place, and, ironically, one who almost certainly contributed financially to the great waves of social housing development in the post-war years in Ireland.

Desmond O'Neill is professor of medical gerontology at Tallaght hospital and Trinity College Dublin