When Katie Murphy's husband died she lived on alone in the small house they had shared in west Mayo. But the house was damp, and the smoky stove did nothing for her respiratory problems. As well as that, she grew lonely and depressed: "She hated to see me leave the house and tried to keep me talking," says local G.P. Jerry Cowley, "but she didn't need a GP so much as friendship, her neighbours were caring but a good distance away."
It was to cater for such needs that Jerry Cowley co-ordinated local support to build a day centre in Mulrany, a seaside village of 300 people which serves as the hub in a hinterland of several thousands more. The centre opened in 1984. Katie and others like her came each day and blossomed. But she still had to return home each night alone, particularly difficult in the long, dark winter nights. Katie finally couldn't manage, and died in care. "It was heartbreaking that we could only do so much for her, and we finally lost her to that sad silent migration to a distant institution which is the fate of many older people, particularly in rural Ireland," says Dr Cowley.
Today Mulrany, at least, is a model of what life could be like for rural older people. St Brendan's Village, which opened in 1994, is a complex of 16 self-contained chalets overlooking Clew Bay grouped round a caretaker's house. The homes are a step away from St Brendan's Unit, offering in-house sheltered accommodation for a further 30 people no longer able to look after themselves. The whole complex - day centre, low support housing, high support housing - offers a continuum of care as, and when, it is needed. Mary Carolan is a good example of how the system works. Now aged 83, Mary was reared in Achill but left as a young woman to earn her living in Scotland. She retained her Irish links and, when she retired in 1981, she came home. So she was an early user of the day centre, where she re-established contact with old friends and made some new ones. But at the time Mary was living in damp rented accommodation, which did nothing for her asthma. So she was delighted to rent one of the chalets in St Brendan's Village and lived there happily for some years. A few months ago, Mary began to find it difficult to manage on her own and so moved into the centre. Today she shares an immaculate bedroom with another resident. She is tiny, spry and very happy: "I have a niece nearby who I see regularly," she says, "I'm very content and feel very safe."
There are others who continue to live in their own homes around Mulrany, and come to the day centre a couple of days a week for contact and stimulation. Chalet residents come and go to the centre as they please, some using its facilities more than others. Some now living in the centre have come straight from living in the village or townland, others have come from hospital for respite care and returned to their own homes - all of which illustrates the variation and flexibility with which the complex interacts with the community.
St Brendan's is now being seen as a social housing blueprint for other rural communities. Certainly the needs are pressing. Very many older people today live alone and isolated in poor housing in rural Ireland. According to the Western Health Board 1997 report, for instance, 14,000 elderly people now live alone compared with 11,000 five years ago. "The link between bad housing and poor health is well documented," says Jerry Cowley. "Many older people live in demountable, pre-cast homes, poor quality houses with no damp-proof coursing. Many have lost their families to emigration, or a wife or husband dies and they end up living alone. When they could no longer look after themselves, up to now the only solution was to move them to faraway institutions, away from the familiar, from friends and neighbours. In my experience, they quickly lose heart in these places and die before their time.
"Our dream was to keep people in their own area. Why should they have to go just because they were becoming older and more dependent? Our old folks' homes are full of people who shouldn't be there and many have lost the will to live. We know this both anecdotally but also from the literature, specifically the successive Care of the Elderly government reports."
The purpose-built day centre has a large day room, dining room, kitchen, many shower and bathrooms and an oratory. It is also the base for delivering a wide range of health-related services such as chiropodist, laundry, district nurse, eye testing, and psychiatric consultations. The bedrooms are furnished in pine which makes them extremely homely.
Each chalet has its own sittingroom and kitchen area, bedroom, bathroom and toilet. Aggie Gavin lived with her husband in Ballina. When he died, she was unable to remain alone in their rented two-storey home due to a physical disability. She brought her own furniture with her to St Brendan's and today her sittingroom is festooned with family photographs. She looks after herself and cooks her own meals: "Everyone comes in and out, and if someone doesn't appear, you would worry about them and check. I am surrounded by love and care and I don't feel alone," she says.
The success of social housing initiatives depends on the thought and planning which goes into location and environment. "Such schemes need to be community integrated, offering the maximum personal dignity, personal autonomy and independence," says Jerry Cowley. "Location is vital. Homes need to be sited in towns and villages accessible to all local amenities. And we need to keep these amenities, our transport, our post offices, we need to retain the infrastructure otherwise the depopulation of rural Ireland will continue and we will become no more than tourist villages.
"Location within the scheme is also important. The homes are built in relatively close proximity to each other, you can see your neighbours. We have good lighting, each house has its own garden, and each resident is offered the maximum independence possible. Each wears an alarm pendant round their neck, which sounds in the caretaker's house and also has a back-up monitor if one of the caretakers is unavailable. When we first built the chalets, we made four disability-friendly, now I plan to convert them all to this. Each home is built to the Department of the Environment's standards regarding insulation."
The caretakers are Sisters Anthony and Matthias of the St Louis Order and Sister Breda from the Order of Little Sisters of Mary. From their large double sittingroom window, they can see each house in the complex, and monitor all the comings and goings so that any stranger would be visible and noticed.
Capital costs of the scheme to date are £1.2m. In order to get the chalets off the ground, the voluntary group running the day centre set up Mulrany Day Centre Housing Ltd, a company limited by guarantee, and affiliated themselves to the Irish Council for Social Housing which offered valuable practical help. 90 per cent of capital funding for the village came from the Department of the Environment Voluntary Housing Capital Assistance Scheme as a non-repayable loan administered by Mayo County Council. Ongoing costs are another matter, and the patchwork nature of grant-aid shows the difficulty and dexterity needed in sustaining such services. Chalet residents pay a rent of £25 per week, two thirds of which is state-subsidised. This money is used toward defraying centre costs. Centre residents pay on a sliding scale according to their means, with all fees still considerably less than current nursing home costs.
THE village employs 25 people, none of whom are grant-aided. A further 23 work there under a Fas scheme. The wage bill is in excess of £6,000 per week. There is a considerable shortfall between what the scheme receives and what it needs, both in ongoing costs and salaries, so fund-raising is continuous and time-consuming: "I asked the Department of Health for £100,000 this year for ongoing costs, but got nothing," says Jerry Cowley.
"I'll ask again next year, and every year. If you create the right environment, people will thrive," he says. "At present many older people are over-medicalised and over-institutionalised. Thousands of older people in rural Ireland today spent their working lives abroad and came home to retire. Over the years they would have collectively sent back sums which in equivalent terms are probably greater than total EU structural funds. If every community offered something like what we have, there would be a shift in the care of older and disabled people to the most appropriate setting - back to the community where we all belong and where we are happiest."
