The lack of extended care facilities for older people in the greater Dublin area has reached "crisis point", according to consultants at one of the Republic's largest teaching hospitals.
Dr Bernard Walsh, Dr Conal Cunningham and Prof Davis Coakley, the three consultant physicians in medicine for the elderly at St James's Hospital Dublin, told The Irish Times they wished to highlight "the severe contraction of extended care beds which have been provided to us in 2002".
The total number of beds available for older people in the hospital catchment area who cannot be managed in a home environment has dropped from 267 in 2001 to 180 last year.
"At present we have 83 in- patients whose only option is extended care, plus 10 young disabled patients who require a long-stay facility," Dr Walsh said, adding that these beds represented approximately 12 per cent of the hospital's total bed capacity.
Asked to what extent the inability to free up a large number of acute beds was limiting the service to patients, Dr Walsh said there were currently 30 patients over the age of 65 "in severe crisis" in the community.
"These are older people with conditions such as heart failure and severe anaemia who need hospital admission but who will have to wait some weeks for a bed to become available."
He said many were likely to attend accident and emergency departments as their conditions worsened, adding to the already severe pressure on the hospital.
Referring to the trends in extended care facilities provided to them since 1997, the three specialists said there was a marked decrease in the number of long-stay beds directly run by the South Western Area Health Board (and before 2001, the Eastern Health Board).
"The most striking feature is the increasing difficulty we have had over the past few years in having extended care beds provided which has resulted in a doubling of in-patients waiting for extended care from 40 in November 2001 to over 80 patients in November 2002," they said.
"If St James's Hospital is to be able to provide for the extended care needs of patients who present to it, it is absolutely imperative that there is an immediate increase in the level of extended care bed provision," the three consultants added.
According to a spokeswoman for the South Western Area Health Board, 122 contract beds were allocated to St James's Hospital in 2002, 49 of which were "new" beds contracted by the board to assist in alleviating pressure on its A&E department.
"These figures do not include the number of beds that would have been allocated from the board's own public hospital and homes," she said. The Eastern Regional Health Authority spent €50 million on fully and partially subvented nursing home beds last year.
The Irish Times understands there is considerable disquiet among consultants in all six Dublin area teaching hospitals that it may aid financial management as cutbacks bite to have approximately 300 patients currently waiting for long-term care.