'To whom it may concern: Dear Sir or Madam, in order to cut down on the consumption of the board's resources, the Western Health Board would be obliged if, after January 1st, 2003, you could arrange to die before your 65th birthday."
This is the sort of correspondence that people in Ballinrobe, Co Mayo, could be getting in the near future, according to Mr Rory O'Neill of the Ballinrobe Active Retirement Association (ARA), who is supporting a campaign to locate a community nursing unit/hospital in the town.
Many members of his association have experience of caring for elderly and infirm relatives at home, or have relatives and friends in health board homes in Claremorris, Swinford, Castle- bar and Westport. Elderly infirm people from Cong, Clonbur and Cornamona could be sent as far away as Clifden or Loughrea for long-term care, and this distance contributes to loneliness and depression, he says.
The demand for a home in Ballinrobe is not new - it was first requested 30 years ago. The Western Health Board says it doesn't have the money, while acknowledging that the rural district has a higher-than-average elderly population, which is likely to increase over the next decade.
Recently the Minister of State for Health, Dr Tom Moffatt, who lost his seat in the election, said his Department was approving funding for the purchase of a site. However, the Ballinrobe ARA says it will not be satisfied until money to build the nursing unit has been "nailed down".
A Galway academic has recommended that home-based care for dependent elderly people should be delivered locally, in a flexible manner, and within the framework of an integrated health and social care system. Dr Eamon O'Shea of NUI Galway's department of economics says the provision of day-care centres and respite care should be expanded for all dependent elderly people, including those with dementia.
Dr O'Shea's recommendations are in a report he completed for the Council of Europe on improving the quality of life of elderly people. It emphasises the importance of a social focus in relation to care of the elderly. Family carers have an important role to play, it says, and should not be seen as a "free resource".