Fiona Tyrrell examines the housing options available to the elderly
Research from the National Council on Ageing and Older People reveals that just under 5 per cent of older people in Ireland live in long-term care, a figure that is low by international standards. Studies also indicate that almost nine out of 10 older people in Ireland would prefer to remain in their own homes.
International best practice and Government policy are now increasingly directed at helping older people stay in their homes as long as possible.
Improved capital funding for sheltered housing, tax breaks for privately run independent living units and the carer's allowance are some of the policies driven by the desire to keep older people at home for longer.
Most recently, Minister for Health Mary Harney announced a major boost to home care provision with the allocation of €30 million in 2006 and an additional €25 million in 2007 for home care packages earlier this year.
This allocation of funding will allow the Health Service Executive (HSE) to provide additional support for older people above and beyond the existing services.
The funding is very flexible and enables the HSE to provide services that range from full wrap-around care by a multidisciplinary team to just some home help or physiotherapy.
A public health nurse or family doctor can refer older people to the HSE for the home help packages. The older person themselves or a family member can also contact the HSE.
For people not in need of medical attention but requiring a little bit of help around the house, there are a number of agencies and companies. One is Home Instead - a company offering services that are designed to allow people to live independently for as long as possible.
Services include light housekeeping, laundry, help getting up in the morning, meal preparation, overnight stays and driving clients to appointments or social engagements.
The rate per hour ranges from €18.50 to €23, but if the older person or the family member funding the service is paying tax, the cost can be claimed back.
One drawback is that clients must pay VAT on these costs, a fact that the owner of Home Instead, Ed Murphy, has been campaigning against over the past number of months.
People looking after family members or neighbours in need of more intensive care can avail of the carer's allowance, a welfare benefit for full-time carers.
Administered by the Department of Social and Family Affairs, the allowance is €180 a week for carers under 66 and €200 if the carer is over 66. The allowance is means tested.
Aside from home help, another big problem facing older people wishing to stay at home is repairs and modifications to their homes.
With Ireland's high level of home ownership, there are many older people with very little disposable income who live in their own homes. It is not unusual for these homes to fall into serious disrepair, according to Gerard Scully from Age Action.
Grants to modify and repair homes are available through the HSE. In theory, this will help people stay at home longer, but in practice it can take up to two years to come through, he says.
Sometimes older people are "faced with the stark choice of living in a house that is uninhabitable or moving into a nursing home", according to Scully.
If living at home is not an option, sheltered housing could be considered. Privately run independent living schemes, so-called retirement villages, are a relatively new concept in Ireland.
Well established in the US and Australia, they are likely to be a big growth area in Ireland. They are aimed at people no longer comfortable living at home but not in need of a nursing home.
Age Action Ireland has noticed a significant increase in queries about them.
Thanks to tax incentives, most new schemes are being developed on the grounds of nursing homes, which means that residents can move into the nursing home when necessary.
In some schemes, nursing home operators sell the housing units they have developed on their land to investors on a sale and lease back basis. In other cases, operators sell the units outright to residents, while other schemes are operated by the nursing home and leased to residents.
Joe and Ingrid Butler, who run Middletown House Retirement Village in Courtown Harbour, Go Wexford, have built 20 independent living houses beside a nursing home they have operated for 23 years. Rent is €285 per week for a one-bedroom house.
Other options include sheltered accommodation for the elderly, which affords older people support and security without making them feel institutionalised, according to Chris White, head of development for the Irish Council for Social Housing (ICSH).
Local authorities and voluntary housing associations between them offer 13,000 dedicated sheltered housing units for the elderly in Ireland. Demand is such that, even at a conservative estimate, this figure could double, says White.
Voluntary housing associations are primarily funded by the Department of the Environment and 75 per cent of the residents must come from the housing list of the relevant local authority. The association chooses the remaining 25 per cent of residents.
The vast majority of residents will qualify for rent allowance from the health board, according to White.
Given that on average it will cost €100-€130 to house an elderly person in sheltered accommodation compared with the minimum €400 a week in a nursing home, the HSE has become "very keen" on the concept, says White.
There has been a growth in the number of locally led housing associations, following the introduction of capital funding grants from the Government. This is likely to continue with 84 more housing associations planning to develop elderly housing schemes, potentially providing an estimated 2,413 units of accommodation.
While the HSE is supportive of housing associations and gives adequate capital and management funding, there is a major shortfall in funding for healthcare and the associations rely on the goodwill of volunteers and donations, according to White.
Meanwhile, there are an estimated 28,000 older people in long-stay beds in Irish public, voluntary or private nursing homes.
Of these, 17,000 beds are in private nursing homes, the rest are in homes run by the HSE and a small number are in non-profit homes.
Tax incentives to build nursing homes over the past four years mean that the number of homes has increased significantly recently and there is an oversupply in some areas, such as the west of Ireland.
Everyone over 70 is entitled to apply for a public nursing home bed thanks to the new over-70s medical card, but Gerard Scully from Age Action Ireland warns that factors such as level of dependency and whether a home is owned will be taken into account.
For people who don't qualify for a public bed, the Government will pay a subvention to help them meet the bill, which can be claimed against tax.
However, the maximum subvention paid is €190 a week.
Depending on location in the State and the level of care required, the cost of care per week in a nursing home is between €600 and €1,000, according to Tadhg Daly, chief executive of the Irish Nursing Homes Organisation.
Although options have increased for older people, much of this is for those who have money - there is still a lot of room for improvement, according to Scully.
Age Action Ireland continues to call for the State pension to be linked to industrial earnings.
A State-operated equity release scheme, if run properly, could also be of great benefit to older people, says Scully. Finally, he also believes that retirement villages should be encouraged by the Government to target lower income older people.