With nursing home beds becoming scarce, it’s time to look at home care for the growing elderly population
AS OUR population ages, there will be a growing demand for supported living for older people. By 2041, an estimated 1.4 million people will be over 65 years of age.
While it is estimated that, by 2021, we will need 35,000 long-stay nursing home beds, up from 23,000 this year, other forms of support will also be required.
Minister of State for Older People Kathleen Lynch recently announced a review of the Fair Deal nursing home scheme, which funds long-term nursing home beds. She said while the provision of these beds would be examined, alternatives would also have to be looked at.
And Minister for Health James Reilly raised his concerns after a report into care needs assessment found it was likely that 80 per cent of the people assessed for long-term residential care had not been considered for or provided with home care options.
Early this year, the Minister diverted €13 million from the Fair Deal scheme to a new “intermediate care” service aimed at elderly patients experiencing delays in discharge from acute hospitals. He said as a society we had too readily allowed for older persons to be admitted into long-term care, and stressed the need for an intermediate tier of facilities and services.
Eamon Timmins of Age Action said there would always be a need for some long-term beds, but the percentage of older people going into nursing homes could be reduced by investment in supporting people to stay in their own community. We haven’t spent enough time considering what happens to older people before they are in hospital and what alternatives there are to caring for them.
“We do need to look at the bigger picture; rather than worrying about the 5 per cent going into nursing homes, we need to look at the needs of the wider population,” he said.
Bryan Meldrun, president of the Home Care Association, which is about to merge with the Professional Institute of Care Providers (PICP), said his members were ready to play their part in providing for the growing older population.
At present, home help services, chiefly involving domestic assistance, and home care packages, which are more extensive and include medical requirements, may be provided to older people in their own homes.
Private companies carry out some of this work on behalf of the HSE. But the model of care that will be offered to people in their own homes in the future will be much more complex, according to Meldrun.
In the past, if a person needed to be moved out of an acute hospital, the Fair Deal scheme was often automatically triggered, he says.
Now, the need for intermediate care has been recognised.
While this is a very positive development, a single assessment tool has not yet been introduced to help judge what type of care an older person needs.
“The single assessment tool must be brought in for use all over Ireland so that whether the older person lives in Tullamore or Dublin 4, they will be offered the same kind of options,” says Meldrun.
He said the industry was changing to adapt to the new demands. It is working with technology companies to explore the possibilities of helping older people stay at home for longer, including exploring if nursing can be carried out in the community with the aid of monitoring devices. “We’re not there yet but we are working to provide the solutions.”
Technology could allow for the monitoring of people suffering from dementia, for example, with an alarm being raised if they leave their home.
“We have to find more cost-effective solutions to Fair Deal, and provide a better quality of life for older people,” Meldrun says.
Housing associations are also changing to adapt to future needs.The Clúid Housing Association has 500 units of sheltered housing in 15 locations around the State.
The accommodation offers low-level support to individual tenants, but the organisation is planning to change that, says its regional director, Tim Porter. It has been in discussions with the Government about providing more supportive care as an alternative to nursing homes.
The new concept is Extra Care Housing, which will offer care and support on site to help people stay independent for longer.
The plan will be for GP services, physiotherapy and public health nurse services to be available in a single housing development, along with a restaurant, kitchens, treatment rooms, gym, library, computer room, shop and other facilities.
Porter mentions a traditional sheltered housing scheme in Co Limerick where one tenant who was otherwise independent was told by a public health nurse that he had to move to a nursing home because he was not eating enough or taking his medication.
“Every day he would walk from the home back to our day room,” says Porter. He had been paying rent of €45 a week, but in the nursing home he was costing the State €1,000 week.
“We got him back eventually with some supports in place,” says Porter.
Clúid will employ staff in its Extra Care Housing developments to provide all the support needed.
The accommodation will cost approximately €200 a week, with contributions from the individuals involved and the HSE. Like all Clúid housing, the developments will be not-for-profit.
They will undoubtedly save money for the Exchequer, but they will also ensure older people get the supports they need to live as independently as possible for as long as possible.
The extra care model has been around for “donkeys years” in the UK, says Porter, and needs to become part of the normal fabric of supports in Ireland. “With the growth of our older population, if we don’t start doing something about services for the elderly, we’ll get swamped,” he warns.
