Elderly care: A key reason for the delayed discharge of older people from acute hospitals in the Republic is the Ombudsman's ruling that everyone is entitled to a publicly-funded nursing home bed, an expert in the care of the elderly has said.
Mo Flynn, until recently the national care group manager for older people with the Health Service Executive (HSE), told doctors attending the annual meeting of the Irish Medical Organisation (IMO) that this perceived right to a publicly-funded bed and the poor organisation of hospital care teams were the two principal factors for delayed discharges.
Using the latest statistics from the Dublin Area Teaching Hospitals she said more than two-thirds of people waiting for long-term care were caught in what she described as the "Ombudsman's dilemma".
"The Ombudsman's ruling . . . has had the clear effect whereby a very significant number of people who would have willingly previously paid for private nursing home care are now waiting to exercise their perceived right to a publicly-funded bed," she said.
"The type of organisation of the hospital elderly care team was a key factor with late referrals and less emphasis upon multi-disciplinary team work affecting the discharge outcome."
Emphasising that the problem was not just about the availability of public beds, Ms Flynn, who is now the chief executive of Our Lady's Hospice in Harold's Cross, Dublin, said there was a need for a national debate about who should pay for long-term care.
"This very substantial proportion of delayed discharges . . . will continue to increase until clarity with regard to eligibility for long-term care and most importantly whether we are following a model of private cost sharing or universal access is provided by Government."
She called for a range of initiatives to prevent unnecessary hospital admission, including the development of public and private nursing home "in-reach" and "out-reach services".
Basing geriatricians and support teams in the community as well as expanding the availability of falls clinics and out patient stroke clinics would also help.
"If community care and step down care, including rehabilitation, were built into an inter-related care system, then following hospitalisation, some older people might only need to access high-level care on a short-term rather than permanent basis," she said.
Also addressing the session on "Care of the Elderly: meeting our responsibilities with dignity", Robin Webster, chief executive of Age Action Ireland, said there was evidence of ageism in both public policy and practice.
He criticised a lack of reference to older people in the title Department of Health and Children and said the lack of breast cancer screening for women aged over 64 was just one example of ageism in practice.
"It is unhelpful that ageing is continually mentioned as an unqualified problem, or burden, especially in economic policy," he said.
Mr Webster called for positive ageing policies that would integrate older people into society rather than age-specific policies that segregate the elderly.
In the practical provision of health services he suggested that a multi-disciplinary approach would be better than a medical dominated one.
He also called for a greater emphasis on community care of the elderly with the aim of improving the quality as well as the level of services.