It has been government policy since the 1960s to support older people to stay at home for as long as possible, yet the reality on the ground is different.
A dearth of practical supports means it is often a struggle for an older person to remain at home. In most cases the vast majority of care ends up being provided by unpaid carers in the family rather than the State.
Worse, the Fair Deal scheme, though meritorious in other respects, has served to intensify the pressure on older people to go into nursing home care. The scheme funds the provision of care in nursing homes but not at home, as happens with an equivalent scheme in the North.
The choice for a patient waiting to leave hospital is often between the certainty provided by a Fair Deal place and the uncertainty of meagrely funded homecare arrangements that could be removed at any time.
So even though nursing home care costs a lot more than home-based care, most of the funding in this area goes on this first option. It doesn’t make sense, but the system has been slow to change.
HSE budgets
As this report makes clear, we spend less on home supports than we did before the economic downturn.
Year after year, homecare budgets were plundered to shore up other more politically sensitive areas of the health service.
Once again this year there is already a ban on approving new homecare packages because of an overrun in HSE budgets.
The problems in homecare are largely to blame for the overcrowding crisis in hospital emergency departments (EDs). Attendances at EDs are up 7 per cent this year, and much of the increase is accounted for by over-65s. These people are flocking to hospitals in part because they cannot get the help they need in the community.
Then, after being treated in hospital and declared fit to leave, hundreds each day remain on in a hospital bed because no stepdown care can be found.
Many of these, the report shows, would prefer to go home, but are more likely to have to go into long-term care.
As one social worker quoted in the report says: “I have never met anyone who was happy to go to long-term care; there’s a lot of grief and loss.”
The situation is crying out for reform. There is a strong case for saying homecare should get a disproportionately large share of any additional funds that become available to the health service in the future.