About 32,000 people are suffering from dementia but their carers get little help from the social services, according to a report published yesterday.
Although old people want to stay at home, the failure to provide an effective community care system means more and more people are going into nursing homes, the National Council on Ageing and Older People's report warns.
It says care managers should be appointed to organise services for families, which would help to keep old people out of institutions. The report's author is Dr Eamon O'Shea of the centre for ageing studies at NUI Galway.
In addition to dementia, which includes Alzheimer's disease, lesser symptoms such as forgetfulness and confusion affect many other people to the extent that they need to be cared for, according to the report. It is estimated there are 97,000 households where a carer looks after a person aged 65 or older.
These carers are mainly women, married, aged between 40 and 54, and their burden is heavy. Those who look after a person with Alzheimer's disease spend 12 hours a day on caring.
The psychological effects on the carers "indicate a worrying level of psychological distress".
Measures to deal with the plight of carers "are needed urgently to counteract the potential for psychological distress inherent in the care of people with dementia".
These should include financial support and services such as respite care to provide them with a break from caring. It should also include training in looking after the needs of people with dementia.
At present only a small percentage of people qualify for the carer's allowance, it says. As for community care services, all that is usually available is a visit by a GP or public health nurse. In some areas a home help, home care attendant or chiropodist may be available.
The people with the best chance of getting daycare are those involved with the Alzheimer Society of Ireland or the Western Alzheimer Foundation - others are "much less likely" to get daycare services.
"Some services, such as social workers, community-based physio therapy, meals-on-wheels and sitting services, are not provided to people in either group (those with dementia or lesser psychological difficulties)."
Providing care should no longer be left in the control of the health boards, which "dampen any sustained attempts at innovation and development by local and community groups", it concludes. Instead, health boards should be obliged to work in partnership with local groups.
Daycare, sitting (staying with the older person while the carer gets a break), and therapy services provided locally could be paid for by a local care manager or through vouchers issued to carers, the report says.
In particular, it warns, the demands of long-stay institutions should not be allowed to dominate the way money is allocated to services for older people. "The most basic principle is that the preferences of older people should be respected; that means they must be supported in their home for as long as is possible and practicable."
Money which would otherwise be spent on residential care should instead be spent on keeping them at home where this is possible.
The report estimates that the cost of caring for a person with Alzheimer's disease at home is £234 a week. Part of this cost is made up of the loss of earnings suffered by the carer who cannot go out to work.
pomorain@irish-times.ie