In his preamble to Budget 2023, Minister for Public Expenditure and Reform Michael McGrath flagged the fact that “these were not normal times, they would be responded to by unprecedented resources and a breadth of measures with a speed of execution”. Although it is too early to comment on the speed of execution of Government policy, it certainly appears as if Santa has arrived early this year, scattering welcome pressies to all.
There have been new cost-of-living supports including electricity credits available to all households; increases in weekly social welfare payments; additional payments to carers; once-off additional payments to those living alone and on disability allowance; reductions in some student contributions; double child benefit; and the list goes so on. These are measures introduced to reduce the financial burdens faced by households and are designed to target those most in need.
But let us drill down deeper and reflect on one especially vulnerable group in our society: people who have dementia and their family members, some of whom provide 24-hour care. Has the budget really been that generous to them? About 64,000 people in Ireland are living with dementia, about two-thirds of whom live at home in the community. The remainder live in nursing homes, welfare homes, hospitals or psychiatric institutions, sometimes in congregate settings far from ideal for their unique and complex needs. As most people know, it was this group of older people who were hardest hit by the Covid-19 pandemic.
In its pre-budget submission 2022, the Alzheimer Society of Ireland (ASI), which provides the main bulk of specialist dementia services, appealed to the Government for €29 million to support the development and expansion of dementia services. Two-thirds of this funding — €18 million — was to be spent on the reconfiguring of specialist day-care centres to comply with Covid-19 requirements and to make them fit for purpose.*
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For many family members, day care is critical to the sustainability of home care. Since the pandemic, many dementia-specific day-care centres have not reopened. Several need upgrading to comply with pandemic requirements, such as space for social distancing, hygiene facilities and isolation rooms. So how adequate is this €2.1 million, the sum set aside in the budget for the restoration of the dozen or more ASI day care centres no longer fit for purpose? Will this investment make any real difference to the lives of the about 60,000 family carers, some of whom may be at breaking point, trying to provide a level of care beyond their capacity?
The Minister, in his statement on Budget 2023, also spoke about the development of a national dementia strategy, the funding for which remains unclear. Is this a new strategy, designed to replace the 2014-2019 national strategy? If it is, how quickly will it be developed? The original national dementia strategy was first mooted in the 2011-2016 programme for government, but its implementation commenced only in 2015. Or is it the continuation of the outdated strategy which Minister of State for Mental Health and Older People Mary Butler alluded to when she said: “We will continue to deliver on commitments under the national dementia strategy”? Do the Ministers not speak to each other?
The first national dementia strategy focused on the delivery of three core workstreams: (i) community education and awareness, through the Health Service Executive’s Understand Together campaign; (ii) the expansion and development of community care services through intensive home care packages, designed for people living with dementia; and (iii) the education and training of GPs through an impressive and successful project led by Dr Tony Foley and undertaken by a group from University College Cork.
GPs are the first port of call for most people worried about their memory and cognitive problems and the training of GPs in dementia diagnosis and assessment is hugely important. That project showed that peer-led interactive training worked well for GPs. More recently, however, this face-to-face dementia-specific training has stopped, with a strong political drive to increase and expand memory clinics across the country. While memory clinics also play a key role in dementia diagnosis and assessment, especially if they are fully resourced and provide follow-up services, they are a specialist service. Ultimately the care and support of people worried about their memory and cognitive functioning rests in primary care. So it is imperative that GPs are upskilled in this area.
Then there is the pressing and thorny issue of nursing home care in Ireland. The privatisation of nursing homes has arguably taken place without any significant public or political debate; the Fair Deal mechanism for determining need is far from fair and not fit for purpose; and the stringent Health Information and Quality Authority nursing home regulations, with a lack of appropriate Fair Deal funding, have meant that in some cases small nursing homes have had to close.
So the extra €47 million allocated to nursing homes in the budget is only a drop in the ocean. It provides funding that is hardly sufficient to pay a once-off annual salary to a senior staff member in each nursing home, not to mention support the rising costs of electricity and heating. Clearly the Government is turning a deaf ear to the repeated requests by Nursing Homes Ireland and other groups for a major overhaul in the funding system, to bring Fair Deal fees into line with the reality of today’s nursing home costs.
Of course, there are some laudable aspects to the budget that may positively impact on the lives of older people, including some people with dementia. These include an increase of 15 per cent in new home care services for people living with dementia, new funding to accelerate the long-awaited Sláintecare reforms and funding to expand the capacity of the HSE safeguarding service.
Finally, it is disappointing that the much-delayed statutory home care scheme first promised by the Government in 2018, and due to be piloted in 2020, has been overlooked in this budget. For in guaranteeing a legal right to a minimum level of home care, this scheme has potential to make a real difference to the lives of all of us as we age.
Suzanne Cahill is an adjunct professor of social work and social policy at Trinity College Dublin and honorary professor of dementia care at the Centre for Economic and Social Research in NUI Galway
*This article was amended on Tuesday, October 18th, 2022 to clarify that the Alzheimer Society of Ireland document referred to its Pre Budget Submission 2022. The ASI’s Pre-Budget Submission 2023 called on the Government to invest €19 million in infrastructure and community supports to meet a growing need for dementia-specific care.