Care options must be fully evaluated

It will be 20 years before the old-age profile in this State matches that of the EU average

It will be 20 years before the old-age profile in this State matches that of the EU average. There is, therefore, plenty of time for the Government to plan for the future and put structures in place to ensure that elderly citizens can live out their remaining years in security and reasonable comfort. Unfortunately, the Department of Finance appears to be driving the agenda on nursing home care. And short-term cost factors, rather than social cohesion and equity, may dictate the final outcome.

Ministers considered the issues yesterday. But political sensitivities are such that formal decisions may not be taken for some time. However, the Government is likely to seek approval for a public/private approach to nursing home care from the social partners. That may involve charging up to 80 per cent of nursing costs to residents or deducting charges from the estates of deceased persons. The contrast with Britain is stark. Last month, a government white paper concluded that health and social welfare provisions there should be responsive to the needs of the population on an equal basis. Here, we are going in the opposite direction.

Instead of charging for nursing home care, it is open to the Government to fund the long-term cost through a small increase in PRSI charges, as examined in a tudy by the Economic and Social Research Institute (ESRI). The numbers involved are relatively small, amounting to about 21,000 residents. And only 5 per cent of the population are likely to need such care in the future. The social fund, raised through PRSI charges, has been in surplus for the past nine years and developing it in this way would represent a creative political approach. Individuals would still be free to pay for special nursing care.

The emphasis being placed on the development of community care by Tánaiste and Minister for Health Mary Harney is to be welcomed. People living in their own homes are generally healthier and enjoy a superior quality of life. In order to live in the community, however, they may require modifications to their houses, support from family carers and more comprehensive care packages. In addition, they will need an adequate pension. At the moment, older people are among those at greatest risk of poverty. And State pensions are the lowest in the OECD as a percentage of gross average industrial earnings.

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Ireland, apart from Latvia, has the lowest old-age dependency ratio within the EU. And the proportion has declined in the past decade. That, however, is about to change, and we need to plan for the future. Last year, the Government was found to have had its hand in the pockets of pensioner residents of nursing homes. And it is now looking for a quick-fix solution. That is not the way to go. We have time on our side and we should use it to best advantage. Planning ahead, in terms of pension entitlements, nursing home care and any future charges, should involve a comprehensive public debate about an issue that is one of the most significant facing this State.