The State’s health watchdog, Hiqa, has warned that the absence of a legislative framework to safeguard vulnerable adults leaves everyone in services and civil society exposed. That lacuna reflects the limited interest politicians and governments have traditionally shown in defending and promoting the rights of elderly citizens. Instead, officials have concentrated on controlling the cost of providing for an ageing population.
This bean-counting approach will have to change to meet the needs of a rapidly changing society. Ireland still has a young population, in European terms, and now is the time to plan for a different and challenging future. Studies have estimated that, within 12 years, a quarter of a million citizens will be aged 80 years or older. That has major implications for homecare services, nursing homes, acute hospital care and town planning.
As things stand, the emphasis is almost entirely on State spending. Cost over-runs involving the Health Service Executive go hand-in-hand with reports of rising trolley numbers in hospitals; a suspension of assessments for the Fair Deal scheme in nursing homes; a limitation on home help hours for independent living and criticisms from Age Action about a lack of suitable housing and a co-location of facilities in town centres. These issues feed into pressure on hugely expensive acute hospital services. Savings in related areas have knock-on effects and no coherent, comprehensive strategy is apparent.
Instead of underpinning this fragmented edifice by legislating for the statutory rights of adults in all care situations, schemes are being devised to charge for services that are currently free. Home care packages involving visiting carers are rarely sufficient to meet the needs of people living alone and, invariably, have to be supplemented by family members. It is all about meeting a person’s desire to live independently and at home, rather than enter a nursing home. Limited HSE supports for home visits are now to be means tested. Further down the line, assessments for the Fair Deal scheme have been suspended because of financial constraints. As a result, there has been an increase in patients awaiting discharge from hospital because there are no suitable places for them to go.
Faced with rising costs, successive governments have slowly abandoned their duty of care to elderly citizens. The first step was to privatise nursing homes – a sector now so dominated by large companies that Hiqa has expressed concern about the possible “reinstitutionalisation of care” within the private sector model. Legislation is required to protect the recipients and providers of all these services. More fundamentally, the State must pay more than lip service to the principle of facilitating and supporting people to live independently for as long as is possible.