Madam, - Some 30 years ago Dr Geoffrey Bourke of the TCD Social Medicine Department and I did a survey of the patients in Dublin's acute general hospitals. We found that large numbers of them were there for social rather than medical reasons, and this was especially true of patients over 65. That still seems to be the case and is an indirect cause of pressure on hospitals' accident and emergency departments.
With reference to your Editorial of February 8th on funding care for the elderly, about 5 per cent of people over 65 need residential care in nursing homes and a further 10 per cent need some form of social help to enable them to continue living independently in their own homes - home help service, home nursing, chiropody, help with shopping and the like - home care packages that vary a lot from person to person.
These are risks we all face, whether for ourselves or for our relatives, and, like the risk of loss of income in the event of disability or unemployment or industrial accident, the cost of meeting them is best met by social insurance.
A relatively small increase in PRSI payments for everyone could fund much of the cost of nursing-home care and home care packages for those older citizens who need these.
This has been done for over the past decade under the social insurance scheme in Germany, the country that pioneered social insurance. Such a scheme here would serve to bring the magic of averages to the rescue of tens of thousands. It would avoid the situation where some people face heavy nursing home bills for purchasing decent residential care for themselves or their elderly relatives, and may even have to sell their own homes to meet their care costs, while other people do not; but no one knows in advance in which group they will be.
Of course nursing homes for the elderly, whether private, voluntary or public, should all be inspected regularly and rigorously, but with the best will in the world it is difficult to ensure decent standards when residential home care is provided in a sellers' market and there is insufficient supply of good quality facilities.
Funding nursing home care and home care packages out of general social insurance would start to change all that. It would bring a significant flow of money into this under-funded area, on which everyone of us could be dependent one day. Entitlements could be credited for those not in employment.
Maybe this idea would be taken up by some of our politicians who would like to do a good deed for older citizens, who will in due time include themselves. - Yours, etc,
ANTHONY COUGHLAN, Senior Lecturer Emeritus in Social Policy, Trinity College, Dublin 2.