Sir, - I am writing as a general medical practitioner who acts as medical officer in the community unit on South Circular Road, Dublin. I wish to respond to recent articles in The Irish Times on step-down units as an adjunct to hospital services for the elderly.
These units have been purpose-built to allow easy movement within them, together with suitable seating in sitting-rooms and easy-access bathing areas. The units are staffed by a physiotherapist and occupational therapist, a speech and language therapist, a dietician and a social worker, as well as by a full nursing service. Medical services are provided by a visiting GP, who can liaise with hospital-based personnel as needed. The units are for people who either need permanent care which cannot be provided in the community or as an adjunct to that care by way of respite. Beds are also available for medically stable patients convalescing after hospital care.
Patients sent to these units for long-term care are assessed by a geriatric consultant in the hospital service who determines their suitability for care in such units. Those coming for convalescence are coming on the basis that they are medically stable and fit for care in the unit. While in the unit, patients have an on-going assessment of their needs by a multi-disciplinary team. If there are serious concerns about patients' welfare they can be transferred back to the hospital service. Such decisions are made by medical and nursing staff together with the patients themselves and their relatives.
The majority of patients I have been in contact with have been happy with and appear to have been helped by the units. The care, I believe, is first-class and the atmosphere of the unit is cheerful and positive. Indeed, I am aware of several people who have made great improvements following transfer from acute hospital units where full rehabilitation efforts had been employed and largely failed.
The implication of recent articles about these units is that patient care is poor and that the units are unsatisfactory places for the care of the elderly. Comparisons with older units without a multi-disciplinary team or which are not purpose-built are unfair. It is precisely because of the multi-disciplinary approach and the ease of movement within the building that a maximum level of independence can be achieved.
As with any service, there are bound to be areas where improvements can be made. I would be keen to hear such constructive criticism. However, I do not feel it is just or wise to dismiss these units, as has been done recently in your paper, without a reasonable analysis. -Yours, etc.,
Patrick Coghlan, Booterstown Avenue, Blackrock, Co Dublin.