Sir, - I would like to commend your Health and Children Correspondent, Padraig O'Morain, for pointing out that the rehabilitation needs of older people in general hospitals are complex and are unlikely to be met by a vague organisation of care termed "step-down" (The Irish Times, January 3rd). The solution to this problem is to provide more focused and rehabilitative care in the general hospital and to develop rehabilitation services in the community.
However, I was unhappy with his perception that there is a difference in skills and postgraduate education between nurses in hospital and nursing homes. We are exceptionally fortunate in Ireland with the professionalism of our nurses and I have the highest confidence that, no matter where they practise, whether in the community, in nursing homes or in hospitals, they take pride in ensuring that they are at the cutting edge of practice. The problem with "stepdown' care in nursing homes does not relate to any problem with nursing skills; it is that they are not structured or staffed with rehabilitation staff (medical, therapist, social work) to carry out the complex demands of rehabilitating older people. - Yours, etc.,
Desmond O'Neill MD, FRCPI, Senior Lecturer in Medical Geronotology, Trinity Centre for Health Sciences, Adelaide and Meath Hospital, Dublin 24.