This was the year people realised just how badly we treat our elderly, but are we ready to pay for the changes needed? asks Paul Murray
It takes a catalyst, and this time it was RTÉ's Prime Time investigation into Leas Cross nursing home, to shock the public, politicians and lobby groups into realising what they already half knew: that there is much wrong with the way we look after our frail elderly.
Coupled with the Rostrevor nursing home case, and the pilfering over decades of millions of euro from older people for their public nursing-home care, it became clear that older citizens had been subject to elder abuse of varying degrees.
As a community we flailed around in the search for a culprit. But we knew we were searching for ourselves, that we had allowed the aged to become ciphers, bit parts judged mainly by the date on their birth certificates.
We watched as hapless health authorities sought to extirpate creaky inspection systems for private nursing homes and pressure grew for independent scrutiny of public beds. Concern sharpened, too, when the patchiness of community care became increasingly evident. This was always clear from calls to Age Action Ireland's information service and has been highlighted in a National Council on Ageing and Older People report.
In the North, 17 per cent of older people get home help. The Republic's rate is 7 per cent. In the North, too, 26 per cent get meals on wheels, while the Republic's rate is 18 per cent. All of which is a horrible indictment of domiciliary care provision and the political failure to follow through on endless reports that have highlighted the need to keep older people in their own homes as long as they wish.
And then came that terrible phrase, "bed blockers", to depict older people who were unable to leave acute hospitals. It was forgotten that in the majority of cases there was nowhere for them to go.
There were continual complaints by the elderly and their families of high nursing-home costs, unreasonable and varying means-testing for subventions and the refusal to provide State financed beds for medical card holders.
So society concentrated on health, with the elderly continuing to be seen as a health issue rather than as a cohort that just might have health issues. Older people were about appliances, nursing home beds and chiropody, and only secondly about an increasingly healthy age group which wanted to be engaged in every facet of Irish life.
It is a gloomy picture, relieved somewhat by Tánaiste Mary Harney's willingness, unlike her predecessors, to pick up this muddy ball and run with it. There is now meaningful talk about older people remaining in their own homes, with promises of more than 3,000 home-care packages. That's the intention, but will the Health Service Executive be able to supervise, recruit staff and implement that policy? Will too much reliance be placed on private care agencies?
From Minister Séamus Brennan, too, there has been an engaging energy on pension issues as the State grapples with the unwholesome fact that only about 52 per cent of us are in an occupational scheme and that our old-age pensions are 32 per cent or so of gross average industrial earnings, way below the OECD average. All of which brings us to two central issues at the core of older people's wellbeing. How can we finance our old age and how will society treat us when we are frail and vulnerable?
For Mr Brennan there are a number of issues. Should there be mandatory occupational pensions? All the signs indicate a preference for the "soft mandatory" version, whereby workers will be compulsorily entered into schemes, but with the option of opting out.
What about ending mandatory retirement ages? An increasingly healthy older population might welcome this, provided current retirement rights were not eroded. Many older people, too, might like to defer their State pension for a larger weekly sum in later years, as has been mooted.
Adequate pensions will assist us pay for any necessary latter-day care. But much will depend on how and how much we are expected to pay. This should emerge early in the new year when deliberations on the long-term care of the elderly are publicised, based largely on the Mercer and O'Shea reports.
Among the options are: a limit of three months on public funding for long-stay care, with private insurance covering longer stays; recoupment of costs by deductions of assets posthumously collected, ring-fenced increases in PRSI to finance such costs, or more State home-care financing.
This is in the context of a seeming unwillingness to create more public-sector beds. However, the Tánaiste can be sure of one thing: there will be cheers if she finally implements statutory inspection procedures for both public and private nursing homes.
In the debate about financing, care standards have sometimes been forgotten.
Paul Murray is head of communications at Age Action Ireland