Imagine that there has been a widespread outbreak of burglaries, and the Minister of Justice responds by demanding that the burglars should be more upfront and transparent about what they are taking from you.
This would indeed be a surprising turn of events but finds a fascinating parallel in the Minister of Health’s pronouncements earlier this month on who should pay for key elements of nursing home care (www.irishtimes.com/news/health/simon-harris-calls-for-nursing-home-clarity-on-additional-charges-1.3145897).
The severity of disability, usually arising from neurological disease, that prompts entry to anursing home invariably requires a broad spectrum of care, including continence wear, wound dressings, equipment such as specialised seating, support from therapists and access to diversion, leisure and transport to hospitals when needed.
To be somewhat fair to the Minister, he inherited a dreadful mess from his predecessors. When the so-called Fair Deal was being introduced, advocates and specialists in the care of older people repeatedly asked the public servants and ministers responsible for implementation in both the HSE and Department of Health in open forums as to the provision of these vital elements of care.
The responses were a tragic masterclass in ducking, diving, weaving and avoiding the question: older people are now living with the consequences. After giving up 80 per cent of their income, up to 22.5 per cent of the value of the their home, and a recurring 7.5 per cent of their other assets, they and their spouses are now being squeezed to the bone and beyond to provide dressings, continence wear, therapy, etc.
Limbo
The issue has been left in a limbo between the HSE (as the nursing home is the older person’s new home, should they not have access to community therapists?), the nursing home sector (not-for-profits seem less inclined to charge for these elements) and the economic vulnerability of these older people.
Rather than blaming the nursing homes, the Minister should admit to this historic lapse, and explicitly include the range of services and supports required for modern day nursing home care within the eligibility and funding of the Nursing Home Support Scheme, rather than endorsing taking even more money (including the small amount left for personal spending) from a very compromised group.
Indeed, TS Eliot may not have been fully correct when he said that April was the cruelest month: July 2017 was pretty uncomfortable for older Irish people. The CSO launched a report on ageing which bizarrely still referred to people over 65 as "dependent". How incongruous to consider Liam Neeson, John Banville, President Higgins, Mary Robinson, Neil Jordan and Christy Moore as dependent!
Rather than welcoming our increased longevity, the media coverage of the CSO report was so negative in terms of a misperception of burden that it was surprising that flags were not flying at half-mast. It was quite depressing to hear the new junior Minister for Older People immediately using the report as a launching pad for the next heist from us as we age, charging for community care.
Diagnostic apartheid
July also gifted us with a flagrant example of diagnostic apartheid for older people. Within the space 48 hours, two visions of healthcare were presented in news releases by the Minister for Health: the first, involving spending hundreds of millions of euros on a strategy for cancer, a disease predominantly of older people, made no mention of public consultation of how we would pay for it, or the raising of a special extra tax.
The second, the provision of community care, usually arising from neurological and/or rheumatological diseases, included a public consultation for “affordability and sustainability”, code for how will we charge mostly older people for these basic health services. The Citizen’s Assembly also seemed suckered by this mindset, voting for an extra tax for community services rather than the same route as all other health care.
What is wrong with us that we cannot seem to value later life as not only a huge benefit personally and socially but also one which unquestioningly should have parity of appropriate service provision and access as with other age groups and health services?
What we are witnessing is known as structural lag, where many are cemented to old-fashioned mindsets on ageing and are unable to recognise and adequately respond to the new realities, and indeed wonder, of ageing. We all have a stake in a radical rethink of our longevity dividend: we still seem to be frustratingly far from the tipping point that will bring us there.
Desmond O’Neill is a consultant physician in geriatric and stroke medicine and professor in medical gerontology, Tallaght Hospital and Trinity College. Dublin @Age_Matters