As a result of Padraig O'Morain's recent article on this page (January 3rd) on the role of the step-down units and nursing homes, there has been a constant stream of calls from Irish Nursing Organisation members in all areas of the health service, demanding a response to the many unfounded, poorly researched and wholly unjustified criticisms he made.
There were also many calls expressing surprise and puzzlement at the stance of the consultant group mentioned. This stems from the simple fact that it is a consultant who would be leading the multidisciplinary team that makes the decision to transfer any patient from an acute hospital to a step-down or other facility.
Presumably this decision is always made taking into account such factors as the patient's physical condition; continuing requirements in terms of nursing care; what level or degree of continuing assistance will be required in terms of physiotherapy; speech therapy or other specialist support; the psychological impact of any transfer on the individual's mental wellbeing; and whether such a transfer would be positive and a step on the road to the return of the elderly person to independent living.
As one would expect with this level of evaluation, on a case-by-case basis, no inappropriate transfers would take place.
At this stage let me say, on behalf of the Irish Nurses' Organisation, that we totally reject and view as insulting the inference in the article that nurses working in step-down units or nursing homes are not of the same standard as their colleague nurses working in high-tech specialist units in acute hospitals.
The skills required of a nurse in caring for the elderly are vastly different from, but no less specialised than, the skills of a nurse in intensive care or elsewhere.
While the latter may be the area that receives most media attention, the role of the nurse in assessing and then providing the nursing and other needs of the elderly patient requires a comparable level of skill, knowledge and humanity, but in an area of the health service which will never receive the same level of attention as treatment in an intensive care or accident and emergency unit.
In a multi-faceted healthcare system, nurse-led step-down units and nursing homes both have pivotal and essential, but different, roles to play in ensuring that the individual patient is cared for in the environment most appropriate to their needs.
Any examination of reality would quickly show that many elderly patients, following an acute illness (e.g. chest infection) or following a more long-term event (e.g. stroke), need a stage of recovery when the frantic pace of the acute hospital ward is not where they need or wish to be.
In this situation it is far better for patients to be transferred to an environment which is much more focused on their requirements, offers the necessary range of support services for the purposes of continuing rehabilitation and/or recuperation, and is in a location geographically closer to their own community and extended family, if one exists.
The step-down unit, nursing home or district hospital also allows for a reorientation of the services required by the patient away from the traditional medical model (one wonders is this the cause of concern to the medical profession) to a system of care which is tailored to the individual's needs and which, most of all, is ensuring the person can resume, independently if possible, the activities of daily living at the earliest possible date.
It must be understood, and this was not clear from last week's article, that the service provided in a step-down unit, a district hospital and a nursing home will and should be different.
The step-down unit will be more focused on completing the recovery from an acute illness. The district hospital will offer a mix of services from short-stay rehabilitation to respite to long stay, while the nursing home will also offer a range of services for patients with different needs.
However, these types of service can be provided only when the nurse staffing levels are adequate and when the unit is comprehensively supported with the full range of specialist services. This is not the case at the moment.
That is why, as part of the Programme for Prosperity and Fairness, the INO secured commitments to increase significantly the number of step-down facilities available, including the necessary professional support services.
Care of the elderly, in whatever setting, is not a cheap alternative to care in an acute hospital. These services are already staffed by highly qualified and highly motivated nurses aided by a committed support team.
However, staffing levels are frequently poor, physical surroundings far from ideal, and access to specialist support services inadequate. Health employers remain slow to improve existing staffing levels, and the INO has a long list of examples where long and unnecessary delays have occurred before health boards admit obvious shortcomings and allocate additional resources to services for the elderly.
There are many inadequacies in our current health service. For example, most people would now agree we need up to 2,000 additional acute beds.
However, the solution to problems with care for the elderly does not revolve solely around additional acute hospital beds, or around leaving the elderly person for longer than is required in an acute hospital.
Against this background it would surely be preferable for all stakeholders to collaborate in dealing with these service shortcomings rather than criticising and demoralising nursing staff who are striving to give high-quality care with inadequate resources.
Liam Doran is general secretary of the INO