An overemphasis on providing nursing-home care has resulted in a lack of services to allow older people to stay at home in their later years, writes Carl O'Brien, Social Affairs Correspondent.
Here is a mantra you are likely to hear at Government level in the coming months: older people should be able to remain in their homes for as long as possible without being unnecessarily directed into nursing-home care.
There should be improvements in community care, home help, nursing care and paramedical services, along with some kind of income maintenance to make these services more affordable for older people or their families. If these sound familiar, it is because they are the conclusions of the Department of Health's Care of the Aged Report (1968), the pages of which have long since yellowed and faded.
Department of Health shelves creak under subsequent government reports which have reached broadly similar conclusions, such as the Comhairle Report on Long-Term Care (1985); The Years Ahead - A Policy for the Elderly (1988); National Health Promotion Strategy (2000); Quality and Fairness - A System for You (2001); the Mercer Report on Future Financing of Long-Term Care (2003); and - yesterday - the National Economic and Social Forum's report on Care for Older People.
Successive governments have commissioned reports, accepted their findings, and then proceeded to ignore them as they funnelled State resources into tax incentives, subsidies and subvention for nursing homes. Now, however, in the face of soaring nursing-home costs, a crisis in the A&E sector and an ageing population, the Government is being prodded into doing something about those reports.
Minister for Health Mary Harney, who also has a personal interest in the area and has demonstrated a solid grasp of the problems at hand, has signalled there will be a Budget package in December which will include some kind of financial incentive for people paying for nursing care for their relatives at home.
An interdepartmental group, including officials from the Departments of Health, An Taoiseach and Social Affairs among others, is finalising what the shape of this package will be.
The conclusions of yesterday's NESF report are likely to feed into this process. As well as advocating tax breaks for contracted nursing care in the home, it urges that community-based financial supports should be made more widespread, the introduction of a right to a needs assessment for older people, and clarification over entitlements to services such as home help, meals-on-wheels, day care, respite, therapeutic/paramedic services, and sheltered housing. They may not be the most ambitious recommendations in the history of policy of care for older people, but they are sensible and achievable for a Government faced with other resource-hungry priorities.
Successive studies show the vast majority of older people wish to stay at home, while international reports show just 5 per cent of older people tend to need institutional or nursing-home care.
The Government's investment incentives for the construction of nursing homes - described in the NESF report as "obscene" - have been to the detriment of community-based care.
Most health professionals agreed that unnecessary admissions to nursing homes could have been avoided or delayed by proper investment in community-based services. Some studies, for example, suggest that 16 per cent of admissions to nursing homes are "social admissions".
In a damning conclusion, the Mercer report of 2003 said the absence of community care was "forcing" people to opt for private nursing-home care.
It is also widely accepted that care at home or in the community would also be cheaper for everyone in the long run.
For years, however, it has been easier and more convenient for governments to erect a scaffolding around care for older people that facilitates the construction of nursing homes.
Administratively it has been less of a headache for governments by allowing the private sector to flourish. This has provided beds, which have relieved pressure on a creaking public system, and care staff, who are off the public payroll.
However, with demand for nursing homes growing by the year and the cost of private care soaring, alarm bells have been ringing at Government level for some time.
The subvention system, which subsidises the cost of nursing-home care for families of older people, has ballooned from just €15 million when it was introduced in 1994 to about €120 million last year.
The cost of contract beds in private nursing homes has been increasing. Just last month one geriatrician said at least 200 contract beds were needed immediately in the Dublin area alone.
The seemingly intractable problems of the A&E crisis are also linked to the overemphasis on nursing-home care, with many older people in acute beds who cannot afford a nursing-home bed.
A greater emphasis on care at home and community-based nursing units will bring its own challenges. There will need to be an increase in the number of long-promised public community-based beds, as well as extra public-health nurses, occupational therapists and care assistants. It may well be that the private sector in time will meet these staffing demands, although this could take longer than anticipated.
Overall, this does not mean the end of nursing-home care. There will always be a need for institutional care that can offer a range of services to high dependency patients. Instead, these developments may represent the first steps towards ending a costly policy which has directed older people who have low levels of dependency into an expensive nursing home without first attempting to care for them in the community.