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Dublin: 11 °C Wednesday 26 June, 2019
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Opinion: We have made no preparations for our ageing population

Ireland’s population is growing older and living longer – and the reality is we are not prepared for the fallout.

Tadhg Daly

‘BABY BOOM ON the wane’, a lead national newspaper proclaimed at the start of the month. While the ‘boom’ in births has been showing a steady decline, the opposite end of the age spectrum is showing a consistent and rapid rise.

Ireland’s population is growing older and living longer. Our older population is increasing at a faster rate than that of our European neighbours. A ‘boom’ is forthcoming that will not go ‘on the wane’.

The debate surrounding requirement for nursing home care is often skewed. Contrary to often-perceived perception, the number of older persons requiring such care is relatively small. Older persons are statistically classified as persons aged 65+; only one in 20 persons aged 65+ require nursing home care. The majority of persons requiring the continuous, specialist care of nursing homes are aged 85+. Around four in 20 in that age category require this care and call nursing home ‘home’. Requirement for long-term residential care doubles for those aged 85+ when compared to those in the 80-84 age group.

The CSO has stated the “very old population” will rise “dramatically” in coming years. Its analysis projects the population aged 85+ will increase 46% by 2021.

We have made no preparations

As a country we have made no preparations for the demographic development of our ‘older old’. The reality is we are ill-prepared for it and, like with many other solutions in Ireland, the focus has only been on the short-term. Inaction will have huge implications for older persons.

The social cost of failing to plan will prove far more distressing than the Exchequer one.  Imagine a family having no option but to care for a loved one at home, even though the older person has complex care needs they are not in a position to meet.

The other outcome in that scenario would be for the person to seek care within an acute hospital setting, an inappropriate setting, at a much higher cost to the State – eight times higher than a nursing home. In that situation, for every 1,000 additional people who can’t access nursing homes, there will be an additional annual cost of €273 million to the Exchequer. Potentially, there could be 8,000 in this category, adding another €2 billion to our severely strained health budget.

None of this takes account of the social or emotional cost for the older person or society and we simply cannot bury our head in the sand. For that reason, Nursing Homes Ireland commissioned an independent report that was published in February. Health’s Ageing Crisis: Time for Action which was undertaken by BDO, warns: “The provision of residential care for our ageing population is rapidly heading for crisis; however this is a situation that can, with the appropriate action, be avoided”.

We are seeing a crisis emerge

People often accuse anyone who commissions a report of having a vested interest. Yes NHI does, but its members are engaging on daily basis with families seeking care for loved ones and we are seeing a crisis emerge. Last week, NHI published results of a survey it undertook amongst 122 private and voluntary nursing homes that highlighted a significant crisis in older person care. Almost half of respondents – 48% – stated typical waiting time for persons awaiting financial support of the Fair Deal scheme was three months or beyond. Survey respondents stated persons have passed away while awaiting Fair Deal financial support.

The inordinate delays are causing stress, distress and bringing significant cost pressures to bear upon families. Families are trying to provide continuous care in a home setting while awaiting Fair Deal financial support. Older persons are remaining within hospitals or being readmitted to them because they cannot avail of the continuous care nursing homes specialise in providing.

As an organisation we are committed to solutions.

This year the State has significantly reduced the resources to enable older persons requiring the dedicated care of nursing homes to avail of it. It cut the allocated spend for the Fair Deal scheme by €35 million. As of 30th June, 1,465 were on Fair Deal placement list. Such a sizeable number defies the purpose of the scheme – to make nursing home care accessible, affordable and access to it anxiety free.

We must plan

This debate is about strategy. We aim to celebrate ageing but must embrace the responsibility that comes with a population that is growing older and living longer. We must plan and act appropriately. The reality for our sector – and we are just one of many stakeholders – is that we don’t know what the future strategy of the country is in relation to meeting our ageing demographics care and social requirements.

As a society we must be informed if the State will continue to provide nursing home care, if the immense investment required for public homes to HIQA’s 2015 environmental standards deadline (€1.7 billion) will be forthcoming, and, crucially, how BDO’s projected requirement for 8,000 necessary new beds will be met. The projection is in keeping with CARDI (Centre for Ageing Research and Development in Ireland) projected growth in requirement for 12,270 nursing home beds by 2021 and ESRI projected requirement for 13,324 beds to the same year.

Over 22,000 people call private and voluntary nursing homes ‘home’ and equivalent staff are employed. Our sector has a key role to play in advising of strategy planning and implementation. We want the Department of Health to lead the required engagement and planning through a forum process that will bring together NHI, HSE, National Treatment Purchase Fund, HIQA, Age Action and other key stakeholders.

The time for inaction is over.

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Tadhg Daly

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