HSE proposal on hospital discharges 'would undermine older people's consent'

HSE CEO Bernard Gloster's memo was criticised by the Irish Society of Physicians in Geriatric Medicine and Age Action but was welcomed by the Irish Association for Emergency Medicine. Picture: Niall Carson/PA

A HSE plan for speeding up the discharge of elderly patients from hospitals is ageist and undermines their liberty, the Irish Society of Physicians in Geriatric Medicine (ISPGM) has claimed.

A memo, issued to hospitals in recent days by HSE boss Bernard Gloster, proposes that older patients who are waiting for a nursing home will have to take the first option offered — at least temporarily.

However, in a letter urging the Irish Human Rights and Equality Commission to intervene, consultants warned against the memo’s tone and content.

“We would view [this] as ageist, undermining consent and liberty, providing challenges for appropriate contact with family and friends at a very vulnerable time by proposing to send older people to residential units far distant from their own communities,” the letter said.

It raised “persisting concerns of adequacy of governance arrangements in nursing homes outlined in the Ministerial Panel on Nursing Homes following covid.”

The letter sent by ISPGM chairman Des O’Neill says doctors have called on the HSE and the Department of Health to invest in rehabilitation for older people, but that they had failed to do so.

Celine Clarke, head of advocacy and public policy with Age Action, said they are “deeply concerned at the tone of this memo and what it implies about the value and respect of older persons”.

She said most people want to age at or near home as enshrined in the Programme for Government. Ms Clarke added: 

The answer to overcrowding in hospitals is not ‘move older people places where they don’t want to go’. 

UCD School of Social Policy assistant professor Sarah Donnelly said: “I absolutely acknowledge we have a crisis in acute care, but targeting older people isn’t necessarily the answer.”

Prof Donnelly said 80% of nursing homes are privately run, and asked: “Who is going to ensure people get transferred to their nursing home of choice or are discharged home if that is their will and preference?”

However, the HSE move was welcomed by the Irish Association for Emergency Medicine, who said it “can improve bed availability at our acute hospitals and reduce the duration of time patients spend on trollies in emergency departments”.

They pointed to research showing: “[F]or every 82 patients who are delayed more than six hours in an emergency department to get to an inpatient bed, there is an excess death”.

Mr Gloster told hospitals: “It is recognised to be the case that what is available may have to be accepted while a patient’s choice is awaited.”