Victoria White: We must outsource eldercare but radically smash the current model

As the blame-game continues over the 884 Covid-related deaths in nursing homes since the pandemic was declared, I’m thinking a lot about my mother’s last two years, writes Victoria White

There are no easy answers to the question of eldercare but it has been their congregated vulnerability which has killed so in nursing homes many since the pandemic began. Picture: iStock

They were awful. There she was, a difficult but very intelligent woman in her eighties, confined to one small room in a private nursing home and having her meals served up to her on a timetable.

Decent conversation at the table was nil because most had dementia. One of her daily companions said nothing but “Ship, ahoy!” She fought back in various ways.

I provided her with books and she read one a day.

A miracle happened when she recognised a lady down the hall as someone she’d known in the distant past. These two bright, urbane women used to meet for surreptitious drinks in each others’ rooms.

When her friend died my mother’s comment was, “She won’t mind at all.” My mother was bored to death and assumed her friend was too.

I have been constantly asking myself if I committed a crime against my mother’s humanity by putting her in that nursing home.

Confinement in a “congregated setting” is defined as such under the UN Convention on the Rights of Persons with Disabilities. I can see it isn’t natural to lump a whole lot of vulnerable people together like that.

It has been their congregated vulnerability which has killed so many since the pandemic began, exactly as their congregated vulnerability killed so many small babies and children in Mother and Baby homes until the 1940s.

There are no easy answers to the question of eldercare, however. I did ask my mother to come and live with us after she fell out of bed and broke her osteoporotic hip but thankfully, she declined and opted for a nursing home.

I say “thankfully” because I had four small kids, no medical training and we didn’t get on.

I am mindful of a friend who insisted on caring for her father at home, only to drop him catastrophically while trying to help him.

A charitable and Christian friend stunned me by validating our decision with the blunt statement, “It’s true that old people used to sit by the fire in the kitchen in Ireland but they fell into the fire by the time they were 65.” Now we often have two or three decades left after the age of 65.

The statistics are glaring: as the Sage advocacy group told the Oireachtas committee on Tuesday by 2041, there will possibly be between 1.3 million and 1.4 million people over 65 living in Ireland; the numbers of people over 80 are expected to treble, to 440,000.

In the blink of an eye, I will be one of them.

While only 5 percent of over-65s require nursing or home care, one in three women - and one in four men - will spend time in a nursing home before they die.

This usually takes about two years, mostly, of course, because they go in there sick or disabled.

Nursing homes must extend some lives and some really enjoy it. I can’t help thinking that some die of boredom and despair, however.

“It’s a lobster pot”, a consultant told my friend’s mother. She died a month ago in the open water of her child’s home.

Writing in The Irish Times, Ann Campbell of the Validity disability rights charity calls for flexible working regimes so that family members can care for elderly relatives. But we are forgetting something here: most don’t want to.

People, particularly women, have lots of opportunities now to pursue their own happiness and for most that does not include long hours of care for a relation who is ill, frail or has dementia.

The report of the Forum on Long Term Care, published by Sage in 2016, showed 56 percent of carers experiencing mistreatment by the care recipient in the previous three months, while a third reported that they themselves had engaged in behaviour which could have harmed their charges.

We must accept the outsourcing of much eldercare but we must radically change the model of care.

My mother’s only option should not have been that private nursing home. At 87 she was too frail to live independently but she was not demented and initially, she was not sick. She should have had access to a supported living facility in the heart of her own community.

Mc Auley Place in Naas, Co. Kildare, is one such facility, housed in the grounds of a former Mercy convent.

My mother’s home in Blackrock, Co. Dublin was surrounded by former religious institutions, at least one of which should now be housing women like my Mum along with elderly nuns and priests.

Instead we have a hotel and a rake of luxury housing schemes.

The State has totally failed to plan for the future of age. Its abdication of responsibility for eldercare is without doubt the greatest scandal uncovered by the Covid Crisis.

While in 2008 public provision accounted for 29 percent of nursing home beds by 2013 that proportion had reduced to 23.1 percent, with the voluntary sector accounting for 10 percent and the private sector, for 66.8 percent.

The State has promoted the proliferation of private nursing homes by designating them “industrial buildings”, eligible for tax breaks against construction and refurbishment, and by giving them a further tax break in 2016 under the Employment and Investment Incentive Scheme.

The State mostly funds the care of the elderly in these homes through the Fair Deal scheme.

Private nursing homes cost Fair Deal on average E915 per week as opposed to the E1,615 paid on average to public homes.

The HSE says the State homes cost more because their costs are higher. This means that as a State we knowingly collude in the provision of less-than-optimal care to two-thirds of nursing home residents.

While the HSE administers the Fair Deal scheme, the contract is between the older person and the home and while HIQUA inspects it does not investigate complaints.

No-one really knows where the buck stops on the provision of medical care to residents of private homes and this is why nursing home managers found themselves bidding against the HSE for vital PPE at the start of the crisis.

The efforts of Fine Gael Deputy Fergus O’Dowd this week to blame these nursing homes because the State has shamefully out-sourced its responsibility to older people must fail.

The issue is not so much the homes themselves as the fact that our State doesn’t offer anything else: there is no statutory right to home-based care and no Fair Deal to support it. There is no plan to integrate supported living spaces into communities and there is little specialised dementia care.

The Taoiseach has called for a rethink of ageing in this country.

The next Government must smash the current model, not only to stop older people dying before their time of infectious diseases but also to stop them dying of boredom.