SPECIAL REPORT: Dementia in Ireland - Fail to prepare, prepare to fail
Within Leinster House, statements, questions, accusations, defences, excuses, and apologies are being offered as we seek answers as to the causes and effects of the economic crisis that brought the country to its knees. The Oireachtas committee charged with asking the questions is largely focusing on whether we should have seen the crisis coming and what pre-emptive measures could have averted it.
For those charged with planning and implementing health policy, there is bountiful āevidenceā to provoke action and implement measures beyond the immediate horizon for care of older persons and dementia-specific care. The āevidenceā serves a stark warning that, if we fail to plan now, we will be facing a health and social care crisis of significant magnitude in coming years.
The ageing of the Irish population is a fact to be celebrated and is a measure of significant advances in living standards, technology, and treatment of medical conditions. However, we must assume responsibility and ensure the appropriate support structures that encompass the living, health, and social care requirements or our older population are planned and implemented for this generation and those forthcoming.
Briefing papers provided to Health Minister Leo Varadkar upon his appointment set out the significance of such challenges. They stated that demographic pressures equate to an additional funding requirement of ā¬200m per annum over the coming years and in the area of long-term residential care, an additional 7,600 nursing home beds (more than 1,000 beds per year) will be required over the next six years.
Worryingly four years into the term of this Government, a clear and cohesive policy and national strategy for the long-term care of our older population remains outstanding.
We need to plan a healthcare model that provides a continuum of care for our older population and enables them avail of the most appropriate care at the most appropriate stages. This continuum includes the provision of long-term residential care which provides ongoing specialist support, interaction, and stimulation to support residents with dementia.
The people who avail of the specialist care provided by nursing homes in our communities are of high and maximum dependency. The vast majority are āolder-oldā.
Nursing Homes Irelandās recently published survey for 2014/15 highlighted how 56% of the nursing home population are above the age of 86. A further 30% are aged between 76 and 85 years. Almost half (45%) of the residents have a diagnosis of dementia. The incidence of dementia rises exponentially with age, and dramatically so in those over 80 years. The CSO states that our āvery oldā population is to increase dramatically in coming years, with numbers aged 85-plus to increase by almost 50% by 2021.
The Dementia Services Information and Development Centreās survey of dementia in long-term residential care, published in January, said the private sector is the majority provider of specialist dementia care at 63%. This counteracts perception that public units are majority providers of dementia care.
Despite the warning coming from the Department of Health, there remains a strategic policy vacuum within the residential care sector. On a long-standing basis, Nursing Homes Ireland has been advancing critical requirement for the Department of Health to take the lead in the planning of our services for our older population. We continue to push for it to bring the stakeholders around the table to advise Government on appropriate planning and policy.
What would such a strategy entail? To enable providers meet the increasingly complex care requirements of our ageing population, the current limitations of the Nursing Home Support Scheme (Fair Deal) must be addressed. There is a critical requirement for introduction of an evidence-based cost of care funding model that recognises the complexity of care for people who require long-term residential care.
The importance of ensuring staff are available to provide the person-focused specialist care befitting of persons with dementia should be a key consideration for any strategy. The national and, indeed, international crisis in nursing recruitment is not confined to acute services, with serious issues surrounding the recruitment and retention of nurses threatening bed capacity in care homes.
Engagement with stakeholders can deliver a plan for the entire health service ā public, private, and voluntary ā that would place the substantial growth in requirement for gerontological and dementia care at the centre of it.
The Government could take heed of the National Economic and Social Council, which advises the Taoiseach on strategic policy issues. It recommended the establishment of a āproblem-solving groupā to enable services in residential care to be provided at optimum level for older people.
Taoiseach Enda Kenny has said he wishes Ireland to become the best small country in the world in which to grow old. Bringing together stakeholders to inform clear policy direction in respect of long-term care can enable his Government leaves a lasting legacy in the care of our older population and people with dementia.
