Jim Daly: No matter what age you are, there's no place like home

The pandemic exposed Ireland's poor planning and provision for life in our later years. Rather than waste that crisis, we must now reinvent nursing homes — and make homecare the norm

Thu, 24 Sep, 2020 - 21:37

Jim Daly

Never waste a good crisis, as stated by Winston Churchill, is a truism well worth remembering today: With all the challenges that are currently facing us as a society, there are also many opportunities that need to be grasped.

One such opportunity for Ireland lies in the need to finally put homecare ahead of residential care in the upcoming budget. Ireland needs to acknowledge that home is the safest place for older people, and we need to move our care out from residential settings and into people’s homes.

Ireland must act in the forthcoming budget to shift the emphasis from nursing home care to homecare. Picture: PA

Despite the progress made in recent years, the budget on residential care still dwarfs that of homecare by a whopping two to one — but Covid-19 has brought us more than enough reasons to reverse this trend. A recent report by the European Social Policy Network for the European Commission looked at 35 countries and how they care for their older people, and noted that Ireland spent 60% of its older persons' budget in 2015 on long-term residential care which catered for 4% of the over-65s.

The other 96% got to share the remaining 40% of the budget. The same report by the EU Commission, titled Challenges in Long Term Care in Europe, also noted that the number of people receiving homecare in Ireland dropped by almost 10,000 between 2008 and 2012, when the financial crisis was at its worst.

Nursing homes play an important role, but such facilities have become the go-to option in Ireland: We should look to the example set by other countries which have switched the focus towards more elder care at home. Picture: Getty Images/iStockphoto

It is not too late for us to learn from our mistakes in the past. Hungary, for example, drastically increased its homecare services during the financial crisis, possibly as an employment stimulus. Estonia has allocated additional funds from the EU structural funds 2014-2020 as a means of tackling the shortage of homecare in that country.

All of the Nordic countries have significantly reduced the number of residential care places available for older people over the past 25 years. Ireland can and must follow suit. The only way to significantly reduce our reliance on nursing homes is to drastically improve and increase the availability of homecare services. Nothing short of a doubling of the homecare budget this October will pay any more than lip service to this reality.

Traditionally, Ireland has had close to 96% occupancy in nursing homes, with demand often outstripping supply. This is rapidly changing, with hundreds of empty beds in nursing homes across the country and ever-decreasing demand for long-term and respite beds becoming the order of the day. Covid-19 has expedited the urgency for enhanced homecare with the realisation that home is by far the safest place for older people.

The HSE has many hospitals operating with reduced capacity — estimated to be in the region of 20%. Acute hospitals are under enormous pressure to discharge patients much earlier than before, and people are now realising that hospitals are indeed the least safe place to be unless you absolutely must be there.

A continuing reluctance to admit older loved ones to nursing homes for long- or short-term stays, and an overriding preference for support in the home, combine for a compelling case to double the amount of homecare available in Ireland this winter.

Covid-19 has fast-tracked an uncomfortable but compelling truth — nursing homes in their current form need to be reinvented, reimagined, and redesigned to accommodate the dignity and needs of our older loved ones.

The introduction of a statutory homecare scheme due next year to deal with the financing and regulation of homecare will be a timely boost to the reorientation away from the traditional reliance on nursing homes and towards a properly funded and available alternative to allow people to continue to live independently with their own front door.

This, coupled with the implementation of the 40 actions outlined in the housing options for older persons policy launched in February 2019, will greatly enhance the range of choices available to us all when we grow older. Nursing homes will always have a place in the care of the elderly but in the coming years the length of stay should ideally be halved from its current average of two to three years to twelve to eighteen months.

A significant shift towards meaningful investment in homecare will mean that older people can continue to grow old and live independent and more fulfilling lives contributing to their family and community which will benefit us all. Early and targeted intervention and assistance in the home can greatly reduce the rate of physical and mental deconditioning, allowing for a fuller and healthier lifestyle, and significantly delay admission to any 24-hour nurse-led care being required.

In general, people are healthier and happier when they enjoy independence, but the number of people receiving homecare in Ireland has been dropping. Picture: iStock

The Government and HSE have a unique opportunity to grasp this nettle in a real and meaningful way and accept that homecare is no longer simply a desired preference but in fact a lifesaving necessity for thousands of older people.

This is a once-in-a-generation opportunity for the Government to reflect the new reality and divert resources away from more traditional avenues in long-term, short-term, residential and transitional care, and towards a doubling of the homecare budget to enable the delivery of an additional 20m home help hours.

Anything less will see the learnings of the Covid-19 crisis wasted as yet another generation of older people are consigned to less than optimum care during their golden years.