We have had DECADES to sort out care for the elderly …so why has the humanity ebbed away?

Nursing homes propelled by prof its, not people

IUSED to be distantly related, by dint of second marriages and the like, to the greediest and most pitiless woman in Christendom. Her father and mother were both old and infirm (by her lights at least) so she ‘had to put them in a home’. She didn’t feel remotely sorry about it; her only regret, which she openly acknowledged, was that the cost of it was ‘eating into my inheritance’.

Nature will teach that woman a lesson, no doubt, in the fullness of time. Some day she may find her own children measuring her up for infirmity and weighing the cost of her continued existence against their own pounds, shillings and pence.

Hers was a character, though, that could have been written by Mary Harney, former leader of the thrusting, right-wing Progressive Democrats, before they thrust themselves right into oblivion.

Harney was, of course, part of a government that thought privatising the care of the elderly was the solution. But more on that in a moment. Back in 2004, she pointed to a failure by families to meet their responsibilities to their elderly relations. ‘When neglectful family members still expect to inherit assets from their relative, there is something amiss,’ she said.

It’s a convenient view for a State that doesn’t want to honour its Constitutional responsibilities to elderly people. Under PD dogma, care of the aged and the infirm becomes an individual responsibility instead of a collective one. Thankfully, though, Article 45.4 of Bunreacht na hÉireann begs to differ.

THANKFULLY, lone instances of blood-curdling selfishness are the exception. Most people who commit their elderly parents to residential care do so under duress, and in a state of heartbreak, because they feel they have no other option. I have a 1986 report on nursing homes in the Republic of Ireland from the National Council for the Aged. It projected a 20% increase in the number of people aged 75 and over by the year 2006. So – surprise, surprise – 31 years ago people were predicting a problem with caring for a growing elderly population.

The census figures released this week carry it further, revealing that the group aged 65 and over has grown by almost a fifth in the past five years.

So we’ve had decades to get to grips with this problem. Instead, we find ourselves now with a barely-regulated commercial nursing home ‘industry’, where the State supplies a reliable income stream to private enterprise and yet residents and their families are still being gouged for money.

In 1997, the Department of Finance instituted tax breaks for nursing homes, with a 15% rate of capital allowance that could be offset against all income types. Among those who availed of the scheme was former health minister James Reilly. Nursing homes became big business and they’re still big business today. Do you think the likes of JP McManus and John Magnier would be involved in the nursing home business if it weren’t profitable?

Accountancy firm JPA Brenson Lawlor, for instance, strongly recommends nursing homes to its clients. A nursing home investment can yield 15%, it says, compared to 1% on a 10year Government bond. ‘We think it’s a no-brainer.’

You don’t (at least I think you don’t) have to be a Marxist-Leninist to find something truly distasteful in this blending of public need with private profit. Vulnerability and avarice surely make a toxic mix by anyone’s reckoning.

You can now pay up to €1,300 a week to live in a nursing home in some parts of the country. For that price, you might expect to be able to take up a permanent residency in a half-decent hotel, like Major Gowen in Fawlty Towers. You’d have room service, laundry, security, meals, no electricity or heating bills, a lift to all floors, a mint on your pillow, free shampoo…

There might be a gym and a swimming pool, a lounge for glasses of sherry, a lobby to meet friends in .... You’d be treated like a patron, instead of a patient. Instead you’re in a nursing home and, under the Fair Deal scheme, if you have no other means, you’re left with €44.40 a week in disposable income to pay for haircuts, books, clothes, Christmas cards. You’re not allowed out on your own and you’re getting stuck with a top-up bill of up to €100 a week for services that you may or may not be able to avail of. Investors, though, are instructed to expect a 15% return.

NOW THERE is talk of adding another tier of regulation to the sector. Minister with special responsibility for older people Jim Daly proposes that nursing homes be asked to disclose any profits they make on additional fees and to account for their income and expenditure on social activities. Another day, another problem, another patch.

Back in 1983 there were 5,104 people in voluntary and private nursing homes. Today there are more than 22,000. That’s how gargantuan the growth of the private nursing home industry has been.

Nevertheless, only some 4% of the over-65 population is in long-term residential care. That means a great many people out there, together with their families, are doing their damnedest to avoid it. It’s also worth saying that they’re getting very little support from the State in this.

This week, it is reported that some 4,600 people are on waiting lists for home-care help from the HSE – up from 4,381 at the end of last year. Health minister Simon Harris is planning a new scheme that is supposed to guarantee a minimum level of home care to people who need it. We don’t know yet how long it’s going to take. We’re told there will be a report on it by the end of the year. I repeat, we’ve had decades upon decades to consider this, and this is as far as we’ve got.

A 1976 study by JAM Gray pointed out that long-term residential care leads almost inevitably to a decrease in activity and a loss of function. People in nursing homes lose both the physiotherapy and the occupational therapy of everyday life – from lifting saucepans and opening milk bottles to decision-making, planning and budgeting. Helping elderly people to stay in their own homes is supposed to be official policy. It’s what almost everyone wants. It’s what the overwhelming majority of elderly people themselves want. It’s what their families want. It’s what their communities want and need. It’s what health and social care experts think is best.

It’s not what investors in private nursing homes want, though. And judging by the piecemeal, haphazard and enterprise-driven approach to public policy – where there is generous support for nursing home care and hardly any support for home help care – it’s not what the State really wants either.