Des O’Neill

Older peo­ple de­serve much bet­ter

The Irish Times - Tuesday - Health - - Front Page - Des O’Neill Prof Des O’Neill is a con­sul­tant geri­a­tri­cian at Tal­laght Hospi­tal

One of the most trou­bling ad­ver­tise­ments on the ra­dio re­cently was from a pri­vate home care agency. A woman ac­tor speaks of how car­ing for her par­ents was re­lieved by car­ers from the agency, par­tic­u­larly af­ter one of her par­ents had a stroke.

No men­tion was made of the pub­lic health nurse, of Home Care Pack­ages, or of the dis­charge ar­range­ments of the stroke team un­der whose care the par­ent had been dis­charged. Our prac­tice in Tal­laght Hospi­tal, and I am sure in most other stroke ser­vices, will only dis­charge pa­tients re­quir­ing Home Care Pack­ages when they have been agreed by the HSE.

Nor was there any men­tion of the con­sid­er­able costs and chal­lenges of try­ing to man­age a pri­vate care pack­age with­out the pub­lic sup­ports avail­able.

Pri­vati­sa­tion of com­mu­nity care

Al­lied to the unan­nounced obstruction to ac­cess to Home Care Pack­ages other than from hospi­tal dis­charge since March 2016, this dis­con­nect from the pub­lic sys­tem amounts to an in­creas­ingly overt pri­vati­sa­tion of com­mu­nity care. This is akin to the rapid pri­vati­sa­tion, with­out de­bate, of the nurs­ing home sec­tor (where a healthy sys­tem man­dates a mix­ture of pub­lic, vol­un­tary and pri­vate nurs­ing homes), or out­sourc­ing of men­tal health care to pri­vate agen­cies.

As dis­cussed in pre­vi­ous col­umns, the prob­lem is not the pri­vate or pub­lic route per se but a fail­ure to openly dis­cuss the eth­i­cal, so­cial and prac­ti­cal prob­lems aris­ing from work­ing with both sys­tems.

Pri­vati­sa­tion of com­mu­nity care has been un­der­way for some time with the con­tract­ing out of Home Care Pack­ages to pri­vate agen­cies. It has been pro­moted by a trin­ity of politi­cians, el­e­ments of the HSE and pri­vate sec­tor (which re­tains a large pro­por­tion of the ¤22 an hour for home care, fur­ther sub­sidised by tax breaks to these fees).

Health­care should be a right

Un­wit­ting sup­port for tak­ing even more money from dis­abled older peo­ple arises from ad­vo­cacy and the pub­lic by those who per­ceive an in­jus­tice be­tween the so-called Fair Deal – which it­self re­moved el­i­gi­bil­ity to State-funded nurs­ing home care – and cur­rent Home Care Pack­age pro­vi­sion, which is not means-tested but maxes out at four calls a day for the most dis­abled peo­ple.

In fact, there are mul­ti­ple lay­ers of prob­lems with this rea­son­ing, which re­ceived fresh oxy­gen from a re­cent doc­u­men­tary on the ef­fect on a fam­ily of dis­charge of a per­son af­ter stroke.

With­out in any way negat­ing the im­por­tant role of fam­ily in pro­vid­ing sup­port to us all, com­mu­nity ser­vices are for the per­son rather than for the fam­ily, and such health­care sup­port should be seen as a right on the same ba­sis as can­cer or car­diac care. It also en­ables peo­ple to de­pend less on care from fam­ily and other in­for­mal sup­ports

A sec­ond is­sue is that the gap be­tween the pay­ment for a max­i­mum Home Care Pack­age and the av­er­age for a so-called Fair Deal would still leave over 100 hours in a week un­cov­ered, and in par­tic­u­lar it would not cover nights which is very of­ten a deal-breaker.

In ad­di­tion, more in­tense rosters in­evitably mean a wide va­ri­ety of peo­ple with vari­able train­ing and ap­proaches com­ing into the home, which can be very stress­ful and desta­bil­is­ing for not only the older per­son but for those liv­ing with them, as elo­quently de­scribed by Ruth Fitz­mau­rice in this news­pa­per on Jan­uary 4th last year : “Our house is filled with nurses and car­ers and they are hurt­ing me. It’s not their fault.”

Trumpian al­ter­na­tive truth

A third is­sue is that the so-called Fair Deal is based on the fact that you are pay­ing for board and lodg­ing in your nurs­ing home (even if you don’t have res­i­dency rights!). With com­mu­nity care, not only do you need re­sources to live in your own home but the first Ir­ish lon­gi­tu­di­nal study on age­ing (Health and So­cial Ser­vices for Older Peo­ple II ) showed that older peo­ple al­ready pay for part of their care.

If we later need nurs­ing home care (as can of­ten hap­pen), are we likely to be fur­ther dou­ble-charged on our homes, as­sets and in­come with this se­lec­tive in­her­i­tance tax on de­men­tia and stroke – some­thing that would be in­con­ceiv­able for can­cer care?

We, the present, future and in­creas­ingly healthy older peo­ple of Ire­land, need to recog­nise our own stake in this sin­is­ter devel­op­ment. Rather than set­tling for a Trumpian al­ter­na­tive truth, we must de­mand a sys­tem that pro­vides com­mu­nity and in­sti­tu­tional care for age-re­lated dis­abil­ity and dis­ease on the same ba­sis as that for can­cer and car­diac dis­ease.

The gap be­tween the pay­ment for a max­i­mum Home Care Pack­age and the av­er­age for a so-called Fair Deal would leave over 100 hours in a week un­cov­ered

With­out in any way negat­ing the im­por­tant role of fam­ily in pro­vid­ing sup­port to us all, com­mu­nity ser­vices are for the per­son rather than for the fam­ily

Newspapers in English

Newspapers from Ireland

© PressReader. All rights reserved.