Why are we squan­der­ing the gift of liv­ing longer?

The Irish Times - Tuesday - Health - - Front Page - Des O’Neill

Imag­ine there has been a wide­spread out­break of bur­glar­ies, and the Min­is­ter for Jus­tice re­sponds by de­mand­ing that the bur­glars should be more up­front and trans­par­ent about what they are tak­ing from you.

This would in­deed be a sur­pris­ing turn of events, but it finds a fas­ci­nat­ing par­al­lel in the pro­nounce­ments of the Min­is­ter for Health this month about who should pay for key el­e­ments of nurs­ing-home care.

The sever­ity of dis­abil­ity, usu­ally aris­ing from neu­ro­log­i­cal dis­ease, that prompts en­try to a nurs­ing home in­vari­ably re­quires a broad spec­trum of care, in­clud­ing con­ti­nence wear, wound dress­ings, equip­ment such as spe­cialised seat­ing, sup­port from ther­a­pists and ac­cess to di­ver­sion, leisure and trans­port to hos­pi­tals when needed.

To be some­what fair to the Min­is­ter, he in­her­ited a dread­ful mess. When the so-called Fair Deal was be­ing in­tro­duced, ad­vo­cates and spe­cial­ists in the care of older peo­ple re­peat­edly asked the pub­lic ser­vants and min­is­ters re­spon­si­ble for im­ple­men­ta­tion in both the HSE and De­part­ment of Health in open fo­rums about the pro­vi­sion of these vi­tal el­e­ments of care.

The re­sponses were a tragic mas­ter­class in duck­ing, div­ing, weav­ing and avoid­ing the ques­tion, and older peo­ple are now liv­ing with the con­se­quences. Af­ter giv­ing up 80 per cent of their in­comes, up to 22.5 per cent of the value of their homes and a re­cur­ring 7.5 per cent of their other as­sets, they and their spouses are now be­ing squeezed to the bone and be­yond to pro­vide dress­ings, con­ti­nence wear, ther­apy and so on.


The is­sue has been left in a limbo be­tween the HSE (as the nurs­ing home is the older per­son’s new home, should they not have ac­cess to com­mu­nity ther­a­pists?), the nurs­ing-home sec­tor (not-for-prof­its seem less in­clined to charge for these el­e­ments) and the eco­nomic vul­ner­a­bil­ity of these older peo­ple.

Rather than blam­ing the nurs­ing homes, the Min­is­ter should ad­mit to this his­toric lapse and ex­plic­itly in­clude the range of ser­vices and sup­ports re­quired for mod­ern-day nurs­ing-home care within the el­i­gi­bil­ity and fund­ing of the Nurs­ing Home Sup­port Scheme, rather than en­dors­ing tak­ing even more money (in­clud­ing the small amount left for per­sonal spend­ing) from a very com­pro­mised group.

In­deed, TS Eliot may not have been fully cor­rect when he said that April was the cru­ellest month: this month has been pretty un­com­fort­able for older Ir­ish peo­ple. The CSO launched a re­port on age­ing that bizarrely still re­ferred to peo­ple over 65 as “de­pen­dent”. How in­con­gru­ous to con­sider Liam Nee­son, John Banville, Pres­i­dent Hig­gins, Mary Robin­son, Neil Jor­dan and Christy Moore as de­pen­dent.

Rather than wel­com­ing our in­creased longevity, the me­dia cov­er­age of the CSO re­port was so neg­a­tive in terms of a mis­per­cep­tion of bur­den that it was sur­pris­ing that flags were not fly­ing at half-mast. It was quite de­press­ing to hear He­len McEn­tee, the new Min­is­ter of State for Older Peo­ple, im­me­di­ately us­ing the re­port as a launch­ing pad for the next heist from us as we age, charg­ing for com­mu­nity care.

Di­ag­nos­tic apartheid

This month also gifted us with a fla­grant ex­am­ple of di­ag­nos­tic apartheid for older peo­ple. Within the space of 48 hours, two vi­sions of health­care were pre­sented in news re­leases by the Min­is­ter for Health: the first, in­volv­ing spend­ing hun­dreds of mil­lions of euro on a strat­egy for can­cer, a dis­ease pre­dom­i­nantly of older peo­ple, made no men­tion of pub­lic con­sul­ta­tion on how we would pay for it, or the rais­ing of a spe­cial ex­tra tax.

The sec­ond, the pro­vi­sion of com­mu­nity care, usu­ally aris­ing from neu­ro­log­i­cal and/or rheuma­to­log­i­cal dis­eases, in­cluded a pub­lic con­sul­ta­tion for “af­ford­abil­ity and sus­tain­abil­ity”, code for “How will we charge mostly older peo­ple for these ba­sic health ser­vices?” The Cit­i­zens’ Assem­bly also seemed suck­ered by this mind­set, vot­ing for an ex­tra tax for com­mu­nity ser­vices rather than the same route as all other health­care.

What is wrong with us that we can­not seem to value later life as not only a huge ben­e­fit per­son­ally and so­cially but one that should have par­ity of ap­pro­pri­ate ser­vice pro­vi­sion and ac­cess as with other age groups and health ser­vices?

What we are wit­ness­ing is known as struc­tural lag, where many peo­ple are ce­mented to old-fash­ioned mind­sets on age­ing and are un­able to recog­nise and ad­e­quately re­spond to the new re­al­i­ties – and in­deed won­der – of age­ing. We all have a stake in a rad­i­cal re­think of our longer lives: we still seem to be frus­trat­ingly far from the tip­ping point that will bring us there.

The pub­lic con­sul­ta­tion for ‘af­ford­abil­ity and sus­tain­abil­ity’ is code for ‘How will we charge mostly older peo­ple for these ba­sic health ser­vices?’

Des­mond O’Neill is a con­sul­tant physi­cian in ge­ri­atric and stroke medicine and pro­fes­sor in med­i­cal geron­tol­ogy, Tal­laght Hospi­tal and Trin­ity Col­lege Dublin @Age_Mat­ters

Liam Nee­son in Si­lence (2016), di­rected by Martin Scors­ese: both men, be­ing over 65, would be re­ferred to by the CSO as “de­pen­dent”

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