From top A Dublin nursing home; Dr Marita O’Brien (left)  and Dr Sarah Donnelly

Dr Marita O’Brien (left)  and Dr Sarah Donnelly write:

The Covid 19 crisis has raised questions as to why older people, particularly those living in
nursing homes were not to the forefront in our planning to tackle this pandemic.

The tragic outcomes from this virus for older people in nursing homes are now the focus of media attention and public interest and outrage. How can we ensure that the lost lives do not just become statistics, but instead a beacon for social change in how we as a society provide care and support for older people?

State resources will always be limited. Prioritizing resources to be made available for spending on public services, like homecare, is – to a large extent – a political choice made by the Government of the day in accordance with their interests and political agenda.

It is evident that past policy and funding decisions on meeting the care and support needs of older people have been guided by social and political philosophy based on the principle of ‘subsidiarity’.

Long-term care and support of older people still remains predominantly the responsibility of the individual and his or her family, with the State intervening only when the level of care is beyond the family’s capacity.

Family members provide the majority of community-based care; Care Alliance Ireland
estimate that 89.5% of both personal care and household tasks are provided by family carers.

Public spending on the Nursing Home Support Scheme to support 23,000 people in 2019 amounted to €999 million compared to €450 million allocated for home care to support 53,000 people.

State intervention focuses on supporting the market to meet care needs. Tax breaks were given to developers of private nursing homes and hospitals the estimated cost of State subsidy to be €10 billion. Many of the investors were attracted by tax breaks, rather than an interest or understanding of older people and their care.

In recent times, the move towards larger nursing homes to take advantage of greater economies of scale, ageing demographics, and a long-term care system underpinned primarily by the State-funded Fair Deal scheme, is attracting large institutional investors to the sector.

Many millions have been spent in acquiring nursing homes, e.g. IMMAC spent €33 million acquiring Beechfield Care, InfraVia €70 million acquiring Carechoice.

There has been a casual ‘turning a blind eye’ to the ongoing human rights violations which our older citizens have been subject to.

As a society, we seem to accept it as the norm for older people to live in hospitals for months while waiting for homecare to be made available; for older people to ‘have to go’ into nursing homes as they live in an area where the HSE homecare budget has been used up.

There was no outcry, when the chief executive of the HSE, Mr Paul Reid told an Oireachtas committee meeting, that one of his main tasks would be getting the overall health budget under control, how a set budget would be allocated to home help hours for this year, and that the HSE would not be breaching it. This resulted in long waiting lists for home support, with 7,217 older people on the list at the end of June 2019.

While this did make headlines and generate some debate among politicians, there was little public interest or outrage. Yet, some of these older people waiting for homecare in June 2019, may now be on the list of those who died in nursing homes due to Covid 19.

Ireland has ratified the European Convention on Human Rights (ECHR) and the United Nation Convention on the Rights of People with Disabilities (CRPD). The State including all public bodies and authorities have an obligation to treat everyone equally and protect human rights, yet these principles and obligations are not reflected in current age care policy and practice.

Everyday older people are deprived of their autonomy when making decisions about where they will live as the necessary support to enable them to age in place cannot be accessed.

Many are deprived of their right to family life, having to live separate from their spouses of 50 years. People with dementia are denied homecare as they do not have personal care needs so their right to live independently is ignored.

The State is failing in its duty to protect the lives and wellbeing of our older people. It’s arm’s length approach of abdicating responsibility for the provision of care and support to private bodies and families has raised issues about their ability to intervene where there are protection issues.

For example, where there are allegations of abuse, HSE Adult Safeguarding Social Work Teams do not have a right of entry into private nursing homes; nor can they enter the home of an older person, where a family member acts as gatekeeper and refuses entry.

The Covid19 crisis has thrown up particular challenges in the care of older people and shed a spotlight on our nursing home and long term care sector. Large ‘congregated settings’ such as nursing homes having been shown to be particularly difficult to manage in this pandemic.

The term crisis refers to change and/or opportunity. Let’s seize the opportunity which this crisis has created to reframe aged care as a collective responsibility.

We all need care and support at some stage in our lives so aged care should be recognised as a public good. Like any public good, the principle of proportionality should apply to decision-making about the allocation of resources.

A government knowingly allocating insufficient resources to meet not alone projected, but even current demand for homecare is not proportionate, as it deprives many older people and families of their right to respect for private and family life.

By reframing care and support of older people as a collective responsibility and a public good, we can put in place the policy and resources we aspire to for when we are older and need support.

Like Denmark, care and support at home, in sheltered and assisted living and nursing homes built in small clusters of apartments could become the norm underpinned by public funds with state involvement in service provision and planning at local area level. .

Covid19 above anything else has shown up how fragile life is. It demands a new normal, a society which promotes human rights, prioritises each person’s needs and provides the necessary resources and support to enable all older people to age in place.

As individuals we must take action, use our voice, be tenacious to shift political attitudes and push for significant policy and funding reform if we want a different future as an older person.

Dr Marita O’Brien is an Independent Health Policy Analyst and Co-Director of Co-Creation Support CLG Follow her @Cocreatesupport

Dr Sarah Donnelly is an Assistant Professor of Social Work, School of Social Policy, Social Work and Social Justice, UCD Follow her @sarahmdonnelly1