Providing proper care for the elderly
By Niall Hunter-Editor
The Government must take action to make improvements in the care of the elderly in Ireland, according to a new report.
The Irish Medical Organisation, in a pre-Budget submission, says these improvements will not only improve the lot of the elderly, but will reduce pressure on our acute hospital services and on A&E departments.
According to IMO Chief Executive George McNeice, elderly citizens value their independence and prefer to remain in their homes within community.
“Services must be delivered in partnership with the elderly, their families and carers, as well as through a range of statutory and non-statutory voluntary and community groups.”
The IMO says there is a need for a coordinated development of integrated primary care and community health and rehabilitation services which will be able to deliver appropriate services to elderly citizens in the appropriate place at the appropriate time.
According to IMO Vice-President and consultant geriatrician Dr Christine O'Malley, a sign of how service provision for the elderly has deteriorated in recent years is the number of beds currently available for care of the elderly.
According to Dr O’Malley, the provision of beds for care for the elderly has declined dramatically between 1968 and 2001.
The figures show that the total number of public beds for elderly care has dropped from 42 per 1,000 population to only 23 per 1,000 population.
The IMO says the failure to provide appropriate hospital care for the elderly is a significant cause of the ongoing A&E crisis.
The IMO's report says the health service has neglected to match public nursing home care beds with the growth of the population in our larger cities.
In the 1980s, the bed complement per 1,000 elderly people in Dublin was only half that available in the rest of the country.
This trend has been aggravated with the increasing urbanisation of Irish society.
"The collision of urban growth, reduction in the existing bed stock and a failure to develop services at an appropriate rate has caused great distress and suffering to many elderly Irish people and their families in the greater Dublin area. Cork, Galway and other growing urban centres exhibit symptoms of the same problems," according to the IMO report.
The Government in 2002 promised an additional 850 public nursing home beds-450 in Dublin and 400 in Cork. However, this, according to the IMO, only represents a beginning, and to truly match elderly bed needs, policymakers must plan for a programme that recognises that up to half of all citizens may experience nursing home care during their lives, and that to plan for this in an organised way will yield great benefits.
It will maximise general hospital used by freeing beds occupied by those awaiting long-term care rather than increase the numbers of more expensive hospital beds, according to the IMO.
"More importantly, it will begin to allow elderly people to enter nursing home care in a more organised and dignified manner than at present, without spending up to a year in a general hospital bed first," the report states.
The IMO says the presence of elderly people awaiting nursing home care in general hospital bed is a 'system failure'.
"It is pejorative to use terms such as 'bed-blockers' for them. Not only have they not caused this situation, but they and their families have often made Herculean efforts to stay at home for many years."
The report says that while private nursing homes can manage care for some elderly people, there is a clear need to provide a significant proportion of care in public nursing homes. "Private nursing homes have no obligation to take all who present to them. Current subvention rates will not meet the cost of many nursing homes."
The report points out that elderly citizens value their independence and prefer to remain in their homes in the community. "They have expressed repeatedly their desire to receive treatment in their homes and to live independently with the support of their families. The increased provision of home-based multidisciplinary professional care, in collaboration with enhanced support from the voluntary services, will do much to make this a reality."
The report says those who need continuing therapy should receive home-based services including physiotherapy, occupational therapy, speech and language therapy and mental health care.
Another important area of care which has been neglected, according to the IMO report, is mental health services for the elderly.
Existing services in this area, according to the report, have significant resource deficits. Most services have populations in excess of the recommended norm of one consultant per 10,000 people over 65 and there are staffing gaps in the provision of important members of multidisciplinary teams.
The report calls for the building of separate acute old age psychiatry units. These units should be staffed with psychiatric nurses and with an appropriate number of this staff and the beds should be on the site of a general adult psychiatric unit.
The IMO says the elderly psychiatric services should have access to long-stay beds designated under the Mental Treatment Act.
The IMO recommends in conclusion, that the deficit in hospital beds for the elderly-acute, rehabilitative and long-term care beds-be immediately addressed; that there be an accelerated building programme of public nursing home beds; an immediate increase in the nursing home subvention; an increase in home-based multidisciplinary care packages for the elderly, and adequate resources provided for old age mental health services.
See also irishhealth.com's Alzheimer Clinic-
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