Caring for the elderly in their own homes isn’t just the right thing to do, it makes financial sense too


We owe it to our older people not only to find the best way of supporting them in their old age, but to make sure that this support is delivered in the way that allows people the maximum dignity, comfort and security.

That means that elderly and infirm people should, where it is humanly possible, be catered for in the comfort and security of their own homes.

Indeed, that is State policy, but, where this is not an option and additional support is needed, there are just two alternatives available: the State (or the family) provides support in the home or in a nursing home.

I think we can do better and I really believe, after studying this problem and consulting with a range of interested groups and individuals, that the solution is relatively simple.

What is needed is some flexibility. You maintain the same health criteria but you change the financial contribution criteria to reflect the different circumstances of keeping an older person in their home with appropriate care support.

That is what my Nursing Home Support Scheme (Amendment Bill) 2016, which was discussed in the Dáil last night, would do.

It would allow for the provision of home-care services to a person who qualifies for and is being offered long-term residential care, in circumstances where suitable home-care services can be devised for that person. Such services are less costly on the State than the long-term residential care being offered.

It is very straightforward. You amend Section 14 of the original Nursing Homes Support Scheme Act 2009 and give the HSE the option to provide home-help care to patients as long as the total cost is less than what it would cost to provide nursing home care.

All the evidence from specialists in geriatric medicine shows that the outcomes for older people are generally much better when they are cared for, and supported, to live in their own homes.

When you think about it, it makes sense. Older people are going to fare better when they are in the environment with which they are most familiar and in a situation where they enjoy the maximum freedom, comfort and privacy possible.

In some cases, the care and medical needs are so great that this is not an option. The Fair Deal scheme was developed by the last Fianna Fáil government to ensure that payment up front was not needed to ensure that an older person received appropriate care in a nursing home.

Financial barriers should not be used to force older people out of their homes, and into nursing homes, especially when you realise that it costs, on average, three times as much to care for someone in a nursing home than it costs in their own home.

So, it makes perfect sense for the State to ensure that – as far as practicable and taking the older person’s needs into consideration – older people can stay in their home.

As Justin Moran, head of advocacy and communications at Age Action, has pointed out: “It is a fact that there are more and more people in nursing homes today who could be supported in the community.”

All the statistics bear this out. About 36pc of people in long-stay nursing home beds have low to medium support needs.

The number of low dependency beds has increased by 44.6pc since 2004, while the number of medium dependency beds has risen by 17.6pc over the last two years alone.

The conclusion is clear: the proportion of people in maximum dependency care is decreasing as a percentage of the nursing home population.

So, why place them in nursing home care when it is not what they need nor what they want? The statutory scheme needs the flexibility to allow for this.

I am not claiming that my bill is some magic solution, but it can allow the small section covered by the bill to be cared for at home. More importantly, it can kick-start the process of putting home care help on a statutory basis.

The Government assures us that it intends to do something. I don’t doubt its intentions, but it does not have a great reputation for either making its mind up quickly or acting efficiently.

Time is of the essence. The people that these schemes are designed to help do not have time to waste.

While Dáil procedures do not allow the Opposition to propose a full system of statutory care, we can make the initial changes now that can pave the way to the goal of having a statutory home-care system. That is what my sensible proposal does, and there is no reason to delay its implementation.

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