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Celebrating Excellence in Care
Health service will face repercussions if we fail to grasp evidence and plan now
Our ageing demographic and bountiful evidence is pointing to a rapid increase in the growth in requirement for nursing home care. Tadhg Daly, NHI CEO, warns of the consequences of not bringing together a strategy to ensure we are positioned to meet our residential care requirements
“Let us not seek to fix the blame for the past. Let us accept our own responsibility for the future” - John F Kennedy.
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t’s a maxim that the art of politics is about managing the present and dealing with issues arising for constituents: ‘delivering’ their ‘requirements’, avoiding controversy, generating the necessary goodwill that will secure re-election. It might be considered a generalisation but much of the reality of politics is about surviving the present and leaving future policy and planning in the hands of those forthcoming. JFK also stated: “There are risks and costs to action. But they are far less than the long range risks of comfortable inaction.” The massive growth in our ageing demographic is well-versed both in political and societal discussions. It does appear on the political horizon. Within discussion surrounding health policy, the ‘ageing demographic’ and ‘challenges’ this presents are often cited. The evidence is presented, but are we facing up to the challenges? Are we living within the present and not planning appropriately for the future? Nursing home care fulfils an intrinsic role in healthcare delivery. Presently, more than 22,000 people require the specialist care provided within the dedicated ‘home from home’ settings that are nursing homes within our communities. It is a small minority of the population and older persons who require this continuous care. Approximately one in 25 people who are classified as older persons – those aged 65+ - presently require nursing home care. As outlined by HSE, at present 90 per cent of frail older people in Ireland live at home, with 80 per cent of them living well and independently. It is our ‘older-old’ population who are significantly dependent upon nursing home care. Approximately one in five persons aged 85+ reside in a nursing home. These persons have high-dependency healthcare needs. The Dementia Services Information and Development Centre (DSIDC) informs that the prevalence and incidence of dementia rises exponentially with age and dramatically so in those over 80 years. The CSO is projecting for every two persons who were aged 85 or beyond in 2011, there will be a third person living in this age category by 2021. It is fantastic that people are living longer and our older
population must always be embraced and celebrated. However, we cannot overlook the enormous challenges this will present for health services in the medium term. Requirement for the specialist roundthe-clock health, clinical and social care provided by nursing homes will grow exponentially. “Even with greater emphasis on care at home and more resources provided to realise it, the demand for residential care is going to increase significantly in the next decade,” the Centre for Ageing and Research and Development in Ireland (CARDI) has stated. “There will always be a significant requirement for long-term residential care,” says the Department of Health’s review of the Fair Deal Scheme. The Department and Minister Varadkar are well briefed on the major challenges we face in meeting the requirement for nursing home care. “On balance it would appear that a minimum of an additional 7,600 beds (over 1,000 beds per year) will be required between now and 2021,” the Department stated in its briefing to the Minister upon his appointment to the health portfolio in July 2014. Such projection is supported by research undertaken by independent agencies such as the ESRI, CARDI and BDO. The Department has estimated that €200m additional spending will be required per annum to meet health needs of an ageing demographic. The Nursing Homes Ireland Annual Survey 2014/2015 revealed a significant slowdown in provision of new beds in the past five years and decrease in the number of nursing homes. State commitment of €200m to bring the physical environments of public nursing homes up to HIQA standards will be very inadequate, when you
consider that the HSE stated two years ago that €834m would be required. Minister Varadkar and Minister with Responsibility for Older Person Care, Kathleen Lynch have recognised the importance of ensuring timely access to nursing home care by reducing waiting period to access funding to four weeks. Speaking in Dáil Éireann on the 10th November Minister Varadkar said it has enabled 265 new beds to be freed within the acute hospital sector, “which is a capacity increase equivalent to a medium-sized hospital”. The ‘evidence’ is bountiful. Back to the question posed: ‘Are we living within the present and not planning appropriately for the future?’ Worryingly, with this Government now moving into its final lap, it has failed to publish a clear and cohesive policy and national strategy for the long-term care of our older population. We need to plan a healthcare model that provides a continuum of care for our older population and enables them to avail of the most appropriate care at the most appropriate stages. In its report, ‘Quality and Standards in Human Services in Ireland: Residential Care for Older People’, published three years ago, the National Economic and Social Council (NESC) recommended the establishment of a “problem-solving group” to enable services in residential care to be provided at an optimum level for older people. The ‘evidence’ serves a stark warning that if we fail to plan now, we will be facing a health and social care crisis of significant magnitude in the coming years. Despite the warning coming from the Department of Health regarding additional bed requirement, there remains a strategic
Even with greater emphasis on care at home and more resources provided to realise it, the demand for residential care is going to increase significantly in the next decade
policy vacuum. NHI continues to push for the establishment of an appropriate forum to bring stakeholders around the table to advise the Government about appropriate planning, policy and strategy to support nursing home care provision. What could such a strategy entail? There is a critical requirement for the introduction of an evidence-based cost of care funding model that recognises the complexity of care for persons who require long-term residential care. DSIDC and the Oireachtas Health Committee have identified the shortcomings of the scheme in this regard. “Payments made through the NTPF need to be commensurate with level of care, staff training and skill mix and type of non-pharmacological interventions expected to be delivered,” DSIDC’s national survey of dementia care published in January stated. Recognising the lead role the private sector is fulfilling in provision of specialist dementia care, the report added: “A new funding model is required if the private sector is to be further incentivised, with more funding allocated to private nursing homes in recognition of the specialist services needed to support persons with dementia, including those with behaviours that challenge.” In its Report on End of Life & Palliative Care in Ireland, the Oireachtas Health Committee stated: “In reviewing the current Fair Deal scheme, an evidence-based cost of care model could be used in assessing the real cost of residential nursing home care in Ireland.” Very disappointingly, the Review of the Fair Deal scheme ‘kicked for touch’ in this regard. Its recommendation was a review of the pricing model be undertaken by the NTPF within an 18 month period. It is inappropriate that the current commissioners are tasked with such a review and it should be independently undertaken. The importance of ensuring staff are available to provide the person-focused specialist care befitting of persons with dementia should also be a key consideration for any strategy. The national and indeed international crisis in nurse recruitment is not confined to acute services, with serious issues surrounding the recruitment and retention of nurses threatening bed capacity in nursing homes. Engagement with stakeholders can deliver a workforce plan for the entire health