Most older people in nursing homes due to gaps in community support rather than necessity

A majority of older adults are in nursing homes due to gaps in community support, not because institutional care is their preferred or most appropriate option, a Government commissioned report has found.The State’s Commission of Care for Older People on Friday published its module one report, which evaluated the healthcare system and examined how well it is working. The report found that despite progress made in recent years, services remained “fragmented and inconsistent” with care often being “delivered in silos”.Ireland has an ageing population, which is putting pressure on health and social services. Adding to this, Government policy is seeking to move away from institution-led care and to allow people to remain in their communities for as long as possible.READ MORE“The ageing of the population and changing household composition, with more single-person households, is likely to reduce the future availability of family/unpaid carers,” the report says.“If there is a continued reliance on volunteer-led services, then there is risk that there will be insufficient financial and other supports for volunteers.” It notes that numbers living with dementia are expected to double over the next 20 years, meaning long-term residential centres are likely to be “put under intense pressure”.The report calls for action to be taken to reduce the risk of dementia earlier in life as well as to help people with the condition to live where they want to for as long as possible.The commission paid particular attention to the increasing privatisation of the care delivered to older people, in nursing homes and home support hours.“The lack of integration of private nursing homes within the wider health and social care services is a major concern of the commission,” it said.The report points to declining home ownership and the growing number of older people living in rented accommodation as a potential threat to the nursing home sector, given many families use the Fair Deal scheme to fund the cost of nursing home care.“Currently 25 per cent of the cost of NHSS [nursing home support system] care is derived from the resident’s income and assets, with a family home the chief asset used to fund the resident’s proportion of the NHSS cost,” the report says.“As home ownership rates decline in the future, so too may the proportion of the cost that can be borne by the resident.”In terms of home support hours, the commission warns that once large institutional providers begin to dominate a market, “their consolidation will further increase over time”.“The increased dominance of private-equity funded providers may be a cause for concern. There is some evidence internationally that this can reduce quality and access.” The commission also raised concerns about short-stay residential care, stating it has the potential to be “harmful”.“It may contribute to the inappropriate institutionalisation of individuals in both the short and medium-term, and in essence it draws the system back into an institutionalisation mindset for those groups who actually require rehabilitation.” The commission is led by Prof Alan Barrett of the Economic and Social Research Institute (ESRI). Module two of its work, which will focus on developing a strategic, costed care framework, is expected to be published next year.