Ombudsman Peter Tyndall discusses the research report 'Meeting Older People's Preference for Care: Policy, but what about practice?' which he launched in June 2016
Report published by Age Action along with the IASW, the Alzheimer Society and UCD
This article first appeared in the October edition of Ageing Matters in Ireland
12 October 2016
The report highlighted the manner in which so many older people are directed towards nursing homes, when they would prefer to remain in their own homes with appropriate support if necessary.
I have no doubt that many nursing homes are working to provide a good quality environment with opportunities for social engagement and recreation. Equally, for some older people, a group setting may well be a preferred option.
However, if the funding system is designed to discriminate in favour of residential provision, and there is insufficient support available to enable people to remain at home, then many people will continue to be denied their right to choose.
Ireland has been slow to tackle the issue of institutional care settings, or congregated settings as they are often referred to. In many other countries, services for groups of people who require support to live and participate in their communities have been provided to individuals and this allowed institutions to be closed.
Active and engaged
The default assumption is that people should be able to live in ordinary accommodation and live their lives as active and engaged members of their communities.
I have personally known people who are suffering from progressive illnesses who have been able to remain in their own homes after they have had to use wheelchairs, be fed with a Peg and use a ventilator. Because of the support they received, they have been able to retain friendships and remain at the heart of their family life and community.
There is no technical difficulty to supporting older people in their own homes if that is where they want to live. We just need the will as a society to do so. We need to have funding mechanisms which default to supporting people at home and not placing them into nursing homes if this is their preference.
The packages we put in place need to be designed to provide a decent quality of life, not a bare minimum. We need to be quick to adapt housing if people are less mobile, and in any event, ensuring that all new build housing can be readily adapted to wheelchair access.
For my office, this is a human rights issue. Everyone has a right to a home and to family life. As a society, underpinning these rights with services and accommodation should be among our highest priorities. We are keen to look at any complaints from individuals themselves, their families or advocates where these rights are not being upheld.
Resolving the issue of support for people in their own homes will have beneficial effects beyond those experienced by the individual themselves. Many older people are forced to remain in hospital for far longer than is necessary. This is bad for them, as they are exposed to infection and can quickly become more dependent in the long term.
In addition, they suffer the loss of autonomy and often dignity which is hard to avoid in a hospital context. The beds they occupy can also be badly needed by others, and this has knock-on consequences both for routine treatment and for emergency departments.
I don’t want to make the case on economic grounds, although it is there to be made. Rather, I believe older people should be able to receive the support they need to live valued lives within their own communities because that is their right, and the appropriate response of a decent society.
It’s time our services and funding mechanisms were re-focused, to show that we in Ireland value the older members of our communities and ensure that they can continue to enjoy their homes for as long as they choose.