As a nation, we are living longer and the proportion of older people is rising. While undoubtedly good news for our older population and their families, the demands placed on wider society as a result of an ageing population pose very serious social and economic challenges now and for future generations.
Between now and 2021, the number of people aged 65 and older will increase by 38pc and is expected to almost double by 2031. However, it is the dramatic growth which is occurring in the older age groups, particularly the population over 85 years of age, and the extent to which Ireland is prepared to meet the care needs of a rapidly growing older population, which is becoming an issue of national importance.
The evidence is clear. Demand for nursing home care is, in many parts of Ireland, now beginning to outstrip supply in the sector. This is manifested in many nursing homes operating at close to full capacity, long waiting lists and significant delays faced by those who have an urgent requirement for nursing home care.
Based on recent research undertaken by BDO, there will be a requirement for almost 8,000 new nursing home beds (the equivalent of about 100 new nursing homes) to meet forecast demand by 2021.
Shortfalls in capacity in the nursing home sector reverberate throughout the wider healthcare sector. Where people cannot access residential care, they will be left with little or no alternative but to be cared for at home – which is unlikely to meet their complex care needs – or alternatively seek care within an acute hospital setting, at significantly higher cost to the State than the comparable cost of nursing home care.
This in turn adversely impacts on the ability of our entire population to access acute hospital care as an increasing number of beds within the acute sector will be occupied by people who could more appropriately be cared for in long-term residential care.
The chain reaction in our healthcare provision cannot be ignored, and its significant economic costs alone will place substantial knock-on pressure on already extremely stretched Exchequer resources.
The introduction of the Nursing Home Support Scheme/Fair Deal in 2009, as a means of helping to fund the cost of nursing home care, has undoubtedly been a very positive intervention and has greatly improved accessibility to and the affordability of nursing home care.
In reality, the Fair Deal has been a victim of its own success, with applicants to the scheme facing delays in the overall approval process. It is estimated that over 85pc of nursing home beds in Ireland are currently occupied by residents under the Fair Deal Scheme. The annual cost to the Exchequer of managing the scheme is estimated to be €974m. This is a figure that will increase, based on future population projections.
Despite increasing demand for nursing-home care, the HSE recently transferred €23m from Fair Deal towards home-care packages and other community supports. This decision will further heighten the difficulties and delays faced by those urgently trying to access essential long-term residential care services.
According to the HSE's service plan for 2014, fewer beds will be funded under Fair Deal than in 2013. The plan comes with an acknowledgement that this will result in an increase in the waiting times for long-term residential care. This will have very serious consequences for the health and well-being of older people.
The Government is aware of the scale of the challenge of continuing to care for our ageing population. However, the absence of a clear strategy on how it proposes to address these challenges is a major concern. Shortfalls in nursing home beds impact on the availability of beds in the acute hospital system, which in turn contribute to delays in A&E departments. This has implications for all and is not just an issue affecting the elderly.
The scale of the challenge facing policymakers, healthcare planners and nursing home operators can no longer be underestimated or ignored. Current policy is not working and is unsustainable in the long run. A national strategy which sets out how our elderly population is to be cared for; how Ireland can realistically care for greater numbers of its older population; and which sets out the role for each party within older-aged care provision must now be developed as a matter of priority.
It is only when these issues are addressed that Ireland will be in a position to effectively meet the care needs of its elderly population.
AUSTIN HICKEY IS CO-AUTHOR OF 'HEALTH'S AGEING CRISIS – TIME FOR ACTION'.