Eilish O'Regan: 'Tough calls are needed if we're to avoid a future care catastrophe'
It is time for some brave discussions.
For many people, not just the elderly but also the disabled, the current system of home care support from the HSE is broken.
Sage Advocacy deals with many of the cries for help from families trying to cope with a caring crisis.
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Its New Deal discussion document is worth examining, as it calls for a social insurance approach in the form of compulsory age tax to be taken from the wages of workers over 40 and employers.
It suggests an "age fund" would be ringfenced and protected to support nursing home and home care.
It would no longer be solely depending on the Exchequer or the over-stretched HSE budget.
The next step is for policy makers in the Department of Finance to analyse how it should be levied, how much would workers and employers be asked to pay and how much it would generate.
The under-40s would be exempt, according to the Sage Advocacy report.
The ultimate hurdle is trying to sell the benefits of the tax to the hard-pressed workers who may be middle-aged but are likely facing many more years of rent or mortgage payments.
There would be an inevitable suspicion that the money would go down one of those many black holes in the health service.
However, it if was possible to set out the entitlements that older people would get as well as the quantity and quality of care which could be delivered there would be more grounds for support.
The Sage Advocacy report looks at how other countries are responding.
It said Ireland should aspire to the Danish model with its emphasis on publicly funded long-term care provided for the most part in community-based settings.
Ireland can also build on the experience of the German long-term care insurance model which generates ring-fenced public funding for long-term care.
It points to Citizens Assembly deliberations on the matter in 2017.
It reported that a compulsory social insurance payment received most first preferences.
As of now, the Government plans to keep the €1bn Fair Deal nursing home scheme separate from the proposed statutory home care scheme to be introduced in 2021.
Minister of State Jim Daly said the proposed new statutory scheme currently being developed will introduce clear rules in relation to the services for which individuals are eligible.
The question of how it will be funded has not yet been clarified although there is likely to be a means test and a co-payment.
At this stage, more transparency about the plan is needed before any decisions are made.