Concluding his recent Covid-19 interview on The Late Late Show, Taoiseach Leo Varadkar signalled, finally, that there is a requirement to look at how we, as a society, care for our older people. His road to Damascus conversion has come with the Covid-19 crisis, as when Minister for Health five years ago he didn't travel this route.
For the past decade, Nursing Homes Ireland (NHI) has advanced to successive health ministers, including Leo Varadkar, the requirement for Government to lead in establishing a Department of Health-led forum to plan for the care needs of our older population. Despite public backing by health and older people, ministers as well as stakeholders, the forum has never come to fruition.
Now its time has come; too slowly perhaps, but better late than never. Our view is stakeholders should be brought around the table to assess the health and social care needs presenting for present and future generations of older people. The expertise should inform policy and resourcing decisions surrounding care of the older person.
On The Late Late Show, the Taoiseach was inadvertently presenting an inherent, long-standing flaw in the governing of this country: that there is no roadmap for the care of older people. Our ask has always been that this is absolutely essential for community-based health and social care providers.
Private and voluntary nursing homes number 460 around every community in the country and are dedicated healthcare settings within our towns and villages. They provide specialised care in a 'home from home' to 25,000 people, directly employing over 30,000 across a range of disciplines. Residents in nursing homes have been medically assessed as having high-dependency clinical, health and social care needs and require specialised support on a 24/7 basis. They can no longer be cared for at home or by relatives.
Private and voluntary homes are the significant majority providers of nursing home care and a Dementia Services Information and Development Centre analysis informs they are majority providers of specialist dementia care. The regulations and standards that underpin the independent regulatory process, and that is subject to continuous inspection by HIQA, applies to all nursing homes: HSE, private and voluntary. It is timely that we would have a forum now.
Slaintecare's core objective is to shift care from acute, back to the community. The Department of Health's Review of Health Demand and Capacity Requirements in Ireland to 2031, published two years ago, states: "By 2031, it is estimated that the over-65 population will account for approximately one half of healthcare activity."
As per the Taoiseach's comments, there is a requirement to support and enhance the current and future role of our sector to provide older people with a continuum of care. There is also a requirement to ensure these 400+ homely healthcare settings are fully integrated within our health services. Relationships with healthcare professionals within our communities can be further enhanced to support residents and the caring, committed, professional staff in our nursing homes. But everybody needs to know from the Taoiseach, a medical doctor himself, what an enhanced integrated relationship with the likes of GPs, occupational therapists, physiotherapists, plus speech and language therapists will look like.
Our sector is 'outward' looking and the role of nursing homes can be maximised to meet the care needs of people in the extended community. Nursing homes provide respite, transitional and rehabilitative care, preventing thousands of admissions, or re-admissions to hospitals, on an annual basis.
There is a role to fulfil, too, in the provision of extended services - both health and social care - for people living in the community. The nursing home should become a hub of services to enable people avail of specialist care away from the acute setting, to combat social isolation, to facilitate services such as meals on wheels, day care and home care.
Independent living and assisted living can be co-located with the services of nursing homes, providing a true community-based continuum of care.
Nursing home care is central and cannot be treated as an outsider as this pandemic has highlighted. The failure to engage and consult in bringing nursing homes around the table to address the 'once-in-a-lifetime' challenges presented by Covid-19 have been well versed. There is a requirement for an enhanced relationship, and parity of esteem, between the sector and the State's key players: the Minister for Health, the department, the HSE. There needs to be less philosophy of private versus public and more collaboration.
Very difficult lessons must be learned from Covid-19, particularly with regard to care of older people.
Time is not on our side. Department of Health commissioned analysis informs of anticipated requirement for an additional 5,300-plus acute beds, 10,000-plus people requiring home care packages and an equivalent growth in the requirement for nursing home beds to the year 2031.
Governments are guilty of focusing on the immediate, often placing long-term planning on the long finger. There is now an urgent requirement for a government to lead in ensuring the appropriate continuum of care pathway is implemented to meet the care needs of older people at differing stages of their care requirements.
This will entail ensuring the appropriate staffing complements and skill-sets are available; that older people have timely access to appropriate medical, health and social care specialists; that appropriate funding structures and appropriate resourcing is provided for the care of the older person. The resources need to meet the requirements of this new dawn, too. Monopoly purchase by one State agency of services is not the way to do it and the current regime of the National Treatment Purchase Fund's take-it-or-leave-it funding has never been fit for purpose.
The Taoiseach showed insight on The Late Late Show that he did not have as Minister for Health. He is right now to look at the care model for older people. Covid-19 has brought care of older people into the national consciousness and it cannot be allowed to diminish. A pivotal moment presents for the incoming government and wider society. The opportunity for an enduring legacy presents and the 400 nursing homes we represent have and will continue to play our part.
Tadhg Daly is CEO of Nursing Homes Ireland