Older adults entering long term care unnecessarily

Too many older adults were entering long term care unnecessarily or prematurely rather than being enabled to stay living at home, according to the OPRAH Report on ‘Older People Remaining in their own Homes, presented to Minister for Older People Jim Daly.

Sponsored by Home Instead Senior Care, the report also identified:

  • Older adults had a strong preference to remain in their own homes as long as possible and enjoy better outcomes when they did so.
  • The number of people requiring home-care will rise significantly as those aged over 80 are projected to quadruple over the next three decades.
  • The existing system incentivises institutional care over home-care – as the Fair Deal Nursing Home scheme is on a statutory footing whereas access to home-care is discretionary and subject to remaining local budgets.
  • At lower levels of dependency, home-care costs can be significantly lower than institutional care.

The OPRAH Study was conducted by Professor Charles Normand from Trinity College Dublin from 2015 to 2017 and it set out to pilot an integrated approach to enable older people, currently at risk of nursing home admission, to remain living at home. The study illuminated barriers experienced by older people in identifying, accessing and managing the complex range of services needed to support successful independent living.

According to the Department of Health, between 2004 and 2013 there was a 44.6% increase in the number of residents in nursing homes categorised as low dependency and a 17.6% increase in the number of residents with medium dependency, suggesting that higher levels of low-medium dependency older people in Ireland are now entering long-term residential care.

“With the right supports, these people could have been at home. The public health system provides both residential and community services, but current funding arrangements are geared towards residential care. For example, while funding for nursing home care is available on a statutory basis there is no comparable statutory entitlement to home care. The need to consider and address this legislative imbalance is now pressing”, said Ed Murphy of Home Instead Senior Care, the leading provider of home care services in Ireland.

The study also uncovered a lack of clarity around entitlement to community care services. There were several cases of older people who were assessed as needing a certain number of hours of care, only to be receiving significantly less. OPRAH participants and their carers also reported a frequent and significant level of difficulty in accessing home support services.

The OPRAH report made the following recommendations:

  • The Home Care Scheme should be made statutory and the budget linked to the ‘Fair Deal’ Nursing Homes Support Scheme, so that it would no longer be easier to access the Fair Deal than a lower cost home care package
  • There is a need for a Support Co-ordinator whose role would be to augment home-care packages by providing access to the wide range of community based supports and services, often delivered by community organisations
  • The individual assessment of needs should place greater emphasis on social and psychosocial needs in addition to health and care needs.
  • There is a need for more housing options including ‘independent housing with care’, enabling older adults live independently in supported clusters, where care and other supports can be provided more cost-effectively and the person can access a greater range of resources.