Jillian van Turnhout (Independent) | Oireachtas source

I welcome this debate. It is vital to take on board the demographic trends. We have seen a dramatic rise in those aged 65 and older, which is a positive development. One sometimes gets the impression, however, that this demographic change is viewed wholly in the light of representing a negative burden on the State. In fact, notwithstanding the increased demand on public health services arising from an aging population, it should be a cause for celebration that public health improvements have reached a stage where people are living longer. Recent Central Statistics Office projections indicate that by 2021, the number of older people will have increased by 200,000. The number aged over 65 is expected to reach 1.4 million by 2046, with the number of over 80s projected to grow as large as 484,000 by that year. These projections certainly do represent a significant demographic challenge, but we have the advantage that we can see it coming.
Returning to the present, it is clear that existing services - community services in particular, as well as bed capacity - are under significant pressure. Nursing Homes Ireland has pointed out that the figures already point to a significant deficit of long-stay beds for older people in a context where demand for residential care will increase significantly in the next decade. Policy relating to long-term care of older people, Nursing Homes Ireland argues, must focus on community-based services and supports and home-based care initiatives.
The Neurological Alliance of Ireland's national survey, Living with a Neurological Condition in Ireland, published last month, examined many aspects of living with a neurological condition such as access to services, the impact of health cutbacks and the overall recession, and the need for community-based services and supports. Although this report does not relate exclusively to older people, the issues are all interrelated. I have asked for a debate in this House on the report because it explores many important issues.
Another important report, which I referred to previously in the House, is the document produced by the Economic and Social Research Institute on behalf of the Irish Heart Foundation. It indicates that the direct annual cost of stroke in Ireland is as much as €557 million per annum, of which €414 million is spent on nursing home care and only €7 million on rehabilitation in the community. The discrepancy in those figures is startling in a context where we know that many stroke survivors, including older people, want to be cared for in the community. Instead of putting the resources in place to accommodate that, we are merely funnelling people towards nursing home beds.
Data from the 2011 census data show that 4.8% of our older population are in nursing homes or hospitals. The nursing home support scheme operated by the Health Service Executive is subject to a multidisciplinary team assessment and provides financial support to people of high and maximum dependency to access long-term nursing care in approved private, voluntary and public nursing homes. Under the scheme, participants make a contribution towards the cost of their care, with the State paying the balance. I am aware of large numbers of people in hospital who are unable to access a place in a nursing home. Everybody knows about this, but it does not seem to be incentivising us to do anything. There are undoubtedly psychological effects for patients who know they should be in nursing home care, which is a significantly different type of care from the medical care one receives in a hospital. The significant majority of people requiring nursing home care are older people, with 22% of those aged 85 and over requiring such care.
Under the HSE's service plan for 2014, which was published last December, an allocation of €23 million from the fair deal budget was earmarked for care in the community and home-based care initiatives. These initiatives include intensive care packages which will benefit 250 people, intermediate transition beds to benefit 650 people, and 130 beds for patients presenting with more complex issues. However, Age Action Ireland has indicated to me its serious concern about the impact of the HSE service plan for 2014 on the 700 to 1,700 infirm and vulnerable older people who will not get a nursing home bed in 2014. How will those people be cared for? The service plan acknowledges that waiting times for a nursing home bed under the fair deal scheme will increase in 2014, with 700 fewer beds being funded. There were already 394 older people on the waiting list when the decision to fund fewer beds was made last October.
The newly published report by Nursing Homes Ireland, Health's Aging Crisis: Time for Action - A Future Strategy for Ireland's Long-Term Residential Care, predicts a shortfall in nursing home beds of approximately 4,000 by 2016 and 8,000 by 2021. Nursing Homes Ireland has argued that the lack of a clear policy and national strategy regarding the long-term care of our older population combined with the current uncertainty around future funding arrangements represent the most significant challenges to the long-term sustainability of the nursing home sector. People left waiting for a nursing home bed as a result of the changes made in the service plan will become more ill. They will be sent by their GP to the local accident and emergency department where they will be admitted to hospital. This is putting additional pressure on the system. Demand is already outweighing a supply that is insufficient to meet the needs of the sickest of our older people.