Marie Louise O'Donnell (Independent) | Oireachtas source

I move:

That Seanad Éireann notes the ratification by Ireland in 1999 of the United Nations Principles for Older Persons which include:

- Article 6: “Older persons should be able to reside at home for as long as possible”;

- Article 12: “Older persons should have access to health care to help them to maintain or regain the optimum level of physical, mental and emotional well-being, and to prevent or delay the onset of illness”; and

- Article 16: “Older persons should have access to the educational, cultural, spiritual and recreational resources of society”;

and calls on the Minister for Health to:

- outline how Ireland is upholding the United Nations Principles for Older Persons;

- maintain Government policy which is to facilitate older people to stay in their own homes and communities for as long as possible; and

- continue to develop alternatives to residential care, including enhanced home care, and to consider the potential of new residential models which would help older people to be more independent and to enjoy a better quality of life for longer.

I welcome the Minister of State, Deputy Kathleen Lynch, who I know is interested in this issue. A student at Oxford once told Albert Einstein that he had set the same examination questions as in the previous year. Einstein said the questions may have been the same but that physics had moved on and that, therefore, the answers would be "very different". It is how we answer things that may change.

We all know that it is an irreversible fact that we are going to get old. We need more creative and imaginative solutions to how our elders are treated. "We fail in clearness of vision or in boldness of heart or in singleness of purpose" - these are not my words but of Pádraig Pearse in The Murder Machine. The American writer Kurt Vonnegut wrote a book called A Man Without a Country. I do not subscribe to the premise, but in the book he speaks about how the most terrifying characters in history were the most enthralling and great guessers. The most profound and loud guessing is happening in parts of Europe and other countries. Our international leaders are sometimes completely unaware of solid information, research, scholarship, investigative reporting and downright common sense. The guessers know no more than the ordinary common man, but they give the illusion - I may be talking with the benefit of age - that we are in control of our destiny when we are not, especially when we get old.

My first point is that we cannot continue to guess our way around the profound topic of ageing, from a European or a national point of view. The topic of ageing is far more important than all of the shouting and roaring about water charges. The population has been getting older in the past 30 years, hence the rise in concern about hospital beds, including step-down beds, step-up beds and bed blockers, as well as nursing homes and primary care services. This problem has been coming for the past two or three decades; it did not just arise yesterday. How we plan for the future is becoming the big reality. As a nation we are very bad at planning; we write plans and give them a language and then shelve them. We rarely activate them. That is the reason 68% of us do not have a will. If ever Ireland or politics needed a more compassionate, imaginative and creative way forward it is on the issue of ageing, but we keep putting aside the big issues. If I was to leave a dog alone at home for three days, the ISPCA would be called and it would become an animal rights issue. An older person, however, can be left at home for three or four days, or die on their own. This is a human rights abuse and it happens all the time. It also happens all the time in institutions; people are unwillingly in institutions, without visits.

In 1999 Ireland signed up to the United Nations Principles for Older Persons, yet current policy is geared towards incubating and congregating older people in long-term care settings. Government policies must help them to live in an anti-fragile world. We should not accept that we will wither away in an unacceptable way because of financial and human costs.

When I was young, I was very interested in Greek drama, from which all great dramas rose. They always had a king or a young man, a princess or a young woman, or a group and no matter what happened in a society, be it through greed, jealousy or war, at the end the elders would always come on the stage and say, "You should have listened; we told you that you needed to be careful about what you did and the decisions you made." They always offered solace, wisdom and hope. We need to listen to our elders who have been ostracised and silenced. We know that they have been silenced in the financial sense, as poverty silences people, as does the old age pension. They might be frail and not have the language or the voice, but we have to listen to what they tell us about how they feel about their lives.

In much of the world average lifespan is past 80 years and rising. More than half of us live without a spouse and a partner. We are also having fewer children, which is another source of concern. Are the autumn days of our lives to be spent in institutions and nursing homes, with intensive care routines? I understand it is not always possible for people to live at home, but I argue the case for greater balance, in favour of staying at home. There are complicated medical needs, against which I do not argue. There is a great book in which all Senators might be interested, or the Minister of State may have read it. It is called Being Mortal by Atul Gawande. It is a brilliant book on ageing. Atul Gawande believes that in some way we have allowed our fate to be controlled by medicine, technology and strangers and he is right. There are those who may think it is a little extreme, but sometimes one needs to be extreme to find common ground.

I am not attacking nursing homes, as they are outstanding in the care they provide, but we need to look more at saving money by using the same ideas, polices and solutions within the home. We need to look at the phenomenon of ageing in other ways. For example, what about having a fair deal scheme package with appropriate care being provided in one's home? The person concerned could still pay at the rate of 7.5%, 14% or 21%. What about having a direct payment scheme for those to decide who they want to mind them in order that they will not always be looked after by people who can often change? My family and I are a living example. Every week, sometimes every day, the people concerned can change.Old age should be multi-generational but has become somewhat private. It is the private aspect which I am trying to twist and turn. We need to reverse this. Age is no longer rare. The wisdom of age is somewhat ignored. There was an example of this recently with the retirement of the great transplant surgeon, David Hickey, who was not allowed to stay on, even as a mentor, at 65 years of age. Senator John Crown has a Bill to allow those who are able and have the capacity to be allowed stay at work.

Google explains everything to us. The wisdom of experience is explained through Google, not through the experience of a human being’s age. Philip Roth, the novelist, said old age is not a battle but a massacre. The older I get, the more I know what he is talking about. The Government should not add to the massacre. Depression is rife among older people. We rarely hear about it because it is the preserve of another chronology. We are not educating enough doctors to study gerontology. It is the least sought after medical specialism in America.

Nursing homes cost five times more than independent living. This comes back to my point about the fair deal scheme. Did nursing homes really find their route in giving ageing people a better way of life, better than what they had in their other lives? No. They were created to clear out hospital beds. The place where we are most likely to spend some part of the frail last years of our lives was never really created for us. I fully accept we have quality and standards in nursing homes and that they are safe. However, it is not happy sometimes. A person might have left their apartment but is no longer allowed to do things because they are not safe. One might have made one’s own jewellery. Now, that person just plays bingo, watches a DVD and has passive entertainment but not purpose. Health and safety has closed down much of the creativity in nursing homes and what older people can do there. The elderly have less freedom than children.

What we forgot in all our protection in health and safety was how to make life worth living. The elderly are frail, weak and cannot argue for themselves. People like us are here to argue for them. Why have we not burned the nursing homes to the ground? There is one here in Dublin that I would burn to the ground. It is because we do not really believe that anything else is possible. We believe it is sort of possible under certain conditions. This comes back to Pádraig Pearse and the lack of clear vision.

We need to develop assisted living as the norm, building it in every village and town. I believe when one is away from home, one has lost one’s freedom, no matter what one’s age. I also believe older people should never disburse decision-making to their children. The Assisted Decision-Making (Capacity) Bill 2013 will be very helpful here. Children are not in charge of their parents. Neither are nursing homes. Elders are in charge of themselves, even when they lack capacity because there was a time when they did have capacity and they can make those decisions. In the lobby of Leinster House, the Proclamation stands. It talks about human rights. This is one.

Privatisation of home care means that one hour of home care costs €25 per hour. At 168 hours a week that comes to €4,200. In 2026, 16% of the population will be over 65. We now have what are termed young-old, people between 65 and 74 years of age, middle-old, 75 to 84, and old-old, 85 years up. That is how long we are living. If one buys into fair deal, one cannot reverse one’s decision.

There are 36,000 people in nursing homes, equivalent to the population of Sligo town. According to the ALONE report, some 12,000 of these people do not need to be there. Up to 12% of elders in nursing homes engage in passive suicide. I saw it myself. Up to 57% of the budget for older person services is being allocated to just 6% of the older population. The percentage of the elder population in nursing home care in Ireland is 35% greater than the EU average. In the past five years, there has been a significant decrease in supports for older people to age at home. The supports have been cut by €1.6 million and the housing adaptation grant by €30 million. I understand everything had to be cut but we must start reversing that. There is too much money going to 80% of stand-alone nursing homes. We need to parallel that money in the communities. We put people’s names down for nursing homes because we do not know or have not developed good home-care supports. The average length people stay in a nursing home is two and a half to three years. There is no incentive to reverse that pattern. Strategies are no guarantee of implementation.

We wait for occupational therapists to tell us what we already know. We are not acting like a smart economy but like the bad economy of bad health. I have just read the WHO report on ageing and health in which Dr. Margaret Chan, director-general of WHO, stated, "There is no “typical” older person ... older age does not imply dependence". We need less emphasis on congregated care and more on community care.

Almost 2,000 years ago St. John said, “When you are old, you will stretch out your hands, and others will dress you and take you where you do not want to go". I rest my case. I am delighted the Minister of State, Deputy Kathleen Lynch, is in the Chamber because she has a genuine interest in our elders. I would like to see policies reversed with fewer stand-alone nursing homes. Instead, I would like more care in the community where the elders deserve to be, in the core of what they built themselves in their lives and want to come back to.