Seanad debates

Thursday, 23 June 2016

Commencement Matters

Care of the Elderly

10:30 am

Photo of Colm BurkeColm Burke (Fine Gael)
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I welcome the Minister of State and thank her for taking this matter which concerns long-term planning. The Minister has set out clearly the need for a ten-year strategy on palliative care. However, we need to consider the HSE's 2015 annual report and the emphasis placed in it on the need for urgency in dealing with demographic influences. Let us consider the figures. In this regard, the Minister of State will have seen the figures quoted previously.

The number of people aged 65 years and over is 600,000, but by 2031 the corresponding figure will be over 1 million, which will represent growth of 400,000 within a short timeframe. The good and interesting news is that the number in the over 85 age group is also increasing. My understanding is that the figure has increased by approximately 20% in the past six years alone. The HSE report cites the fact that the number in the over 85 age group is growing by approximately 4.5% per annum. I am looking for some joined-up thinking among those involved in elderly care, including in the private and the public sectors. The fair deal scheme is functioning well in the sense that there are now over 23,000 people in private nursing homes under the scheme. The question is how we plan for what will happen in the long term and whether we can have the same ratio in the coming 15 years. How can we provide for care in nursing homes without the necessity of people having to be admitted to hospital? An issue arises when elderly persons are referred to hospital from nursing homes. Is the emergency department the appropriate route for them?

The matter I am raising relates to long-term planning and the need to put something comprehensive in place to deal with the growing number for whom we will have to provide in the coming ten, 12 and 15 years. That is the context in which I am raising the matter with the Minister of State.

Photo of Helen McEnteeHelen McEntee (Meath East, Fine Gael)
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I thank the Senator for raising this Commencement matter.

Ireland's population is ageing rapidly, with advances in health care leading to a dramatic rise in the older population.As the Senator mentioned, in the next 20 years the number of people over 65 will double and the number of people in their 80s will treble. While that is obviously very positive, it brings its challenges. These demographic changes will have significant social and economic implications. Demand for community services is rising as more people are supported at home rather than in hospitals or nursing homes.

The challenges arising from population ageing can be met if we plan effectively and necessary adjustments are made over time to our services. We need to ensure that levels of service are sufficient to meet the growing needs, that they are co-ordinated and integrated effectively, and that the preferences of our older people are at the heart of this process.

Significant additional resources were provided to older persons services in 2015 and two weeks ago we provided €40 million in additional funding to support home care services, and to develop short stay and transitional care beds. There will, however, always be a cohort of older people who require a quality long-term residential care option. This must continue to be available to anyone who needs it, and therefore we will ensure that the nursing homes support scheme is funded to a level whereby successful applicants do not wait more than four weeks for funding.

Most older people want to stay in their own homes for as long as they can. It is widely accepted, not just within the Department and the HSE but also among advocacy groups, that people live happier, longer and healthier lives when they live in their communities and when they contribute to their communities. Home care services are a key element of how we can support them to do that.

The Programme for a Partnership Government is committed to supporting, on a multiannual basis, the development of home care services. We are now supporting more people at home with more complex needs than would have been possible in the past. The more of this we can achieve, the more and better the options that we can offer to older people.

The integrated care programme for older people which is currently being established and implemented across four pilot sites, inclusive of community health-care organisations and hospital groups, will bring a focus to the clinical requirements of the small but ever increasing number of older people who have complex care needs and who are at risk of admission to hospital emergency departments in an unscheduled manner. This was an issue the Senator raised.

This programme will see the development of access to specialist teams such as consultant geriatrician-led multidisciplinary teams and will bring a case management approach to supporting identified older people living in their own community through bespoke care plans and where the resources such as home care, day care and respite can be interlinked appropriately to meet their needs so that each organisation will know what each person's care plan is and can deal with it appropriately.

The Department of Health is committed to developing a national integrated strategic framework for health workforce planning, in collaboration with other Departments and agencies. A cross-sectoral steering group has been established to develop this workforce-planning framework for health services that will support the recruitment and retention of the right mix of staff across the health system. It is envisaged that a plan will be submitted by the end of the year setting out how we can ensure that there is an adequate supply of appropriately trained health professionals to provide high-quality services that are delivered safely and cost-effectively.

In that regard additional funding is required on an annual basis. We also need a change in how we provide our services. I believe that shift is happening, but obviously we need to ensure it happens as quickly as possible.

Photo of Colm BurkeColm Burke (Fine Gael)
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I have a question on home care. One of the big problems in rural areas is finding suitably qualified people to look after elderly people. Can we develop a new initiative in that area? It is now a fundamental issue. I am dealing with a case where someone is on dialysis three days a week and is living in a rural area. That person needs that additional support but in a rural area it is quite difficult to get. I ask the Minister of State to consider a new initiative to encourage people living in rural areas who might not be in the workforce at the moment but could be encouraged to come in and provide this kind of back-up support. Could something like that be done?

Photo of Helen McEnteeHelen McEntee (Meath East, Fine Gael)
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The cross-sectoral steering group that has been established has been given the remit to look at this. I will certainly ensure there is something specific for elderly people and those living in rural areas. In recent years it has been a mixture of lack of funding and also not having the relevant stage. I will bring that to attention of the group.