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THERE was once a time – and not that long ago – when you would find IDA billboards in Irish airports announcing to the world that we were the “young Europeans”. Maybe we still are, but we are also the ageing Europeans, and therein lies a problem.

The problem is our elderly and how we are going to look after them. The problem is serious now, but it will become much graver over the next decade because of the ageing pattern of our population. 

Why? Currently we have 415,000 people who are over the age of 65. And even they are not adequately provided for. But the real problem in terms of caring for the aged won’t kick in until 2006. After that the number of people over the age of 65 will really shoot up, and the estimate is that the current figure will double within 30 years.

“The reality is that the figures for our elderly population will begin to soar after 2006. This is going to leave us with a very big problem, and what we want to see is some government policy recommending an integrated approach between the private and public sectors,” according to Joe Stanley, the author of a new report published by the Irish Nursing Homes Organisation.

“There must be a concentration of policy and planning if services are to be consistently developed in accord with the best available evidence of increasing demand.” 

In its new report, the Irish Nursing Homes Organisation has set out to highlight the problems that lie in wait.

“Basically we’re saying that every so often there is a hue and cry about caring for the elderly, but then that passes and nothing much seems to be done,” says Mr Stanley. 

“We favour the philosophy that the elderly should be kept at home for as long as possible, and the notion of community care. But the reality is that a lot of elderly people require some kind of residential care.

“Looking at the statistics at the moment, and the projections for the future, it is clear that the problem of caring for the elderly is going to become acute in the next three decades.

“As a society we are going to end up with an awful lot of elderly people on our hands, and we have to start addressing ways in which we are going to cope with this.”

At present the 400 private nursing homes in the country provide beds for old people. Beds are also provided by the public sector, though financial cutbacks have impacted very seriously on this sector. But with the number of over 65s set to explode between now and 2030, something needs to be done as a matter of urgency. That will require a response from both the private and public sectors. 

“Up to now, the response has been very ad hoc. The response of public sector has been restricted by budgetary cut backs, and it is obvious that more and more people are going to be looking at private nursing homes.
“One of the problems at present is that the availability of private beds is very unevenly distributed. We have an oversupply of beds in some parts of the country, and a shortage of beds 

“What we have to face is a situation where the number of persons aged 65 and over living in the State is projected to rise from 413, 291 (or 11·4% of the population) in 1996 to 449,900 (11·4%) in 2006, 577,400 (14·1%) in 2016, and 753,500 (18·2%) in 2026. 

“Provision of all care services, including long term care, must be carefully planned to meet the developing demand in an appropriate and sustainable manner. Most health care planners work on the basis that there will be a continuing requirement for 5 per cent of those aged 65 and over needing to be accommodated in long term care, but increasingly the norm of 10% of those aged 75 plus is being used.

“Demographic pressures are not the same in Ireland as in other Western countries, and Ireland should not be faced with the same question of affordability of social provision for older people as have arisen in other countries. There is, therefore, welcome time and opportunity for proper planning.”

What Mr Stanley and his organisation want to see is recognition of the Irish Nursing Homes Organisation as a credible body with a serious contribution to make.

Beyond that the INHO wants to see uniformity of standards in the implementation of the Nursing Homes (Care and Welfare) Regulations 1993 and the Nursing Homes (Subvention) Regulations 1993.

All of this could mean in the end some kind of register for private nursing homes, and even some form of licensing system.

“No consideration has yet been given to the possible conflict for health boards as providers, purchasers and regulators of long stay care services,” says the INHO report. 

Instead of creating its own facilities from grass roots sites, it might be better in the long term if health boards took over existing nursing homes. That’s one possible solution.

Cost effectiveness of services is also a real consideration. At present it costs on average about £350 a week in a private nursing home, though this amounts varies from region to region and could be double that in the Dublin area. However, it is estimated that the average cost in the State sector is £400 per person.

“The cost of services provided by the private sector has to be examined closely in comparison with the cost of services provided directly by the State,” says Stanley.

“Such an examination must be completely objective and free of ideological bias and include every available aspect of cost benefit analysis. It must also include the essential element of ‘free choice’, so that those needing care can avail of it in a setting of their choice and as close as possible to the community.”

The INHO also favours the putting in place of a licensing system to ensure provision of services according to the actual level and location of identified need – medical, social and cultural. In other words, it is time to end the ad hoc approach to caring for our elderly.

What the INHO package appears to mean is a growth in the number of private nursing homes. If the State is unable or unwilling to extend the public sector facilities to offset this, then the very least the State should do is to introduce legislation to ensure that the establishment and running of private nursing homes conform to a set of criteria that place the interests and welfare of old people above money and profit.

At the very least, the report from the INHO should ensure that a proper debate can now take place, and that legislators have at their disposal information and recommendations to enable them to bring in new legislation to guarantee a level of caring for our elderly to match anything available elsewhere in the EU.