Commission highlights long-standing gaps in care for older people

In March 2024, the Government established an independent Commission on Care for Older People to examine care and supports for the sector.

As a commitment in the Programme for Government, the Commission was set up in recognition of the disproportionately negative impact of the Covid-19 pandemic on older people.

The remit of the Commission is broad and being advanced through three consecutive modules. In Module 1, the Commission examined the effectiveness, adequacy, and efficiency of the services and supports currently provided within the health and social care system.

The Module 1 report was published at the end of last month. It contains a number of findings that, while perhaps unsurprising for anyone with knowledge of the area, are important in drawing attention to long-standing deficits in the services and care for older people.

For instance, the Commission states that the greater private provision in long-term residential care is “happening without appropriate debate and analysis”.

More broadly, it finds that long-term care is not sufficiently person-centred.

“Older people are often required to ‘fit’ into services, rather than services being built around their needs and preferences,” according to the report.

It points out that most older people in nursing homes are there due to deficits in community supports rather than because they chose long-term residential care as a preference.

In relation to home care, there is a lack of a consistent care needs assessment and case-mix classification model to connect people’s assessed needs with funding. Also, the number of publicly funded hours provided for home care is often inadequate and differs across the country.

Indeed, equity of access to different care services was repeatedly noted in feedback as a key challenge for older people nationally [across the country].

The Commission also points out that access to public services is, in many cases, dependent on possession of a medical card, the lack of which “effectively locks some older people out of community-care services”.

The report highlights the absence of a HSE clinical governance structure to bring together the full continuum of health and social care services for the demographic.

“As a result, care integration for older people is limited and services are often delivered in silos,” according to the report.

It recommends that the health and social care system should align with universal design principles to create a ‘single door’ system.

“An older person must be able to access services based on a holistic understanding of their need rather than on an individual diagnosis,” the Commission states.

However, importantly, the Commission acknowledges that improvements have occurred. It highlights the work of the enhanced community care (ECC) programme, specifically the chronic disease management programme (CDM), and the integrated care programme for older people (ICPOP).

Also, it notes how community specialist teams for older people offer support to avoid unnecessary hospital admissions.

“The CDM and ICPOP models allow for better coordination of wraparound services to be provided to the population,” according to the report.

“Dementia advisers are reporting that, in areas where ICPOP teams are operational, the integrated care system has a hugely positive impact on the quality of care a person with dementia receives, and that it is working very well in terms of meeting their needs.”

However, the Commission says the “significant capacity issues” in general practice need to be addressed, including the regional variation in the number of GPs.

“Such capacity constraints and the lack of specific funding for GPs that aligns with ICPOP and the care of older people may prevent development of an expanded, CDM-like programme for older people that has the potential to address the specific health challenges of ageing.”

The issues, as well as others raised in the Commission’s report, are well-known. But the report is an important reminder that these deficits need to be addressed as a matter of priority.