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Ageing in Place - Delivering a Fair Recovery for Older People
Ireland has an increasingly ageing population and it is imperative, both from the perspective of the individual and the supporting structures, that ageing in place becomes the default approach.
The objective of a pension system is to provide citizens and residents with an income that removes them from the risk of poverty in old age, yet the Irish pension system is characterised by incomplete coverage and a generous system of tax reliefs that disproportionately benefit the better-off in society. (More than 70 per cent of these very lucrative pension-related tax reliefs accrue to individuals in the top income quintile).
Social Justice Ireland proposes a single-rate universal state social welfare pension from January 2022 at the rate of the State Pension (Contributory). The significant additional expenditure required could be funded through reform of Ireland’s system of pension-related tax reliefs, and through a moderate increase in Employer PRSI, as detailed in our report on the Universal Pension from March 2018. This would involve standard-rating the tax break on all private pension contributions.
According to Eurostat, 9.9 per cent of Ireland’s population aged 65+ are living in a dwelling with a leaking roof, damp walls, floors or foundation, or rot in window frames or floor, and that’s before accounting for illness or disability which requires further home adaptations. That’s almost 69,000 older people. Research by TILDA puts the rate of people aged 50+ living in substandard accommodation at 57.8 per cent, with the most prevalent housing condition issues relating to damp, mould or moisture.
The expenditure in respect of the Housing Aid for Older People plummeted from €30.8m in 2010 to just €12.8m in 2020, while Housing Aid for People with a Disability reduced from €39.8m to €26.6m in the same period. The number of grants across both schemes fell from 11,552 in 2010 to 6,455 in 2020. To provide for a standard of living into older age, the cuts to Housing Aid for Older People and Housing Aid for People with a Disability must be restored, starting with an allocation of €85m in Budget 2022.
Being well at home is also about the availability of care supports appropriate to the needs of older people. According to the most recently published HSE Performance Reports there were 417 delayed discharges of older people up to the end of September 2020, and 2,964 older people awaiting homes support packages. The Government committed to the introduction of a statutory right to home care in 2021, however we are yet to see any detail of this.
Social Justice Ireland believes that ultimately it should allow for choice on the part of the care recipient from a ‘basket of goods’ that ranges from healthcare to home care, personal care to social inclusion. In the meantime, an increase in the current provision of home support packages to older people is urgently required. The average number of hours provided by the HSE per older home care recipient for the first nine months of 2020 was 6.3 hours per week. While the number of people in receipt of home support increased by 649 on the same period in 2019, 158,050 fewer hours were delivered.. Budget 2022 must include an allocation of €106m for additional home care supports and address the most current waiting lists.
The Community and Voluntary sector provide a range of key supports for older people, from befriending and social inclusion supports, to home care and assistive technologies. These supports are particularly important for those older people living with dementia and their families. The additional revenue supports to frontline Community and Voluntary organisations dealing with the Covid-19 emergency were welcome, however for these supports to be sustainable post-Covid, a multi-annual increase in allocation is required starting with an allocation of €35m in Budget 2022.
The impact of Covid-19 on nursing home residents is well-documented. Approximately 3.7 per cent of all people aged 65+ reside in nursing homes, as per Census 2016. While the health focus should be on enabling people to age at home, for those for whom nursing home care is appropriate, nursing home policy must take cognisance of the vulnerability of residents, their advanced medical conditions, and the retention of a quality of life. Social Justice Ireland welcome the inclusion of measures to safeguard nursing home residents in the Programme for Government. This must be adequately funded and address both the shortfall in coverage and the disparities of funding between HSE-led and private and voluntary facilities. It must also be provided in consultation with nursing home providers, residents, families and carers.
The Government is yet to publish the nursing home pricing review, promised by November 2019 and delayed again in October 2020, which would provide much-needed clarity to this area. Funding for nursing homes should be aligned to the needs of the residents; and to resource staffing and safeguarding reforms in nursing home care to ensure the safety of residents. Social Justice Ireland proposes an increase in funding for Nursing Homes to take account of demographic change pending publication of this report. This would cost an additional €35m in Budget 2022.
Of the 11,929 safeguarding reports made to the HSE National Safeguarding Office in 2019, almost 28 per cent (3,337) were made by people aged 65+, with 11.7 per cent (1,392) made by people aged 80+. The most prevalent types of abuse reported were psychological (1,356), physical (1,046) and financial (875). Immediate family members were most likely to be reported as alleged abusers (1,235 – an increase of 28 per cent on the previous year). More is needed to support adult safeguarding in Ireland with an increase in safeguarding supports at local and national level.
Budget 2022 should contain an additional €2 million to increase the capacity of the HSE Safeguarding Teams and develop a public awareness programme to support older people experiencing abuse.
Read the full text of our Budget Choices 2022 Policy Briefing - Delivering a Fair Recovery - HERE.