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Budget 2021 must support our ageing population
Covid-19 disproportionately affected older people, particularly those accommodated in congregated settings. People aged 65+ accounted for 25 per cent of all Covid-19 cases, 55 per cent of all hospitalised cases, and 93 per cent of all confirmed Covid-19 related deaths. 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.
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 €13.9m in 2018, while Housing Aid for People with a Disability reduced from €39.8m to €29.7m in the same period. The number of grants across both schemes fell from 11,552 in 2010 to 7,262 in 2018. 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.
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 724 delayed discharges of older people up to the end of September 2019, and 7,252 older people awaiting home care packages. The Government committed to the introduction of a statutory right to home care in 2021, however we are no further along as to what this might entail. 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 2019 was just under 7 hours per week. While that represents an increase in the average number of hours compared to the previous year, the number of older people in receipt of home care supports by the end of September 2019 decreased by 5,531 compared to the same period in 2018. Additional home care supports must be provided to at least 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 recent 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.
Ireland is at the “upper end of the spectrum” of deaths in nursing homes, according to a special envoy for the World Health Organisation. Over half of all confirmed Covid-19 related deaths were of people in nursing homes. While the establishment of a Covid-19 Nursing Home Expert Panel in late May to review the measures taken to protect nursing homes was a welcome step, it does not make up for the inadequacy of the Government’s initial response to the pandemic’s affect on these people. Approximately 3.7 per cent of all people aged 65+ reside in nursing homes. 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, and take account of the recently published ‘Ethical considerations relating to long-term residential care facilities in the context of Covid-19’.
The Government is yet to publish the nursing home pricing review, promised last year, 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.
Of the 11,780 safeguarding reports made to the HSE National Safeguarding Office in 2018, over 27 per cent (3,218) were made by people aged 65+, with 11.6 per cent (1,378) made by people aged 80+. The most prevalent types of abuse reported were psychological (1,261), physical (1,012) and financial (811). Immediate family members were most likely to be reported as alleged abusers (964). More is needed to support adult safeguarding in Ireland with an increase in safeguarding supports at local and national level.
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 pension tax reliefs accrue to individuals in the top income quintile). Social Justice Ireland proposes a single-rate universal state social welfare pension from January 2021 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, 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.