‘I wouldn’t want to be back on my own again’: accommodating Ireland’s expanding older population

After being brought breakfast in bed every morning, 99-year-old Jimmy Grant takes his mobility aid and goes for a walk.

He has a typical route he follows, up and down the corridor and then out into the gardens around his home in Kilmoganny, Co Kilkenny.

“I’ll look out my window and I’ll see him, and I’ll think: ‘Oh I better go for a walk’,” says his housemate Ian Parkhill (77).

“It’s almost like watching Rocky outside sometimes. He has a course he does and he’s up and down,” adds Lisa Prendergast, nursing manager at St Joseph’s supported care home, where Grant lives.

Supported care homes are similar to nursing homes, but are specifically for people with low to moderate dependency needs. The 19-bed Kilkenny unit allows residents to remain within their community with appropriate support.

Grant moved to St Joseph’s two years ago, after living in the same home for 97 years. A farmer his whole life, Grant shed tears when he first moved, but now he says he “couldn’t ask for anything better”.

He goes to mass every Wednesday, and watches the local GAA matches on television. Every Sunday, he visits his wife who lives in a different home due to her having increased medical needs. They have a “cup of tea and a chat,” he says.

“It’s great,” Grant says of life in St Joseph’s. “The staff and the others [residents] ... Everyone is so lovely. Some days I find the days very long, and more days I wouldn’t.”

Grant is one of a growing number of people aged 80 and over living in Ireland.

Modelling from State think-tank, the Economic and Social Research Institute (ESRI), suggested the population aged 80 and over is projected to increase by up to 94 per cent – or by 135,000 people – from 2015 to 2030.

This growing proportion of older people has resulted in increased and more complex health needs.

Research from the Irish Longitudinal Study on Ageing (Tilda) found more than three quarters of adults in Ireland aged 58 and older have two or more medical conditions, while those over 80 tend to visit GPs more often, their hospital stays tend to be longer and they use outpatient services less.

In recognition of this, the Government established a commission on care for older people, which last month published its first report examining existing services for older people.

The report acknowledged the significant improvements made in recent years, with increasing supply of home support hours and a move towards decongregation, but said services remained “fragmented and inconsistent” with care often being “delivered in silos”.

The ESRI’s Prof Alan Barrett, who led the research, noted that there were home support hours and nursing homes, but he pointed to a lack of intermediate options between the two.

The Government-commissioned report found a majority of older adults are in nursing homes due to gaps in community support, not because institutional care is their preferred or most appropriate option.

This is something that St Joseph’s seeks to reconcile. Manager Prendergast says independence and autonomy is a key part of life in the home.

Regulated by the State’s health services watchdog, the Health Information and Quality Authority (Hiqa), St Joseph’s is a registered charity, with residents paying €240 per week and the rest being supplemented by the Health Service Executive (HSE).

Photos of residents are framed on the walls of the sittingroom. A notice board for activities is hung up in the hallway, advertising beauty time, movie nights and arts and crafts, among others.

A small chapel is located outside of the main building, which is regularly used for mass. There is a garden outside where some residents tend to herbs they have planted.

There are activities but “we don’t force them on them”, Prendergast says.

“This is their home at the end of the day. Some people are more introverted; some people are more extroverted.

“We have a cocktail party during the summer. One gentleman loves his can of Guinness in the evening so he’ll have that. They’re adults, after all, so long as there are no reasons like medication or their health, then they can have a drink if they want to,” she says.

Resident Kathleen Kelly (79) loves when music is played; she gets up and starts dancing. But bingo is also a big hit.

“I have the car outside and if I need something I can go and get it or whatever. And then sure it’s lunchtime. I might have visitors,” she says.

The supported care home is seen as an alternative model of care for people who are ageing. The commission’s report points to a number of key factors that will make caring for this demographic more difficult than in previous decades.

Currently 25 per cent of the cost of nursing home support system care is derived from the resident’s income and assets, with a family home the chief asset used to fund the resident’s proportion of the cost.

However, an increasing number of older people are renting.

“As home ownership rates decline in the future, so too may the proportion of the cost that can be borne by the resident,” the commission’s report states.

The State relies heavily on family carers but family structures and dynamics are changing.

“With smaller family sizes, high levels of employment, and greater distance between family members – this reliance on family care will pose major challenges in the years ahead,” the report adds.

Access to rehabilitation for older adults is “grossly inadequate”, the commission says.

“Without access to rehabilitations, older adults experience preventable functional decline, often leading to premature or inappropriate long-term care placement.”

Dementia is another looming challenge, with the condition placing significant additional pressures on the health system.

A study from researchers in Trinity College Dublin (TCD) published last year, found more than 100,000 cases of the disease could potentially be prevented in Ireland over a 12-year period if a number of treatable risk factors are tackled, including hearing loss, physical activity and high cholesterol.

Prof Rose Anne Kenny, chairwoman of medical gerontology at TCD, and founding principal investigator of Tilda, says it is important to take action to tackle rising dementia cases.

“Hearing, vision, loneliness, cholesterol management are modifiable risks. Things that aren’t as modifiable are things like education, but you can encourage lifelong learning,” she says.

Kenny calls for screening, identification of abnormalities and pathways in place to ensure those risks can then be managed.

“At the moment, if you’re new to Ireland, it can be difficult to get access to a general practitioner, or if you have never had a GP before and you’re in your 50s, 60s or 70s and want one but we’re short on GPs,” she says.

“Those risk factors, they don’t just affect dementia. If we get that right, we can reduce stroke risk, heart failure risk and kidney failure risk.

“If we can manage those three components, their risk factors, and prevent those three components, that would have a serious impact on quality of life, on longer independent living and that people would be more likely to age in place and also reduced healthcare costs.”

Kenny says the majority of intermediate support is currently being provided by informal carers such as family, friends and neighbours. But she says if you’re vulnerable but not requiring a nursing home, you are “vulnerable to frailty, vulnerable to falls and vulnerable to fractures”.

“Encouraging and enabling earlier physical activity and physical programmes and social support programmes and networking, that would help,” she adds.

The Government has taken some steps to improve care for older people. Expenditure on home support hours has increased significantly, as has funding for the nursing home support scheme and community initiatives to support older people.

However, the commission says promises made under Sláintecare, the Government’s 10-year strategy to overhaul health and social care and move towards universal healthcare, have been “underdelivered” which has caused further delays in care due to the hospital-centric system.

“Promises and deadlines that were initially established have not been met and new plans have been set with continued risk of not meeting these goals either,” the report says.

“The consistent lesson is that while Ireland has strong policy intent and clear evidence on what works, the absence of systematic implementation, co-ordination and accountability mechanisms means older adults continue to experience fragmented, reactive and often ageist care.”

Tom Prendergast has been living in St Joseph’s since July but he says he feels like he’s being supported to live independently.

“They do everything they can for you here. This is a family, basically. It’s not a massive home,” he says.

Kelly says there is “always a friendly face around to talk to”.

“You get to know everyone and it’s lovely,” he says. “It’s like a big family. Home is still there in your head, but I wouldn’t want to be back on my own again.”