tadhg daly , ceo, nursing homes ireland

Future Health Summit 2016

A True Continuum of Care;

Meeting the Care Requirements of our Ageing Population

Tadhg Daly – Nursing Homes Ireland

27th May 2016

PROVIDING LEADERSHIP SUPPORTING MEMBERS PROMOTING EXCELLENCE

Positive Ageing


Need to address the language and public discourse;

• Demographic time-bomb!

• ‘Burden of ageing’ - a bounty not a burden.

• Need to celebrate ageing of our population.

• Requirement to develop a continuum of high quality care services and supports that are responsive to the changing needs and preferences of people as they age

A challenge – yes.....................and as a Society we need to plan.

Ageing Population –Something to be celebrated


DEMOGRAPHICS – KEY NUMBERS - KEY CHALLENGES

Age 2011 2021 % Growth(2011-2021)

2031 2041 2046 % Growth(2011-2046)

65-69 172.1 225.6 31% 281.2 333.2 354.6 106%

70-74 130.1 191.6 47% 238.3 291.1 318.7 145%

75-79 101.4 139.5 38% 192.1 245.6 269.3 166%

80-84 69.8 90.1 29% 143.9 187.4 213.8 206%

85+ 58.2 85.0 46% 135.5 219.0 262.9 352%

Total 65+ 531.69 731.9 38% 991.0 1,276.3 1,419.3 167%

% of Pop 11.6% 14.9% 18.7% 22.4% 24%

4.5% 23,920 32,930 44,590 57,430 63,870

Nursing Homes Ireland

• Across all 65+ cohort, population to grow from • 2011 - 11.6% population• 2046 – 24% population

• 65+ population to grow• 2011-2021 + 38%• 2011-2046 + 167%

• 85+ to grow • 2011-2021 +46%• 2011-2046 +352%

0

200,000

400,000

600,000

800,000

1,000,000

1,200,000

1,400,000

1,600,000

2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2026 2031 2036 2041 2046

Aged Population Growth & Split by Age

65-69 70-74 75-79 80-84 85+

Source:

CSO Census of Population 2006 + 2011 & Population and Labour Force Projections 2016-2046


Demographics - An Ageing Population


An Ageing Population

• Internationally accepted benchmark-4.5% of over 65 require LTC

•Levels of frailty and the complexity of medical need increases with age, prompting a greater and often essential need for residential care

•Figures for Ireland indicate that approximately 23% of our over 85 population require long-term care


Challenges

• Population aged 85+ growing by 46%, worth pointing out approximately 22% of our over 85’s require long-term care – this is the cohort with the greatest levels of frailty.

• Dementia Care - The increase in the number of people with dementia could be as high as 132,000 people by 2041, almost three times the current estimate of 47,000 in 2011. Prevalence and Projections of Dementia in Ireland 2011 – 2046, December 2014

• “Over the next 30 years the number of people aged over 65 will double. At the same time, the number of us living to be over 80 is set to quadruple. We need therefore, to be able to cater for the needs of a more diverse ageing population who want to live independent and active lives in their communities.,” Programme for Government May 2016


Challenges

• Impact of ageing demographic across the entire health service – knock on effects throughout the acute hospital and wider healthcare sector

• Discretionary access to primary care• Increased complexity and higher dependency • Delayed Discharges• Acute hospital is the most inappropriate place for

older person whose acute needs have been met • Staffing and workforce planning – current nurse

recruitment crisis


Changing role of nursing homes

• Increased Dependency levels• Increased specialisation • Dementia Care • Age profile • Reduced length of stay• Complex care needs


Community Care

• Home Care – enhanced / intensive• Home Help• Day Care• Respite Care • Rehabilitation • Convalescent Care • Short stay / Intermediate • Independent living

Discretionary with access and availability unclear and inconsistent – varies from region to region, a postcode lottery

Continuum of Care


• National Positive Ageing Strategy – National Goal 2. “Support people as they age to maintain, improve or manage their physical and mental health and wellbeing.”

It focuses on promoting the development and delivery of a high continuum of high quality care services and supports that are responsive to the changing needs and preferences of people as they age and at end of life.

• Requirement to have appropriate care at the appropriate time – people needing support should have access to a range of quality services, so that their care and support can be tailored to their individual needs, preferences and circumstances

• Such care should be available through a developed continuum of care to include homecare, day care, independent living, nursing home care (short and long stay), and other community-based services

• Not about Homecare V Residential

• Shift from Acute to Community

• Development of a true continuum of care

• Independent regulation (registration and inspection) of homecare must be a priority

“Our focus now, more than ever, must be to look beyond traditional models of service delivery if we are to deliver local services for local communities,”

Pat Healy, HSE Director Social Care


Continuum of Care

• Single Assessment Tool - interRAI

• Role of nursing home sector in complimentary services (homecare/ day care/ meals and wheels)

• Nursing homes a hub of community services?

• Complimentary services – Primary Care

• Independent living – care communities

• Homecare commissioning – focussed on time and task

• Funding model? Co – Payment?


NHI recommends that a new scheme mirroring Fair Deal with dedicated funding should be introduced on a statutory basis for community care.

This scheme could mirror the principles of Fair Deal and Money Follows the Patient:

• A uniform assessment (SAT)

• Equitable access to those assessed as requiring such care

• Dedicated ring-fenced funding

• A co-payment model that makes such care affordable and accessible?


Fair Deal Review

The future?

NHI concerned at lack of planning• Sunday Business Post, December 2015: “EXCLUSIVE: HSE

chief – no plan, no money and no vision for health

“Ireland’s ageing population requires careful planning and policymaking that is grounded in evidence and research so that the future of old age in Ireland is one that promises everyone a healthier, more secure, and fulfilled later life,” CARDI

“It is extremely encouraging in the 32nd Dáil to see a consensus emerging on the health service. I have made it very clear that I want to see consensus on a 10-year plan for the health service,” Minister for Health Simon Harris, TD May 2016


The future?


Where is the plan?

• What is Government policy?

• We must be ambitious as a Society

• Positive developments – National Positive Ageing Strategy, National Carers’ Strategy, National Dementia Strategy

• Requirement for overarching policy – cohesive national strategy

• Policy on future provision of long-term care? Fair Deal review

• Requirement to address ‘Ageing in Place’ – Home care, day care, Independent living

• Workforce planning

• Urgency to develop a strategy with ambitious implementation plan

• Implications of inaction

Plan

Need to plan – in all our interests

• Ageing Demographic

• Demand for residential care

exceeding supply

• Development of ‘continuum of care’

• Cohesive national strategy

• Doing nothing is not an option


Future Policy?

• NHI campaign for Dept of Health led “Forum on Long-Term Residential Care”

• Bring together all of the relevant stakeholders involved in the provision of long-term residential care for older people

– Department of Health

– HSE

– NHI

– HIQA

– NTPF

– Representatives of Older People

• “Too many reports, too much talk, not enough action”

Quality & Standards in Human Services in Ireland: Residential Care for Older People,

National Economic and Social Council (NESC), July 2012, recommendation:

“A problem-solving group of those influencing provision of long term care (e.g. providers, the Department of Health, and HIQA) may be useful to examine and address the challenges of providing sufficient quality long term care in an equitable and sustainable way.”


Unit A5, Centrepoint Business Park

Oak Road Dublin 12

(01) 429 2570

www.nhi.ie [email protected]

www.nhicareawards.ie

www.careersinnursinghomes.ie


http://www.nhi.ie/

mailto:[email protected]

http://www.nhicareawards.ie/

http://www.careersinnursinghomes.ie/

tadhg daly , ceo, nursing homes ireland

Healthcare