- Ireland faces significant challenges in caring for its aging population as the number of those over 65 is projected to double by 2046, with the over 85 population increasing over 350%. - There is an urgent need to develop a continuum of high quality care services including homecare, nursing homes, and other community supports to meet the needs of this aging population. - A cohesive national strategy and long-term plan is required to adequately prepare for and address the implications of these demographic changes, however currently there seems to be a lack of planning and policy from the government on how to achieve this.

1. 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
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2. Positive Ageing
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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.

3. Ageing Population –
Something to be celebrated
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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

4. 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
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Demographics - An Ageing Population

5. PROVIDING LEADERSHIP SUPPORTING MEMBERS PROMOTING EXCELLENCE
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

6. PROVIDING LEADERSHIP SUPPORTING MEMBERS PROMOTING EXCELLENCE
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

7. PROVIDING LEADERSHIP SUPPORTING MEMBERS PROMOTING EXCELLENCE
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

8. PROVIDING LEADERSHIP SUPPORTING MEMBERS PROMOTING EXCELLENCE
Changing role of nursing homes
• Increased Dependency levels
• Increased specialisation
• Dementia Care
• Age profile
• Reduced length of stay
• Complex care needs

9. PROVIDING LEADERSHIP SUPPORTING MEMBERS PROMOTING EXCELLENCE
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

10. Continuum of Care
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• 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

11. • 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
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Continuum of Care

12. • 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?
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13. 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?
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Fair Deal Review

14. 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
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15. The future?
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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

16. 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
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17. 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.”
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18. Unit A5, Centrepoint Business Park
Oak Road Dublin 12
(01) 429 2570
www.nhi.ie info@nhi.ie
www.nhicareawards.ie
www.careersinnursinghomes.ie
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