Older people’s access to health and social care is a lottery

The Older & Bolder alliance has today (Tuesday 22nd February) launched their baseline statement on Health and Social Care “One for All, Age Friendly Health & Social Care: Principles and Experience” which identifies inequalities in the current system and outlines some of the changes required to meet older people’s specific health and social care needs.

Ms Patricia Conboy, Director of Older & Bolder said that the reality is that the ability to afford health insurance, our age, medical card status, category of illness and even where we live affects our access to health and social care. She said that older people’s access to palliative and end of life care, dementia care, or carers’ supports, for example, should not depend on geographic location. However in practice it does; where individuals live also affects how they age and how they die and Ms. Conboy said “This is a unique moment in our country’s history: the prospect of a new government brings with it the opportunity to reshape our systems of health and social care.”

“The problems in the current system such as inadequate capacity, overcrowding and long delays affect all Irish people but they do not affect us equally.”

Ms Conboy continued “We need to dismantle our unequal two-tier system and replace it with a universal system of health and social care”. Older & Bolder is seeking a system where access to quality care is provided on the grounds of need; and to which people contribute, whether through taxation or social insurance, on the basis of ability to pay. The alliance believes that plans for the long-term development of a comprehensive system of universal health and social care must include appropriate provision for the long-term care of older people with social care needs who want to continue living in their own homes and communities.

“Older & Bolder believes that developing primary care as people’s first and continuing point of care will improve quality and access and relieve pressure from our overcrowded accident and emergency service. For older people, it will be particularly important that primary care teams can provide age-attuned (gerontological) care to allow for safe management of prescriptions, appropriate chronic disease management and also diagnosis, advice and support for age related conditions such as dementia, stroke, bone health and immobility”. 

Ms. Conboy also said that plans to finance health and social care through a ‘money follows the patient’ model, where funding is provided on the basis of the number of patients treated, must ensure that hospitals and care services are not penalised for treating older people with multiple conditions (co-morbidity) and people of all ages with complex care needs.

Another area of concern, highlighted by Ms. Conboy, was access to information. This applies at the systemic level where it is very difficult to get an accurate baseline picture of current levels of primary care provision including, for example, factual information about the composition and deployment of primary care teams.

The issue of access to information also affects older people at the individual level. “Older people and their families consistently report difficulties in accessing clear information about their health and social care rights and entitlements and this must be addressed.” The current practice of referring people to GPs and Public Health Nurses is deficient because older people have no way of knowing what the overall level of home or community services available in their local areas is, and what the criteria are for accessing those services.

Older & Bolder’s statement on age friendly health and social care also includes illustrative case studies of three individuals. Their experiences highlight both positive and negative aspects of older people’s interaction with the health and social care system.

Older & Bolder is an alliance of eight non-governmental organisations in the ageing sector: Active Retirement Ireland, Age & Opportunity, Alzheimer Society of Ireland, Carers Association, Irish Hospice Foundation, Irish Senior Citizens Parliament, the Older Women’s Network and the Senior Help Line.

Download One for All, Age Friendly Health & Social Care: Principles and Experience (PDF 215 kb)