Research Report Supports Older People Remaining at Home

Research Report Supports Older People Remaining at Home

• Older people want to remain at home
• Ireland is biased towards nursing home care against the desires of older population
• Housing options are lacking in Ireland affecting older population

The OPRAH Report on ‘Older People Remaining in their own Homes’, was presented recently to Minister for Older People Jim Daly. Sponsored by Home Instead Senior Care, the report identified:

• too many older adults were entering long term care unnecessarily or prematurely rather than being enabled to stay living at home
• older adults have a strong preference to remain in their own homes as long as possible and enjoy better outcomes when they do so
• the number of people requiring home-care will rise significantly as the those aged 80+ are projected to quadruple over the next 3 decades
• the existing system incentivises institutional care over home-care – as the Fair Deal Nursing Home scheme is on a statutory footing whereas access to home-care is discretionary and subject to remaining local budgets
• at lower levels of dependency, home-care costs can be significantly lower than institutional care

The OPRAH Study was conducted by Professor Charles Normand from Trinity College Dublin from 2015 to 2017 and it set out to pilot an integrated approach to enable older people, currently at risk of nursing home admission, to remain living at home. The study barrier illuminated barriers experiences by older people in identifying, accessing and managing the complex range of services needed to support successful independent living.

“Although nursing homes provide much needed and valued services for older people, many want to stay living in their own homes. Since the 1960s, Government policy has aimed to support older people to remain living at home for as long as possible, yet the experience on the ground is somewhat different”, says Ed Murphy, CEO and Founder of Home Instead Senior Care in Ireland.

According to the Department of Health, between 2004 and 2013 there was a 44.6% increase in the number of residents in nursing homes categorised as low dependency and a 17.6% increase in the number of residents with medium dependency, suggesting that higher levels of low-medium dependency older people in Ireland are now entering long-term residential care.

“With the right supports, these people could have been at home. The public health system provides both residential and community services, but current funding arrangements are geared towards residential care. For example, while funding for nursing home care is available on a statutory basis there is no comparable statutory entitlement to home care. The need to consider and address this legislative imbalance is now pressing”, stated Ed Murphy of Home Instead Senior Care, the leading provider of home care services in Ireland.

The OPRAH study sought to delay, or prevent, the need for older people to enter long-stay care. It aimed to do this through identifying older people’s needs, and implementing home-based care plans in response. However, the study uncovered a lack of clarity around entitlement to community care services. There were several cases of older people who were assessed as needing a certain number of hours of care, only to be approved of receiving significantly less. OPRAH participants and their carers also reported a frequent and significant level of difficulty in accessing home support services.

“In reality, it is too complicated for older people to understand what care they should receive and what they are entitled to. This has serious consequences. Without information or access to essential services, older people with little or no family support had to go into long-term care”, advised Murphy.

Following completion of the study, the OPRAH report concluded with a set of recommendations that make community-based supports accessible and utilised by Ireland’s older population. Specifically, OPRAH recommends:

• The Home Care Scheme should be made statutory and the budget linked to the ‘Fair Deal’ Nursing Homes Support Scheme, so that it would no longer be easier to access the Fair Deal than a lower cost home care package
• There is a need for a Support Co-ordinator whose role would be to augment home-care packages by providing access to the wide range of community based supports and services, often delivered by community organisations
• The individual assessment of needs should place greater emphasis on social and psychosocial needs in addition to health and care needs.
• There is a need for more housing options including ‘independent housing with care’, enabling older adults live independently in supported clusters, where care and other supports can be provided more cost-effectively and the person can access a greater range of resources.

The OPRAH report was presented to Minister for Mental Health and Older People, Jim Daly TD for consideration during the recent public consultation on home care services.  The consultation was carried out to help inform the development of a new statutory scheme and system of regulation for home care services.

Speaking about the OPRAH report and home care consultation process, Minister Daly said: “I am very happy to receive this significant contribution to the consultation on home care. It will inform the discussions and add the lived experience of older people to our discernment on this important process”.

The design, development and implementation of the OPRAH initiative was led across 2013 to 2015 by Age Friendly Ireland, through funding provided by the Atlantic Philanthropies. The independent evaluation of the OPRAH initiative was conducted by the Centre for Health Policy and Management at Trinity College Dublin. This independent evaluation was made possible through funding provided by Home Instead Senior Care.