Helping older people who need support to continue living at home

Contrary to public perception, most older people in Ireland are still living in their communities, largely independent and often alone in their own homes. The 2022 Census reported that 190,000 people aged 65 and over are living alone, 116,000 of whom are women and 74,000 of whom are men. This figure represents an increase of about 20 per cent of older people living alone in their own homes since 2016.

The Census figures also reported that about 30,000 (21,000 women and 9,000 men) of those over 85 lived alone in 2022. Only about 5 per cent of people over 65 live in nursing homes in Ireland.

And while many older people manage very well living alone, there are others who need help with daily living tasks, physical adaptations to their homes and/or psycho-social supports to keep them motivated to be as independent as they can.

Isolation is another big issue as a lot of people didn’t leave their homes during Covid and still haven’t got back out and about

—  Jennifer Hankey Kinsella

Some of these individuals can make do with assistance from public health nurses and primary care teams but others will need in patient assessments and plans to improve their ability to continue to live at home.

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“Falls and fears of falling is a big issue,” explains Jennifer Hankey Kinsella, ward manager at the Community Rehabilitation Unit at Our Lady’s Hospice and Care Services, Harold’s Cross, Dublin. “Isolation is another big issue as a lot of people didn’t leave their homes during Covid and still haven’t got back out and about.”

Described as a step-up rather than a step-down facility, the community rehabilitation unit at Our Lady’s Hospice offers short-term accommodation to older people who need support to continue living in their own homes.

Now one of several such facilities in Ireland, it was the first one of its kind when it was opened in 2003. Patients are referred by their GP, primary care teams or geriatrician.

Margaret Fitzpatrick (71) is staying in the unit when we visit. She has Parkinson’s disease and also suffers from acute anxiety and arthritis. “It’s my third time to stay here and my mobility has improved since I came in,” says Fitzpatrick who uses a rollator to help her walk.

As someone who worked as a nurse and nurse manager for 40 years in the Irish health service, Fitzpatrick is full of praise for the multidisciplinary team which gives her access to doctors, nurses, physiotherapists and occupational therapists. “It’s very hands-on and every aspect of care is looked at. Each person works with the staff to set goals and make priorities about their care. You may or may not go out 100 per cent better but you’re given the best shot at continuing to live at home for as long as possible,” she explains.

Fitzpatrick says that many older people feel like they are in the wrong place when they attend acute hospitals. “Everything is at such a fast pace and we operate at a slower pace. And visits to consultants are limited to such short amounts of time. This approach is specifically geared to rehabilitation.”

Patients get reviews of their medication and cognitive ability as well as electrocardiography tests and blood pressure monitoring in the first few days of their stay.

Paddy Crowe (84) is staying at the unit for the first time, following six weeks in hospital with fibrosis on his lungs. “My biggest problem is shortness of breath, for example when I’m getting dressed or making my bed. Going to the gym here every day has improved my breathing immensely,” he explains.

I’m looking forward to going home now because I feel differently about my breathing and my ability to exercise and live half normal

—  Paddy Crowe

Crowe, who has lived alone since his wife died in 2009, cooks for himself. He has someone to help with housework and good support from his adult daughter and sons. “I’m looking forward to going home now because I feel differently about my breathing and my ability to exercise and live half normal,” he says.

Daniel Maxwell (79) is in the community rehabilitation unit for the 15th time when we visit. “I’m here five weeks now as I’m getting my bedroom and bathroom put in downstairs and adaptations to my kitchen,” explains Maxwell who lives with his son and daughter-in-law in the family home.

Maxwell, who has Parkinson’s disease, says that the exercise programmes are what help him most. “I do the morning exercises and I do Tai Chi in the afternoon. Sometimes, I find it hard to get out of the chair but other times, it just clicks. I used to be a heavy smoker but I stopped smoking one of the first times I came here. A doctor put a patch on me on my way to the smoking room and I never smoked again after that day.”

Eleanor O’Grady, senior physiotherapist at the community rehabilitation unit in Our Lady’s Hospice says that it’s all about getting people to do as much as they can for as long as they can. “We encourage people not to give up and to keep moving,” she says.

Kayleigh Veale, occupational therapist says that it’s about getting the balance of physical, cognitive and social activity to keep well. “We help people make a timetable for their days to include community-based exercise groups and day centres,” she explains.

Patients are also given personalised exercise plans to do at home and given one-to-one support in the model kitchen in the unit to check how they manage making tea, cooking their breakfast, etc. The occupational therapist and physiotherapist also do home visits to check if people need additional physical aids and support in their own homes.

Dublin Bus runs a scheme in which a staff member will accompany an older person on their route to encourage them to use public transport again. Volunteers bring patients for walks around the grounds at the weekends when occupational therapists and physiotherapists aren’t at work.

“The benefit of this unit is that we have 17-18 people with similar goals to stay at home and increase their activity levels. They get support from each other and great friendships have been formed with people who come here,” says Veale.

It’s a postcode lottery for homecare packages. People become more dependent on us the longer they stay here

—  Kayleigh Veale

Community-focused healthcare policies such as Sláintecare are deemed to be more suited to the needs of older people but access varies across the country. The shortage of home healthcare workers is now a bigger problem than funding for homecare packages.

“It’s a postcode lottery for homecare packages. People become more dependent on us the longer they stay here,” says Veale.

As our population ages, there is no doubt that more community rehabilitation units such as the one at Our Lady’s Hospice in Harold’s Cross will be needed to support older people to live as independently as possible in their own homes for as long as possible.

Health economists know that it’s the cheapest solution but more importantly, experts in older age healthcare know that keeping people in their own communities is best for their physical, psychological and social wellbeing once they are supported to do so.