Given that we all age from the moment of conception, it is hard for gerontologists to escape musing on ageing, even when on vacation. As I scrambled up onto my windsurfer for the eighth time one morning off the coast of the Dingle peninsula, I reflected on how ideally the sport ticked all the boxes for the types of exercise recommended for warding off age-related disability – balance, resistance and flexibility.
Granted that we might not see windsurfing adopted for a while yet by the excellent Go For Life exercise programme run by Age and Opportunity, it was heartening to see how many parents of often quite mature vintage joined their children in learning the basics at the wonderful Jamie Knox Windsurf School in Castlegregory.
As we know from many studies in ageing, the rule of thumb for good prevention is to start early but it’s never too late.
Returning refreshed from leave, it didn’t take long to become confronted with reality.
A disappointing feature of the present Government is the complete absence of any mention of the National Positive Ageing Strategy in its programme. Older people – us as we age – should be a valued group whose more varied and often complex needs require tailored approaches.
Waiting list
This lack of focus was reflected in the waiting list initiative announced recently by Minister for Health Simon Harris, with no emphasis whatsoever on one of the key issues in ensuring an effective public hospital system, that of timely and sufficient support at home for those who are discharged with disability through stroke and other conditions.
A key element of this is the home care package scheme, a service which is as important a component of healthcare for acquired neurological and rheumatological diseases of later life as chemotherapy is for cancer. However, these were effectively frozen in late March, and only restarted, with many mixed messages and obfuscation, effectively through the main acute hospitals.
A Kafka-esque aspect for me is that I run a rehabilitation unit in a smaller hospital to support discharge from the main acute hospitals, but which does not have access to these home care packages. This means we are having to return the patients to the acute hospital, with attendant distress and double inefficiency, adding length to discharge and delaying admission of those in the general hospital to the rehabilitation unit.
Even worse is the kite now being flown by the incoming Minister for Older People, with what appears to be bipartisan support from Fianna Fáil, that older people should now be expected to pay for home care packages on the same basis as the so-called Fair Deal.
Those with good memories will remember that the so-called Fair Deal replaced eligibility for nursing home free of charge other than 80 per cent of the State pension with what is now a much more onerous financial burden: 80 per cent of income, 7.5 per cent per annum of assets, and up to 22.5 per cent of the value of your home.
The population at large were gulled into this the first time around by making it difficult to access the eligibility for nursing homes and forcing people to pay privately or, as the scandal unfolded, charging people illegally for nursing homes.
Extremely difficult
A similar pattern is now becoming apparent with home care packages, with access having been made extremely difficult (if your relative needs one, do not let them be discharged from hospital until it is in place), clearly hoping that families will either be forced down a private route and/or start to see charging for these vital services as “fair”.
This is accompanied by apocalyptic predictions of the growth in numbers of older people, completely ignoring evidence worldwide that the health of older people is improving year on year, with significant reductions in severe stroke and dementia.
Even one advocacy group for older people seemed to have been taken in by these positions as evidenced by correspondence to this paper in recent weeks.
Older people, and us who are the future older people, were fooled the first time around with the so-called Fair Deal.
On the basis of fool me once, shame on you, it would be tragic and indeed shameful if we let ourselves be fooled twice into allowing ourselves as we age to be the only group to have eligibility for healthcare so dramatically diminished on a repeated basis.
Des O’Neill is a geriatrician and co-chairman of the Medical and Health humanities Initiative.