The Irish Medical Organisation's consultants' committee has criticised plans to treat elderly patients in "step-down" facilities such as nursing homes. A number of health boards have indicated that they will be investing in step-down facilities as a way of freeing acute hospital beds.
Elderly people recovering from acute illness needed more intensive step-up care; this included active rehabilitation, nursing and medical care in the acute hospital sector rather than in private nursing homes, said Dr J. Bernard Walsh, chairman of the Irish Society of Physicians in Geriatric Medicine.
He said he rejected the term "step down" and any policy that might lead to sick elderly patients being transferred to a totally inappropriate facility away from the main campus of a general hospital.
"Promoting step-down facilities represents a failure to appreciate the complex nature of illness and the rehabilitation needs of older patients admitted to a general hospital," said Dr Des O Neill, a consultant geriatrician at Tallaght Hospital.
He said one in four people over 65 develops an acute confusional state following general anaesthetic and five out of every six medical admissions over the age of 75 have multiple illnesses or rehabilitation needs, he added.
"The optimal goal for this rehabilitation is at the time of the acute event and there is good evidence for the effectiveness of general hospital-based acute rehabilitation programmes," he said.
Step-down care has been associated with increased death and institutionalisation after hip fracture in the US and with increased overall bed usage in Britain.
The members of the IMO consultants' committee referred to plans for step-down care as an "ageist solution".
They describe it as a form of second-class care with unspecified specialist medical, nursing and therapist support.
"It is not needs based and is likely to be a harmful pattern of care for our developing elderly population," they said.
The consultants have called on the Department of Health and the health boards to invest in a greater number of stroke and rehabilitation units in general hospitals.
They also point to the need for a comprehensive domiciliary rehabilitation programme for elderly patients after hospital discharge.
The district care units in the Eastern Regional Hospital Authority area are an example of the success of such programmes and the consultants suggest that an enhanced version of these be implemented.
District care units offer intensive nursing, occupational therapy, physiotherapy and speech therapy to patients in their homes for a number of weeks after discharge.
They enable the rehabilitation programme which has been started in hospital to be continued in the community. The number of people over 65 in the Republic is expected to double by the year 2030.