An elderly relative was recently admitted to the sort of place you are going to be hearing a lot more of: a "step down" facility. A step-down facility is a place in which care is provided by nurses with occasional visits from a doctor. Essentially, it is a nursing home, whether run privately or by a health board.
You are going to hear a lot more about step-down facilities because they are seen by health boards as part of the solution to the beds crisis in the hospitals.
The thinking is that elderly people are blocking beds in acute hospitals. If they could be moved into beds in nursing homes, health board homes and other such places, acute beds would be "freed-up". The Minister for Health and Children, Mr Martin, has provided funding for the health boards to move 500 patients from hospitals into nursing home beds.
I put quotation marks around "freed-up" because actually the beds won't be freed-up at all. They will be occupied by younger people. If you are an older person you are a bed-blocker. If you are young you are a patient in a bed which has been "freed-up".
Consultants in the Irish Medical Organisation have described this attitude as ageist.
My relative was admitted for respite care while her carer received a rare, well-earned break. About a week after her admission, her daughter noticed an injury which she took to be a fractured arm. For the following 24 hours the nurses assured her this simply could not be so.
So did a visiting doctor, without performing any tests. One nurse even urged my relative to use a walking frame and stated "you were able to use it this morning", referring to the morning after the daughter had noticed something wrong.
When she was finally admitted to hospital at 10 o'clock at night on the daughter's insistence, an X-ray revealed the woman had, indeed, fractured her arm. Subsequently, her consultant reluctantly decided to operate on the arm. She died four days later.
Is this an isolated example of an unfortunate oversight in a non-acute health board home and which just happened to involve a relative of someone with access to the opinion columns of The Irish Times?
Well, less than a fortnight after my relative's death, the IMO's consultants' committee issued a statement attacking plans to treat elderly patients in "step-down" facilities such as nursing homes.
The statement quotes Dr Des O'Neill, a consultant geriatrician at Tallaght Hospital, as follows: "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."
"More people ended up disabled," says Dr O'Neill. "More died or went into long-term nursing care eventually." So while this "frees up" acute beds, in the long run it costs more - in lives, health and money.
Part of the reason for this is that the treatment of older people is a more specialised matter than most of us realise. An illness can present an entirely different set of symptoms in a very old person than those which a younger person would experience.
"You can have a heart attack with no pain," says Dr O'Neill. "You can have a stroke with no weakness in the arm or leg, you can have pneumonia with no temperature." Confusion can be written off as something which goes with old age - but there is every possibility it is symptom of a physical illness.
The IMO consultants' committee bluntly described the whole concept of "step-down" facilities 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."
Far better, according to the committee, would be to invest in more stroke units in general hospitals and in rehabilitation units also in general hospitals.
Certainly, as far as this punter is concerned, I would rather have care in a rehabilitation unit in a general hospital than in a nursing home, regardless of whether the latter is run by the health board or privately. (As a rather important aside, if the home is run privately it is, at least, subject to inspection by a health board every six months; if it is run by a health board there is no such inspection regime.)
Without in any way wishing to diminish the status of their colleagues in "step-down" facilities, if I was looking for nurses who are completely up-to-the minute in their profession, I would look for them in a general hospital and not in a home.
But where are we to find beds for all the people flowing through casualty? Perhaps the answer is to restore the 3,000 beds which were taken out of the system during the heaviest of the health cuts.
That is what will make the difference and will allow rehabilitation beds to be provided in general hospitals with up-to-the-minute staff and a full range of onsite medical services available. It beats being marooned in a "step-down" facility so as to "free-up" beds in an ageist world.