Study reveals dearth of palliative care

The Health Service Executive has defended its standards of care after a new study of end-of-life care for older people revealed a marked shortage in the number designated palliative care beds available in Ireland.

The study - End-of-Life Care for Older People in Acute and Long-Stay Care Settings in Ireland- was jointly commissioned by the National Council on Ageing and Older People and the Irish Hospice Foundation.

The study's authors, a research team based at the Irish Centre for Social Gerontology, NUI Galway, surveyed end-of-life care in over 300 acute care and other long-stay facilities across Ireland.  They also canvassed views from older people who are currently in receipt of end-of-life care and staff working with them.

The report says the majority of older Irish people die in acute and long-stay settings such as acute hospitals, public extended care units, private nursing homes, voluntary nursing homes and welfare homes. However, out of the 20,000 beds in the healthcare system, just over 100 were designated for palliative care.

It also found there were low levels of formal bereavement support for families and a lack of privacy and internal accommodation for families and friends of patients. Moreover, it said facilities  can vary hugely from region to region.

In addition, the study found that there was significant problem with the level of education and training for those providing palliative care. It said most staff working in the area had not received any formal qualifications in the area.

Fewer than a third of all palliative care facilities said their nurses held any form of post-registration qualification in palliative care, while only a third said their staff had attended short courses on the subject. The study found only one in eight doctors were found to have received specialised training in treating the terminally ill.

In response, the Health Service Executive said additional funds have been allocated for improving palliative care in recent years.

It said a total of €12 million was provided in 2006 and 2007 to enhance specialist in-patient beds, to appoint consultant multi-disciplinary palliative care teams and to develop home care support. The HSE Service Plan also commits to delivering a further €3 million this year.

"This investment delivered a significant increase in the numbers of palliative care patients receiving specialist treatment in both hospital and community settings," it said.

The HSE also said a five-year plan for the development of palliative care is nearing completion. "This plan will provide for revenue and capital investment in order to ensure equitable provision of services across all parts of the country."

Dr Ciaran Donegan, chairman of the National Council on Ageing and Older People, said the study's findings raised the question of the value placed by Irish society on how the elderly are treated at the end of their lives. "The process of dying is reflective of broader social values and the study findings suggest that neglect of end-of-life care for older people is indicative of ageist attitudes in our society," said Dr Donegan. 

The Labour Party health spokeswoman Jan O'Sullivan said the report "demands an urgent response and immediate action".

"The picture that this report paints of terminally ill people, having to share rooms, where their families have little or no recourse to bereavement counselling, and where pain management services are at best patchy, is a sad reflection on the sense of priority that the HSE attaches to palliative care," she said. "Surely people who have lived a life where they have worked hard, reared families and paid taxes are entitled to something better."