My wife’s uncle Denis could often be heard to say: “Someday we’ll all be dead and gone.” In an age when it is difficult to distinguish between fact and spin, let’s all agree this statement is true. What is also true is that Ireland has one of the fastest ageing populations in Europe.
Storm Éowyn’s devastation highlighted two critical issues: the fragility of critical infrastructure in the face of extreme weather and, more disturbingly, its severe impact on our older and most vulnerable citizens.
I have had personal testimony of older people confined to their beds for days, unable to heat their homes, prepare meals or even call for help due to power outages. These first-hand accounts reveal the true human cost of our infrastructure’s vulnerability which has physical and societal dimensions.
The Programme for Government includes several elements needed to address the challenges of an ageing society and economy. These include a Social Enterprise Empowerment and Development allocation, housing options for positive ageing, a focus on exercise and wellbeing, adult safeguarding, support for carers, meals, transport, strengthening the nursing home sector, a (long-awaited) statutory home care scheme and supports.
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Some of the elements are clear, but some seem like the wrong AI platform was used. Collectively, however, they are now the responsibility of government as a whole and the Minister for Older People Kieran O’Donnell in particular. He has an important opportunity to creatively develop these elements into a coherent whole informed by the work of the Commission on Care for Older People, which is still under way.
One key challenge arising from our ageing population is an increasing dependency ratio. Migration may mitigate some of the impact but, nevertheless, the challenge is real. Planning for demographic change by health and social care services is necessary, but the answer cannot simply be more of the same.
Nationally, there is a need for greater collaboration and integration, mobilising a response across all sections of our society and economy.
A Red C poll for Sage Advocacy revealed that four in five people believe care services are now too concentrated in private hands
In 2014, a report by a consortium of area-based partnerships and national NGOs, entitled, Individual Needs ... Collective Responses, made it clear that “the purpose of services for older people is to improve wellbeing and these services are more likely to be effective if aligned with the known determinants of wellbeing”.
Analysis of data from The Irish Longitudinal Study on Ageing (TILDA) indicated that the largest and most significant direct determinants of personal wellbeing among older people involved social connections, notably the quality of relationships with partners, children, relatives and friends, as well as an active participative lifestyle.
On the basis of this analysis the report suggested that “services for older people, as currently funded by the HSE ... may not adequately reflect all, or even the most important, risk and protective factors affecting personal wellbeing”.
The report also suggested that “while hospital and residential services to meet the needs of older people are important, they may have assumed disproportionate importance relative to the social connections which sustain the wellbeing of older people in their home environment. This, in turn, invites reflection on the question of whether the right services are being commissioned in all cases, and whether there is need to create a more innovative stream of commissioning”.
Ireland has a rich history of innovative and transformative movements. What we now need to consider is the development of a strong social institution capable of mobilising people and resources, from parish to parliament, using a model, like the GAA, that is inclusive, to help us seek out and build on the opportunities of our ageing society and economy as well as address the challenges. It is essential that we keep the social and economic dimensions linked.
In this context it is welcome that the social enterprise approach first espoused in the report Individual Needs ... Collective Responsibilities and more recently by Sage Advocacy in its 2020 report Choice Matters’ is starting to emerge in government thinking.
For decades, social support and care for older people in Ireland has been siloed and fragmented across and within the state, private and voluntary sectors. Some voluntary organisations, many founded from the 1960s onwards to fill glaring gaps in community-based provision, now struggle to exist.
Many are losing long-serving volunteers due to a combination of ageing and the demands of regulation. “Fewer but better” may be the view held by the public of many charities, but achieving this takes more than slogans.
Private providers dominate the nursing home sector with an increasing threat of a partial sectoral collapse due to lack of profitability; but not-for-profit and private providers alike are funded differently to state facilities. An ageing society does not need more “Fair Deal”, it needs a new deal.
Public sentiment supports a change in approach. A Red C poll for Sage Advocacy in 2023 revealed that four in five people believe care services are now too concentrated in private hands and back the creation of a national not-for-profit care organisation.
Ireland needs a new centre of gravity in the social care sector. It needs an approach which is place-based and outcome-focused, one which appreciates the tensions between social and business objectives, but works to harness them where possible. An approach which appeals to social patriotism across all generations as well as to social investors and public innovation funds.
Vice-Admiral Mark Mellett is former chief of staff of the Defence Forces, founder/director of Green Compass, chair of Sage Advocacy and adjunct professor at UCC’s college of business and law
