Madam, - Maev-Ann Wren's recent series of articles in your newspaper were, in my opinion, lopsided in that they focused on peripheral topics and failed to address one of the central issues in the current healthcare crisis - the manner in which we provide and fund extended residential and community-based care for our elderly citizens.
"Live long and die fast" was the mantra of one of my senior colleagues in the UK. But the reality for a great many of our older citizens is that while medical science has made great progress in warding off disease, frailty may often be the price of longevity.
In addition, demographic changes will see a dramatic increase in the percentage of over 65-year-olds in our population over the next 10 years. Furthermore, modern, smaller and often non-classical family units are unable to provide care in the home for their elderly relatives as was more common in the past.
The result is an ever-increasing number of deserving, vulnerable elderly citizens seeking long-term care in a shrinking number of State-funded extended care places, while community care services remain under-funded and often merely aspirational. The requirements of younger, chronically disabled adults - though these are smaller in number - are just great and equally, if not more so, neglected.
These ill and frail citizens fall through the cracks in our healthcare system and end up in over-burdened acute hospitals, needing care but not in the costly setting of an acute general hospital. Through no fault or deliberate act of their own, they languish, often for months, in this setting, their names on extended care waiting-lists, while the emergency departments heave and elective admissions are cancelled. If the health service can be compared to a train, current extended care strategies (or lack of them) have the effect of blocking the movement of one carriage and in effect stopping the entire train.
The solution is clear - increased availability of appropriate extended and respite care facilities and adequately staffed and funded community-care services. How to fund these requirements is less clear. Like the subject of third-level fees, this a volatile and contentious issue: should the State be obliged to fund extended care for all its citizens when appropriate? Should individual be obliged to fund their own care? Should the family home be surrendered to assist in funding care?
There are valid arguments for every perspective. However, in the absence political leadership and public debate on this urgent issue, the situation continues to fester and the health service limps on. - Yours, etc.,
Dr DERMOT POWER,
MD, MRCPI,
Claremont Park,
Dublin 4.