MINISTER OF STATE for Disability, Anne Rabbitte has said around half of all adults under 65 years of age who are living in nursing homes in Ireland are in the right setting.
The other half would be better accommodated in different settings, she said.
According to the HSE, there were 1,228 individuals living with a disability under 65 years of age in nursing homes as of July 2023.
Some 15% of these individuals are under 50 years of age.
This is down slightly from the 1,320 in June 2020 before the publication of a landmark report from the Ombudsman into the issue which highlighted the inappropriate nature of this accommodation for under 65s.
Disability groups have long campaigned for this practice to end and highlighted that increased investment in community services and independent living facilities is needed.
Minister Rabbitte told The Journal that work is underway currently to catalogue where the best support is available for some of these impacted individuals.
“What’s happening there at the moment is there has been funding laid out in this year’s Budget to ensure that there is a passage from nursing homes into independent or supported independent living.
“And what’s also being catalogued is where is the best support for some of those people. So we think it’s actually going to be approximately 50% need to be moved out into independant accommodation and 50% perhaps – there or thereabouts – they’re actually best placed with the nursing care supports that they require at this moment in time,” she said.
“So yes, there’s more funding needed, but there’s funding actually allocated in this year’s Budget to assist with [this], and has been for the last three Budgets,” the Minister added.
The Minister said the 50% of people who are best placed in nursing homes are “appropriately placed”.
“That is not me that makes that decision, that’s the clinical discharge team within the hospital settings when they’re discharging. They need nursing care support 24/7 and they’re clinically best placed,” she said.
A spokesperson for the Department of Equality, Children and Disability said that in certain circumstances, nursing homes are an appropriate care option where a person has a clinically-assessed complex medical and social care requirement which cannot be supported in the persons’ homes.
However, it accepts that for others under the age of 65, nursing homes are not an appropriate placement.
For these individuals, it said “alternative, more sustainable supported living solutions are needed to give them greater independence and choice in their daily lives”.
Following an initial mapping exercises conducted by the HSE to identify persons under the age of 65 in nursing homes, the HSE is currently engaging with approximately 560 individuals for review and assessment for transition into the community or continued nursing home placements.
Sinn Féin TD for Cavan-Monaghan Pauline Tully recently raised this issue in the Dáil and asked Public Expenditure Minister Paschal Donohoe to outline the Government’s roadmap for transitioning these adults into more appropriate long-term accommodation.
Speaking to The Journal, Tully said the Government has failed to give an acceptable answer to this question yet and added that she was surprised to see the Minister state that around half of impacted adults were in the appropriate place for their needs.
“I do wonder if more supports such as physiotherapy and speech and language therapy were made available in the community to survivors of strokes, for example, would the number be as high,” she said.
“Of the 560 being assessed for possible transition into the community, how many will be transitioned in 2024? It is very unclear how much if any of the money allotted to disability in the Budget will be allocated to moving people out of nursing homes,” she added.
Support for transitions to the community
According to the Department, in 2021 Government provided investment of €3m as part of the HSE National Service Plan (NSP) to enable 18 people under the age of 65 to transition to their own home with support.
Budget 2022 provided a further allocation of €5.5m (rising to €13.5m in 2023), to address the situation of people with disabilities who are inappropriately placed in nursing homes. In 2022, 22 transitions took place.
By the end of August 2023, 20 individuals have moved from nursing homes to more appropriate homes in the community.
The Department says that Budget 2024 provides the basis to continue to improve access to enhanced disability services throughout the country.
An additional €195m in 2024, will bring total investment in disability services to €2.8bn.
This is an increase from €1.7bn at the close of 2017.
Ombudsman Report
In May 2021, the Ombudsman published a report with the findings of its investigation which looked at the appropriateness of the placement of people under 65 in nursing homes for older people.
The investigation found that Ireland still has significant progress to make to facilitate a person-centred approach to care and one which is in keeping with the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD).
Ombudsman Peter Tyndall wrote in the report: “Once you start unpicking the issues, it is clear that the systems are not in place to support people with disabilities.”
Tyndall qualified the investigations findings at the time by saying that of the 1,320 people under the age of 65 being accommodated in nursing homes at the time of the investigation, he had no way of gauging the overall percentage of residents who wished to move into the community.
He also noted that there was no source of official information which paints the bigger picture at the time of writing the report.
Because of this, he recommended that detailed information be gathered on the circumstances of each of the individuals concerned, including the recording and analysis of their will and preference in relation to their placements.
Since then, the HSE has set up a steering group to implement the recommendations of the Ombudsman’s report.
As of this year, two surveys are ongoing to establish a more complete picture of under 65s in nursing homes and their needs.
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