Stretched to the Limit: Elderly miss out on care services due to lack of information

The Covid-19 pandemic has drawn public and political attention to the Irish health system and the courageous work of health workers on the front line. Before the pandemic struck, reporters from The College View identified and examined some of the major pre-coronavirus challenges faced by the Irish healthcare system, including waiting lists for some chronic conditions, the dependence on locums (doctors in temporary positions) in short-staffed hospitals, and the difficulty some parts of the population – Travellers, the homeless – have in accessing healthcare. These stories present facts and context to understand the Irish health system have been stretched to its limit as it deals with the effects of Covid-19.

A Trinity College Dublin study has found that lack of information is depriving large numbers of elderly from receiving essential community care.

Between 15-30 per cent of families seeking elderly care in 2019 were unable to access home help, according to The Irish Longitudinal Study On Ageing (TILDA).

Of the people who were unable to access services, 18 per cent was due to unawareness that there were services available.

The study’s data, suggests its authors, that the “inability to access community care stems from lack of awareness of availability and a reluctance to apply for services.”

According to the study by Peter May, Christine McGarrigle and Charles Normand, “significant proportions of people who needed community care services were unable to access them.”

Speaking to The College View, Dr May said a reason some individuals don’t access help is because of proximity. “There are many potential reasons. A common one in Ireland is that the service is not available locally.”

She said: “For example, we’d like everyone to have good access to a GP. But there are not enough GPs for the number of potential patients, especially in remote or rural areas where the financial pressures on a practice are generally higher and it’s hard to hire and retain staff,” May said.

The study also found that 16 per cent of elderly individuals in Ireland whose families requested home help in 2019, were not eligible for services.

The study published in October of 2017, is based on data from 375 completed end-of-life interviews.

The TILDA sample was carefully constructed to be representative of the population over 50 in Ireland in terms of socioeconomic conditions, geography and age. There is also “no evidence connecting this unmet need to socioeconomic or geographical factors.”

The services included in home care are personal care attendants, meals on wheels, community care and allied health services.

On average, deceased participants received help from one person providing two hours of assistance per day in the last three months of life.

According to researchers, 40 per cent of people received no help at all while 10 per cent received 24-hour care from family and friends at the end of their life.

In some circumstances, family-and-friend helpers can access financial support such as the HSE Carer Allowance, and in some cases older people and their families paid helpers from their own resources.

Over three quarters of deceased participants or 76 per cent who were helped by family and friends received fully unpaid assistance in the last three months of their life.

The study reveals that informal care and care from family members or friends, comprised a substantial proportion of the care received by older people in the last three months of life.

On average, most people received two hours of care per day according to the researchers, however, 10 per cent received 24- hour unpaid assistance in the form of informal care.

One individual, who lost her father last year after not being able to sustain home help services, said that it can be near impossible for families who are denied access.

In an interview with The College View, Hazel Kelly, who lost her father Tom at the age of 81, said that the main reason people are hesitant to place their loved ones in care homes is due to “guilt”.

She said: “I suppose the guilt is the main thing, you don’t feel it’s right for them to go into a nursing home. You’d like to be able to take care of them. But, there’s a lack of services really to help back you up.”

Kelly told how it was “absolutely” difficult to access services while taking care of her father at home, ultimately having to move out of her family home to get two hours of services per day.

She said: “My dad has dementia, and he would have been a bit aggressive with it, but even with the dementia diagnosis, the social worker and district nurse came around and interviewed us.

“At that point I was working full time and also being woken up consistently. I’d have to lift him off the floor, the usual, and I was begging them, literally begging them, I said ‘please, please help me, I can’t do this on my own,” she said.

“Meanwhile my dad was going, ‘I don’t want anyone in.’ They went by what my dad said.”

“I know you have to respect the older person. I do get that, but they have got dementia, and the carer tends to get hurt by the patient — they hurt the ones they love the most.”

Dr May said: “the HSE should be a responsive provider but it’s not clear that they should be initiating health care interactions in all circumstances. People are usually (though not always) the best judge of what they need.”

Kelly also told how she was never made aware of the fact that there were any home services available in the first place.

She said: “I wasn’t made aware of anything, I phoned around everywhere trying to get help, I looked everything up, nobody gave me anything.

“When my dad started going in and out of the hospitals and started having falls, I started to push, but the most services I got for my dad was me having to move out of the family home and put my dad’s life at risk.”

“I had to move out of the family home, put my dad’s life at risk, in order for him to get the proper care. Even with that, he only got two hours and meals and wheels, and that was me pushing that hard.”

Clara Kelly, Joy Nwagiriga, Roisin Maguire

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