The Dawning of a New Era for Health Care of Older People in Ireland?


Can COVID 19 be the Dawning of a New Era for Health Care of Older People in Ireland?

It’s time for actions to speak louder. The talking must stop now

Dr. Diarmuid O'Shea, President of the Irish Gerontological Society

“Lockdown” to battle COVID 19 started on March 27th.  In truth though, the restrictions began on March 13th.  It is fitting that the first stage of the exit strategy from these restrictions is entrusted to the vulnerable and to those over 70.

Cocooning these groups has resulted in their noticeable absence from our society.  Society will be better  for their return and as they rediscover their confidence and neighborhoods over the next few weeks, we will observe and support how they are doing.  We will also watch the daily statistics reported – the  numbers  tested, numbers positive, numbers admitted to hospital, numbers admitted to ICU  and the numbers dying in our communities to see what, if any effect, this first stage of a return to our new normal will bring.   In essence, as a nation, we will collectively hold our breath.  How often do we do that together?

The talking must stop

This is not just a time to observe, pause and reflect.  It is a time for action.  We must now start the conversation about what we have learnt, and how we can improve and transform the care that older people receive in our communities.   The talking must stop soon.  It should be about “Action not Words” and implementing what we have learned from the experiences of COVID 19.  

We now have an exit strategy. We have something to aim for. There is a light at the end of the tunnel.  It seemed at times that there was little end in sight with all the challenges we faced at work, in our communities, and in our homes.  Those that are shielding themselves, those that are helping and supporting them, and those who are working in health care settings, continue their work while understanding the risks and by following the HSE hygiene and social distancing guidance .

As we all reflect, I wonder what each of us thinks of our response to this pandemic and what it tells us about our own and societies response to ageing and older people.

During this crisis, “age” has been a central theme.  I am encouraged by some aspects and responses to this and worried by others.  On the positive side it is heartening to see the responses in our local communities.  The community spirit and the supports for people shielding themselves are great to witness. How we harness these positives in the aftermath of COVID-19 will be important.  

What price are we willing to pay for no change?

However, when we see the outcomes of death in congregated living units for those that are less able, or vulnerable with complex and multiple illnesses, it gives us all pause for thought.  It raises the question of what we want for these particular groups.  What price are we willing to pay for change - or no change?

This current pandemic will drive home to everyone the importance of the public health agenda across the life cycle and the different health outcomes people experience related to social class, age, gender or income.  However, how can a real societal recognition - and even acceptance that we must support those that are less able and vulnerable, irrespective of age - be translated into action and funding? 

As an indication of how health care and health promotion have improved, we will continue to see successful ageing.  With this comes a growing need for a broader understanding and appreciation of the work and infrastructure that is required to support ageing in place in our communities.

A watershed moment for Sláintecare?

So, can Sláintecare be part of the blueprint for recovery?  In 2018, the WHO Global Conference on Primary Care issued a renewed declaration on primary care, emphasising the critical role of primary health care around the world.

 Declaration on Primary Care

The Sláintecare Implementation Strategy - published in August 2018 - committed to the use of “all available mechanisms and process to ensure health care is delivered at the lowest level of complexity as is safe, efficient and good for the patient”. This includes priority resourcing of primary and social care.  The report goes onto explain how specialist community service “Hubs” providing specialist ambulatory care for older people will be required in order to deliver integrated, person-centered care as close to home as possible.  These teams will need specialist health care professionals with expertise, training and education in management of conditions in older people.      

Everything we are learning has and is changing utterly.  This should be another “watershed moment” in how we deliver care with and for the older people of Ireland.  We have seen watershed moments before and not acted strongly or decisively enough. 

This pandemic will, I think, reframe how we support a range of people in our communities and hospitals, how we manage and treat them when they become ill, how we enable and empower them to recover after a setback, and then how we enable and empower them to return to as near independent living as possible.  This will come at a financial cost.  For this transformation to happen we must act and advocate appropriately or, in time, we will be talking about another missed opportunity.  

We now need to harness the changes and the energy we see that are required to bring about this change.  We need to build on the community initiatives we have seen grow over the time of this crisis and we must deliver on this promise of change.

Speed trumps perfection

We have had enough words, now is the time for action.  You have to start somewhere, and no plan is perfect. As Dr. Mike Ryan (World Health Organisation) said in March “Move quickly – speed trumps perfection”.  So why not start with Sláintecare? Build on the considerable progress made across our communities since the beginning of February and go from there. 

Thank you for all your efforts to continue supporting and caring for older people in society, we all owe you a debt of gratitude.

Friday 8th May 2020