How can Ireland meet future care needs?

Care needs in Ireland are rising, in large part because of our growing and ageing population. Our care system is already under pressure, and we need to plan for future demand.

Care in Ireland

Countries take different approaches to decide the accountability for care between the family, the state, and the market. In Ireland, there is a considerable reliance on informal family care, often provided by women, as well as on overseas care workers.

Despite reform programmes, Ireland’s care services are still oriented towards institutional care, rather than care in the community. For example, all older people are eligible for financial support for nursing home care under the Fair Deal Scheme, but there is no equivalent for homecare.

While care services are often state-funded or subsidised, they are increasingly provided by private providers, including childcare companies and nursing homes owned by international investors.

• According to Pobal, in 2022–2023, three-quarters of early learning and care and school-age childcare services were provided by private organisations.
• ESRI researchers estimated that in 2022 almost three-quarters of all nursing home beds were in private nursing homes.

While private provision has expanded Ireland’s care capacity, the Irish Human Rights and Equality Commission, and others, caution that the commercialisation of care can erode the quality of care and workers’ conditions.

Current issues in care

Lack of access to care and shortages in the care workforce are a challenge across countries. Current issues in access and provision of care in Ireland include:

• Parents reporting waiting lists for childcare places.
• Adults with disabilities having difficulties accessing personal assistance services.
• Older people remaining in hospital awaiting homecare packages.
• Care providers citing problems with rising running costs and staffing shortages.

Periods of austerity in many countries drained formal and informal care resources. Unpaid carers often feel overextended because they are seeking to fill gaps left by inadequate formal services, while paid care workers generally have low pay and limited career prospects.

COVID-19 showed that care is vital for human survival. Lockdowns and the closure of care services revealed society’s dependence on frontline care workers and on the care provided in families and communities.

Anticipating future care demand

Internationally, demographic and social changes are accelerating the demand for care. Ireland’s population is ageing (see Figure 1), and there are growing numbers of people with disabilities and long-term care needs. While Ireland’s falling birth rates may reduce future demand for childcare, it will increase old-age dependency (the proportion of older people to workers).

Care solutions

An increased need for care represents a success of Irish society, reflecting higher life expectancy, inward migration, and high employment. The care sector needs to expand to keep pace with demand.

Care policy interacts with different elements of social and economic policy, from health, gender equality, migration, to the labour market. Because of this, Ireland would have to take multiple actions in diverse fields to meet future care needs.

Globally, there is a growing focus on investing in caring through a ‘care infrastructure’ of care services, care jobs, and care leave and social protection supports for carers. Approaching care as infrastructure emphasises how society – and the economy – are reliant on paid and unpaid care work.

One example of the range and depth of actions which could future-proof care provision is provided in the International Labour Organization recommended care policy package (Figure 2).

Source: Adapted from International Labour Organization (2022)

Actions to meet Ireland's future care needs could include:

• Population-led planning of care places. Provide disability, childcare and long-term care services which correspond with current and future population need.
• New statutory entitlements to care services, such as personal assistance (PA) services, homecare, and respite. For example, providing a statutory scheme for homecare may be an issue for the new parliament.
• Designing more care-supporting social welfare schemes and employment laws, such as expanded care leave and flexible working to enable employees to provide unpaid care at home.
• Creating appealing employment paths for care workers which provide for sustainable, well paid careers with promotional opportunities and make the sector more attractive.