Dáil Éireann díospóireacht -
Wednesday, 27 Jan 1999

Vol. 499 No. 1

Written Answers. - Services for the Elderly.

Seán Ryan

Ceist:

105 Mr. S. Ryan asked the Minister for Health and Children if his attention has been drawn to the public concern regarding the absence of clear discharge protocols for elderly patients from hospital; if his attention has been drawn to the fact that elderly patients are frequently sent home without prior notice and without contact being made with the local public health nurse resulting in vital community supports not being in place; the steps, if any, he is taking to deal with this problem; and if he will make a statement on the matter. [1952/99]

Róisín Shortall

Ceist:

114 Ms Shortall asked the Minister for Health and Children the number of elderly or chronically sick who require nursing home care who are currently in each acute hospital; and the proposals, if any, he has to provide appropriate care for these patients. [1950/99]

Breeda Moynihan-Cronin

Ceist:

120 Mrs. B. Moynihan-Cronin asked the Minister for Health and Children the assistance, if any, available to chronically sick patients in need of long-term care who cannot be accommodated in health board facilities. [1949/99]

Minister for Health and Children (Mr. Cowen)

I propose to take Questions Nos. 105, 114 and 120 together.

This Government's policy on the care of older people is to maintain them in dignity and independence at home with the support of the community care services where necessary and where this is no longer possible, to ensure they have access to the best possible medical or long-term care. This has been the policy adopted by successive Governments since the publication, in 1988, of a report on the development of services for older people entitled "The Years Ahead".

The number of elderly and chronically sick patients in each acute hospital who require long-term nursing home care or who are awaiting placement at a level of care more appropriate to their needs is set out on the attached table.

The report of the review group on the waiting list initiative was recently published and the Government is committed to ensuring that its recommended approach is implemented. It pointed out,inter alia, that a significant proportion of acute hospital beds were being inappropriately used by patients who did not need, or who no longer needed, acute hospital care. This problem arises due to a shortage of places in the areas of “step-down” or convalescent care, rehabilitation facilities and community based services which reduce the need to use acute hospital care. Accordingly, I have provided extra funding in 1999 of £9 million for services for older people which will be an important factor in helping to free up acute hospital beds which are currently occupied by patients who could be accommodated in more appropriate convalescent or extended care facilities or discharged home if adequate community supports were available. It will be used to improve the home help service, increase the number of nursing and paramedical staff in the community, provide support for carers, enable a number of new health board convalescent or extended care facilities to open and increase the number of private nursing home places either subvented or contracted by health boards. There are also a number of chronic sick in acute hospitals who have completed the acute phase of their illness and who are awaiting placement at a level of care more appropriate to their needs. The task of identifying and securing appropriate alternative care facilities for them is under way and this also will have a significant impact on freeing up acute beds in general hospitals over the coming months.

With regard to discharge planning and liaison between the acute hospital and community sectors, the report of the review group also pointed out that some progress had been made in relation to improving arrangements in this area but noted that few hospitals appeared to have a clearly defined policy in this regard. It recommended that health boards and voluntary hospitals should develop clear written policies on planning the discharge of elderly patients and liaising with the relevant community based services.

I am assured that arrangements for the discharge of elderly patients are in place in all acute hospitals. Notice of discharge varies from site to site with some discharges being arranged at short notice in circumstances where there may be increased demand for admissions to acute beds through accident and emergency departments in some hospitals. I want to assure the Deputy however, that no elderly patient is discharged without an assessment of his or her future needs being undertaken.

Number of patients in acute hospitals awaiting placement to facilities more appropriate to their needs as at 17 January 1999.

Health BoardArea	Hospital	Total
Eastern	Mater	21
	Beaumont	17
	James Connolly Memorial	19
	St. James's	36
	St. Vincent's	45
	Tallaght	19
	Naas General	9
	St. Columcilles	12
	St. Michael's	14
	Subtotal	192
North-Eastern	Cavan General	6
	Monaghan General	8
	Louth County	7
	Our Lady's Navan	7
	Our Lady of Lourdes	15
	Subtotal	43
Health BoardArea	Hospital	Total
North-Western	Sligo General	7
	Letterkenny	10
	Subtotal	17
Midland	Tullamore General	13
	Portlaoise General	3
	Longford/WestmeathGeneral Hospital, Mullingar	1
	Subtotal	17
Mid-Western	St. John's Limerick	4
	Wexford	1
	Dooradoyle Regional	Nil
	Limerick Regional	8
	Nenagh General	1
	Ennis General	1
	Subtotal	15
South-Eastern	St. Luke's	Nil
	St. Joseph's	3
	Our Lady's, Cashel	Nil
	Subtotal	3
Southern	Tralee General	9
	Cork University	59
	Mallow General	6
	St. Mary's Orthopaedic	2
	Bantry	Nil
	Mercy Hospital	13
	Subtotal	89
Western	Health Board hospitals(UCHG, Merlin Park,Roscommon, Castlebar)	30
	Portiuncula	12
	Subtotal	42
	Total	401