The care of older people in rural areas in the past was carried out by and seen as the responsibility of families, i.e. sons or daughters, nieces or nephews.  As the farming couple got older the son took over the farm and brought in a wife.  There may have been a daughter or two at home until they either entered a convent or got married themselves.   The old couple didn’t hand over the farm until after their death.  In one way this ensured their care.   In the cities there was a strong community spirit, more so than today.   Families looked out for their elderly and where there were no family’s neighbours helped out. There was a great social divide between the rich and the poor particularly in the cities. The women kept the home and the men provided the income.  Large numbers of people lived in dire conditions in tenement housing and managed to survive by helping each other.  The life span in the 19th and first half of the 20th centuries was shorter than today.  Those who were in dire poverty or sick and had nowhere to live could go to the Workhouse or the County Home, but this was an appalling option for most.

“The Old Age Pensions Act 1908 introduced a non-contributory pension for ‘eligible’ people aged 70 and over. It came into law in January 1909 across England, Wales, Scotland and Ireland.” (Irish Genealogy Toolkit)

Today older people could be said to be financially better off.  If they have council accommodation or own their own houses they could scrape by on the non-contributory pension.  Those who have worked and contributed to a pension will be better off and will probably have some savings.  In the latter half of the 20th century nursing homes began to spring up around the country. Initially the Health Boards ran Welfare Homes or County Homes as they were called in rural areas for the poorer members of society.  The demand for nursing home places increased in this time because women were now working outside the home to supplement the income and help pay the mortgage.   They were no longer available to care for their elderly relatives.

Advantages & Disadvantages of Home Care

When accommodated to live in their own homes older people are more content as they are surrounded by what is familiar.   Memories good and bad are tied up in the various household items.   They have neighbours and friends who have been there for years and they know the locality, the local shops and church community.   If they are in any way dependent, they or their family members may call on the Public Health Nurse for advice regarding their care.   Depending on their income and whether or not they have a medical card, they may either buy in help from one of the many homecare companies in the form of Home Help for domestic tasks or Health Care Assistant for personal tasks.  Many of the Healthcare Assistants now carry out both domestic and personal care tasks. The elderly person may qualify for a home care package from the Health Service Executive (HSE).  There are day centres, community centres and retirement groups which they might attend if they so wished.   Some of these are provided or subsidised by the (HSE), there are also meals on wheel and internet shopping.   Some local supermarkets will deliver for a fee.

The greatest disadvantage of homecare for the person living alone is loneliness.   This can lead to depression, an unwillingness or lack of interest in cooking and eating, lack of interest in personal hygiene and a general overall decline.  Some elderly people will not go to the various services available and this is their right but if they only see a care worker once a day or three times a week and spend the rest of the time looking at the four walls their health will deteriorate.  Another fear is of being burgled or the house going on fire or if the person is confused or has early dementia they may wander out at night and not find their way back. 

Advantages and Disadvantages of Nursing Home Care

The advantages of nursing home care are that the older person is in a safe environment, is warm, sheltered, fed and personal hygiene is catered for.  Their general health is monitored and anything abnormal noted and treated.  A care plan is drawn up for each individual care recipient based on a history taken from the resident him/herself and family members.  Activities are provided to occupy or entertain the residents. 

There is more focus today on end of life care in nursing homes.  A survey by the National Council on Ageing and Older People (2008) states: “…it is necessary to nurture and support a person-centred approach to care involving well-trained, educated and supportive staff who are aware of end-of-life needs of patients from an early stage of the process.”

Nursing home staff say that while they would very much like to spend more time on leisure activities and outings with the residents, the fact is they are so busy with the daily routine that all their time is taken up and they are often short staffed.

The disadvantages are that the resident has very little choice in managing their own daily activities.  They may not be able to make friends in the nursing home because of the high numbers or residents with dementia.  They must fit in to the routine of the home.   The family may not visit as frequently as the resident would like.  The resident may not have a true sense of belonging because they have no specific role in contributing to smooth running of the residence.  Most nursing homes are private and therefore have an eye on the profits.  This is not always conducive to working in the best interest of the resident.

Best Practice in the Care of the Elderly

Best practice in the care of the elderly is to accommodate the individual’s preferences where possible.   This will almost always be to live at home. Some elderly tell me that it can be so lonely seeing nobody for hours and often days that going to a nursing home has to be better than that.   In the same way as young people need career advice older people need good advice about their options as to how best to live out their lives?

Example: Mrs Hopkins was a wealthy lady who, with her husband after his retirement, downsized from a very large city house to a small house in the suburbs.   Six months later her husband died suddenly.  Mrs Hopkins was in her early seventies at the time and she was extremely lonely after his death.   She hadn’t got to know many people in the new area and anyway they were mostly young couples out at work all day.  Since she had no family, she made a decision without consulting anybody, to go into a nursing home.

She was presented with a very attractive picture, by the nursing home owner, of life in the nursing home so she sold her house and moved in.  This was a big mistake as things were not as she had expected.   She was very restricted in leaving the nursing home to go shopping etc. as it was in a rural area and she didn’t drive.  Public transport was poor.   At least two thirds of the residents were too old, deaf or had dementia and she couldn’t make friends with them.   She felt trapped except for occasional visits from her niece and nephew who took her out to celebrate festivals such as Christmas and Easter with them. This is a true story, the disadvantages for Mrs Hopkins were that she had money and could make this decision alone but once she sold her house, she couldn’t reverse her decision.  She should have consulted a care expert who had no vested interest in her final decision.

Residential Care

Many older people do not need nursing care, yet they cannot safely live independently.  Could we provide them with a level of care between being independent and dependent?  Say, local community residences managed and run by a higher qualified Healthcare Assistant.  A place where the resident could live in his/her own neighbourhood, near neighbours and family, shops and services familiar to them.  A residence were the resident would have a role to play, according to ability, in the running of the home.  Served by the Primary Care Services i.e. the Public Health and Community Nurses visiting.

Conclusion

Life has changed in the last fifty years or so in Ireland.   We are financially better off than we were in the 20th century; women have left the domestic scene to pursue careers, of necessity, as the cost of living has risen beyond the means of one salary.  Older people cannot depend on families and the community to the same extent as before. Other systems of care have come into play and are of a high standard for the most part but there is the problem of funding.   Nursing homes, private, public and voluntary can be accessed through the Fair Deal Programme while the annual allocation of funds last.   Home care packages are available free of charge for those with medical card who need them, and they offer services over and above the normal community services from the HSE but again they are subject to a limited annual fund. 

I am left with a question: Given our systems of care for our elderly citizens can we say that we value and respect them as they deserve?