Care of Older Persons and Reopening of Day Care Services | Commencement Matter
18 November 2020
Senator Ivana Bacik:
"I thank the Acting Chairman and welcome the Minister of State to the House. It is good to see her back here again and I thank her for all of her work on the areas within her brief. I am aware that the Seanad recently discussed day care services for persons with disabilities. My Commencement matter has a specific focus in asking the Minister of State to outline when community social day care facilities for older persons and respite facilities for older persons and their families are expected to reopen. It is a more specific issue.
"To give some context, we know that many families are struggling to cope because community day care facilities for older people have remained closed. Day care centres are used by approximately 14,200 people. Their closure means many carers are lacking a crucial support mechanism that enables them to take respite breaks. Sage Advocacy, a support and advocacy service for vulnerable and older adults that has been in communication with me, has been undertaking extensive research into a phenomenon known as carer burnout. The Minister of State will be well aware that this is seriously affecting those carers for whom services have not resumed. We await publication of the research findings but we are well aware of the issue.
"Many people have contacted us because they are exhausted. Yesterday, in an article in The Irish Times, Professor Suzanne Cahill reported that 70% of spouse carers for people with dementia had at least two chronic health problems, one third had clinical depression and most had visited a health service professional in the previous month. This is clearly a wider public health issue as well as an issue of empathy, compassion and rights for older persons. Many facilities remain closed, meaning many older people may become increasingly socially isolated from their peer group and others. The lack of social interaction will have a negative effect on their mental and physical health and the health of their carers.
"While I am conscious that we have had extensive discussion of this issue in the Oireachtas, without a timeframe there is a lack of certainty. I am aware that the HSE is undertaking risk assessments in respect of local services, which is very welcome, and that huge efforts are being made by those working in this area to ensure that services will be provided. However, the Government’s position remains that some services may not be suitable for reopening. Again, I understand that with current Covid-19 restrictions, the usual dynamic of social interaction has changed. Some facilities may simply not be suitable. The positive news on vaccines gives us hope that services will return to normal in due course. For many people and their families, an issue arises due to the absence of a timeframe and clarity on when all services will be able to reopen. The Minister of State, in answer to a parliamentary question on this matter last month, stated she would ask the HSE to continue to assess the risks and benefits of reopening and would explore alternative methods of service delivery for older people. Has she received an update on this? What arrangements will be made for those for whom reopening is simply not a viable possibility in the short term?
"We have found ways to ensure our childcare facilities, schools, universities and colleges could reopen, at least in some form, within the parameters set out to protect public health. We are discussing plans for reopening the hospitality sector, including restaurants, as well as other sectors of society. This is clearly a vitally important part of a broader discussion around quality of life, especially as we have seen other healthcare facilities opening. Very important issues around the provision of healthcare for people in a non-Covid-19 environment are being recognised. I ask that the reopening of all day care services for older people be prioritised."
Minister of State at the Department of Health (Deputy Mary Butler):
"Gabhaim buíochas leis an gCathaoirleach Gníomhach and I congratulate her on taking the Chair. I also thank Senator Bacik for the constructive way in which she always raises these particular issues as they are very close to all of our hearts. I have just spent the last hour on a webinar with Irish Rural Link and a significant part of the conversation was spent discussing care of the elderly, meals on wheels, day care centres and active retirement groups which are hoping to restart. This is, therefore, a very timely Commencement matter.
"As we are all aware, community services such as day care and respite play an important role in enabling older people to continue living in their communities and maintain their social connections. However, the introduction of physical distancing, isolation and restricted contact with loved ones has changed the usual dynamic of social interaction.
"The HSE is working closely with providers and community staff to identify where service is most required and has been undertaking risk assessments of local services. This is to ensure, insofar as possible, that day care and respite services can resume in the context of Covid-19, having regard for public health advice. Services will resume when it is safe and all infection prevention and control measures and the requirements of physical distancing can be maintained to protect service users and staff and prevent any further spread of the virus. Unfortunately, I am not in a position to give a definitive timeline. When I was appointed to this role on 1 July our aim was to open these services in September and that is what we were working towards. The risk assessments were being undertaken in every community healthcare organisation, CHO. I was very hopeful at the time that we would be able to open them, even at a restricted level. Unfortunately, as we all know, the virus knows no boundaries and with the escalation again in the figures from the end of September into October, it has not been possible to do so.
"Some day centres may not be suitable for reopening due to the constraints of their physical environment. It will be necessary to continue or expand alternative service delivery models. Some of the issues identified by the HSE include the sharing of facilities with other groups or clients and transportation of clients to day care centres where family members cannot assist. This has proven to be hugely problematic where some day care centres use small minibuses to move perhaps ten or 12 service users. The availability of isolation areas should a client or a member of staff become unwell is also an issue that has been identified.
"The HSE has established a focus group to ensure day care centres continue to be prioritised and to develop a plan to assist service providers in having a suite of options available for the provision of day care and supports. This plan will be developed in line with the current Covid-19 roadmap.
"Additional or new home support packages are being put in place for the most vulnerable clients, with the focus on both the carers and the persons who attend the day care services. A model of day care in the home is being finalised. Focused on individuals with dementia especially, this model is being reviewed with a view to transferring it to regular day care centres. The model will continue to develop even when day care centres reopen and will be based on the needs assessment and benefits for client and carers.
"At present, the HSE is only allocating respite provision to clients most at risk of carer breakdown or an inappropriate admission to hospital. As the Senator will be aware, the whole premise of the winter plan is to try to keep older people at home as much as possible and avoid having to transfer them to acute hospitals. We are very conscious of those who are most at risk of inappropriate admission and respite occurs in such circumstances."
Senator Ivana Bacik:
"I thank the Minister of State. As always, she gave a comprehensive response and I note more detail is provided in the written response. I always endeavour to be constructive.
"This is clearly a vitally important issue. The Minister of State frankly acknowledged that while the plan was to reopen in September, unfortunately that has not been possible. It is still very disappointing and frustrating for persons in need of these services and their families not to have any sense of a timeline. It gives hope to hear that a focus group has been established in the HSE to ensure services are being prioritised. It is also very helpful to hear about alternative service delivery models within those proposals. However, it would be great to be given a better indication of the sort of timeframe that might be envisaged by the HSE's focus group.
"Clearly, planning is ongoing and, as the Minister of State noted, within that plan there is a recognition that some services will not be able to reopen and that alternative methods of delivery should be available. Perhaps she will elaborate a little more on the timeframe. Are we talking months or some time in the spring, for example? That would be helpful."
Minister of State at the Department of Health (Deputy Mary Butler):
"I fully understand the impact that the continued delays in reopening recreational respite services is having on older people and the important role this service plays. My mum attended a day-care centre near to where we live. She misses going there, the friends, the chat and the conversation. It is very important for people. All I can say is services will resume when it is safe to do so, but I cannot see that happening before Christmas. I am very hopeful that when we come out of lockdown, we will be able to open services, even at a reduced level, in the spring. That is what I am aiming for and I am working closely with the Department and the HSE to ensure that will become a reality. It will be difficult and not all services will be able to reopen. If we could, however, open some services at a reduced capacity, it would give hope to many and I will continue to work towards that."