Health Services Executive

Assessment of Need for Residential Care for Older People

Background

In January 2005 the Tanaiste and the Minister for Social & Family Affairs established an inter-departmental group of senior officials, from the Departments of Finance, Health & Children and Social & Family Affairs and chaired by the Department of an Taoiseach. Taking account of the proposals in the Mercer and O'Shea reports the Group were asked to identify policy options for a financially sustainable system of long-term care and to address issues associated with the benefits, services and grants currently in place.

In line with the recommendations of the Long-Term Care Working Group and associated Government decisions, the DoHC requested the HSE undertake an up-to-date needs assessment of residential care services for older people. Prospectus were commissioned by the HSE to become members of a Task Force, with responsibility for project managing the full assignment, working with the HSE Assistant National Director and Task Force members to ensure agreed work was delivered on time and to the required standard.

Objectives

The brief given to the Task Force was to carry out an assessment of need for residential care services for older people, assuming that a medium term target figure of 4% of the over-65 population would be in long-stay residential care at a given time. The group were asked to determine how many new beds would be required in order to reach this target. This 4% target, which was set by the Long-Term Care Working Group, was derived from taking the current OECD average across the 15 member countries of 4.5% of the older population and reducing it by 0.5% going forward. It was understood that this target could not be reached unless there was a significant investment in the development of a comprehensive range of community services, including sheltered housing, to support older people's preference to remain living in their own homes.

As well as assessing the need for long-stay beds (including dementia specific beds), the Task Force also assessed future need for community support/intermediate care beds and respite beds because both are critical to supporting older people living in the community. The Task Force also considered the way in which residential care resources should be used in the future, with reference to new health strategies, the changing needs and preferences of the older population and the impending introduction of modern standards of care.

Approach Taken

The Task Force adopted a two-phased approach to this piece of work.

Phase 1 involved the development of a clear and accurate estimate of residential care needs of older people throughout Ireland. This took the form of detailed data gathering and analysis on the supply and demand side, and identification of key findings. The supply-demand analysis was determined by analysing supply (bed stock), while reflecting known capital plans for public bed stock, against demand, based on accepted best practices. This approach supported the objective of determining the requirement for long-stay residential care beds within four categories of bed type, i.e. extended (long-stay) care beds, dementia specific care beds, community support/intermediate care beds, and respite care beds, and across four dependency levels.

Phase 2 considered high-level procurement options, and represented a separate project.

Outcomes

The outcome from Phase 1 was a final report for initial consideration by the HSE, which made a number of recommendations relating to:

• Residential Care Requirement Targets
• Population Projections
• Bed Requirements
• Reconfiguration and Upgrading of Bed Stock
• Procurement of Additional Capacity

The report was submitted to the Department of Health & Children for consideration. Prospectus has also subsequently completed Phase 2 of this project, Outline Procurement Options for Residential Care for Older People.