Best way to care
Meeting individual need not imposing a one-size-fits-all approach is the best was forward for older people’s care, Tadhg Daly writes.
Standardisation is a good thing. Commoditisation is a bad thing. Particularly in healthcare, and uniquely in nursing home care.
It’s vital, as the Leas Cross report has underlined, that baseline standards are maintained by all nursing homes providing care for older people. It’s essential that these standards are constantly inspected by independent experts. But it’s just as important that this kind of care does not become commoditised, does not become subject to a one-size-fits-all approach.
The one-size-fits-all approach assumes a bulk-buy approach to the care of a particular sector of the population which necessarily commoditises that sector into ‘the old’ or ‘the elderly’. It becomes an issue of numbers. Nursing home care should never be about numbers. It’s about individuals. Each individual who enters a nursing home is different and good care responds to that uniqueness. Nursing homes will provide a particular kind of care requiring investment in technology and equipment. They will also provide another kind of care requiring investment in people, surroundings and stimulation.
Professor Des O’Neill, in his report on Leas Cross, observed that nursing homes throughout the country have highly committed, professional, well-trained staff who are “striving to deliver excellent care.” He’s right, and Nursing Homes Ireland (NHI) supports their commitment through the publication of documents to assist nursing home operators in the best management and care of their residents and the provision of training for its members.
However, NHI’s best efforts will be vitiated if the intent of the National Treatment Purchase Fund (NTPF) to pursue a one- price-fits-all policy with nursing homes is allowed to happen. Setting the price of care without taking into account the level or differing kinds of care required for individual residents makes no sense, will drive some nursing homes out of business and force others to cut costs and resources. Driving down the cost of care in this indiscriminate way will inevitably drive down the quality of care at the same time, and the resident will suffer. Furthermore clarity is required on what is included in the Fair Deal. As it stands many essential services such as social programmes are excluded. These form an integral part of life for clients of nursing homes.
One of the most positive steps taken in healthcare in recent years was Minister for Health Mary Harney’s Fair Deal scheme. When it comes into effect, it will represent a major step forward towards ensuring that providing care for older people does not beggar either the older person themselves or their families, unless the NTPF chooses to use it merely as a bargaining tool with nursing homes. This is not what it was intended to be. Minister Harney has quoted personal experience when talking about nursing home care for older people and it is clear that she does not see such care as reducible to a bed, a set number of trained professionals, and nothing more.
The nursing home owners and operators in NHI don’t see their work in that slice- and-dice way either. They got into the business because they liked working with older people. Their nursing homes offer care, attention and respect, backed by the highest nursing standards – not a bulk-purchased commoditised “care” process.
We in NHI have a significant contribution to make in developing those services, so that residential care for our older people is the best that it can be. We have the expertise, the commitment and the willingness to work alongside the Government and all other key stakeholders in the sector to create a service to be proud of.
And that’s where NHI believes we should be going. In the aftermath of Leas Cross, there’s the temptation to believe that as long as nursing homes pass the requisite inspections, that’s enough. It isn’t enough. Rigorous inspection and speedy action can correct flaws in a system. But it cannot create a world-class service informed by warmth, commitment and a constant desire to learn and improve. NHI wants to create that world class system, and it can’t hope to achieve it if a ‘yellow pack’ approach to the sector dis-incentivises operators from responding to individual need with innovation and investment.
