ThD

A Third Wayfor

The Third Age

Mervyn TaylorMarch 7th 2013

AgeingIreland is

The life cycle is getting longer

The Troika is getting worried - the impact of ageing on our public finances

http://www.finance.gov.ie/documents/publications/other/spuapr2012.pdf

Rising Life Expectancy Requires

• New ways of organising pensions, care and mutual support

• The allocation of healthcare risks between state and individuals will have to adapt

• New models of housing and urban design • New methods for countering isolation• Greater use of technology• A growing political and policy focus on ageing• Turning associated social & economic challenges into

opportunities

Older & Colder“…..75% of resources focused on 5%”

< 5%

15%

80%

‘Fair Deal’

<€1 BillionState funds

+€240 M

Residents Funds

+Costs of

Regulation

Regulation isn’t enough- compliance rather than quality?

“Looking back at my experience of Leas Cross…It was abysmal ….lonely and cold…. no one seemed able to care for my father. He was in pain and suffered greatly in his last days”Mary Fletcher-SmithThird Age National Advocacy Programme Consultant. (Her father, Peter, died in Leas Crosss on 6th June 2005)

H-Block HospitalA husband and wife live separately in open wards funded through‘Fair Deal’. Their home lies empty.

HusbandWife

‘Less of the same’ is not a cause worth fighting for

Private Sector Dominance is Undesirable“Providing care homes for the elderly and disabled should offer one of

the safest investments on the stock market”

There has to be a better way!!!

“…age is often made to look pathetic and marginal. We cannot escape the picture of the geriatric ward or certain kinds of residential institution. This is ‘warehousing’ – stacking people in containers because we can think of nothing else to do with them”. Rowan Williams. Archbishop of Cantebury. 2012

People Before Premises!!!

‘Policy Go Leór’

“National health policy in Ireland since 2001 – and even earlier - is underpinned by the idea that health services should be delivered, to the greatest extent possible, in the communities and homes where people live, and should avoid unnecessary admissions to hospitals and other institutions” (McKeown 2012)

Implementation is the issue

“..a public service that appears to have the formal aspects of a public interest culture, and yet is demonstrably weak in leadership and implementation capacity” Rhodes and Boyle, 2012:55 IPA

A THIRD WAY FOR THE THIRD AGEAn initiative to improve the range and quality of supports and services available to older people through innovative public interest

trusts

National Economic & Social CouncilReview re Quality, Standards & Regulation - 2012

• Lack of trust in the state & pessimism in its capacity to achieve public good

• Individual organisations need to be helped to improve

• Alternative institutional models of provision (e.g. social enterprise) needed to stimulate wider change in areas such as elder care

‘SMART REGULATION’Plurality of forms of regulation

• No ready-made blueprints to resolve many issues• Solutions have to be developed through an

exploratory process with the users themselves • A series of related steps rather than isolated actions

involving users at every stage • Getting a range of perspectives, especially with

regard to whether the desired outcomes have been attained.

• User participation is part of a process of illuminating the outcomes individuals and groups would like

The response to loneliness and insecuritycannot be ‘outsourced’ & regulated

Dependency levels in nursing homes - more people could live at home

20100%5%

10%15%20%25%30%35%40%

Low

Medium

High

Maximum

LowMediumHighMaximum

Source:DoH Long Stay Activities

What a ‘Third Age Trust’ will do

• Organise the provision of support and care for older people within the trust area and develop new supports and services based on identification of need.

• Contribute to social and economic development by identifying opportunities for innovation and job creation

• Attract additional resources through engagement with citizens, community and corporate groups

• Contribute to a national process of innovation and learning regarding the design and delivery of public services.

• Promote positive attitudes and approaches to ageing and inter-generational solidarity without denial of the inherent challenges.

Four Pillars of the Third Way• Individualisation of supports and

services based on needs and preferences and with a strong focus on collective responses focused on home.

• Intelligent Networks to respond to and organise needs across defined areas

• Innovation regarding the use of resources and attracting new resources

• Institutional Learning & Oversight to ensure best use of resources, quality of experience and outcomes, and transfer of learning across public, private and social enterprise sectors.

Individualisation‘‘....how to wrap supports around the individual based on

where they are in the lifecycle’ NESC

“There’ll be nothing about us without us”

Intelligent Networkswho needs what, when, where at what time with what resources

Homes

Personal Care• Companionship• Chiropody• Physio & Massage• Hairdressing• Respite Support• ‘The Dog’

Health Care• Nurse• Health Care Assistant• GP / ANP• Emergency Support• Palliative Care

House Care• Handy(wo)man• Gardening• ICT / Security• ‘The Remote’

Getting There• Shopping• GP & Hospital visits• Meals• Socialising• Religious• Political

INNOVATION - Best Use of ResourcesContinuum of Care & Cost

Series10

200400600800

100012001400160018002000

Hospital (Teaching) Hospital (General)Community Hospital Nursing HomeHigh Support Housing Boarding Out'Home Care (High Dependency) Home Care Visit (Palliative)Respite Grant 4 Star Hotel

Costs per day

Innovation for Self Directed Support

Needs & Preferences

Nursing Home Support Scheme

Home Care Packages

Direct Payments

Social economy supports

Community, Family, Mutual & Self Support

Europe is focusing on social innovation

December 2011Commissioner László Andor announced plans for the promotion of the social economy and social enterprises through the European Social Fund. Further financial support will also be provided over the period 2014 to 2020 through the Programme for Social Change and Innovation.

Institutional Learning & Oversight

• At national and at local level new approaches are needed to ensure learning and accountability

• The OECD & the NESC have suggested a need for ‘performance dialogue’ regarding standards and quality.

• A variety of providers, the regulator, older peoples’ advocates & wider stakeholder interests need to be able to present their differing perspectives

• Independent chairing will be crucial

How far have we got?

ENGAGING & FUNDING (Jan- Dec)

€300,000 for 2013Reform of ‘Fair Deal’Building Support for Change

SCOPING WORK (Feb-Sept)

NESC dialogueInternational projectsPartnerships Reference GroupEU SupportsLegal & Governance

DATA ANALYSIS (March – July)

Census 2011TILDA (Longitudional Study Older People)National Disability SurveyOperational Data

NATIONAL BUSINESS CASE (April – August)

LOCAL BUSINESS PLAN (March – Sept) DL-R

Analysis of National Datasets

• 'Secondary Analysis of Relevant National Datasets on Support & Care Needs of Older People in the Republic of Ireland'.

• Census 2011• TILDA• National Disability Survey• HSE Operational Data

National Business CaseLocal Business Plan

Reference Group

“Ar scáth a chéile a mhairimíd”

We live (and we die) in each other’s shadow