Thursday, 18 November 2010
Dáil Éireann Debate
Deputy Joe Behan: I thank the Ceann Comhairle for giving me the opportunity to raise this important matter on the Adjournment today. As Members know, dementia is an umbrella term for a group of conditions which cause brain cells to die. Alzheimer’s disease is the most commonly known form of dementia and is a condition which has a potentially devastating impact on the cognitive, emotional and physical life of the affected person and poses enormous challenges for their families. Dementia is progressive in its nature, but thankfully in some cases the progression can be slow and because of this the person can often live independently and with dignity in his or her local community with a range of supports. It is also important to note that while dementia is usually a condition of older age it is not part of the normal aging process.
The Alzheimer Society of Ireland reported recently in its pre-budget submission that there are currently 44,000 people with dementia in this country and they predict that this will rise to more than 100,000 over the next 25 years. There are estimated to be approximately 50,000 carers of people with symptoms of dementia at present but when one adds in the number of other family members who assist and whose lives are affected by this condition, it represents one of the most serious challenges to the health care system in this country and is worthy of detailed consideration and prioritisation by the Members of Dáil Éireann and the Government.
I attended the launch of the Alzheimer Society of Ireland pre-budget submission some time ago and I was struck particularly by the testimony of the daughter of a person with dementia. She described in heartrending detail the progression of the illness which her mother endured and how it came to affect her own health in a serious way as well. That presentation prompted me to request this debate today.
The Government should give serious consideration in the forthcoming budget to the following four key points made by the Alzheimer Society of Ireland. First, protection should be given to the current funding level of €14.61 million for the community services provided by the Alzheimer Society of Ireland nationally. This would help to sustain the basic level provision of day care service, carer support groups, social clubs for carers and persons with dementia, and the Alzheimer’s disease national helpline to current service users. Second, the current levels of service should be extended to the 1,000 people on waiting lists throughout the country at an additional cost of € 4.6 million. Third, the 4,400 younger people with dementia who currently have little or no support structure or services should have a regional case management service to assist, post-diagnosis, in accessing entitlements, services and information. This would cost €350,000. Fourth, a public campaign promoting risk reduction and prevention of dementia in the general public should be organised and supported. This would cost €250,000.
I believe that there are compelling reasons to designate dementia as a national health priority. A national dementia strategy would enable the formulation of a strategic and fully co-ordinated response to meet the needs of people with dementia and their carers. It is an extremely worthwhile objective and I ask that the Government consider this matter carefully and sympathetically when framing budget 2011.
Minister of State at the Department of the Health and Children (Deputy Áine Brady): Dementia is a most distressing condition, both for those suffering from it and their families. It presents a significant and growing challenge to health and social services.
Alzheimer’s disease represents about 70% of the cases of dementia. People are living longer and, as a consequence, are more likely to develop some form of dementia. While dementia is not solely related to age, the prevalence is higher in older people and increases with age. It is estimated that approximately 5% of people over 65 years of age have some form of dementia, with this figure rising to 20% for people over 80 years of age. Research and published work on dementia have outlined the complexity and range of issues involved in its effective management. This work also emphasises the need for co-ordinated, multi-layered and well-resourced services which respond to the individual needs of people with dementia, and of those who care for them.
There is an intimate link in Government policy between the care of older people and that of people with dementia. It stresses the need to provide support in dignity and independence, through the provision of appropriate services to the people concerned and their carers. Recent years have seen dramatic changes in both the concept and practice of services for older people. Enormous strides have been made in developing a comprehensive, community-based service. This will continue to focus on helping people to remain in their own homes and communities.
There has been an unprecedented level of investment in this sector. The Government has provided over €200 million in additional funding for new service developments in recent years. This year, therefore, the Health Service Executive will invest in the region of €211 million for mainstream home help services and approximately €130 million for home care packages. This commits the executive to providing almost 12 million home help hours to over 54,000 people; to deliver home care packages to over 9,500 people at any one time or to some 13,000 clients over the course of the year; and to maintain over 21,000 day care or respite places, benefiting an estimated 80,000 people.
On 1 July 2009, the new regulatory regime for residential care settings for older people came into force. On that day the Health Information and Quality Authority, HIQA, commenced an independent system of registration and inspection of all nursing homes. The Health Act 2007 (Care and Welfare of Residents in Designated Centres) Regulations 2009 underpin the National Quality Standards for Residential Care Settings for Older People in Ireland.The standards include supplementary criteria for dementia specific residential care units which should be read in conjunction with the general standards. Since the commencement of the regulations the authority has inspected all designated centres for older people, some 600 centres and published approximately 550 inspection reports.
The demographic make-up of Irish society is changing. Our population is ageing. The number and proportion of people diagnosed with dementia can be expected to increase, and with it demand for services. In recognition of this, the Department of Health and Children has started the process of developing a policy on dementia that will support the delivery of long-term care services. The policy will be developed on the basis of the best evidence available from national and international sources.
One of the first issues to be addressed is the need for comprehensive data on the prevalence of dementia in Ireland, on dementia specific services and on demographic trends. Officials from the Department held discussions with relevant stakeholder groups and the Health Service Executive earlier this year on the first stage of the process. Arising out of these discussions an advisory committee was formed to oversee a project to provide a comprehensive research evidence base to inform the development of the policy. I expect this project to be completed and submitted in 2011. Following this, formal work on the national policy will commence.
In addition, the HSE is currently exploring the potential for changes in care pathways for people with dementia, and will make recommendations for the future provision of dementia care across all health and social services. An audit is under way within the HSE of the current specialist dementia care services available both in residential or hospital settings and community services and it is hoped to have it completed by the end of this year. This work will also feed into the overall dementia policy formulation.
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