Advanced Life Support, Burns Pack, Dressings & Bandages, Drugs & I.V. Solutions, Response Kit, Patient Carrying Devices & Comfort, Rescue Equipment, Resuscitation Device, Safety Equipment…
5. Marketing plan
5.1 Price Segmentation
In order to segment our market, the following steps will be taken;
Euro per week
Double room (for a couple) 1500
Single room 950
2 people sharing 1400
We offer a superior service that suits all pockets and personalities. An elderly couple's relationship and privacy must be respected at all times. Similarly friends who wish to share a room may do so, although we have many single rooms available for a slightly higher price.
5.2 Promotion and Advertising
The advertising and promotion process will start while the nursing home is in the process of being built and will be very intense at the beginning. The promotional strategy involves contacting General Practitioners Surgeries, Medical Centres, Hospital and Clinics throughout the North Dublin area. An information brochure and an explanatory booklet will be sent to surgeries, medical centres and hospitals in order to target potential clients. Furthermore posters and booklets will be sent to Local Health Clinics, where families of potential customers can access materials about the treatment and care of elderly people.
As a result of this intense promotion, we expect to be fully booked by the time we open the house. Nevertheless brochures will be sent to Hospital and Clinics once a month, to be placed in waiting rooms. General Practitioners will be kept up to date with any new technology or service that will be introduced. Customer's families will be contacted personally; queries and special requests will be dealt with. Customer's families will be contacted on a monthly basis in order to provide them with the customers' health profile or any issue related to health or customers' stay in the clinic.
Furthermore an advertising campaign will be launched in some local radio stations. The campaign will run on Lite FM, Newstalk, Country FM and Lyric FM for the initial four months. The spots will run at specific times, for example during health debates and talk shows. The total cost of the campaign is 1560.00,
II) Promotion and advertising material
III) List of Contacts
6. Organizational Plan
6.1 Form of ownership
Our business will be a limited company. We have chosen this form of ownership because of reduced taxes and national insurance liabilities that this form of ownership provides. Furthermore, the personal assets of the shareholders are viewed as distinct from those of the company. This means that the directors are not personally responsible for the company debts in the unlikely case of failure. The new tax incentive scheme means that we have the following option; €31,750 be offset against the home owners trading income in any one year. The full investment can be written off over a 7 year period at 15% per annum for the first 6 years and 10% in year 7. (Irish Nursing Home Report)
6.2 Identification of partners or principal shareholders
Our company has five partners who provide part of the money for the financial start-up. One of the partners, Sandra Urban, will function as the director of our company. A second partner, Julie Garsiot, will be an administrator and a financial manager. Two of the five employed nurses, Valentina Salaris and Marianne Griffiths, are also shareholders. Our fifth shareholder is Mr. Dunne, a sleeping partner.
We hope the remainder of the finance will be provided by AIB bank.
6.3 Authority of principals
Five principals will set up the business. All the principals will provide some private capital for the start up. The principals will receive a dividend from the profit depending on their shares. The director of the company Sandra Urban provides the largest part of the financial start-up capital: €150,000. Her remuneration will be €2.500 a month. The administration and financial and manager Julie Garsiot will provide €100,000 of the initial capital. Valentina Salaris and Marianne Griffiths will both provide €50,000 of the starting capital. The fifth principal, Mr Dunne, is a sleeping partner. Although he provides us with capital of €100,000 he does not contribute to the daily running of the business.
The responsibilities of success or failure have been taken on by the five principals. Furthermore, most of the principals act as employees as well as employers. This is a cost-saving strategy. The partners stand only to lose their share capital.
IV) Allocation of investment
V) Allocation of Shares
6.4 Management-team background
We will keep the management team quite small throughout the development of the business. We, the management team, have several years of experience in different fields such as business, finance and nursing and will draw on this in order to run the business successfully.
We will employ only high trained staff, with experience in geriatric care. They will provide the best care possible to our guests in order to fulfil all their needs and comply with government health regulations.
6.5 Roles and responsibilities of members
Director:
Sandra Urban's tasks include contacting creditors and debtors, sponsors, government; local community council and other financial organisations in order maintain the cash flow. She is in charge of promotion, advertising and maintaining the internet site. These three tasks will be more demanding in the initial stages of the project. Once the business is established these tasks will become secondary.
The administration and financial manager:
Julie Garsiot is responsible for developing and implementing cost-saving strategies. She will give advice to the director regarding cost-saving strategies and financial matters. Her responsibilities also include administration work including correspondence with clients' families, as well as company accounts.
Nurses:
Our nursing staff is fully registered with An Bord Altranais, the Irish Nursing Board. The company guarantees full care of elderly people and to provide the best qualified support for them. There will be a 24 hours nurse on call. Furthermore, the nurses will have special training to facilitate indoor and outdoor activities, chiropody and physiotherapy. This will have a positive impact on physical as well as psychological state of the clients.
Care workers:
They will assist and support the nurses, for example they will change the beds' linens and do the laundry as well as caring for the clients
Doctor:
There will be a local doctor on call. In a case of emergency he will provide medical help.
Building Maintenance Staff:
His responsibilities include keeping the house, garden and facilities clean and maintaining a proper standard of living.
Kitchen staff:
They provide a good quality and healthy food following a specialized nutrition plan which is created by doctors and nurses according to the needs of the residents.
Cleaning staff:
Daily cleaning is required to keep the home at a hygienic standard.
Quality of Life and activities Staff
There will be an aroma therapist, a yoga trainer a hairdresser paying regular visits in order to provide a special service.
7. Assessment of risk
7.1 Evaluation of the model's weakness
Competitors:
There are other nursing homes in this area. This is because the natural environment is perfect for our resident's health. We have tried to choose an area with few competitors and there presently is no registered nursing home in Skerries.
Nursing services and home help; that are nurses who come to elderly houses several times a week to wash them, do their shopping etc. This could provide a cheaper alternative to our facility. Other nursing services such as "meals on wheels" etc. could be seen as further competitors.
The Slan Abhaile programme, presently being conducted by Donnybrook hospital, integrates the elderly back into the community. This too would be a company competitor.
People's decision to move into our home:
The decision to go into a nursing home could be viewed as descending the social ladder. The risk of being isolated would also potentially cause problems.
To give up or sell your home where you lived for years and to get used to new surroundings might be a very big step to take for people. Separation anxiety would play a huge part in this decision. We need to change the public opinion with information. Therefore, we will develop brochures and leaflets as well as a website through which information distribute widely. People might have not enough money to cover the costs of living in our home. The elderly might prefer staying with their family or alone instead of moving to a new place. However, present government incentives should solve this.
7.2 Contingency Plan
If our venture fails the house could be converted into a youth hostel (because there are many tourist attractions in the vicinity and the area is quiet). If we do not get enough clients we will put more emphasis on promotion in the local area and neighbouring countries (UK, France). We could also take in people with physical disabilities. We will seek further investors as well as donations from charitable societies. We would launch an information campaign, so that people would change their attitudes and accept that living in our old people's home is the best treatment possible.
8. The Financial Plan
8.1 Balance Sheet and Profit and Loss Year 1
8.2 Balance Sheet and Profit and Loss Year 2
9. Bibliography
RTE report 27 January Prime Time
Irish Nursing Home Association Report
www.bplan.com
www.homecaremedicalsupplies.ie
www.alzheimer.ie
www.dementia.ie
www.enableproject.org
www.ageaction.ie
www.ncaop.ie
www.retirementservices.ie
www.irishambulance.net/equipment.htm
www.finh.ie/index.as
10. Appendix
Profile of the Nursing Home Industry
There are currently 455 registered nursing homes in Irelandcatering for over 15,000 people. It is anticipated that demand for beds is set to double over the next 25 years. So this would indicate that there is significant capacity for growth in the industry going forward. However demand is likely to be higher in the Eastern and Southern areas, with some other areas of the country oversupplied.
Industry Regulations:
----------------------------------
The Health ( Nursing Homes) Act 1990 and The Nursing Home (Care & Welfare) Regulations 1993 were introduced to place strict regulations on nursing homes with regard to Health Board registration and standards of accommodation and care. These regulations provide for inspections by Health Board officials at least twice a year.
The main areas covered by the legislation also include:
1. Medical Staffing
2. Planning approval
3. Fire safety
4. Accommodation standards
5. Sanitary facilities
6. Equipment
Outlook/ Threat to the Nursing Home Industry :
----------------------------------------------------------------------------
Over the past 50 years, life expectancy in Ireland has increased from 57 to 73 years for males and from 57 to 78 years for females. This represents an increase of 27% and 36% respectively. These demographic trends, coupled with the better healthcare and increasing affluence in society are serving to increase the demand for Nursing Home facilities. Modern society is now more inclined to place older relatives in specialist care facilities as opposed to caring for them within the home. The Nursing Home Sector has changed significantly in recent years with the introduction of the 10 year capital allowance break in 1998, which has encouraged nursing home owners to extend their existing properties and or build bigger "purpose built modern facilities". Under the tax incentive scheme, the capital cost of building or refurbishing a nursing home qualifies for capital allowances of up to €31,750, which can be offset against the home owners trading income in any one year. The full investment can be written off over a 7 year period at 15% per annum for the first 6 years and 10% in year 7. The tax-based incentive scheme on offer to investors in the private nursing home sector is one of the few established schemes left in tact by the Minister for Finance and in the absence of a definite tax-break deadline will make the nursing home an increasingly attractive investment option over the next few years
The Health Boards also contract beds in Private Nursing Homes for convalescent purposes, because of the shortage of and demand for hospital beds. In July 2002 The Minister for Health & Children, Micheal Martin announced plans to pilot a Public Private Partnership initiative, which will make an extra 850 beds available in Community Nursing Units (CNUs). 450 of these beds will be provided in the region covered by the Eastern Regional Health Authority (ERHA) and a further 400 beds in the Southern Health Board (SHB) region. However recent cutbacks have resulted in the health boards, simply leaving these people in hospital rather than incurring the additional cost of placing them in a home. The hospital bed is a fixed cost, whereas the nursing home is an optional one for the health authorities, and of course this practice is obviously contributing to the lack of beds in public hospitals.
Staffing:
-------------
This is the primary strategic issue facing the Nursing Home Sector at present. It is important for a nursing home to achieve optimum levels of nursing staff. An adequate level of high calibre staff who provide a high quality standard of care and have a good relationship with residents and their families will serve to enhance the reputation of a home and influence occupancy levels. The number of staff required will depend on the level of dependency of the residents, eg. Alzheimer sufferers. Staff shortages have been a major headache for the industry up to recently, but many operators are now sourcing nursing staff from Overseas. The cost of labour is by far the most expensive overhead faced by nursing home operators. It is estimated that between 45-55% of the total turnover in a typical nursing home will be ploughed directly into staff salaries.
Key Considerations to be addressed:
-------------------------------------------------------------
The cost of building a nursing home facility to the necessary health board standards can be an expensive process. The site, build and fit-out costs for say a 50 bedroomed nursing home can reach as much as €5million. When considering a lending proposal for the Nursing Home Sector a Bank will be looking to ascertain the background and experience of the borrower within the sector. Relevant qualifications, proven management skills and overall knowledge of the sector will help determine the nursing home operators ability to meet the opportunities and threats facing the industry. It is also important that they are aware of and adhere to the legal regulations governing the industry. A detailed business plan is a pre-requisite. This should outline project costings, funding details, proposed staffing levels and cashflow projections .
ؠIs the nursing home to be purpose built or converted from previous use.
ؠWhat type of nursing home is it? Convalescent home, long term elderly care, or special needs.
ؠHow many bedrooms single/shared, en-suite facilities
ؠWhat is the planned level of fees and how are they to be collected i.e standing order/cheque
ؠWhat is the planned staff mix ( medical and administrative)
Indicative Nursing Home Cost Breakdown:
---------------------------------------------------------------------
The following graph provides an indication of the average costs facing a nursing home operation:
As can be seen from this diagram, wages are by far the most significant cost facing a nursing home. Wages range between 45% and 55%. Food and medical costs generally account for 8% to 10% of turnover, other direct costs ie. Light & heat run at between 5% and 7%. Trading profit margins should average between 15% and 25% after directors remuneration & tax.
Fee Income:
-------------------
The level of fee charged depends on location, however, it is also dependant on the standard of home involved, ie. Purpose built quality homes comprising mainly on suite single rooms can expect to charge higher fees. Sustainability of fee rates is also an important factor to consider.
Location ~~~~~~~~~~ Fee per week
--------------- ------------------------
Rural €350 to €550
Urban €650 to €850
Analysis (1)
This analysis assumes a 50 bed nursing home, fee rate of €650 p.w, directors remuneration €50,000 p.a, a bank borrowing of €3m over 15 years at interest rate of ECBOR +2% = 4.625% p.a (July '03). It demonstrates sustainability to meet loan repayments vis- a-vis factors such as costs and levels of occupancy.
Analysis (2)
The second analysis demonstrates the difficulties that can arise around cost control. Here we have an example of a similar sized nursing home, a weekly fee of €750, a bank borrowing of €2m, but with staff and other costs rising to 88% of turnover, a 100% occupancy level would have to be maintained in order to break even.
Key Factors for Success:
------------------------------------
ؠKnowledge of, and experience in the sector together with strong business acumen in both caring and administrative functions
ؠLocal competition - if there are a number of nursing homes in the vicinity it will be difficult for operators to pass on extra costs because of the high level of competition between them
ؠAvailability of staff - with the introduction of job sharing and part time nursing options, qualified nursing staff may be scarce thereby increasing labour costs. With the increased quality of care, nursing homes are having to pay hospitals rates for nursing staff
ؠSuccession planning is important due to the complex nature of the business and the variety of skills.
July 2003 ~~~~~~~~~~End~~~~~~~~~~
National Council on Ageing and Older People
DEMOGRAPHY
Ageing In IrelandFact File No. 1
It is estimated that there are 429,100 persons aged 65 years and over living in the Republic of
Ireland in 2001, representing 11.2% of the total estimated population of 3,838,900.1
There are more older females over the age of 65 than males (56.7% as against 43.3%), reflecting
women's longer life expectancy.1
All recent demographic projections anticipate significant growth in the numbers of older people
in Ireland over the next ten years, a period in which the overall population of the State is
expected to remain stable.
Projections prepared for the Council indicate that the population aged 65 years or more will grow
by around 107,771 persons in the period 1996-2011. It is estimated that the number of people
aged 65 or over will represent 14.1% of the general population in the year 2011.2
Age Breakdown
? Just over 21% of older people are aged 80 years or more. A higher proportion of females than
males are over 80 years.1
? Population projections indicate that the proportion of persons over 80 years or more will have
increased to 24.9% by the year 2011.
? Again, a much higher proportion of older females (28.9%) than males (19.8%) will be aged
80 years or over (see Table 1).2
Table 1. Age breakdown of older population by gender in 1996 and projections for 2011
Age category Males (%) Females (%) Overall (%)
1996 2011 1996 2011 1996 2011
65-69 years 34.0 35.9 28.1 29.5 30.6 32.3
70-74 years 28.3 25.9 26.4 22.8 27.2 24.2
75-79 years 19.9 18.4 20.7 18.8 20.3 18.6
80+ years 17.8 19.8 24.8 28.9 21.9 24.9
Sources: Central Statistics Office (1997) and Fahey (1995)
Life Expectancy
Life expectancy of Irish males aged 65 has improved by one year or 8% over the last seventy
years while Irish female life expectancy has improved by four years or 30 %.
In 1926, an Irish male infant was expected to live only 57.4 years, with Irish female infants
slightly better at 57.9 years. Since then, Irish male life expectancy has improved by 16 years or
27%, while female infant life expectancy has improved by 21 years or 36%.
? Life expectancy figures for 1996 show that Irish men at birth could expect to live until 73.0
years and Irish women until 78.5 years.3
? The average Irish man at 65 years could expect to live for another 13.8 years, and the average
Irish woman for another 17.4 years in 1996.
? Having reached 75 years, Irish men could expect to live for another 8.1 years and Irish
women another 10.4 years in 1995.
? Between 1991 and 1996 life expectancy improved by 0.7 years for males and 0.6 years for
females.
? In 1996 Irish life expectancy at birth for both males and females ranked second lowest out of
the fifteen member states of the EU.3
? The life expectancy of older Irish men has shown very little improvement over the past fortyfive
years. Life expectancy for men at 65 years has improved by only 1.6 years in the period
1950-52 to 1995. The life expectancy of Irish women at 65 years improved by 4.1 years over
the same period.
? Women live longer than men in Ireland. An Irish baby girl born in 1996 is expected to live
5.5 years longer than an Irish baby boy. The EU average gap between the sexes in 1996 was
6.4 years.
? More positively, projections prepared for the Council assume that men at 60 years of age will
be living an extra 2.1 years and females an extra 2.5 years by 2011 compared to 1991.2
Sex Ratio
? There were 1,906,300 females and 1,880,600 males in Ireland in 2000. In 2000, therefore,
females outnumbered males by 25,700. Males outnumber females in Ireland from birth to age
65. Females outnumber males for age groups over 65 as a result of lower female mortality.1
Marital Status
? Marital status in older Irish people shows a marked gender difference: males are more likely
to be married or single, whereas females are far more likely to be widowed. This reflects the
established likelihood of husbands dying before their wives, partly because they have shorter
life expectancies and partly because they are usually older than their wives at marriage.3
? The figures for single older people are high for both males and females when compared to
figures for other European countries. By contrast, the number of divorced or separated
persons is very low.
? The proportion of single people in the older population is expected to decline in the near
future, reflecting the marital patterns of those who are currently in late middle age in Ireland.
? The size of the married older population is expected to increase significantly for both males
and females.
? Note that Table 2, below, does not project the number of divorced/separated older people.
The future size of this population is impossible to predict given that divorce legislation has
only recently been introduced in Ireland.2
Table 2. Marital status of older Irish people 1996 and projections for 2011
Marital status Males (%) Females (%) Overall (%)
1996 2011 1996 2011 1996 2011
Single 23.3 17.9 18.1 11.8 20.4 14.5
Married 59.6 67.1 32.8 39.6 44.2 51.8
Widowed 15.4 15.0 47.9 48.6 34.0 33.7
Divorced/separated 1.7 - 1.2 - 1.4 -
Sources: Central Statistics Office (1997) and Fahey (1995)
Geographical Location
? Roughly half of the older population (48.1%) live in rural areas according to the 1996
Census.3 This compares with 42% of the population aged less than 65 years, demonstrating
that rural areas generally have an older age profile than urban areas.
? The older rural population has a distinct demographic profile: 46.8% are male according to
the 1996 Census, compared to 39.2% of the older urban population.
? In addition older men in rural areas are far more likely to have never married than older men
in urban areas (29.0% in rural areas compared to 17.0% in urban areas).
? By contrast, urban females are more likely to be single than their rural counterparts (21.0% in
urban areas compared to 14.7% in rural areas).3
? Population projections indicate that the Eastern Regional Health Authority (ERHA) area will
see the greatest growth in its older population in coming years.
? The North Western and Western health board regions will continue to have the oldest age
profiles in the coming decades. This is because rural areas are likely to experience static or
falling numbers of people under 65 years in the years ahead (see Table 3).2,3
? In the 1996 census, Leitrim had the highest percentage of its population aged 65 and over at
15.7%, while South Dublin and Fingal had the lowest percentage of its population aged 65
and over (5.2% and 5.6%).
? At 10.2%, Leinster had the lowest proportion of the population aged 65 or over, while
Connacht had the highest percentage of its population aged 65 or over at 14.2%.
Table 3. Proportion of population aged 65 years or more by health board region 1996 and
projections for 2011
Region Percentage aged over 65 years Projected change in
older population,
1996-2011
1996 2011
North Western 13.9 16.9 +3,962
Western 14.0 16.6 +6218
Mid-Western 11.8 15.0 +8,750
Southern 12.1 14.5 +13,602
South Eastern 11.9 14.8 +11,782
Eastern Regional
Health Authority
9.7 12.5 +50,763
North Eastern 10.2 14.2 +8,810
Midland 12.2 15.2 +3,884
STATE 11.4 14.1 +107,771
Sources: Central Statistics Office (1997) and Fahey (1995)
Living Arrangements
? Less than 5% of the older population resided in long-stay care institutions in 1995. This is a
much lower proportion than is commonly believed.4,5,6
? In 1996, there were 106,943 older people living alone (25.9%).3 This is quite low as in other
European countries the proportion is closer to 40%.2
? Women are more likely than men to live alone in old age. In 1996 there were 70,885 (30.0%)
women aged 65 years or more living alone compared to 36,058 men (20.3%).3
? As people move through their old age they are increasingly likely to live alone, mainly
because of bereavement. The 1996 Census revealed that 29.7% of people aged 75 years or
more lived alone.3
? The overall number of older people living alone is expected to have risen to 137,812 (26.4%)
by 2011. Most of this rise will be in the older female population, where the number living
alone is expected to increase to 91,654 (31.5%). The number of older men living alone is
expected to increase to 46,158 (20%).2
European and Worldwide Comparisons
? In European terms Ireland has a relatively small population of older people.6 In 1996, 15.2%
of Ireland's population were aged 60 years or over. Italy and Greece are world leaders in
terms of having the greatest proportion of their population aged 60 or over: 22.3% of the
population of both countries in 1996. The figure for The Netherlands was 17.8%, while for
Belgium it was 21.5%.
? In 1996, 16.5% of the population of the US were aged 60 or over. The figures for the Russian
Federation was 16.7%, for China, 9.5% and for South Africa, 6.7%.7
Reference Material
1. Central Statistics Office, 2001. Irish Life Tables No. 13 (1995-97).
2. Fahey, T., 1995. Health Service Implications of Population Ageing in Ireland, 1991-
2011. Dublin: National Council for the Elderly.
3. Central Statistics Office, 1997. Census 96. Principal Demographic Results. Dublin:
Stationery Office.
4 Department of Health, 1997. Survey of Long-Stay Units, 1995. Dublin: Stationery Office.
5. Moran, R. and Walsh, D., 1992. The IrishPsychiatric Hospitalsand Units Census. 1991.
Dublin: Health Research Board.
6. Central Statistics Office, 1996. Labour Force Survey, 1995. Dublin: Stationery Office.
7. US Census Bureau, 1996. Global Ageing into the 21st century. USA: US Department of
Commerce.
Useful Contacts
Central Statistics Office, Ardee Road, Dublin 6. Telephone 01 497 7144; Skehard Road, Cork:
021 453 5000.
Website: www.cso.ie.
National Council on Ageing and Older People
22 Clanwilliam Square
Grand Canal Quay
Dublin 2
01 676 6484/5
01 676 5754
email : [email protected]
www.ncaop.ie
? National Council on Ageing and Older People, 2001
National Council on Ageing and Older People
INCOME
Ageing in IrelandFact File No. 3
In general, the income pattern of older people is radically different from that of younger
adults. The absolute income levels of older people are understandably lower than the
population in general because, for most people, retirement brings a significant reduction
in income, with older people becoming dependent on some form of pension for the bulk
of their income.
The income status of older Irish people has improved substantially in the last quarter of a
century, mainly because of increases in the level of social welfare pensions. Older people
are not a homogenous group, however, and a significant section of the older population is
at risk of poverty. On the other hand, some older people have lower financial
commitments than younger people as they have fewer dependants and will normally not
have to make mortgage repayments. All those aged 70 and over, and many over 65, are
also entitled to non-cash benefits such as free telephone rental that further reduce their
expenditure commitments. However, many older people may have extra costs due to
illness and lose economies of scale when, through the death of a spouse or companion,
they begin to live alone.
Income Levels
? A study published by the National Council on Ageing and Older People in 1999 found
that around 60% of all elderly households lived on ?100 per week, with 90% living on
less than ?200 per week.1
? Older people living alone are in a worse position compared to other types of
households with older people: almost 75% of single elderly households live on ?100
per week or less compared to 57% of couple households.
? Despite their low income levels, approximately 86,500 people aged 65 years or more
will still fall within the tax net in the tax year 2001-2002.2
? Little information on the income levels of older people in institutional settings is
available. It is clear, however, that charges imposed by both the public and private
sector institutions on residents who are dependent on social welfare pensions leave
them with very little disposable income.
Sources of Income
? The 1999 study found that among households containing only older people, by far the
largest part of household income is provided by pensions, either social welfare or
occupational pensions.1 Social welfare pensions make up 70% of the total income of
older people living alone and this rises to 90% when occupational pensions are
included. In households with more than one elderly person the proportion of income
derived from social welfare pensions falls to 84%, but is still the largest source.
? Among the elderly living alone, old age contributory pensions and widow's
contributory pensions each make up a quarter of total income, followed closely by
occupational pensions which form 20% and non-contributory old age pensions which
form 16%. The large proportion provided by the widow's pensions is indicative of the
make-up of the single elderly group, 70% of which is female. If we look at
households containing two or more elderly, old age contributory and non-contributory
pensions come to predominate, followed by private and public sector pensions which
together make up over 27% of the total income of these types of households.
? Although self-employment and farming income are received by a very small minority
of pensioners, they make up a sizeable proportion of single elderly households'
incomes. While only 3% of single elderly households receive income from farms,
39% of this group are reliant on this source of income. This compares to 11% of dual
elderly households receiving farm income with 8% of these households being reliant
on this income.
? Although income from interest and dividends is often taken to be a major component
of incomes amongst the elderly, on average interest on savings and dividends makes
up 2.5% of the total incomes of elderly people living alone and 5% of two or more
elderly living together.
Social Welfare Pensions
? There are two main categories of social welfare payments to older people in Ireland:
contributory and non-contributory.
? Contributory pensions are earned by contributing social insurance payments (PRSI)
whilst employed. Additional payments are made to the contributor for adult
dependants and children. Payments may also be made to orphaned children and to
surviving widows/widowers on the death of the original contributor. Some older
people have not accumulated enough social insurance contributions to qualify for the
full pension rate. Some may qualify for pro rata payments. To qualify for the
retirement pension you must be aged 65 and be retired from insurable employment.
? Non-contributory pensions do not require social welfare contributions but recipients
must satisfy a means test. The means test often results in partial payment of these
pensions.
? In the future the rates of the contributory and of non-contributory pension are to be
equal, thus eliminating the gap between the two payments. This will be achieved
through phased increases, bringing the rate of the old age (non-contributory) pension
in line with that of the old age (contributory) pension.
? Over the last ten years, the number of recipients of retirement contributory pensions
increased by 30,393. During this time, the number of recipients of old age (noncontributory)
pensions fell by 25,200. Pre-retirement allowance was introduced in
March 1990 and the number of recipients has increased by 7,045 since then.3
Non-Cash Benefits
Free schemes or non-cash benefits are available to older people and include free travel at
certain times, the medical card, allowances for free electricity/natural gas, TV licence and
telephone rental. Free schemes should not be seen as purely income supports. While they
contribute to the costs of what can be viewed as necessities in today's society, they have
a significance above and beyond that of being purely an income support mechanism. Free
schemes help to lessen the likelihood of economic social exclusion among older people.
? From May 2001, all people aged 70 or over became entitled to allowances for
electricity/natural gas, telephone rental and for a free TV licence.4 People aged 65-70
may also be eligible for these benefits depending on their means and the number and
type of person with whom they are resident.
? From July 2001 all those aged over 70 years have been entitled to the medical card.
Roughly three quarters of all older people qualify for the medical card by passing a
health board test which assesses means and needs. The number of older people judged
to be eligible for the medical card in 1999 was 312,687.5
? Recent studies of older people in the community found that in the region of 30% of
the people over 65 lacked a medical card, which gives free access to medical
services.6 Those without a medical card have been found to have a lower number of
visits to the GP. A disturbingly high 11% of the elderly have neither a medical card
nor private medical insurance. This has obvious negative implications for illness
prevention and health promotion, given that older people have been found to use
medical services more than the population in general.
? Under the new Drug Refund Scheme and Drug Cost Subsidisation Scheme, an
individual or family will only have to pay ?42 per calendar month for all approved
prescribed drugs, medicines and appliances for use by that person or his/her family in
that month.7
? All people are entitled at age 66 to a free travel pass for use on public transport.
Research carried out in 1994 indicated that 44% of a sample of over 65s had no
access to the use of a car in rural areas, 48% had no access to public transport and
22% had access to neither a care or public transport.9
? The reasons why those entitled to a free travel pass may not or, in certain cases,
cannot ever use the facility include: distance from pick-up points; impaired mobility
and inconvenience of service availability; lack of appropriate public transport
vehicles/inaccessible vehicles, and a complete absence of services between the origin
and destination.9
Poverty
? Poverty can be measured in both income terms and in relation to a person's access to
items or activities considered to be necessities. Being without particular necessities is
an indicator of deprivation. Deprivation is estimated on three levels. The first level,
basic deprivation, may be defined as an enforced lack of food and clothing; the
second level concerns housing quality and durables, while the third level on which
deprivation is measured is secondary deprivation. Secondary deprivation takes
account of lifestyle items and consumption indicators.
? The Council's 1999 study on income and deprivation among older Irish people found
that 10% of older people are income poor and experience basic deprivation. It also
found that older people were also more likely to experience housing deprivation than
the general population.1
? Income poverty is estimated by measuring the number of people in a population that
fall below certain poverty lines. A poverty line is a percentage of the average income
in a population. Older people were found to be more at risk of poverty than any other
household type at the 50% and 60% poverty line. Over a quarter of elderly
households fall under the 50% poverty line, while over half of elderly households fall
under the 60% poverty line.
? Older people have a high reliance on social welfare pensions and are greatly affected
by its adequacy or otherwise. Those on non-contributory pensions and widow's
pensions are at a greatly increased risk of poverty. Those reliant on the old age noncontributory
pension are at twice the risk of poverty.
? Income poverty among older people is related to gender to a substantial degree, with many older
women over-represented among the poor. This is due to Irish women's high degree of dependency on
the non-contributory pension or the widow's pension. Elderly women living alone in rural areas have
an increased risk of poverty at the 50% line.1
Table 1. Poverty rate by reliance on sources of income for elderly households
50% income
line
60% income
line
Combined
deprivation
and income
line
50%
adjusted
income line
60%
adjusted
income line
Percentage poor
Old age
contributory
pension
16.1 68.6 6.5 4.4 56.2
Old age noncontributory
pension
59.8 95.7 22.8 18.5 95.7
Widow's
contributory
pension
69.9 88.1 11.9 14.3 86.7
Occupational
pension
14.3 34.1 4.9 12.2 34.1
Note: The widow's non-contributory pension has been excluded because the numbers are
rather small.
(Source: Layte et al, 1999)
Healthy Ageing and Income
? The correlation between lower socio-economic status and poor health is well
documented and is vital to our understanding of the well-being of older people.8
? Basic or secondary deprivation has proved to be a strong predicator of physical ill
health among older people. The results on deprivation probably reflect the effect of a
long-term lack of resources, rather than a short-term effect.1
? Being poor or deprived was also found to increase the likelihood of experiencing
psychological distress. As poverty, deprivation and having a chronic illness often go
hand in hand, these three factors together strongly increase the risk of psychological
distress.1
Lower income in old age can cause deprivation in housing quality, clothing and nutrition.
It may also contribute to social isolation and reduce physical activity.1 Investigation of
the link between income poverty and social participation showed that if resources allow,
older people will replace contact with neighbours with contacts with friends and family,
when age permits.
Reference Material
1. Layte, R., Fahey, T., and Whelan, C.1999. Income, Deprivation and Well-Being
Among Older Irish People. Dublin: National Council on Ageing and Older People.
2. Revenue Commissioners, 2000. Unpublished data.
3. Department of Social, Community and Family Affairs, 2000. Dublin: Stationery
Office.
4. Department of Social, Community and Family Affairs, 2000. Fact sheet: Budget
2001.
5. General Medical Services (Payments) Board, 2000. Financial and Statistical Analysis
of Claims and Payments 1999.
6. Garavan, R., Winder, R. and McGee, M.H., 2001. Health and Social Services for
Older People (HeSSOP). Consulting Older People on Health and Social Services: A
Survey of Services Use, Experiences and Needs. National Council on Ageing and
Older People.
? Eastern Regional Health Authority, 2000. Drugs Payment Scheme.
? Fahey, T. and Murray, P., 1994. Health and Autonomy Among the Over-65s in
Ireland. Dublin: National Council for the Elderly.
? Farrell Grant Sparks, 2000. Rural Transport. A National Study from a Community
Perspective. Dublin: Area Development Management
Useful Contacts
Retirement Planning Council of Ireland, 27-29 Lower Pembroke Street, Dublin 2.
Telephone (01) 661 3139, fax (01) 661 1368.
Comhairle, 7th floor, Hume House, Ballsbridge, Dublin 4. Telephone 01 605 9000, fax
01 605 9099.
National Council on Ageing and Older People
22 Clanwilliam Square
Grand Canal Quay
Dublin 2
01 676 6484/5
01 676 5754
email : [email protected]
www.ncaop.ie
? National Council on Ageing and Older People, 2001
National Council On Ageing And Older People
COMMUNITY CARE SERVICES
Ageing in IrelandFact File No. 6
The health strategy document Shaping a Healthier Future1 outlines a clear commitment
to maintaining at least 90% of persons aged 75 years or more in their own homes. To
achieve this, a comprehensive system of home and community care supports is essential.
The key community care support services for older people and their carers as identified
in The Years Ahead report2 (the main Irish policy document on services for older people,
published in 1988) are domiciIiary nursing, home helps, day care centres and meals
services with occupational therapy, physiotherapy, chiropody, speech therapy and social
work services additional as appropriate. There is evidence, however, that access to these
services is limited and variable within and among regional health boards3. In addition, the
projected increases in the older population will have obvious and serious implications for
the provision of community health and social services.
The following information is derived from a review4 of the implementations of the
recommendations of The Years Ahead report carried out by the Council in 1997, unless
otherwise stated.
Nursing Services
? Alongside a good medical service, The Years Ahead report identified a
comprehensive nursing service as being vital to caring for older people at home.
Community nurses perform a number of vital functions, including health screening,
anticipatory care, liaison with other community care professionals, health education,
management and administration of medical appliances and aids, and home nursing.
? In 1995 there were 1,410 full-time public health nurses in Ireland, roughly one for
every 2,500 persons of all ages (Table 1).
Table 1. Number of Public Health Nurse posts in 1995
Health
board
1987 WHOLE TIME
EQUIVALENT
(WTE) 1995
WTE 1995
Excluding
Superintendent
PHN
WTE 1995
Excluding
Superintendent
PHN and Senior
PHN
Population
N Ratio N Ratio N Ratio
EHB 365 434.73 1:2976 425.73 1: 3039 404.73 1: 3197 1,293,964
MHB 78 105.47 1: 1946 103.47 1: 1984 101.47 1: 2023 205,252
MWHB 103 125.42 1: 2527 123.42 1: 2567 109.42 1: 2896 316,875
NEHB 105 129.73 1: 2356 126.73 1: 2412 117.73 1: 2597 305,703
NWHB 97 106.33 1: 1976 104.33 1: 2014 101.33 1: 2074 210,112
SHB 129 180 1: 3034 176.00 1: 3103 161.03 1: 3391 546,209
SEHB 130 157.49 1: 2482 154.49 1: 2531 146.49 1: 2669 391,046
WHB 147 171.21 1: 2055 168.21 1: 2092 159.21 1: 2210 351,874
Total 1154 1410.38 1382.38 1301.41 3,621,035
Ratio 1:3065 1: 2567 1: 2619 1: 2782
Source: Department of Health, 1995 Census of Public Health Nurses
? The number of posts increased by more than 250 between 1987 and 1995. The current
ratio is superior to the target of 1:2,616 mentioned in The Years Ahead report.
? Nurse to older person ratios vary significantly across the health board regions. The
best ratio occurs in the Midland Health Board region (1:1,946) and the worst occurs
in the Southern region (1:3,034). Feedback from public health nurses reveals
widespread dissatisfaction with the current number of posts.
? As well as public health nurses, all health boards have established panels of general
nurses who provide nursing care to older people at home on a part-time basis. These
nurses are seen as providing particularly beneficial services to chronically or
terminally ill older people living at home. They also allow the public health nurses to
concentrate on other duties.
? Excluding superintendent and senior public health nurses who carry managerial roles,
it has been found that four health boards are below the recommended ratio level of
public health nurses to patients.4
? There is still a need for more nurses to carry out liaison responsibilities and a need for
more nurses dedicated to the care of older people.4
? A study of older people's use of and need for community health services (the
HeSSOP study, 2001) found that the public health nursing service was the most
frequently used of the home-based services.5 The study found that 15% of older
people reported using the public health nurse service and many of this group (14%)
wanted to use more of this service.
? While less than 1% of the sample of older people reported using the personal care
attendant service, 17% of these people would also have liked to use this service more
frequently.
? Just 3% and 2% of older people respectively reported that while they did not use the
public health nursing service and personal care attendant service, they would have
liked to.5
? Despite many of the people in the 2001 study having difficulty with the tasks of daily
living, approximately one-third had no informal help whatsoever. The most common
reason given as to why people did not avail of the public health nurse service was
lack of information.
Home Help Services
? Home helps provide a range of services to older people. These may be divided into
personal care (eg bathing), home care (eg cleaning), tasks outside the home (eg
shopping), companionship and monitoring.
? The most important factors in determining the need for a home help are: the degree of
dependence; level of mobility; living conditions; availability of an informal carer, and
degree of isolation.
? In 1998, there were approximately 12,000 (mostly part-time) home helps and 20,000
recipients of the service.7
? In is often assumed in assessing a person's need for home help services that they
should neither substitute nor supplement existing informal arrangements where care is
already provided by relatives or neighbours. The 2000 community study found that
requests for home help services appear to be turned down if there seems to be
someone else fulfilling the role of a 'home help'.5
? In the same study, of the 5% of older people who used home help services, 14% of
this group reported that they would like to use this service again. A further 3% of
older people who did not receive the home help service would have liked to.
? The Joint Committee on Women's Rights (1996) estimated that, based on current
patterns, population growth and care provision, around 100,000 older people will
require home care by the year 2011, an increase of 30%.
? The Review of the Implementation of the Recommendations of the Years Ahead study
revealed widespread concern about the level of provision of the service.4
? The 1994 study found there were six models governing the delivery of the home help
service across the country. Table 2 below outlines these models and indicates the
particular models used by each health board.
Table 2. Models of delivery of home help service
Model of delivery Health board
1 Overall responsibility with Superintendent PHN North Eastern and some areas of
South Eastern and Southern
2 Overall responsibility with Superintendent PHN and
Superintendent Community Welfare Officer
Areas of Eastern and South
Eastern
3 Home Help Organiser employed by health board Western and Midland and areas
of Mid-Western, North Western,
Southern and South Eastern
4 Overall responsibility with Superintendent PHN but with
input from Home Help Organiser
Parts of North Western
5 Voluntary organisations have responsibility Most of Eastern and areas of Mid-
Western
6 Overall responsibility with Superintendent PHN but
Home Help employed by voluntary organisation
Areas of North Western and part
of Southern
Source: Lundstr?nd McKeown (1994)
? The home help service is usually delivered directly by the health board, but in the
Eastern health board and in some areas of the Mid-Western and North Western health
boards there is a large voluntary input.
? A 1994 report showed that the commonest complaint among home help clients in the
study was that they required longer hours of care.6
Day Centres
? It is estimated that under the National Development Plan, between 1998 and 2000
over 1,000 day-places per week will have been provided in ten new day care centres
(twenty places per centre multiplied by five days per week).
? The HeSSOP study of older people in the community included day time services in its
survey of health and service use by older people. Day hospitals and day care units
were viewed as the more 'medical' services, while day centres and day clubs were
seen as places with a 'social' emphasis. Some 15% of older people reported using the
more medical daytime services while 2% of people had attended the more socially
orientated services.5
? The study found that 4% of the older people who did not use day centres or clubs
would have liked to have availed of these services. Barriers to service use identified
by older people included being unaware of the service or lack of adequate
transportation.5
? The main purposes of day centres are: to provide a service such as a midday meal, a
bath and a variety of paramedical services; to promote social contact and prevent
loneliness; to relieve caring relatives, particularly those who have to go to work, and
to provide social stimulation in a safe environment for older people with mild forms
of dementia.
? The number of day care places for older people is difficult to estimate, as many are
provided by the voluntary sector. The 1997 review of implementations of
recommendations of The Years Ahead report found that at least 4,000 places were
provided nationally (Table 3).
Table 3. Provision of day care places for older people 1996
Health board Places provided Centres provided
Eastern 200 board places Approx. 1,600 voluntary
places in 68 centres
Midland 248 (approx.) 17
Mid-Western 280 (approx.) 14
North Eastern 315-420 (approx.) 21
North Western 410 13
Southern 250 (approx.) 17
South Eastern 10-25 in each centre 43
Western 153 (approx.) 12
Source: Interviews with Programme Managers of Community Care and CSEs
? The current number of day care places is widely accepted as being inadequate and
most health boards have plans to extend this sector. The level of provision is also
uneven across the country with the western and southern regions having particularly
low numbers of places.
Meals Services
? In the HeSSOP study only 1% of older people reported using meals-on-wheels.
Around 17% of those who did use meals-on-wheels would have liked to have
received more of the service, while a further 1% of people who did not use the service
would have liked to. Lack of information regarding the service and stigma prevented
people from availing of this service. Factors that appeared to be associated with a
need for meals-on-wheels were depression and lack of family help rather than
immobility.5
? Almost all meals services to older people are provided by voluntary organisations.
Despite the perception, meals services are not simply a form of economic support for
poorer older people. Older people have a higher risk of malnutrition than younger
people and meals services have an important role to play in maintaining nutritional
health.
? The most commonly reported nutritional deficiencies in older people are of iron,
protein, vitamin C, folic acid, calcium, vitamin D, zinc, water and fibre. Poor
nutrition in old age can negatively influence the health, longevity and quality of life
of older people.
? Commonly cited major risk factors for malnutrition in older people are social
isolation, recent bereavement, poor dentition, reduced mobility, psychiatric morbidity
and multiple medication usage.
Other Services
? A number of other professions are also involved in the care of older people living in
the community. In general, these services are provided in community health centres
or hospitals, despite evidence that many older people require these services at home.
? In the HeSSOP study, 3% of older people in the community had used physiotherapy
during the past year. Despite the low level of usage, there was a high satisfaction rate
with the service (97%). Eight per cent of people who used the service would have
liked to have received more physiotherapy while 5% of older people who had not
received physiotherapy in the past year would have liked to have received this
service.
? Chiropody was one of the health and social services used most by older people in the
community (16% of respondents). On average, older people who availed of this
service used it about three times a year and seemed to be quite satisfied with the
service (96%). However, the provision of this service is not keeping pace with
demand. Some 14% of the respondents already using this service would have liked to
have received more of this therapy while 12% of older people who did not use this
service would have liked to.
? Occupational therapists are involved in the care of older people by advising on how
they might adapt their homes to cope with increasing disability. Where necessary,
occupational therapists are also involved in the allocation of medical appliances and
aids.
? In the HeSSOP survey of older people in the community, less than 1% of older people
used occupational therapy. While only one person out of a total number of seven who
had used the service during the year would have liked to have used more of the
service, 1% or 12 people who had not previously used the service reported that they
would have liked to.
? Lack of information was reported as the biggest barrier in older people's use of these
therapeutic services. Nine per cent of older people in the community survey reported
that they did not know a service was available while a further 2% had never heard of
the service in question, and 14% rated obtaining information as difficult or very
difficult. GPs were preferred by the majority of the respondents (79%) as informants.
A large portion of older people felt that better health information was important for
improving their health.5
According to a 2001 report,8 prepared for the Department of Health and Children, an
additional 1,300 chartered physiotherapists and 875 occupational therapists will be
needed if adequate services are to be provided in the years ahead. To help alleviate the
expected shortages of therapists, the report recommends that a fundamental review of the
training system should be undertaken; that appropriate two-year courses should be made
available to enable assistant therapy grades to be expanded significantly; that the
Department of Health and Children should review the career structures within the three
professions, and that, in the short term, a concerted drive should be undertaken to recruit
from overseas.
