According to the 2006 Census, more than 160,000 Irish people are carers looking after parents, siblings or chronically ill spouses. Those being cared for may be elderly, chronically ill or have an intellectual or physical disability.

 Not only is it a lonely life, it can also be an arduous one, both physically and mentally. Bernadette Brady, who spent years caring for her elderly mother, a dementia sufferer, wrote in the Irish Times last December: “I was working 365 days of the year, 24 hours a day in total isolation as a sole carer. I was on my knees with exhaustion.”

Lives curtailed
Tiredness is just one cross carers have to bear. A November 2008 report by the Care Alliance found that carers were more likely than the general population to report poor health and lower quality of life, and more likely to suffer from back pain (from lifting a disabled or frail person), depression and anxiety. They have little or no time for socialising or leisure activities, are constantly on call and are often sleep-deprived. They are often overwhelmed and their work goes unacknowledged.

The Carers Association estimates that three million hours of care are provided each week in Ireland by family carers, at a value to the State of more than €2.5 billion a year – a figure that is not included in Ireland’s gross domestic product (GDP). Even this simple fact is a slight, say carers, who feel it’s just another way their contribution is unrecognised.

Punishing cutbacks
To heap insult upon injury, carers have been ever more poorly treated in recent years. The Government had plans to publish a national carer’s strategy, as promised under social partnership and the Programme for Government. This plan was abandoned in March 2009 in what the-then minister for social and family affairs, Mary Hanafin, described as a “difficult decision”. An outrageous decision would be more like it.

Then, in December, both carers’ allowance and carers’ benefits were cut in the budget by €8.50 a week. That might not seem like much but, for someone struggling to get by on little more than €200 a week, it was a significant cut. Still, carers had to count themselves lucky. Before the budget, the Government was also considering taking away the half-rate carers’ allowance, which is paid to those in receipt of another social welfare payment, such as a pension. That payment survived the cuts but it’s questionable if it will make it through another slash-and-burn budget.

Any cut to payments for carers is not only disgraceful but short-sighted. The cost to the Exchequer of these payments is far less than it would be to pay for full-time institutional care for the sick and disabled people concerned. If carers are not adequately supported by the State, they may not be able to continue caring full-time.

It seems entirely obvious that they should be given as much help as they need but the myopic authorities don’t always see it that way.

Need for leadership
In some cases, it’s not necessarily more money that is required but for someone “on high” to take responsibility of support for carers and put in place a standardised, over-arching system, rather than the uneven patchwork of help options currently available.

A home care package scheme, that can include anything from home help to physiotherapy to cash payments, is in operation. However, as Caring for Carers pointed out in February, this scheme is not available nationwide. It is implemented on an ad-hoc basis and there are no national guidelines for the operation of the scheme or admission to it.

Furthermore, although annual respite care grants of €1,700 are available to carers, the respite system is somewhat piecemeal, with care provided by the HSE in some areas and by voluntary organisations in others.

In any case, carers need more than a week or two’s respite a year. They need regular respite services, including some night-time respite care, so that they can, even once every so often, get a full night’s sleep.

Let’s care for carers
While improved State support for carers may be a long time coming, there is plenty that the rest of us can do for carers. They need practical and emotional support from family and friends; an hour off every now and then or a quick chat on the phone could make the world of difference to someone.

As our population ages, it’s inevitable that more and more people will become family carers, so it’s ever more imperative that their valuable role in society is recognised and rewarded.

Carers’ Week (www.carersweek.ie) runs from June 14th to 20th and comprises dozens of events for carers, including social outings

Useful websites
Age Action Ireland: www.ageaction.ie
Carers Association: www.carersireland.com
Caring for Carers: www.caringforcarers.ie
Care Alliance (an umbrella organisation for family carers’ groups): www.carealliance.ie
Carers.ie caters specifically for end-of-life carers

Working it out
It’s time for employers to wake up and smell the arthritis cream. Actually, that’s a sad little joke based on the bizarre attitudes Irish companies have to older workers. Organisations need to realise that growing older does not mean you, or your body and mind, stop working. The employer’s office will not be filled with glasses containing dentures or littered with walking sticks. In fact, an office with older workers might just be more profitable.

Our workforce is getting older and we all need to start doing the maths. As you may have read, the Irish Government recently announced plans to raise the retirement age. As part of the new National Pensions Framework, the age we retire is set to rise to 66 in 2014 and to 68 by 2028. It’s a necessary move because of our pensions deficit and possibly because we are living longer, healthier lives.

By 2025, it is predicted that 36 per cent of Ireland’s population will be over the age of 50. As time goes by, clearly, there will be proportionally fewer young people and more experienced older people available to work.

Companies in denial

However, Irish companies seem almost determined not to think about the greying of their workers. In 2008, the Manpower Ireland Older Worker Survey found that, despite almost 70 per cent of the average workforce currently being aged between 30 and 45, 72 per cent of employers failed to recognise that the average age of their employees will inevitably increase in coming years.

A year earlier, the same survey found just 9 per cent of Irish employers had strategies to recruit older workers and barely a quarter had put in place plans to retain older staff members after retirement age.

 It’s time for the corporate world to wise up and begin to harness the power of the silver worker.

Silver workers

There are obvious benefits to employing older workers and to encouraging them to stay in the workforce past 60 or 65. In 2006, Entrepreneur magazine found older workers were more likely to be committed, detail-oriented, punctual, honest, efficient and confident, among other positive traits.      

In June 2009, a study by the Sloan Center on Aging and Work at Boston College found older workers were far more likely to be resilient and cope better than their younger colleagues during times of economic downturn.

Time for a rethink

Given the value older people can bring to the workplace, the Irish corporate world certainly needs to move away from forced retirement, which remains prevalent and effectively dismisses workers on simple age grounds, although they have a wealth of experience and may still retain ample energy and enthusiasm for their jobs.

 Our managerial culture needs to overcome age stereotyping. Bosses have to avoid making silly age-based assumptions about workers. Just because someone is over 55 or 60 doesn’t mean they are going to be a fuddy-duddy or a stick-in-the-mud. Old dogs can learn new tricks in the workplace. It’s also important to recognise the different perspective and insights older people can bring to the workplace.

 With a little imagination, employers can devise ways to motivate and encourage older employees by giving them new challenges, and providing training and education – people of all ages gain job satisfaction through being given responsibilities and having a sense of accomplishment.

 A separate study by the Sloan Center on Aging and Work found that people over 50 are more likely to stay in employment if they can control their hours, keep some autonomy and learn new skills.

Looking ahead

Companies and organisations also need to make practical adjustments to facilitate what is known in the US as the ‘silver tsunami’, or the increase in older employees. Sometimes it’s as simple as providing larger computer screens to those with poor eyesight. More generally, however, employers need to provide more flexible working arrangements and modify job specifications to suit workers in their 60s.

 Instead of pushing someone out the door at 60 or 65, it makes sense to implement phased retirement or other compromise solutions, such as shorter working weeks, switching to occasional consulting work, telecommuting, decreasing the number of shifts spent working antisocial hours and moving older people to less physically taxing work, if relevant.

Smart thinking

A recent article in The Economist gave an example of how a blue-chip company sought to accommodate older employees. BMW conducted an experiment in which it staffed a production line entirely with older workers. At first “the pensioners’ line” was less productive. However, the firm brought it up to the level of the rest of the factory by introducing 70 relatively small changes, such as new chairs, comfier shoes, magnifying lenses and adjustable tables, according to The Economist.
 

Irish workers are getting older. The silver tsunami is an unstoppable tide. The  companies and organisations that recognise this, and allow for it now, will enjoy a successful longevity.

For more information on this subject read the article Challenging the silver ceiling [insert link here]

Useful links
National Pensions Framework: www.pensionsgreenpaper.ie/downloads/NationalPensionsFramework.pdf
Manpower Mature Worker Survey: www.manpower.ie/company_information/press_office/main_press_release_mature_worker_survey_2008.asp
Entrepreneur magazine survey: www.entrepreneur.com/humanresources/hiring/article167500.html
Sloan Center on Aging and Work at Boston College: www.bc.edu/research/agingandwork
‘The silver tsunami’, The Economist: www.economist.com/business-finance/displaystory.cfm?story_id=15450864

So, what do you do? Complain to family and friends? Tell everyone how much better things used to be back in the day? There is another option. You could actually do something about it.* (Yes, even in apathetic Ireland.)

Grannies on the rampage
You could, for example, follow the example of the Raging Grannies, a loose but flamboyant collective of older American women who campaign for peace, justice, and social and economic equality.

Sporting large, vividly-coloured hats and using street theatre to get their message across, the Raging Grannies protest on all sorts of hot-button issues, including banking reform, immigrant rights and the environment. As their website says, they deliberately set out “to shock with their unladylike antics” and they seem to have a marvellous time doing it.

The Grannies are part of a wider global movement that sees older people becoming actively involved in campaigns for social, political and environmental change. In 2008, we saw a powerful example of the energy and determination of older activists, when thousands took to Irish streets to protest against cuts to the medical card scheme. Ultimately, the government rowed back.

Elder activism
Elder activism, as it is called in America, has a long and proud history. In 1970, a lifelong activist named Maggie Kuhn was outraged at being forced to resign at the age of 65. In response, she founded an organisation to campaign for social and economic change. Initially known as the Consultation of Older and Younger Adults for Social Change, it quickly became known as the Gray Panthers, because of the older profile of its members.

Since then, the Gray Panthers has been an influential activist group, particularly focused on health care reform, but has also campaigned on issues such as ageism, arms dealing, education, the environment, housing, public welfare and workers’ rights.

More recently, Grandmothers Against The War (GAW) has had a high media profile. With their catchcry of “Take us instead!”, GAW members have protested vigorously against the Iraq war, asking the US administration to send their grandchildren home and to dispatch them to the front line instead.

A leading older activist is our own much-respected former President, 65-year-old Mary Robinson. Among the many organisations in which she is involved is an independent group called The Elders, made of up of senior world leaders. The 10 members also include Kofi Annan and Desmond Tutu, while Nelson Mandela and Aung San Suu Kyi are Honorary Elders. They work both publicly and behind the scenes to help end conflicts and alleviate human suffering.

Get involved
But you don’t have to be a distinguished world leader or have such lofty goals to be an activist. You can become involved in a local community group or small activist organisation. You can write letters, hand out flyers or help to organise information meetings. All you need to be an activist is time, energy and some firmly-held beliefs.

There are many Irish groups, from human rights campaigners to eco-warriors to animal rights crusaders, who are always appealing for volunteers and would be delighted to have some experienced individuals help with their cause. If you’re not sure where to start, have a look at the Volunteering Ireland website (www.volunteeringireland.ie), which lists plenty of opportunities to help with campaigns.

Not only is activism good for the world, it’s also good for you. It provides a social outlet and is a way to meet like-minded people. It can also to lead to an improved sense of self-worth from the quiet gratification born of helping someone people and the sense of deep satisfaction that comes from contributing towards positive change.

So do yourself a favour. Get active and help make the world a better place. Stll not convinced? Then think about all the ripples that might be created when you drop this one activist pebble into the world’s great big pond.

*Article inspired by Martin Luther King Day in the United States, January 18thUseful links

www.raginggrannies.com            Raging Grannies
www.graypanthers.org                 Gray Panthers
www.gawba.org                              Grandmothers Against the War (GAW)www.theelders.org                        The Elders
http://iscp.wordpress.com         Irish Senior Citizen’s Parliament
www.volunteeringireland.ie     Volunteering Ireland

Have your holidays left you wondering if all is as it seems? The season is a time for long-distance travel, bittersweet reunions, long chats and lots of observation. In the year or so since you’ve been separated from family and friends, you might have noticed the things that changed: your brother’s thinning hair, your niece’s new baby, your wrinkles and everyone’s increasing age.

If you’re like me, you might also have wondered if you’ll ever see some of them again. Was this holiday the last time you’ll hug and talk to your ageing parents or dear friend?

Realising their fragility, and perhaps your own, marks the start of an awareness of our own mortality and it’s not pretty – some of us go quickly, while others just fade away.

About 12 years ago, I visited my father in New York during the winter holidays and knew something was different about him. As we were leaving the local train station for the return flight home, I became very upset. My husband and I were both puzzled. It had been a good visit but it was harder than normal for me to leave. “Dad’s not well,” I said. “I just feel it. Something’s not right.”

Many of us have had this strange experience. The Dad I had known was a lively, generous man who was fond of jokes, stories and entertaining. He was always the centre of attention and when he threw a party everything was the best, the biggest, the brightest.

Enter the shadow
I didn’t put my finger on it that day but somehow he had faded a little. On the holiday, we’d sat at the big table discussing our plans for the coming year and I looked at him. He was a quiet shadow figure; a bit blurred around the edges. He seemed to be slowly, almost imperceptibly, fading away.

It made no logical sense. Aged 60, he was still working in a big Wall Street firm and loving life as a government bond trader and senior manager. But the change that I sensed in him wasn’t just the slowing down that we all experience with age. He was quieter and far more uncertain of his steps and memories.

I questioned him but was told everything was fine and to stop worrying. Within months, he was diagnosed with diabetes and then he told us that he had not been able to feel his legs for a couple of years. Typical Irish man! He had suffered in silence rather than admit to some health ‘weakness’.

He packed in his beloved job and began visiting specialists for his legs, eyes, diabetes and memory loss. Any time the memory issue was pointed out, he became angry and said there was nothing wrong with him. There was no way he would go to a neurologist – they were head shrinkers!

Time passed and a retirement that should have equalled golf and days of leisure became a dark and anxious time. Visits to the golf course lengthened as he struggled to find his way home from a course he had used for more than 20 years. Some days, in his confusion, he pulled to the side of the road to calm his anxiety and pounding heart. Where was he? Where had he come from? What on earth was he doing?

Since he refuses to see a neurologist, there has been no diagnosis bar some kind of diabetes-related dementia or possibly Alzheimer’s. My stepmother has gone through the five stages of grief: denial, anger, bargaining, depression and finally acceptance. It’s exhausting for her and sad for all of us to be so far away.

Learning to cope
How do we cope with our parents’ frailty and the abyss of personal mortality? Everyone is different but I think laughter soothes the soul. Life isn’t fair but it’s the way we cope with it that helps us survive and thrive. Carers need to laugh when they can or they will quite literally cry themselves sick.

A friend recently told me a story about Alzheimer’s care and it might make you smile.

A neighbour had lived in the American mid-west when he was growing up, the youngest of three boys. Their grandmother lived with them and she was diagnosed with Alzheimer’s while they were in their teens.

To the delight of their parents, Tom’s oldest brother offered to take grandma out for a drive each Friday afternoon when they got back from school. The outing provided Tom’s parent’s with some needed down time from the tireless care and monitoring that their grandmother required. Each Friday, the parents would watch from the window as the oldest boy would walk their grandmother to their station wagon. He opened the door for her, sat her down in the front passenger seat and strapped her seatbelt. His younger brothers took their seats in the back.

It was a lovely family scene.

On these trips, the teenagers would drive their grandmother to the local Beer Barn, a drive-thru grocery establishment. The station wagon would pull up to the window and the 19-year-old brother would tell the clerk: “She’ll have a case of Coors Light” and nod to his smiling grandmother. The drinking age was 21. The clerk would look at her through the driver’s window and conclude that she was clearly of age. He would order a worker to load a case of Coors Light into the back of the station wagon and would take the money from the oldest brother.

Tom said they would bury the beer in the snow next to their basement door when they got home. Grandma always seemed to enjoy the ride and she never recalled enough detail about where they went to expose the caper.

You have to smile. Dementia is not funny – and Dad certainly isn’t getting any better – but laughter certainly brings us all together in a positive, life-affirming way.

The “Fair Deal” for nursing homes is a welcome development but, asks Margaret E. Ward, is removing people from their home and community really the best solution?

As we get older, we all worry about becoming a burden on our families. We ask ourselves:  “What happens if I get sick and can’t work – or if I die unexpectedly – who will look after my family, partner, pet, dependent relative?” It’s such a concern for Western societies that several very lucrative industries: insurance, nursing homes and care support services have developed to diminish our anxieties.

Cultural compassion
Many cultures never have to ask themselves these questions because they know the answer: their family, community and friends will look after them and their dependents if things go wrong. To them, it’s the natural progression of community life and responsibilities.

In Ireland, communities are in disarray. Our society’s financial pressures mean families are working harder then ever and often both man and woman, adult children and grandparents work full time. This leaves very few people in the community to look after those who can no longer help themselves. If we’re lucky and have the funds we can pay for someone to mind us in our homes. It’s not ideal, but it’s all we have at the moment.

What if we imagined something new that is good for everyone? Research into long life and happiness has revealed a few interesting truths: regular exercise, mental stimulation and small meals that are high in fruit and vegetable are all beneficial. One of the newer findings involves community. People who feel they belong to a community or group do better than those who are isolated from others. It’s important for all of us to have a purpose or a sense of place.

Living longer, healthier lives

The beautiful island of Sardinia, between the coast of Italy and Africa, has among the highest population of people over 100 in the world. One man in the island’s Ogliastra villages lived to 112 and, until his death, was the oldest man in the world. He was not alone. Researchers found a rate of 90 centenarians out of a population of 18,000. So, one in every 200 people in the region has lived to celebrate 100. In the United States, the comparable figure is about 50 lower with only one person out of every 10,000 alive at 100.

A traditional Sardinia greeting, akentannos means may you live to 100 years. Luigi Ferrucci of the US National Institute on Aging and chief researcher of the Sardinian study said: “These are people who not only have a very long life, but they are healthy up to a very old age. These are not people who’ve gotten diseased or dementia at 70 years old and somehow lived another 30 years.”

Scientists have been studying places like this Italian island, parts of Japan and California to see what makes them live such long, healthy lives. Diet certainly contributes a part but community seems to be a big part of it, too.

These sprightly older people are part of families, groups of friends, community events and more. Often they do physical work from an early age until well beyond retirement age – sometimes working into their 70s and 80s. Irish research has also clearly indicated that individuals who remain in employment past the retirement age of 65 are healthier and happier. Those who live longest are engaged in their communities and as such, they stay physically and mentally active.
Surely the research shows that we have it wrong? Nursing homes are not the best answer. Community care of incapacitated older people is more natural and humane than the institutionalisation of nursing homes and hospitals.

Yes, we can argue the resources are not there but if, as a society, we made this a priority then government policies and higher employment in the care sector would have to happen. We need more funding to help people stay at home and in the community.

Useful links
Sardinian centegenarians: http://www.benhills.com/books/IslandOfTheAncients/index.html

Advice on living beyond 100
http://ezinearticles.com/?Exploring-Longevity-Among-Centenarians&id=2565275

http://www.bluezones.com/move/144-how-to-move-like-a-centenarian

Writing today’s column hurts. I don’t want to admit what’s happened to me. It seems so silly because this occurs to most of us eventually.

Ok, here it is (deep breath): I found my first grey hair recently. Big deal, right? Most people I tell say things like: “My cousin went grey at 18” or “I’ve been dying over my grey hair for the last ten years.

Oh, there had been some foreshadowing; I can’t deny that. Over the summer, my tactful hairdresser Jean said: “At some stage in the next few years we’ll need to think about covering over grey.”

I completely dismissed the comment “No, my mom’s hair was dark and she did not go grey until she was in her fifties.” No doubt Jean – who is my exact age – had seen the grey hair among the blonde highlights but didn’t want to say anything. She let me find it myself a few days later. This is a bit like finding out you were wearing baby vomit on your suit after you had a meeting with your boss asking for a raise. The horror.

Now, in these recessionary times you’re probably saying what’s the big deal about one (ok, now maybe it’s two) grey hairs. I will save money on highlights, right? And aren’t I lucky I have hair at all?

Panic stations
People who know me find my panic totally bizarre. I’m not overly fussed about my appearance. I drop the kids to school every morning and I rarely wear makeup. For most of my life people have thought I am much younger than I really am – and Photoshop-assisted by-line photographs certainly help that impression.

I’m also not easily upset. In fact, I positively thrive in adversity. Calm under pressure is part of a journalist’s job. I covered 9/11 from downtown New York City for one of the Sunday papers and have travelled to Kinshasa in the Democratic Republic of Congo – the rape capital of the world. I took both in my stride but this one grey hair has sent me to my panic stations.

Strangely, I have nothing against grey hair on others. My husband has been salt and pepper for years and I think he gets sexier every time I look at his increasingly grey hair. Many women look better grey.

Finding my own grey hair did not come as a surprise but my reaction to it has been upsetting because it’s completely out of character. It seems grey hair is a bit like wrinkles; you think they give the face character until that wrinkly face in the mirror is yours.

Age is often on my mind but not my age, more the age of other people (Every Monday readers, my parents and in-laws for example) and their changing needs and concerns.  So, yes the one (or maybe three) grey hairs have made me realise that I am getting older. I’m stiff when I wake up – never noticed that before – and I have more around my mid-section than I did five years ago.

Search and destroy
What did I do about that hair? No, I did not pull the coarse intruder out from the roots or dye it. I ordered a battery of blood tests for menopause, thyroid disorders, diabetes, cholesterol, liver and kidney functions. You name it and I was probably tested for it.

The results were interesting – there is absolutely nothing wrong with me. I am just getting older.

Unsatisfied with my glowing report, I then decided my next step was to research the issue to death. I needed answers.

Grey hair facts
What causes grey hair? It’s the same thing that causes freckles – pigment. In the womb, everyone’s hair is white. Then melanocytes, cells in our hair follicles, produce pigments including melanin. The pigment combination gives our hair its colour.  When the melanocytes stop creating pigment the hair goes transparent and appears grey next to healthier, darker hair.

Apparently, we tend to go grey around the same time as our parents but not always. It’s also a myth that if you pluck out grey hair then two will grow back. Grey hair can be harder to colour because it’s not as absorbent as healthy hair. Doesn’t that make you wonder how they managed to get Anne Bancroft’s hair black with that lovely grey stripe in The Graduate?

Early greys may indicate an underlying medical condition. A thyroid imbalance or B12 deficiency can cause your hair to lose colour. Smokers are also four times more likely to have grey hair than those who don’t take a few puffs. The chance of going grey goes up 10-20% every decade after you turn 30.

Interesting stuff but the facts are not making me feel any better. I am bereaved over my loss of youth and have started experiencing the five stages of grief – denial, anger, bargaining, depression and acceptance.

It’s way too early for acceptance. Instead, I just part my hair on the other side and pretend the grey hair – that little bugger! – isn’t there.

 “Mouse, I can’t take it anymore,” she said in a ragged whisper. “Please kill me. PLEASE.”

 “You’re crazy. What are you talking about mum? It must be the morphine making you talk like that,” she said.

 It was a terrible situation for anyone to be in. A nightmare of the worst imagining. That teenage girl was me.

Versions of this story are more common than you might think. The only variables are age, illness and relationship. Many of our friends and neighbours are caring for terminally ill – pain ridden –  husbands, wives, parents and children with little support from the state or others. For some, the agony is too much to bear.

Choosing to die
In July 2009, the British conductor Sir Edward Downes and his wife Joan ended their lives at a Swiss assisted suicide clinic in July. Lady Downes, 74, had terminal cancer and the 85-year-old conductor was nearly blind and increasingly deaf. He had been forced to give up conducting and relied heavily on his wife’s assistance but he was not in any pain.

Announcing their death, the family released a statement that read, “After 54 happy years together, they decided to end their own lives rather than continue to struggle with serious health problems. They died peacefully, and under circumstances of their own choosing, with the help of the Swiss organisation, Dignitas, in Zurich.”

Although the case conjures images of Romeo and Juliet it raises many issues not just because it was assisted suicide – which is illegal and many feel is morally wrong – but because Sir Downes was not terminally ill. Did both of them have the right to choose death? Should it only have been an option for her because of her terminal illness?

 Suicide support groups say people generally think about ending their life because they see no way out. It is important to show those who feel suicidal that they have choices. Surely, Sir Downes had the option of a live-in carer or others way to get through his remaining years without his wife?

 These difficult questions need public debate. If, for example, you legally take away a person’s right to die then, as a society, shouldn’t you take responsibility for the dignity of their natural death?

Dignity in dying
How do we wish to die? In 2004, the first Irish survey on death and dying found that 67 per cent of those interviewed wanted to die at home, pain-free, conscious and surrounded by their loved ones. Of the 30,000 people who pass away in Ireland annually only one-third get their wish. The rest – 20,000 – die in hospitals.

Would you like to pass away alone on a trolley in A&E while a drunk vomits nearby? This is an extreme example but many dying people occupy hospital beds on busy wards and do not receive the care and respect they deserve in their final moments.

Do we have a right to choose dignity in our dying? The hospice movement, and society, seem to believe that we do but our government’s policies do little to respect that notion. 

 Hospice care, a health service focusing on dignity in dying, is generally only available to those who have cancer and it is largely funded by voluntary contributions, not government funding. Why?

 End of life care
According to an article in the Irish Times “the average Irish person’s lifetime expenditure on health services is about €300,000 and almost 25 per cent of that sum, €70,000, is spent in the last year of life. More than 40 per cent of that is spent in the final month. Spending on patients in that last year is estimated at 10-15 per cent of a country’s total health budget. In Ireland this would amount to €1.6-€2.4 billion of the total health budget of €16 billion. And yet the current budget for hospice care is only €75 million, less than 5 per cent of the entire budget.”

End of life care (palliative care) depends on your diagnosis and where you live, according to Eugene Murray, chief executive of the Irish Hospice Foundation. The group is working to change this situation by offering palliative care to patients with conditions other than cancer and to expand their network but, of course, this will take time and funding.

Back to reality
The reality is that there are thousands of people in Ireland who do not experience a dignified death because the resources, and will, are not there to provide it. Thousands more families are struggling to care for and support dying relatives and friends. They lack proper supports from government, the community and society. Under that kind of mental, physical and emotional strain it’s likely that – in their rare quiet moments – they ask themselves if anyone cares about their loved one’s dignity in dying and what lies ahead for them at the end of their days?

Useful links
Living with dying and dignity, Irish Times
http://www.irishtimes.com/newspaper/weekend/2008/1213/1229035646035.html

Dying for guidance, the Guardian
http://www.cardi.ie/node/2390

Suicide prevention groups
Samaritans jo@samaritans.org, www.samaritans.org, 1850 609090 (Republic of Ireland) or 08457 909090 (UK including Northern Ireland)

Aware Defeat Depression, www.aware.ie, info@aware.ie, 01 6617211
1890 303 302

Your local doctor, listed under ‘General Practitioners’ in the Golden Pages or visit www.icgp.ie. Go to, or contact, the Accident and Emergency Department of your nearest general hospital.

International care perspectives
UK green paper on funding care for older people, Guardian article
http://www.guardian.co.uk/society/2009/jul/14/green-paper-care-system-elderly

Holland’s care budget offered to older people instead of a place in a care home. Nearly 100,000 people have taken this option. Daily Mail report: http://www.seniorsworldchronicle.com/2009/07/uk-care-for-elderly-should-allow-us-all.html