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Chapter 1: Introduction and Background
Public health provision of residential care in Ireland dates from the early nineteenth
century. Many changes to how this care was funded and provided have taken place.
Analysis of the type of facilities provided reveals a shift from an “institutional” type
facility for long-stay or residential care to a more home-like facility. Analysis of the
funding provided also reveals a shift in the level of contributions an individual
makes to their care provision. Originally, residential care was provided in “county
homes”. These county homes were previously used as “workhouses” and aimed to
provide accommodation for people who were financially poor or had nowhere to
live. At the same time the only other community residential services available to
older people were provided by the voluntary sector. Disease and infection soon
began to spread in the county homes and “The Care of the Aged” report (Department
of Health, 1968) subsequently recommended that older people should be enabled to
remain in their own homes for as long as possible, and that this should be supported
by the government’s policies, initiatives and funding.
The “Care of the Aged” report led to the development of “geriatric hospitals” and
“welfare homes”. Welfare homes were built all over Ireland and were all built to the
same architectural design. They were built for older people without means or who
could no longer financially support themselves in their own homes. They were also
built to cater for older people who were socially isolated or without family to care
for them. They were not originally designed to cater for medical or nursing needs,
and the older person was expected to be able to walk through the doors of the
welfare home fully mobile and without physical dependence. As a result of this the
welfare homes were usually predominantly staffed with care assistants and small
numbers of nursing personnel. Conversely, the geriatric hospitals were designed to
cater for the physically or medically dependent older person. Both welfare homes
and geriatric hospitals were institutional in design and contained large wards
(Florence Nightingale-style). Problems began to arise as the residents in the welfare
homes grew older and began to experience the health problems associated with
increasing age. By 1988 the Department of Health recognised that the welfare homes
now had a completely different type of resident from those originally admitted, and
that the geriatric hospitals were institutionalised in their approach to care (National
Council on Ageing and Older People, 2000).