Review of Services for Older People in South Tipperary

Review of Servicesfor Older Peoplein South TipperaryMarch 2008Commissioned by Community Consultants Ltd.as part of the Social Audit for South Tipperary.Co. Tipperary Information Service34/35 Croke StreetThurlesCo. TipperaryTel. (0504) 22399tippinfo@eircom.net

Review of Services for Older People in South Tipperary (2008)ContentsList of Tables and Figures..........................................................................................4Executive Summary ...................................................................................................5Introduction....................................................................................................................8Research Context .......................................................................................................9Aims & Objectives.....................................................................................................9Methodology............................................................................................................10Terms of Reference..................................................................................................11Policy Context..............................................................................................................12Older People and National Policy............................................................................13Quality of Life and Social Inclusion........................................................................14Statistical Profile..........................................................................................................16Older People in South Tipperary .............................................................................17Income and Income Supports.......................................................................................24Income Levels..........................................................................................................25Sources of Income....................................................................................................27Social Transfers .......................................................................................................27Medical Cards ..........................................................................................................30Other Income Supports ............................................................................................30Services in respect of Income Supports...................................................................31Conclusions..............................................................................................................31Health and Care Services .............................................................................................33Health Status of Older People..................................................................................34Health and Care Services for Older People .............................................................35Health and Care Services in South Tipperary..........................................................38Nursing Services ......................................................................................................38Home Help Services ................................................................................................39Home Care Packages ...............................................................................................39Day Services ............................................................................................................40Meals Services .........................................................................................................43Therapeutic/Community Care Services ...................................................................44Respite, Convalescence and Long-Stay Services ....................................................45Elder Abuse Service.................................................................................................47Active Listening Service for Older People ..............................................................48Personal Alarms .......................................................................................................48Support for Carers of the Elderly.............................................................................49Conclusions..............................................................................................................49Social & Recreational Services....................................................................................51Social Interaction and Participation.........................................................................52Active Retirement Associations and Social Clubs...................................................55Visiting and Befriending Interventions....................................................................58Lifelong Learning ....................................................................................................59Sport and Physical Exercise.....................................................................................60Conclusions..............................................................................................................63Housing and Housing Supports ...................................................................................65Housing and Older People .......................................................................................66Housing Support Schemes .......................................................................................67Standard of Housing in South Tipperary .................................................................692

Review of Services for Older People in South Tipperary (2008)The Role of the Local Authorities ...........................................................................69The Voluntary Housing Sector ................................................................................70Supports for Repairs and Maintenance ....................................................................71Safety & Security.....................................................................................................71Conclusions..............................................................................................................72Transport......................................................................................................................74The Need for Public Transport among Older People...............................................75Rural Transport in South Tipperary.........................................................................76Rail and Conventional Bus Services in South Tipperary.........................................79Conclusions..............................................................................................................79Service Infrastructure...................................................................................................80Improving the Quality of Public Services at Local Level........................................81Delivering Public Services to Older People.............................................................82Examples of Good Practice......................................................................................84The Role of the CDB’s in Co-ordinating Services ..................................................85Conclusions and Recommendations ........................................................................86Appendix......................................................................................................................91Statistical Appendices..............................................................................................92Abbreviations...........................................................................................................96Organisations Consulted ..........................................................................................97References................................................................................................................993

Review of Services for Older People in South Tipperary (2008)List of Tables and FiguresFigure 1: Age-dependent population in per cent by Local Authority17area, 2002Figure 2: Age pyramid for South Tipperary 2006 18Figure 3: Projected age pyramid for South Tipperary 2021 18Figure 4: Per cent of persons aged 65 and over and living alone by19Local Authority area, 2002Figure 5: Map of Ireland indicating the percentages of older people by 20Local Authority areaFigure 6: Map of South Tipperary showing the percentage of people21aged 65 and over in each EDFigure 7: Map of South Tipperary showing actual numbers of people22aged 65 and over in each EDFigure 8: Map of South Tipperary indicating the locations of Local38Health OfficesFigure 9: Map of Day Care Centres in South Tipperary 40Figure 10: Map of long-stay, respite and convalescence services in South 45TipperaryFigure 11: Map indicating Active Retirement Associations and Social 56Clubs for Older People in South TipperaryFigure 12: Participation in Sports by Age Group 61Figure 13: Areas covered by the RTP in South Tipperary in relation to 78older people populationTable 1: Population increase in South Tipperary 2002-2006 17Table 2: Population projections for South Tipperary 18Table 3: Projected increase in the older population of South Tipperary 19to 2021 by age groupTable 4: Proportions of persons aged 65+ by marital status 2006-2021 19Table 5: Persons aged 65 and over in each South Tipperary town by 23age groupTable 6: Income Sources of Older People 27Table 7: Social Transfers to Older People 27Table 8: Pension Statistics for Co. Tipperary 29Table 9: Findings from the EU-SILC's 2004-2006 for those aged 65+ 30Table 10: Findings from the EU-SILC's 2004-2006 for those aged 65+ 34Table 11: List of Day Care Centres in South Tipperary 41Table 12: Barriers to "Getting out of the house" 54Table 13: Active Persons aged 55 and over classified by intensity,62frequency and session duration in the previous 4 weeksTable 14: Housing deprivation by age group 66Table 15: Routes operated by Ring-a-Link 77Table 16: Percentage of persons 65 years and over living alone by local 92authorityTable 17: 65+ Population in South Tipperary by Local Electoral Areas 93Table 18: 65+ Population in South Tipperary by Electoral Divisions 93Table 19: 65+ Population in South Tipperary by Towns and Aggregate 95Rural Area4

Review of Services for Older People in South Tipperary (2008)Executive SummaryResearch Context – This report forms part of the pre-development research that hasbeen carried out in the context of the cohesion process through which the LDSIP andNRD Programmes will be delivered by a single organisation and is intended to informthe strategic, countywide roll-out of social inclusion services in South Tipperary.Aims & Objectives – The objectives of this research are to provide a comprehensivestatistical profile of older people in the county, determine current levels of and gaps inservice provision and highlight any issues in relation to public service delivery forolder people. It is the aim of the report to balance the views of service providers andservice users based on identified needs of the target group.Methodology – The research uses a strongly consultative approach in an overall mixof methods which includes comprehensive documentary research and the analysis ofqualitative and quantitative information gathered as part of a broad consultationprocess with service providers and service users. The report consists of two parts: astatistical profile and a services review.Policy Context – Current national strategies and action plans (National DevelopmentPlan 2007-2013, National Action Plan for Social Inclusion 2007-2013 and Towards2016) form the policy context for this report and are considered on the basis of trendsin public service delivery as identified by current research. The main objective ofnational policy is to support older people in maintaining their health and in livingactive lives in their own homes and in their own communities for as long as possible.Statistical Profile – Ireland has a low population of older people by internationalstandards, but this is expected to change radically in the next few decades. Theanticipated changes in age structures have so far been counteracted to a large degreeby the strong recent inward migration within the 15-64 age bracket. South Tipperaryis traditionally a county with a large age-dependent population as well as a highproportion of older people who live alone. The 2006 Census recorded an olderpopulation in the county of approx. 13 per cent (10,650 persons aged 65 years andover). This is expected to increase by almost 50 per cent in the next 15 years. It isestimated that the number of older people in the county will reach 15,600 or 15.6 percent of the overall population in 2021. The number of older people living alone isexpected to double in the same period from 2,864 to 5,168. Statistically, however, themajority of older people live with a partner, spouse or family member. Almost 60 percent of people aged 65 and over live in rural areas. Within South Tipperary, the olderpopulation is a higher percentage in the north and north-west of the county with fewexceptions. The largest numbers of older people can be found in the towns and theirhinterlands.Income & Income Supports – Older people show relatively low levels of incomepoverty as a result of extensive social transfers and other income supports (such asconcessions). Housing deprivation is thought to be a significantly greater challengefor them. In South Tipperary, it is estimated that 2 per cent of people aged 65 and overare experiencing consistent poverty, but up to 10 per cent are at risk of it. There is aminority of older people who are affected by anomalies in the social welfare/pensionsystems. Income supports are largely determined at national level and the role of localservice providers (apart from local branches of the DSFA that administer thesesupports) is restricted to the provision of adequate information and advocacy services5

Review of Services for Older People in South Tipperary (2008)as well as the detection and feeding back of social policy issues. The availability andequal distribution of concessions can be and should be addressed more effectively atlocal level.Health and Care Services – The Health Service Executive is the single most importantstatutory agency responsible for the delivery of health and care services to olderpeople in South Tipperary as elsewhere in the country. The voluntary sector makes asignificant contribution to the provision of such services, particularly those that enableolder people to live (quasi-) independently in their own homes (i.e. day care andmeals services). The provision of health and care services is subject to greatgeographical variances in South Tipperary and would appear to be particularly variedin respect of community-based services. In addition, the voluntary sector isexperiencing growing difficulties in sustaining service provision resulting from therestricted availability of funding under Section 39 of the 2004 Health Act, amongstother factors. It is acknowledged that the provision of community services for olderpeople is currently undergoing changes and that the restructuring of primary careservices by the HSE may address some of the issues identified in this report.However, there is considerable scope to improve service delivery at local level in themeantime through better networking, sharing of resources, better cooperation with thevoluntary sector and improved information provision in respect of the services that areavailable.Social & Recreational Services – Contrary to common perception, social isolation isnot widely experienced by older people; nor is age per se a barrier to socialparticipation. It is estimated that only 7 to 15 per cent of older people experienceisolation or loneliness, although it is true that rural dwellers are at a greater risk oflosing social supports with increasing age. Intervention strategies to combat socialisolation and loneliness would appear to exist only sporadically and in an uncoordinatedmanner in South Tipperary although it is acknowledged that communityand health workers as well as voluntary groups carry out significant work in thisregard. The importance of social, educational and recreational opportunities to thecapacity of older people to live independent, active lives is frequently underestimatedby medical care models. These services are largely provided by the voluntary sector,although various agencies play a significant role in enabling community groups tooffer such activities. Lack of information and adequate transport are seen as the keybarriers to older people’s participation in these activities. In addition, the voluntarygroups involved in them experience considerable difficulties in adapting to a changingvolunteering ethos and environment. While the availability of organised activities inspite of these issues would appear to be satisfactory in most parts of the county, theinfrastructure to support informal physical and social activity is very inadequate. Thelack of safe public places, walkways and cycling lanes was seen as a major obstaclefor older people to live active lives.Housing and Housing Supports – Research suggests that older people areexperiencing significantly higher levels of housing deprivation than the rest of thepopulation. The majority of older people are owner-occupiers, while an estimated 10to 17 per cent of them rent from the local authority or in the private sector. Thenational housing support schemes have been recently reviewed and the effectivenessof new approaches in addressing housing deprivation among older people in SouthTipperary will not be seen for some time. Maintenance, small scale repair services andadaptations as well as the provision of safety and security equipment represent themain needs of older people in respect of housing (both owner-occupiers and tenants).6

Review of Services for Older People in South Tipperary (2008)These needs cannot necessarily be met by the private sector. On the contrary, there issignificant scope for public intervention by statutory and voluntary organisations. Acountywide Local Authority policy on elderly accommodation (based on the SouthTipperary County Council policy and the progressive approach by Tipperary TownCouncil) is desirable. An integrated strategy could pursue a coordinated response tonational schemes such as the “Scheme of Community Support for Older People” andwould allow for better information provision on housing supports from theperspective of the service user. The input and participation of the voluntary sectorparticularly in the area of safety and security is perceived to be key to the success ofsuch strategy.Transport – Lack of information and adequate transport are the main barriers for olderpeople in accessing services that will support them in maintaining active, independentand fulfilling lives. While the provision of adequate information can be addressedthrough improved coordination and PR at a local level, the provision of adequate andaccessible public transport presents a greater challenge. The Rural TransportProgramme (formerly Initiative) has had a significant impact in this regard,particularly in the rural areas. Policymakers have recognised the potential of theinitiative and have begun the process of mainstreaming. In South Tipperary, twoservices operate under the programme; Kilcommon/Upperchurch RTI and the Ring-a-Link service which covers the largest part of the county. Significant gaps in serviceprovision exist in the Cahir area and north of Clonmel. The adequacy of conventionalpublic transport in meeting the needs of older people is doubtful, but was notexamined in detail by this report. The door-to-door nature of the RTP services isconsidered to be a more viable model in meeting these needs. The introduction ofsuch a service in the urban centres and/or the maximisation of communally operatedvehicles through their joint use by voluntary groups should be examined in thiscontext.Service Infrastructure – The principles underlying public service delivery arepresently the subject of a paradigm shift that is attempting to address the growingdiscontent with their quality. This shift from the “Welfare State” to the so-called“Development Welfare State” will put greater demands on statutory and voluntaryorganisations, specifically in respect of service users’ involvement, focus onprevention and early intervention and accountability. Strategies, action plans andpolicies which are newly devised at a local level should therefore adopt theseprinciples, where possible. In South Tipperary, the infrastructure for delivering highquality public services for older people is significantly compromised by the lack of asingle coordinating body with a responsibility for implementing an integrated serviceprovision strategy. This report concurs with the observation that flaws in the strategicplanning of services at national level inadvertently obstruct local service delivery. Atthe same time, it concludes that there is significant scope at a local level to improveservices with a coordinated response, both from an intra- and inter-organisationalperspective. Suggestions for such a response are included in the “Conclusions andRecommendations” on page 86 of this report.7

Review of Services for Older People in South Tipperary (2008)Introduction8

Review of Services for Older People in South Tipperary (2008)Research ContextIn January 2004, the Irish Government agreed a series of measures designed toimprove local and community development programmes and deliver them in a morecoherent, transparent and focused manner. 1 As part of these measures, existing localdevelopment initiatives were asked to amalgamate into one integrated localdevelopment company per county to provide “a single access point for localcommunities to a far wider range of programmes heretofore”. 2 In South Tipperary, itis envisaged that this integrated local development company, once established, willimplement a rural development strategy as well as the rollout of social inclusionservices throughout the county. This is referred to as the “cohesion process”.This report, entitled “Review of Services for Older People in South Tipperary(2008)”, forms part of the pre-development research that has been carried out in thecontext of the cohesion process and is intended to inform the strategic extension ofsocial inclusion services to all areas of South Tipperary.Aims & ObjectivesOlder people in South Tipperary are a target group that has been the subject of anumber of service reviews and strategic documents, prepared predominantly byagencies and organisations that are directly involved in the delivery of services to thispart of the population. More recently, work has been carried out from a multi-agencyperspective. 3In addition to providing a comprehensive statistical profile of older people in SouthTipperary, this report aims to include and expand on existing plans and servicereviews in a bid to• Determine the current level of service provision to this target group,• Identify gaps in the coverage of these services on a geographic basis• Assess qualitative aspects of services delivery, and• Highlight issues that may inhibit the smooth delivery of quality services.Statutory service providers and voluntary organisations aiming to support olderpeople in their communities as well as individuals from the general public havecontributed a significant portion of the information in this report. It is the aim of theresearch to compare public service delivery standards and community expertise withidentified local needs of older people.1 “Ó Cuív Outlines Government Decision to Improve Local and Community DevelopmentProgrammes”. Press Release Department of Community, Rural and Gaeltacht Affairs, 4 February 2004.2 http://www.pobail.ie/en/CommunityLocalDevelopmentProgrammes/CohesionProcess/3 I.e. through the establishment of a Elderly Services Review Group under the auspices of the CDB’sSocial Inclusion Measures Group9

Review of Services for Older People in South Tipperary (2008)MethodologyThis “Review of Services for Older People in South Tipperary” uses a stronglyconsultative approach. Besides documentary research, it uses a mix of methods aimedat gathering information (in the form of hard data and qualitative feedback) from olderpeople themselves (as actual or potential service users), from primary and secondaryservice providers (voluntary or statutory) and from other organisations supportingolder people in their communities.Statistical ProfileThe statistical profile contained in this report is based exclusively on documentaryresearch, and as such draws primarily on nominal data available from the CentralStatistics Office. The information collated as part of the Census 2006, conducted inApril of that year, represents the most up-to-date information that is available for thecounty. This data has been analysed at various geographical levels as well as on alongitudinal basis (i.e. comparing data from the 1996, 2002 and 2006 Censuses).Where appropriate, a comparative analysis with national data has been included tohighlight local variances. In some instances, national data is used in the absence ofappropriate local data.Services reviewThe actual review of services to older people in South Tipperary from a quantitativeand qualitative perspective represents the core of this research. In order to put it in awider context, it is preceded by a chapter on national policies, which impact on thedelivery of public services to older people. Research carried out on a national levelfeeds into the individual chapters which follow various topical areas of servicedelivery. Older people are, in fact, a very well researched group of the Irishpopulation thanks to the work of the National Council on Ageing and Older People(NCAOP) and a number of other national lobbying and/or support organisations. Thebroad spectrum and vast amount of research carried out by or on behalf of theNCAOP constitutes a powerful resource for anyone wishing to find out about theneeds of older people.The documentary research on services for older people in South Tipperary is – asmentioned above – supported to a large degree by public consultation. A number ofavenues were pursued to ensure the input of service users and service providers alike:• Public Consultation: A call for submissions was published in the localnewspaper inviting members of the general public to submit their views on theneeds of older people in specific parts of the county and/or the ways in whichservices provided for them could be improved.• Targeted Consultation with Community-Based Service Providers: Inaddition, organisations and agencies were identified that provide services toolder people in a primary or secondary capacity. These included GPs, healthand social care services, housing and transport services as well as communitygroups which involve or support older people in their areas. All identifiedorganisations were invited to participate in the wider public consultation(above). They were also asked to partake in a telephone survey which aimed to10

Review of Services for Older People in South Tipperary (2008)establish the nature of their organisation and/or the service they provide aswell as to identify any issues in relation to service provision.• One-to-one Consultation with Key Personnel of Statutory ServiceProviders: Key personnel in local statutory service providers were consultedon a one-to-one basis in order to identify any issues in relation to thecoordination of services to older people in the county.The information gathered in this way was categorised in the case of quantitative dataand reviewed and summarised in the case of any qualitative feedback or information.Finally, the provision of services at a countywide basis was mapped using some of thedemographic findings of the statistical profile as a reference point.Terms of ReferenceThe purpose of this services review is not to evaluate the work or judge the quality ofservice provided by single organisations and agencies. It rather adopts a non- or paraorganisationalviewpoint that tries to evaluate service provision as a means ofachieving the social integration of older people in their community as far as possible.National policy has recognised the value of community-based service models inrecent years (increasingly so in its own right rather than as a partial substitute forlong-stay care facilities). Such models respect the right of a person to remain in theircommunity notwithstanding an increasing dependency on support services with age(such as, for example, health and social care services). In evaluating service provisionin the county, this report, therefore, looks at the interaction of statutory and voluntaryservices in the wider community (at level of the town or village).The National Economic and Social Forum (NESF) recently published a report onpublic service delivery. 4 A number of quality standards discussed in this report areadopted by this research in reviewing service provision to older people in the county.This is done in the belief that the Forum’s report will influence national policy andstrategic service planning in the future.Lastly, this report recognises the importance of older people’s full participation ineconomic, social and cultural life. It has therefore adopted a relatively broaddefinition of the terms “service” and “service provider”. Social groups, such as ActiveRetirement Associations or Senior Citizens Clubs, are seen as equally importantservice providers as, for example, social or health care providers, in that bothultimately contribute to an individual’s capacity to participate in and engage withsociety.4 National Economic and Social Forum: Improving the Delivery of Quality Public Services. Dublin2006 (= Report 34).11

Review of Services for Older People in South Tipperary (2008)Policy Context12

Review of Services for Older People in South Tipperary (2008)Older People and National PolicyThe vision of government and the social partners for older people in Ireland is set outin Towards 2016. It is to support older people in maintaining their health andwellbeing, in living active and full lives, independently in their own homes andcommunities for as long as possible. 5 This requires that in the long term, every olderperson would• Be encouraged and supported to participate as best possible in social and civiclife• Have access to an income that is sufficient to sustain an acceptable standard ofliving• Have adequate support (meaning access to good quality health, education,transport, housing and security services in the community) to enable them toremain living independently in their own homes for as long as possible• Have access to a range of care services that ensure that the person hasopportunities for civic and social engagement at community level. 6To realise its vision, Government is pursuing two key goals in the coming years: (1)to increase investment in community care services and (2) to maintain incomesupports for pensioners based on a minimum rate of €200 per week in current terms. 7In this regard, the following measures, amongst others, are envisaged in the shortterm:• A Green Paper on Pensions reviewing all the pillars of pension provision waspublished in October 2007 and is currently the subject of an extensiveconsultation process• €88 million will be invested in long-term residential care with a view tocreating 2,300 additional public and private long-stay beds and implementingstricter nursing home inspections• A new Nursing Home Support Scheme is currently being introduced whichaddresses anomalies between residents in public and private facilities• Additional Home Care Packages aimed at facilitating older people to stay intheir homes will be provided. A steering committee has also been establishedto oversee the funding and delivery of this service.• Additional home help hours and day places will be provided• Community Intervention Teams (CIT’s) will be rolled out in various parts ofthe country• A policy statement “Delivering Homes, Sustaining Communities” andsubsequently a revised framework of grant aid will address issues in relation tothe Disabled Persons, Essential Repairs and Special Housing Aid for theElderly, grant schemes5 Compare National Action Plan for Social Inclusion 2007-2016, p. 48 and Towards 2016, p. 60.6 Ibid.7 NAPinclusion, p. 50. The Social Inclusion Report for 2006/7 commits to €300 per week by 2012 asenvisaged by the Programme for Government (p. 30).13

Review of Services for Older People in South Tipperary (2008)• Future Housing Action Plans will address special needs of older people in amore strategic manner. (Guidelines to this effect have been issued to LocalAuthorities)• All local authority housing for older people will be upgraded with regard tocentral heating systems by the end of this year• The Community Supports for Older People scheme will continue to prioritisehome security and other measures for older people• Older people will be encouraged to access further and higher education andparticipate in family literacy projects• The participation of older people in the labour market will be encouraged andfacilitated (however, this does not extend to those aged 65 and over; rather, theEmployment Action Plan was extended in 2006 to those aged 55-64).• The transition of the Rural Transport Initiative into the mainstreaming processwill be facilitated following the launch of a new RTP (Rural TransportProgramme) in February 2007• A National Carers Strategy will be developed. (Public consultation is currentlyunderway)In line with these aims, the National Development Plan 2007-2013 is committed toinvesting €9.7 billion in the older people programme with a specific focus onresidential care and on services that enable older people to live independently in theirown homes and communities for as long as possible. 8With the start of a new NDP cycle last year and the relatively recent introduction ofthe ten-year strategic framework for meeting future economic and social challenges,i.e. Towards 2016, it is evident that public service delivery to older people is verymuch in transition. Changes in national policy will have a delayed impact on servicesat a local level and may temporarily cause a certain level of disruption for the serviceusers. At the same time, widespread consultation is currently taking place in a numberof areas that affect older people, so that there is an opportunity for individuals andlocal organisations to participate in the shaping of better services. Service providersshould therefore view the national developments outlined above as the direction offuture service delivery while examining their scope to respond to local needs withinthis framework and perhaps influence national policy in return.Quality of Life and Social InclusionIn addition to increasing awareness of national policy as a framework in which localservices are bound to operate, it may be a valid approach for local social inclusion andservice coordination measures to review some of the theoretical concepts on whichthey are grounded. A shift in paradigm is clearly taking place in the way poverty isbeing defined and viewed. The study of “quality of life” and the emerging socialmodel of “(positive) mental health” may offer valuable insights into the complexity ofdeterminants of poverty and social exclusion and into how older people may besupported in overcoming them.Whilst monetary factors such as income levels present easy-to-use and easy-tomeasurequantitative data, it is vital to recognise the importance of health, social and8 Social Inclusion Report Ireland 2006-2007. Dublin: Government of Ireland 2007, p. 29.14

Review of Services for Older People in South Tipperary (2008)community supports as well as housing conditions. Studies on the quality of life ofolder people have consistently identified that• social relationships• social activities• health and wellbeing• home and neighbourhood• independence and control, and• being able to cope financiallyare equally important factors in the social inclusion of older people. 9While current policy generally reflects a broader focus on non-monetary aspects ofpoverty and has tried to address some of the above issues by way of housing supports,measures to improve access to services or to encourage active participation, thecoordination of services at local level still lacks a thorough understanding of theinteraction between the various quality-of-life determinants. It would appear that thecommunity and voluntary sector on the one hand and the statutory sector on the other,who have traditionally serviced distinct areas, are increasingly overlapping due tomore comprehensive and holistic approaches to public service provision. Channellingthis development is possibly the biggest challenge for local service delivery.As regards measures that can positively impact on the quality of life of older people ata local level, the findings of a study on older people’s quality of life undertaken by theHealth Promotion Research Centre at Galway NUI 10 highlighted an increasing needfor:• Comprehensive befriending services that can address a perceived lack ofpeople and community among older people, particularly those in isolated areas• Access to appropriate transport to encourage independence and involvement insocial activities• Supports to promote and maintain positive attitudes to health and well-being• Budgeting advice and income supports (i.e. to meet fuel, taxi costs, …)• Access to information on services as there is a high reliance among olderpeople on health and social servicesIn addition, the study recommends that social, housing and security needs amongolder people be assessed and subsequently addressed at a local level. 11The following chapters will highlight the validity of these and other issues for SouthTipperary.9 Hodgins, Margaret et al.: “Enhancing the Quality of Life of Older People in Poverty with particularreference to those living alone.” CPA Research Seminar January 2007, p. 2 (handouts).10 The publication of this study by the National Council on Ageing and Older People is expected in thenear future.11 Hodgins, Margaret et al.: “Enhancing the Quality of Life of Older People in Poverty with particularreference to those living alone.” CPA Research Seminar January 2007, p. 5-6 (handouts).15

Review of Services for Older People in South Tipperary (2008)Statistical Profile16

Review of Services for Older People in South Tipperary (2008)Older People in South TipperaryAt approximately 11 per cent, the proportion of older people in Ireland is presentlylow by EU and international standards. It is anticipated, however, that this figure willrise to 29 per cent by 2050 mainly due to the fact that life expectancy is increasing. 12In the shorter term, the actual number of older people will continue to increase due toanticipated growth in the general population.Figure 1: Age-dependent population in per cent by Local Authority area, 2002(Source: Mapping Poverty, CPA 2005, p. 15)South Tipperary has traditionally been a county with a relatively high age-dependentpopulation, which comprises those in the age brackets 0-14 and over 65. Figure 1illustrates the varying proportions of the age-dependent population across Irelandbased on Census information from 2002 and 2006. In 2002, South Tipperary’s agedependentpopulation formed 34.6 per cent of the overall population. This figure hasdecreased to 32.9 per cent in 2006 while overall population increased by of 5.2 percent.2002 2006 Variance0-14 years 17,391 22.0% 17,528 21.1% +13715-64 years 51,743 65.4% 55,042 66.1% +3,29965+ years 9,987 12.6% 10,651 12.8% +664Total population 79,121 100.0% 83,221 100.0% +4,100Table 1: Population increase in South Tipperary 2002-2006 13It is evident from Table 1 that the unexpected decrease in the proportion of agedependentpopulation is due to large population growth in the 15-64 age bracket. Thisgrowth can be attributed largely to the strong inward migration experienced by Irelandand South Tipperary in recent years. It would be expected that in the longer term,12 National Action Plan for Social Inclusion 2007-2016, p. 49.13 Source: Census, Volume 3. CSO 2002-2006.17

Review of Services for Older People in South Tipperary (2008)increasing life expectancy will have a negative impact on age dependency ratiosacross the country.Indeed, Table 2 shows population projections for South Tipperary which suggestclearly that the over-65 population will experience the greatest growth in next 15years and will, in fact, grow at twice the rate of the overall population. The changes inthe age structure of the county are further illustrated in Figures 2 and 3.2006 2011 2016 2021 Variance0-14 years 17,528 18,547 19,103 19,397 +10.7%15-64 years 55,042 58,907 62,157 65,363 +18.8%65+ years 10,651 11,472 13,361 15,618 +46.7%Total population 83,221 88,926 94,621 100,378 +20.6%Table 2: Population projections for South Tipperary (Source: NCAOP Report 81)In addition to the changing age structures of the population that will result from anincrease in the proportion of older people, it is anticipated that the number of peopleaged 65 and over who live alone will also increase dramatically.Figure 2: Age pyramid for South Tipperary 2006Figure 3: Projected age pyramid for South Tipperary 2021 14Furthermore, small changes will take place in age distribution within the 65+ agebracket. Not only is the 65-79 age bracket largely responsible for the proportionateincrease of the older population which is expected to take place in the next 15 years14 Base information derived from NCAOP Report no. 81, p.110-113; and Census, CSO 2006.18

Review of Services for Older People in South Tipperary (2008)(Table 3); within the 65+ age group, their proportion will also increase from 74.6 to80.0 per cent.2006 2011 2016 2021 Variance65-79 7,946 8,866 10,603 12,484 +57.1%80+ 2,705 2,606 2,759 3,134 +15.9%Total 65+ population 10,651 11,472 13,362 15,618 +46.7%Table 3: Projected increase in the older population of South Tipperary to 2021 by age group 15South Tipperary has traditionally shown comparatively high percentages of olderpeople who live alone when viewed in the national context (Figure 4). In 2006, SouthTipperary came 14 th in a list of the 41 Local Authority areas in the country thatshowed the highest percentages of over 65’s who live alone. With the exception ofClare, South Tipperary was the only non-city Local Authority area in the top 14located outside of the country’s northern region.Figure 4: Per cent of persons aged 65 and over and living alone by Local Authority area, 2002(Source: Mapping Poverty, CPA 2005, p. 16)The expected increase in the number of people aged 65 and over who are living alonemust be viewed in conjunction with anticipated alterations in marital status. Table 3shows projections for South Tipperary in this regard that illustrate a sharp increase inthe percentage of older people who will be separated and/or divorced.2006 2011 2016 2021 VarianceSingle 16.5% 14.5% 13.1% 12.4% -4.1%Married 48.1% 47.3% 49.1% 49.1% +1.0%Widowed 32.6% 33.7% 31.3% 30.2% -2.4%Separated 2.8% 4.5% 6.5% 8.3% +5.5%Total 65+ population 100.0% 100.0% 100.0% 100.0%Table 4: Proportions of persons aged 65+ by marital status 2006-2021 1615 Based on information derived from NCAOP Report no. 81, p. 110-113; and Census, CSO 2006.19

Review of Services for Older People in South Tipperary (2008)It is estimated that the increase in the proportion of older people living alone will bein the region of 6 per cent in relative terms. This means that the actual number ofpeople aged 65 and over who live alone is expected to almost double between nowand 2021, from currently 2,864 to 5,168. Females will continue to constitute twothirds of the older people who live alone.South Tipperary has a relatively large older population which, of course, is the maincontributor to the high age dependency ratio mentioned above. With 12.8 per cent ofthe population aged 65 and over, the county ranks 8 th on the list of the LocalAuthority areas with the largest proportion of older people in the population. Figure 5illustrates the geographical variations in Ireland in respect of the percentages of thepopulation that are 65 years and older.Figure 5: Map of Ireland indicating the percentages of older people by Local Authority area(Census 2006)Within the boundaries of South Tipperary, the majority of people aged 65 and over• Are women (54.1 per cent)• Are aged between 65 and 69 (29.6 per cent)• Live in rural areas (59.8 per cent)• Are married (48.1 per cent)16 Based on information derived from NCAOP Report no. 81, p. 122-135; and Census, CSO 2006.20

Review of Services for Older People in South Tipperary (2008)• Live with a partner, spouse or family member (70.4 per cent)At present, three out of ten older people live alone, of whom the greater proportion arewomen due to their longer life expectancy compared to their male counterparts.In socio-economic terms, older people form a very distinct group as the distribution ofsocial classes among them differs markedly from that of other age groups. In SouthTipperary, they show the highest proportion of unskilled workers and – with theexception of managerial and technical professions – the lowest levels of non-manual,skilled manual and semi-skilled workers compared to any other age group.Figure 6: Map of South Tipperary showing the percentage of people aged 65 and overin each ED (Census 2006)Figure 6 shows the variance among the electoral divisions in South Tipperary inrespect of the proportion of older people as part of the overall population in each ED.It illustrates that the hinterland of Clonmel in the Fethard direction is a relatively“young” area in terms of age structure. The older population is more denselyrepresented in the north/north west of the county with some exceptions. The areaswith the highest proportions of older people are located• West of Tipperary Town surrounding the villages of Emly, Lattin, Cullen,Monard and Limerick Junction• In and around Knockavilla northwest of Cashel• In and north of Dualla, northeast of Cashel• In the Southeast of Cahir• In and around Clogheen in the south of the county, as well as in• Fethard Town and• Cashel Town21

Review of Services for Older People in South Tipperary (2008)The actual numbers of older people in the various electoral divisions that form SouthTipperary are illustrated in Figure 7. In the context of public service delivery to olderpeople in the county they indicate the potential number of services users in any givenarea. It is evident from Figure 7 that the urban centres have larger concentrations ofolder people as would be expected. This would be likely to make them suitable ascentres for delivery of services to older people. The number of people aged 65 andover is listed for each of South Tipperary’s towns in Table 5.Figure 7: Map of South Tipperary showing actual numbers of people aged 65 and overin each ED (Census 2006)In addition to the urban centres and their surroundings, the following areas wouldconstitute potential service centres based on the number of older people who residethere: 17• Clogheen/Ballyporeen• Ardfinnan/Newcastle• Killenaule• Cappawhite/Annacarty/Dundrum• Bansha• Emly17 The Holycross/Dualla area also shows higher numbers of older people. However, for the purposes ofhighlighting potential service centres it is presumed that service users would avail of services inThurles due to its relatively close proximity.22

Review of Services for Older People in South Tipperary (2008)Town 65-69 70-74 75-79 80-84 85+ Total 65+Clonmel 556 467 406 265 179 1,873Carrick-on-Suir 201 163 156 110 84 714Tipperary 178 182 134 129 69 692Cashel 110 90 100 85 67 452Cahir 120 95 81 57 43 396Fethard 48 40 37 32 17 174Table 5: Persons aged 65 and over in each South Tipperary town by age group(Census 2006)More detailed statistical tables in respect of the population of over 65’s in SouthTipperary can be found in the appendix.23

Review of Services for Older People in South Tipperary (2008)Income and IncomeSupports24

Review of Services for Older People in South Tipperary (2008)Income LevelsInformation on income levels among older people in Ireland comes largely from theannual “EU Survey on Income and Living Conditions” (EU-SILC), but the materialwellbeing of older people has also been the subject of a number of national studies. 18From these we know that the income of older people is significantly lower than that ofthe overall or of the working age population 19 and is highly dependant on SocialWelfare payments.An analysis of the 2004 EU-SILC which focuses specifically on older people showedthat, at 27.1 per cent, older people had the highest rate of income poverty whencompared to other age groups in the population. 20 Although the at-risk-of-poverty-ratefor the elderly has notably decreased to 13.6 per cent in 2006, 21 the factors whichincrease the risk of an older person experiencing poverty have not changed. 22 Olderpeople who• Are women;• Live in a rural area;• Live alone;• Have a low educational attainment; and/or• Live in the Border, Midland and Western regions of Irelandare more likely than others to be income poor.Higher income poverty among older women is largely viewed as a result of factors intheir previous lives. 23 Many women who worked full-time in the home are likely, lateron, to be reliant on the state non-contributory pension and are unlikely to haveadditional income from occupational pensions. Even those who have been workingoutside of the home are likely to have had lower-value occupational pensionscompared to those of their male contempories due to anomalies in wage distribution inthe past. 24Significant differences in the distribution of income levels between urban and ruralareas also exist but are not exclusive to older people. 25 They have been addressed inthe National Anti-Poverty Strategy and its successor, the National Action Plan forSocial Inclusion. The 2004 EU-SILC established that income poverty for those aged65 and over living in rural areas was over 10 per cent higher than for urban dwellers. 2618 Such as the 1997 Living in Ireland Survey by the ESRI and the NCAOP Report no. 55: Layte,Richard et al.: Income, Deprivation and Well-Being Among Older Irish People. Dublin: NCAOP 1999.19 Compare: A Social Portrait of Older People, p. 16ff.20 Prunty, Martina: Older People in Poverty in Ireland. An Analysis of EU-SILC 2004. Dublin: CombatPoverty Agency 2007, p. 4 and 35.21 The EU-SILC 2006. CSO November 2007, p. 5.22 Prunty (2007), p. 4.23 Prunty (2007), p. 32 and Layte, Richard et al.: Income, Deprivation and Well-Being Among OlderIrish People, p. 7.24 Hughes, G. and Watson, D.: Pensioner’s Incomes and Replacement Rates in 2000. Dublin: TheEconomic and Social Research Institute 2005 as quoted by Prunty (2007), p. 32.25 Compare: Mapping Poverty. CPA 2005, p. 59ff.26 Prunty (2007), p. 33.25

Review of Services for Older People in South Tipperary (2008)A study conducted by the NCAOP in 1999 concluded that older people living alone inrural areas were 40 per cent more likely to be in poverty than other older people. 27Whilst the finding that older people living in the Southern and Eastern regions ofIreland are less likely to experience income poverty than those in the BMW region isencouraging from the perspective of South Tipperary 28 , older people in this countymay nevertheless be at considerable risk of poverty due to the predominantly ruralcharacter of the county.Whether or not an older person owns or rents their home would appear to have littleimpact on their vulnerability to income poverty. It does, however, have an impact ondeprivation and consistent poverty rates. 29The level of educational attainment is, of course, directly linked to income levels,both pre and post retirement. It is estimated that people with upper secondaryeducation are half as likely as those with lower secondary education to experiencepoverty. 30The fact that older people in Ireland showed the lowest consistent poverty rate(compared to other age groups) at 3.3 per cent in 2004, 31 would suggest that lowincome poverty does not directly translate into higher levels of deprivation. Thefindings of the EU-SILC would suggest, on the one hand, that secondary SocialWelfare payments for older people including benefits such as the Household BenefitsPackage and non-cash benefits including concessions from private service providershave a positive impact on deprivation levels. It must also be noted that older people,in general, have lower financial commitments than younger people. 32Whilst general deprivation levels among older people would appear to becomparatively low, older people are particularly vulnerable to housing deprivation. 33Here and in terms of other forms of deprivation, older people who live alone andthose who are not home owner-occupiers are most likely to be at a disadvantage. 34If the findings of the 2006 EU-SILC are applied to the older population of SouthTipperary it can be estimated that:• Almost 1,500 older people in the county are income poor (i.e. “at risk ofpoverty”). These are likely to be women, to be living alone and/or to be livingin rural areas.• Consistent poverty 35 is likely to be experienced by at least 225 older people inthe county who tend to live alone in rented accommodation.27 Layte (1999), p. 52.28 Mapping Poverty. CPA (2005), p. 12ff.29 Prunty (2007), p. 34-35.30 Prunty (2007), p. 36f.31 Prunty (2007), p. 4. According to the 2006 EU-SILC this rate has dropped to 2.1 per cent.32 Compare “Ageing in Ireland Fact File” No. 3, NCAOP 2001, p. 1.33 Prunty (2007), p. 43. and point 19 in Comments and Recommendations Layte (1999).34 Prunty (2007), p. 43.35 In addition to low income, consistent poverty takes into consideration assets of an individual andexpenditure patterns and therefore gives a more accurate picture of deprivation.26

Review of Services for Older People in South Tipperary (2008)• More than 1,000 older people in South Tipperary are at risk of combinedincome poverty and basic deprivation. 36Sources of IncomeAs mentioned above, the income of older people relies heavily on Social Welfarepayments. It is estimated that these constitute between 55 and 70 per cent of theaverage income of older people in Ireland. 37 Those relying on non-contributorypensions are at a higher risk of income poverty than those who are in receipt ofcontributory or occupational pensions. It is estimated that approximately one third ofolder people have occupational pensions. 38Between 7 and 11 per cent of people aged 65 and over earn at least part of theirincome. 39 In April 2006, for example, 8.8 per cent of those over the age of 65 were inemployment; three quarters of them were men. 40 Although there is no legal upper agelimit for employment, employers commonly set retirement ages at 65 or 66 years ofage as part of the terms and conditions of employment, thereby restricting olderpeople from accessing or remaining in the labour market.Social TransfersAge GroupProportionof IncomeSocial Welfare 56%Occupational Pensions 21%Earnings 13%Investment Income 9%Other Income 1%Table 6: Income Sources of Older People 41The CSO estimates that social transfers (i.e. Social Welfare payments and non-cashbenefits) reduced the risk of poverty among older people by over 84 per cent in2006. 42 Table 7 gives an overview of social transfers most commonly paid to olderpeople, which would contribute substantially to this risk reduction. Most of these areadministered by the Department of Social and Family Affairs.PaymentState Pension (Transition)State Pension (Contributory)DescriptionPayable to people aged 65 who haveretired from the workforce.Payable to people from the age of 66who have sufficient social insuranceDSFADSFA36 See: South Tipperary County Development Board: County Development Plan 2003, p. 18.37 Layte (1999) suggests that over 80 per cent of those living alone and 74 per cent who live in ahousehold with other persons rely on Social Welfare pensions. NCAOP, see point 10 of the Commentsand Recommendations. See also: A Social Portrait of Older People, p 16ff.38 Brian Nolan: Poverty and Older People in Ireland.39 Ibid.40 QHNS, adjusted season, table 11 CSO.41 See A Social Portrait of Older People in Ireland, page 17.42 The proportion of older people at risk of poverty dropped from 85.9 before to 13.6 per cent aftersocial transfers in 2006. Compare EU-SILC 2006, p. 8.27

Review of Services for Older People in South Tipperary (2008)State Pension (Non-Contributory)Widow’s/Widower’s Pension(Contributory)Widow’s/Widower’s Pension(Non-Contributory)Early Farm Retirement SchemeLiving Alone IncreaseOver 80 IncreaseIsland AllowanceCentenarian’s Bountycontributions; other income allowed, buttaxableMeans-tested payment to people aged 66or over who do not qualify for StatePension (Contributory). Subject tohabitual residence test.Payable to widows/widowers who havenot remarried and are not cohabiting.PRSI contributions of individual or latespouse are considered.Means-tested payment forwidow’s/widower’s up to and includingage 65 who are not entitled toWidow’s/Widower’s ContributoryPension. Transfers to State Pension(Non-Contributory) at age 66.Payable to retiring farmers between theages of 55 and 66 who satisfy variouscriteria.Additional payment for certain socialwelfare recipients who are living aloneand are aged 66 years or overIncrease in the personal rate of a socialwelfare pension when the recipientreaches age 80Additional allowance for social welfarepensioners aged 66 or over and otherSW recipients who are living on certainislands off the coast of IrelandAward made by the President to markthe 100 th birthday of a person living inIrelandHousehold Benefits Package Electricity/natural gas allowance, free TVlicence and free telephone rentalallowance. Available to people aged 70.Also available to certain recipients of SWpayments aged 66 years and over.Free TravelFree Travel Pass for people aged 66 orover and recipients of certain SWpayments entitling them to free publictransport incl. the schemes under theRural Transport InitiativeNational Fuel SchemeMeans-tested payment for people whocannot afford their own heating costsBereavement GrantPaid on the death of all insured peoplewho satisfy PRSI requirements or on thedeath of certain SW payment recipients.Carer’s AllowanceMeans-tested payment for thoseproviding full-time care to someone.Higher rates for carers aged 66 or over.Carer’s BenefitPayment for those providing full-time careto someone who is ill or incapacitated.Respite Care GrantPaid to carers annually for each personbeing cared for.Age Tax Credit Additional tax credit to people aged 65and over.Medical CardAll those aged 70 years are entitled.Under 70s have to qualify via a meansand needs test.Various Supplement (Heating, Community Welfare OfficerDiet etc.)DSFADSFADSFADAFDSFADSFADSFAOfficeof thePresidentDSFADSFADSFADSFADSFADSFADSFARevenueHSEHSEEssential or Urgent Community Welfare Officer HSETable 7: Social Transfers to Older People28

Review of Services for Older People in South Tipperary (2008)Pension Statistics (see Table 8) would indicate that almost 59 per cent of those olderpeople who are in receipt of a state pension in South Tipperary qualify for thecontributory, almost 40 per cent for the non-contributory and just over 1 per cent forthe State Pension (Transition). It is thought that a large proportion of the noncontributoryState Pension recipients are women who would have worked part or allof their lives in the home.Pension65+RecipientsState Pension (Transition) 1.4%State Pension (Contributory) 58.8%State Pension (Non-Contributory) 39.8%Table 8: Pension Statistics for Co. Tipperary (DSFA March 2008)Anecdotal evidence suggests that a small minority of persons aged 65 and over do notqualify for a State Pension or any of the non-cash benefits. It would appear that asmall group of women are affected in this way, particularly where a lack of socialinsurance contribution (i.e. by those who have worked in the home) is coupled withownership of capital or property (e.g. in the case of a farmer’s wife or widow) thatleads to an exclusion from non-contributory payments on the basis of the means test.Such anomalies in the Social Welfare system are policy issues and are currently fedback to national level via the consultation process that is taking place in the context ofthe Green Paper on Pensions 2008.Other issues highlighted or difficulties reportedly experienced by older people in thecontext of social transfers include:• Women who worked full-time in the home prior to 1994 are at a greatdisadvantage in regard to their state pension rights.• The similarity in current weekly rates for contributory and non-contributoryState Pensions does not adequately reward those qualifying for the former forthe time spent in employment.• The means-testing of the spouse or partner of a recipient of the State Pension(Contributory) presents equity issues where the spouse or partner is penalisedfor having savings and investments which are held jointly in both names forlegal reasons only.• The Living Alone Allowance has not increased substantially since 1996. At€8.00 per week it is completely inadequate.• Widows and widowers under the age of 66 should qualify for the LivingAlone Allowance.• Free travel under the Companion Free Travel Pass is compromised where apass holder is not in a position to undertake the return journey (for example,where a companion accompanies the pass holder on a travel to hospital for aninpatient stay).• The current State Pensions do not support people aged 65 and over who wishto continue in employment as it does not offer any options for deferral.29

Review of Services for Older People in South Tipperary (2008)A mechanism exists within the Citizens Information Service to report social policyissues such as these anomalies in the administration of social transfers to older peopleto the relevant Government Departments.Medical CardsMedical cards contribute significantly to the reduction of poverty rates among lowerincomeolder people, since medical costs are likely to increase with age. At presenteveryone aged 70 or over is entitled to a medical card. Those aged 66-69 or 66 andyounger are entitled to a medical card if they pass a means test or have an entitlementunder EU rules. Medical cards entitle the holder to free GP services, hospital care,dental/optical and aural services, drugs and medicines and medical/surgical andtechnical appliances as well as community care services.The EU-SILC findings of recent years (see Table 9) would indicate that that thepercentage of persons aged 65 and over in Ireland who are in possession of a medicalcard is increasing steadily and in 2006, reached 85.2 per cent. Approximately onethird of people in this age group also have private medical insurance, with one in fiveolder people likely to be availing of both private health insurance and the medicalcard.2004 2005 2006Has a medical card 83.2% 84.6% 85.2%Has private medical insurance 33.5% 33.9% 33.9%Table 9: Findings from the EU-SILC's 2004-2006 for those aged 65+ 43Other Income SupportsOther income supports for older people in the county include concessions offered bypredominantly private, but also some public service providers. These are subject togeographical variances which may lead to anomalies and inequities.An example of this are the charges levied by local authority and privately-run refusecollection services in the county and the waivers or discounts offered to old-agepensioners in this regard. Differences in the waiver/discounts apply under the variousTown, Borough and the County Council(s) and private operators can deemgeographical residence to be a great disadvantage. Anomalies have been highlighted,for example, in the Tipperary Town area where older people who live outside of thetown’s boundaries cannot avail of a waiver of bin charges offered by Tipperary TownCouncil.The cost of funerals has been highlighted as an area which is not currently the subjectof any financial supports, but may be considered in the future if there is a sufficientweight of anecdotal evidence. According to a submission received in the context ofthis research, older people on lower incomes are greatly concerned about the cost of43 EU-SILC 2006, p. 23.30

Review of Services for Older People in South Tipperary (2008)funerals. The attempt to secure funds for one’s own funeral can result in debt, and canpresent mental health problems for the older person and take their focus away fromliving and enjoying life.Concessions for older people to encourage them to participate in cultural, social andphysical activities in their communities have not been investigated in detail by thisreport, but are considered an area worth exploring in the context of enhancing thequality of life for older people in the county.Services in respect of Income SupportsAs outlined above, the majority of income supports in the form of social transfers toolder people in South Tipperary are operated within the framework of nationalpolicies and legislation. Social transfers and non-cash benefits (with the exception ofthose conveyed through the Community Welfare Office and any concessions offeredby specific service providers) follow stringent eligibility rules and are assessed in astandard way across the country.Key organisations involved in the distribution, administration and management ofincome supports for older people, and the provision of information about them,includeAt a primary level• Department of Social and Family Affairs• Community Welfare Officers (HSE)• Citizens Information Service• Money, Advice and Budgeting Service• RevenueAt a secondary level• Local authorities,• Private service providers, and• Cultural or social institutions offering concessions.Primary income support services are accessible in most of the urban centres of SouthTipperary with local offices and outreach clinics. With the exception of theCommunity Welfare Service which has a considerably wider outreach coverage, theseservices can also be accessed via LoCall telephone numbers and dedicated websites.In addition, some of the primary service providers (i.e. Citizens Information Serviceand Community Welfare Officers) are involved in outreach presentations to olderpersons’ community groups.ConclusionsOlder people tend to have lower incomes than the rest of the population. However,lower expenditure needs and the extensive receipt of social transfers and non-cashbenefits have contributed to a significant decrease in the number of older people who31

Review of Services for Older People in South Tipperary (2008)experience income poverty and deprivation. It is estimated that just 2 per cent of theolder people in the county are experiencing consistent poverty, although up to 10 percent are at risk of combined income poverty and basic deprivation. Females, thoseliving alone, and those living in rural areas form the predominant risk groups withinthe older population of the county. However, older people are considerably morelikely to suffer from housing deprivation than income poverty. Since measures tocounter income poverty (i.e. social transfers) are largely administered within anational framework, local poverty intervention efforts should probably focus moreintensely on the housing issue. 44Anomalies and inequities in the administration of social transfers to older people inSouth Tipperary within the national framework are detected and fed back through theCitizens Information Service on an ongoing basis. The current consultation process onthe Green Paper for Pensions is an additional opportunity to influence national policyon income supports for older people.At a local level, efforts should be made to address anomalies in concessions that areoffered to older people by public and private service providers. The provision ofpublic services by the various local authorities, exemplified by the waiver in refuseservice charges, raises equity issues for older people on a geographical basis. Theconcept of consistent concessions for older people across the county could also beadopted by cultural and social service providers to alleviate costs for older people,thereby promoting their participation in such activities.The impact on older people of increasing funeral costs was identified only briefly, butmay be an area worth exploring further in the context of income supports and qualityof life for older people.The primary income support services for older people in South Tipperary are mostaccessible in the urban centres of the county. The outreach clinics held by CommunityWelfare Officers, LoCall telephone numbers and presentations to community groupsprovide additional points of access, particularly for older people in rural areas. Infurther improving income support services for older people, the identified keyorganisations should continue the strategic information provision through anincreasing number of such access points in the future, while identifying and utilisingadditional information access points (i.e. GP surgeries, church parishes etc.).44This will be further explored in the chapter on housing.32

Review of Services for Older People in South Tipperary (2008)Health and CareServices33

Review of Services for Older People in South Tipperary (2008)Health Status of Older PeopleThe health status of older people can have a significant impact on their daily activitiesand can ultimately limit their capacity to live independently, increasing their need forhealth and social care services. Several indicators are used to determine the healthstatus of older people. These include levels of (physical and mental) chronic illness,hospitalisation levels, reported restrictions on daily activities, and self-rated/perceivedhealth status.It is estimated that more than half of the population aged over 65 year has a chronicmental or physical illness, the occurrence of which increases with age as might beexpected. The proportion of older people who report chronic illnesses has been on theincrease in recent years, which is likely to be directly related to longer lifeexpectancy.2004 2005 2006Smokes 14.0% 14.8% 14.5%Has a chronic illness or health problem 50.7% 51.6% 56.1%Table 10: Findings from the EU-SILC's 2004-2006 for those aged 65+ 45The following factors can increase the risk of an older person experiencing chronicillness: 46• Gender: Women are more likely to have a chronic illness or condition as theirlife expectancy is higher.• Education: Older people with lower secondary or less education are morelikely to have a chronic illness or condition than those with upper secondaryeducation or above. 47• Tenure Status: Tenants are considerably more likely to have a chronic illnessthan owner-occupiers.• Poverty: Those in consistent poverty are more likely to have a chronic illnessthan those who are not consistently poor.• Poor Housing Conditions: Poor health and the risk of developing a chronicillness are directly linked to poor living conditions, such as dampness,pollution, grime or lack of central heating.The physical health problems experienced by older people can significantly impact ontheir psychological health and vice versa. It has been proven that women experiencehigher levels of psychological distress than men and that chronic illnesses –particularly those that limit mobility – as well as deprivation and the experience of45 EU-SILC 2006, p. 23.46 Compare Prunty (2007), p. 45-46.47 Education is also a proven factor in self-rated health and future health expectations indicating thateducation plays an important role in facilitating health throughout the lifespan and maintainingindependence. (O’Hanlon, Ann et al.: Health and Social Services for Older People II [HeSSOP II].Changing Profiles from 2000 to 2004. Dublin: National Council on Ageing and Older People 2005 [=Report No. 91], p. 113f.).34

Review of Services for Older People in South Tipperary (2008)consistent poverty notably increase the risk of psychological/mental ill-health. 48 Themajority of older people, however, are in good mental health with two thirds of themexpressing high morale and enjoying positive mental health. Younger age brackets(65-69 and 70-74 years) and those with higher income are more likely to be in thisgroup. 49In addition to experiencing higher levels of chronic illness, older people are more thantwice as likely as those aged 15-64 to spend a night or more in hospital. In 2004, 19.1per cent of older people had in-patient stays in hospital during the previous 12months, compared to 8.8 per cent in the younger age bracket. 50Given that current policy is directed at enabling older people to live independently intheir own homes in their own communities for as long as possible, it is worth notingthe extent, to which older people feel their daily activities are compromised due to illhealth. In 2004, 47 per cent of those aged 65 and over felt that their daily activitieswere limited by their health status; approximately one third of them considered theselimitations to be “strong”. 51 Mobility problems would appear to have a highprevalence within the range of limitations experienced by older people. 52Despite the noted restrictions that health problems pose for older people withincreasing age, their own perception of their health status is strikingly positive. 53 In2004, 58 per cent of people aged 65 and over and 50.2 per cent of people aged 75 andover rated their own health as good or very good. 54 According to other sources, thisfigure could be as high as 75 per cent. 55 This would clearly indicate that older peopleare more accepting of health-related difficulties. The majority of older people alsohold a positive outlook with up to 90 per cent believing that their health would be thesame or better over the coming year. 56Health and Care Services for Older PeopleAccess to medical and care services plays a vital role in maintaining good healthamong older people, thereby reducing the limitations they experience in their dailyactivities. This, in turn, impacts directly on the prolonged capacity of older people tolive independently in their own homes and communities. Delivering health and socialcare services in the community to support people in reaching their full capacity forindependent living respects the wishes of the majority of older people. Living at homewith family support is also found to be the most desired preference of older people inthe event of their needing long-term care, while long-term care in a nursing home istheir least preferred option. 5748 Layte (1999), points 38 and 39 of the “Comments and Recommendations”.49 HeSSOP II, p. 114.50 Prunty (2007), p. 44.51 Compare A Social Portrait of Older People, p. 29 (Figure 25).52 In 1999, almost half of those with a chronic illness also experienced mobility problems. (Layte[1999], point 33 of the “Comments and Recommendations”).53 Comp. Prunty (2007), p. 44f.54 Comp. A Social Portrait of Older People, p. 27 (Figure 23).55 HeSSOP II, p. 113.56 Ibid., p. 113.57 Ibid., p. 178f.35

Review of Services for Older People in South Tipperary (2008)Policy has long recognised these linkages and the importance of home and communitycare services for older people. The National Development Plan 2007-2013 will invest€9.7 billion (or 19.6 per cent of the overall investment) into the “Older PeopleProgramme”, 48.5 per cent of which will go into the sub-programme “Living atHome” which focuses on home care packages, home help and meals-on-wheelsservices, Community Intervention Teams and respite/day care services. 58The Health Service Executive is the single most important statutory agency in termsof the implementation of the “Older People Programme”. In addition to acute medicalservices, it has the overall responsibility for coordinating and providing or supportingthe provision of: 59• Community-based nursing services (i.e. Public Health Nurses),• Home help services,• Day care services,• Meals services,• Therapeutic services (physiotherapy, chiropody, occupational therapy, etc.),• Respite and convalescence services, and• Long-stay care services.The significant contribution of the voluntary sector in providing community-basedservices for older people is most prevalent in the delivery and coordination of daycare and meals services. Informal and family carers constitute the third pillar in thehealth and social care of older people. In fact, up to one third of older people avail ofinformal care through a spouse or partner, relatives in or outside the household andneighbours or voluntary organisations. 60 Within the group of carers for older people, aminority (an estimated 5 to 9 per cent – most of whom are women) is aged 65 andover themselves. One in five of them have their own difficulties in carrying out theactivities of daily living. 61 Older carers are thought to be a particularly vulnerablegroup of carers who are less likely to avail of support services, such as respite care. 62The use of health and social care services by older people in Ireland is relatively wellresearched thanks to two NCAOP related studies in 2000 and 2004. These so-calledHeSSOP-studies (Health and Social Services for Older People) provide valuableinformation on the uptake of services, the attitudes of those who use them and thehealth status of older people in general. Some of the findings present unexpectedchallenges for the delivery of services for older people.The repeat HeSSOP-study in 2004 found, for example, that only a minority of olderpeople avail of community-based services (with the exception of GP services) or useappliances such as mobility aids, presumably because older people are found to beparticularly passive in terms of their approach to healthcare needs and services. 63 Thehigher acceptance of health-related problems among older people, mentioned earlier,58 Comp. NDP 2007-2013, p. 255ff.59 The Community Welfare Office is part of the HSE and expands provision to older people into theareas of income and housing supports.60 HeSSOP II, p. 89 and 114.61 Ibid., p. 114.62 Ibid., p. 114.63 Ibid., p. 222.36

Review of Services for Older People in South Tipperary (2008)is likely to be linked directly to an underestimation of health and social care needs byolder people, which complicates a model of service delivery that is exclusively basedon need.In terms of medical services, HeSSOP II confirmed very high levels of satisfactionwith GP services combined with high levels of continuity of care. 64 This, combinedwith the fact that nursing services provided by Public Health Nurses are the mostcommonly used community-based service for older people (with approximately 15per cent of older people using them regularly 65 ), highlights the important role of theseparts of the health and social care of older people.The same report reached interesting conclusions in the area of community-basedservices:• Home help services: There is relatively low uptake of home help services inIreland by international standards, which is coupled with low levels ofprovision of this facility (thought to be about half that of comparable Europeancountries). Urban dwelling and older age increase the likelihood of a personusing these services. 66• Meals Services: Meals-on-wheels services are more likely to be used by urbandwellers and those in higher income brackets. 67• Day care services: Only two to five per cent of older people use day carecentres. Barriers to the use of day care services include transport difficulties,inconvenience, illness and not enjoying their particular activities. 68The greatest challenge for these community-based services is stigma which has beenproven to act as a major barrier to their uptake. Up to ten per cent of older peoplewould feel stigmatised by and would therefore not use meals-on-wheels, home help orpersonal care services. 69Worryingly, HeSSOP II also confirmed a trend of increasing numbers of people (4-16per cent) paying for community-based health and social care services, which signals asignificant personal investment in health services by older people on the one hand, butalso presents a risk to older people with lower incomes of not being able to afford thesame level and quality of service.There is a common perception that the use of long-stay care is more prevalent than itactually is. It is estimated that only about 5 per cent of the population aged 65 andover is availing of long-stay care, such as nursing homes. 70 An increase in the numberof people availing of private nursing homes correlates with a decrease in the numberof older people in geriatric and psychiatric hospitals in recent years. The most64 HeSSOP II, p. 155 and 223-31.65 HeSSOP I as quoted in Community Care Services. Dublin: National Council on Ageing and OlderPeople 2001 (=Ageing in Ireland Fact File No. 6).66 HeSSOP II, p. 156.67 Ibid., p. 157.68 Ibid., p. 133 and 156.69 Ibid., p. 178f.70 Long Stay Care. Dublin: National Council on Ageing and Older People 2001 (=Ageing in IrelandFact File No. 7).37

Review of Services for Older People in South Tipperary (2008)common reason for residence in long-stay care is chronic physical illness (35 percent), followed by mental disorders (26 per cent) and social reasons (19 per cent).While there are significant differences between the primary medical/social status ofolder people in the various types of long-stay care settings, the proportion of olderpeople who suffer from mental infirmity and dementia has been shown to rangebetween 6 and 24 per cent (again, depending on the care setting). 71 This may also beless than commonly thought.Health and Care Services in South TipperaryThe provision of community-based health and care services in South Tipperary willbe examined in the following section, using information provided by the HSE and thefindings of a survey of voluntary organisations that are involved in their delivery. Ascan be seen from the above, health and care services for older people constitute abroad service area which cannot be examined in a full and in-depth manner as part ofthis research. The focus of this chapter therefore is on providing a synopsis of theservices in the county and highlighting any issues in service delivery that arise in thesurvey. Acute medical services such as GP and hospital services and schemes fordrugs and medicines (i.e. Long-term Illness Scheme, Drugs Payment Scheme, etc.)are not explicitly included in the services review, but may become the subject ofspecific submissions in the context of the other health and care services. 72Nursing ServicesIn addition to the Community Care Centre in Clonmel, the HSE operates 21 localHealth Centres in South Tipperary, which represent the main access point for nursingservices provided by Public Health Nurses.Figure 8: Map of South Tipperary indicating the locations of Local Health Offices71 Department of Health Survey of Long-Stay Units 1996, as quoted in NCAOP Fact File No. 7.72 A lack of GP services has been reported in Cashel, resulting in long waiting times for patients.However, this could not be investigated further as it falls outside the scope of this research.38

Review of Services for Older People in South Tipperary (2008)Although the services offered through Public Health Nurses are not exclusivelytargeted at older people, this age group does constitute a sizeable proportion ofpatients. Nursing services in the health centres are typically offered on a part-timebasis (one to three days per week or half days Monday to Friday) and include legulcer clinics, dressings, and other wound treatments. Home visits to older people whoare incapable of travel or have no transport constitute a considerable part of the workof Public Health Nurses and are usually made outside of clinic hours. Public HealthNurses are also an important point of access for other services, such as day carecentres, meals-on-wheels, home helps and therapeutic services. Needs are assessed onthe basis of the objective of keeping the older person in their home.Home Help ServicesHome help services are coordinated by the HSE. They are usually free of charge toMedical Card holders and are available on the basis of a needs assessment by a PublicHealth Nurse. In the case of non-Medical Card holders in need of home help services,charges apply based on an assessment of financial circumstances. The service is notprovided exclusively to older people, although they constitute the majority of serviceusers. Home helps provide a range of services from light housework, shopping andprovision of meals to personal care, but are not expected to provide nursing ormedical care. Home help services are distinct from Home Care Packages (see below),but may form part of the latter.In 2006, an average 1,335 persons per month were in receipt of home help in SouthTipperary, which was provided by 626 home helps employed by the HSE. 73 Greaterdemand for home help services exists in parts of the county (i.e. in the Tipperaryarea), while the level of skills and qualifications among home helps can be consideredinadequate, particularly in those instances where service users may progress toneeding personal care, rather than home help services.Home Care PackagesHome Care Packages are an administrative scheme aimed mainly at those who requiremedium to high levels of caring support to enable them to continue to live at homeindependently. Home Care Packages are tailored to an individual’s need and mayinclude nursing, therapeutic services, home care attendants and/or home helps. Asopposed to home help services which are available to a variety of clients, older peoplein their own homes and those in acute hospital or long-stay residential care areprioritised under the Home Care Packages scheme, the latter with the purpose ofenabling them to return to their own homes and communities.The scheme is in its infancy in South Tipperary as in most other parts of the country.In 2006, a total of 14 Home Care Packages were deployed. 74 The scheme, which hasevolved from a range of pilot programmes around the country, is expected to receivepriority funding under the new National Development Plan and should be rolled outon a more widespread basis in South Tipperary in the coming years. Anecdotal73 HSE Planning, Monitoring and Evaluation PCCC, December 2006.74 Ibid.39

Review of Services for Older People in South Tipperary (2008)evidence confirms a need for more Home Care Packages in the county, particularlyfor patients who leave convalescent care after a period of hospitalisation.Day ServicesDay services for older people are almost exclusively implemented through day carecentres which provide a range of social and rehabilitative services. Whilst some of theday centres in Ireland are provided directly by the HSE, those located in SouthTipperary are run by voluntary organisations. There are currently eight day carecentres for the elderly in South Tipperary, all of which were surveyed as part of thisresearch (Figure 9). Day care services are also provided through the MillenniumResource Centre in Glengoole to service the area in the north east of the county.Figure 9: Map of Day Care Centres in South TipperaryDay care services are seen as an alternative to hospital or other residential care andform an important pillar in the Government’s policy of enabling older people to liveindependently in their own homes in their own communities for as long as possible.Access to day care centres is by referral, usually through a GP or Public Health Nurse.The range of services provided by the day care centres in South Tipperary varies to asmall degree, but typically consists of transport to and from the centre, meals andsocial, physical and rehabilitative activities including outings. Chiropody andhairdressing are offered less frequently. A few centres also offer medical care(GP/PHN/Opticians), laundry, personal care (i.e. showers) and shopping services. Ingeneral, however, the biggest emphasis in the day centres is on social activities andexercise.40

Review of Services for Older People in South Tipperary (2008)Est.PaidStaffVol.Service/weekServiceusersCahir Day Care Centre 2004 2 5 days 20/day €6/dayCappawhite Day Centre for the Elderly 2004 12 3 days 115/week €7/dayCarrick-on-Suir Day Centre for the Elderly 1984 3 5 days 75/week €6/dayCashel Day Care Centre for the Elderly 1988 5 3 days 60/week €6/dayClonmel Day Care Centre for the Elderly 1990 13 5 days 100/week €5/dayFethard & District Day Care Centre 1996 23 5 days 75/week €6/daySt. Vincent’s Day Care Centre for the Eld. 1989 6 5 days 72/week €5/dayVee Valley Day Care Centre (Clogheen) 1994 4 5 days 70/week €5/dayTable 11: List of Day Care Centres in South TipperaryA survey of the day care centres identified a high level of consistency across thecounty with regard to the management of the centres, service delivery, funding andservice users.According to this, viability issues present by far the biggest threat for the day carecentres and the services they offer. Almost all of the centres reported funding andstaffing difficulties. The financial/funding difficulties experienced by day services inthe county are impacting on their capacity to deliver a quality service, reach andmaintain adequate staffing levels and plan service delivery in the medium- and longterm.These problems appear to be rooted in the following.A substantial amount of funding for the day care centres derives from the HSE underSection 39 of the Health Act 2004, which states: 75Fees(1) The Executive may, subject to any directions given by the Minister under section 10 and onsuch terms and conditions as it sees fit to impose, give assistance to any person or body thatprovides or proposes to provide a service similar or ancillary to a service that the Executivemay provide.(2) Assistance may be provided under this section in any of the following ways:(a) by contributing to the expenses incurred by the person or body;(b) by permitting the use by the person or body of premises maintained by the Executive and, whererequisite, executing alterations and repairs to and supplying furniture and fittings for such premises;(c) by providing premises (with all requisite furniture and fittings) for use by the person or body.(3) Assistance may be provided to a person under this section whether or not the person is aservice provider.Day care centres, like other voluntary service providers, take part in an annualapplication process for Section 39 funding which closes in January. A number ofcentres reported difficulties with the time delay involved in the funding process asfunding for the year may not be confirmed until several months into the year. Inaddition, the budget for the scheme has not increased in recent years, so that the HSEis unable to meet the growing dependency on this particular source of funding byvoluntary service providers. This growing dependency results from the fact that mostday care centres have exhausted community fundraising channels and have increasingdifficulties in sustaining the time input required for fundraising activities in the lightof staff required to meet the demand for quality day services. Although not explicitlystated in the Health Act, the HSE maintains that the intention of Section 39 funding isto facilitate the start-up of services, rather than to sustain (or even develop or expand)them in the longer term.75 Health Act 2004, p. 33f. (= Act no. 42 of 2004).41

Review of Services for Older People in South Tipperary (2008)A solution to this problem will require lobbying the HSE at national level to eitherincrease the Section 39 funding available to the HSE South for elderly services (whichhas been limited to €600,000 annually) or initiating a mainstreaming process for daycare centres in general.In addition to the financial difficulties experienced by the day care centres in SouthTipperary, the following were reported as presenting barriers to quality servicedelivery.• A lack of communication, co-ordination and networking among day carecentres and other services for the elderly in the county: Although some ofthe day care centres are in communication with each other, this is taking placeon an informal level. A formal exchange among the day care centres isdesirable and would offer opportunities for information sharing, jointlobbying, joint training and management support. An extension of such anetwork to other service providers for the elderly would offer an even greaterpotential for integrated service delivery (such an opportunity exists in Cashelbetween the Day Care Centre and St. Patrick’s Hospital for example).• Lack of statutory support and recognition: The current continued absenceof the HSE Co-ordinator for Elderly Services is regrettable in the eyes of mostday care centre managements, who generally report a lack of support fromstatutory agencies. A lack of recognition by the statutory sector is perceived tobe undermining working relationships and efforts to deliver quality services inthe interest of the service users. 76 Long decision-making processes andindecision further compromise the delivery of services by the day care centres.• Staffing: Due to inadequate funds being available to employ permanent staff,a number of day care centres rely on employment schemes and initiativespredominantly organised through FÁS. These lead to high staff turnover andrepeated problems in the up-skilling of new participants. The relatively lowwages available through the schemes are perceived as obstacles to recruitingadequately qualified and motivated staff.• Lack of subsidies for services: The services offered by the day care centresare not sufficiently subsidised. Anecdotal evidence would suggest fundingissues in respect of community-based services which are offered within thesetting of day care centres. However, this requires further investigation. 77• Service user restrictions imposed by the HSE: Several day care centresview the exclusion of nursing home residents from their client base as anobstacle to integrated service delivery in the interest of the user. Allowingnursing home residents to use the day care centres would enable existing userswho move into long-term care to continue participation in day care centreactivities, thereby reducing the high client turnover experienced by the centres.In addition, it would address the lack of stimulation/activities for nursinghome residents, which is reported by nursing homes and the wider community.76 One day care centre viewed the relationship with the HSE and other statutory agencies exclusivelypositively. Incidentally, this day care centre is located in the immediate vicinity of these agencies.77 Feedback from day care centres would suggest that services (i.e. chiropody) which are reportedlyfree to Medical Card holders outside of the day care system incur charges if used within the setting of aday care centre.42

Review of Services for Older People in South Tipperary (2008)• Stigma: A number of day care centres identified their reputation among thegeneral public as a barrier to service usage and wider community support.Access to the service depends on the referral of Public Health Nurses and GPsand this may in itself contribute to the perception among potential serviceusers that day care centres are “the last resort” before moving into full-timecare. However, once involved in the activities of the centres, service usersquickly recognise the value of the service. A more accurate public image ofthe service is therefore desirable both from the perspective of service providerand service user. A name change was also suggested on the basis of theconnotations that are associated with the term “day care”.• Restrictions imposed by the voluntary setting of the centres: A number ofday care centres reported difficulties arising from the voluntary status of theirorganisation. These range from restricted capability of the managementcommittees to a lack of volunteers and demand for more volunteeringopportunities. Competitive relationships with other voluntary organisations(i.e. for funding or service users) pose additional difficulties in somecommunities.• Inadequate facilities: In some instances, day service delivery is compromisedby structural issues. Cashel Day Care Centre, for example, comprises of twounconnected buildings requiring service users to cross a road in order to availof showering, nursing and therapeutic facilities or services.• Coordination of service provision: Feedback from day care centres inrespect of service take-up and demand is somewhat conflicting and wouldrequire further investigation. Waiting lists in some centres would suggest thatthere is a higher demand for day care places than are available. Other centreshave vacancies and are reporting difficulties in sustaining service usernumbers. This, however, may have to be considered in the light of accessbarriers such as transport, security issues and stigma.Meals ServicesThe meals-on-wheels service provides meals to older people living in their own home.Need for the service is usually assessed by a Public Health Nurse or by the voluntarycommittee running the service. Similar to day care centres, meals-on-wheels servicestypically receive funding through Section 39 of the Health Act 2004. At present,meals-on-wheels services are the only service type in South Tipperary for whichdevelopment funds are available.Meals-on-wheels services presently operate in• Clonmel (Mary Aikenhead Meals-on-Wheels)• Cahir (soon to be operated from Cahir Day Care Centre)• Carrick-on-Suir• Fethard• Tipperary (through Tipperary Community Services)• Glengoole (through Millennium FRC)The services provided vary greatly with some being run on a few days and some fivedays per week; some exclusively on a voluntary basis with others having the support43

Review of Services for Older People in South Tipperary (2008)of or exclusively by paid staff. The majority of meals-on-wheels services have been inexistence for 40 years and more.In general, the services play a very important role, not only in providing meals, butalso in offering opportunities for social contact for older people who live in their ownhomes. Like day care centres, they contribute significantly to enabling older people tolive independently in their own homes in their own communities for as long aspossible.Issues highlighted by the meals-on-wheels services who participated in the surveyinclude:• Funding: Although many report joind-up initiatives and financial supportthrough other community organisations and, in some cases, generous privateand business donations, funding levels are inadequate and longer-term fundingfrom committed sources would be welcome.• Recruitment: The number of hours, for which paid staff are required, wouldappear to be unattractive to potential applicants (e.g. not enough hours or atwrong time of the day). The transition of an organisation exclusively run byvolunteers to a voluntary organisation with professional support is thereforeparticularly difficult for some of the meals-on-wheels services.• Service Expansion: The insecurity and delay in the administration of fundingapplications to statutory agencies prevent the planning of medium-term servicedelivery and service development/expansion.• FÁS Employment Schemes: The meals-on-wheels services in Cashel andTipperary have been changed to operate under a FÁS CommunityEmployment Scheme. These arrangements would appear to be the result ofisolated local efforts rather than a general policy.Meals-on-wheels services do not extend to the entire county. In some areas, homehelps will provide similar services. However, some areas of the county are reported toleave older people isolated in their homes isolated without the option of a hot meal(e.g. Killenaule, Emly, Ballymacarbery).Therapeutic/Community Care ServicesTherapeutic or community care services for older people are understood to include thefollowing:• Occupational therapy services help older people with disabilities to liveindependently at home and include the provision of medical, surgical andsafety equipment and adaptations to the home/environment.• Speech & language therapy is available for older people who have problemswith communication and/or swallowing disorders.• Physiotherapy addresses the physical needs of a patient and their treatment. Italso advocates independence in the home environment.• Chiropody services (or foot care) help maintain mobility in old age. They areavailable, amongst others, through day care centres.44

Review of Services for Older People in South Tipperary (2008)• Ophthalmic services provide specialist clinics for (older) people with eyecomplaints.• Nutritionists provide practical advice on healthy eating and are available totrain, update and advise those who care for older people.Some of the professionals offering these services provide home visits on a regularbasis. Community care services are reported to be inadequate or inaccessible for olderpeople in some parts of the county (e.g. in Mullinahone, Carrick-on-Suir, Holycross,Dundrum, Cashel), but were not investigated in more depth in the context of thisresearch. Anecdotal evidence would, however, indicate extensive waiting periods forcommunity-based therapeutic services, particularly if patients require home visits.Respite, Convalescence and Long-Stay ServicesRespite, convalescence and long-stay services are predominantly provided through anetwork of nursing homes and district hospitals. According to the HSE, there arecurrently 18 private and 5 public nursing homes in South Tipperary which provide atotal of 901 beds, 622 of which are private and 279 public. 78 Respite beds areavailable in most of the private nursing homes, while the district hospitals inClogheen (St. Theresa’s) and Carrick-on-Suir (St. Bridget’s) provide respite andconvalescent services exclusively. The latter are supported by a unique local initiativeentitled “Clinical Winter Initiative”, based on which the HSE will pay for any olderperson’s convalescence stay for up to one week, regardless of their entitlement to aMedical Card.Figure 10: Map of long-stay, respite and convalescence services in South TipperaryThe cost of a place in a private nursing home ranges from €550 to €700/week.However, older people requiring long-term care can avail of a subvention schemeoperated by the HSE. A revised scheme, entitled “A Fair Deal on Nursing Home Care78 HSE Planning, Monitoring and Evaluation PCCC, August 2006. These figures may have changedslightly in 2007. Public nursing homes include the district hospitals in Clogheen and Carrick-on-Suir.45

Review of Services for Older People in South Tipperary (2008)Support Scheme”, was supposed to come into effect in January 2008 removing equityissues that previously existed between the subvention of public and private long-staycare. An average of 363 persons per month are in receipt of Nursing HomeSubvention in South Tipperary and would be affected by the new legislation. 79However, the introduction of the new scheme has been delayed due to legalobstacles. 80According to a survey of private nursing homes in South Tipperary as part of thisresearch, the demand and the supply of private long-term care are in balance in thecounty despite seasonal variances. Issues in relation to services for older people thatwere highlighted by the private nursing homes are as follows:• There is an unsatisfied demand for community care/therapeutic servicesincluding speech & language, occupational therapy and physiotherapy.• Nursing home residents are excluded from day care centres’ activities. 81 Thisis particularly disappointing for those residents who do not suffer dementiaand who would benefit from extended social contact and varied day timeactivities.• There is a shortage of (Irish) nurses available to work in long-term residentialcare, resulting in more lengthy recruitment and training processes for non-Irishstaff. Staff retention also presents a difficulty in the light of higher publicsector pay.• Administrative demands and regulations complicate the work of nursing homemanagement and staff and take up time that it is perceived could be betterspent on residents’ care.• Equity issues arise where nursing home residents avail of external medicalservices. Recent changes in regulations impose charges for out-of-hours GPservices used by resident Medical Card holders as well as for the transport tonon-acute services which were previously covered by the HSE.• Access to outpatient services and the long waiting periods involved in sameare perceived as a particular strain on nursing home residents and older peoplein general.• Although a number of nursing homes reported good support from thecommunity, most would welcome more involvement from voluntary groups intheir area, particularly in providing external social contacts for those residentswhose only contact is with fellow residents and nursing home staff.The public nursing homes in South Tipperary include:• Cluain Árann Residential Welfare Home, Tipperary• St. Patrick’s Hospital, Cashel• St. Anthony’s Unit, Clonmel• St. Theresa’s Hospital, Clogheen• St. Brigid’s Hospital, Carrick-on-Suir79 Ibid.80 Press releases on 27 March 2008 confirm that the “Fair Deal” scheme “has been beset by legalobstacles, in particular constitutional issues regarding the right to property”, so that the scheme hasbeen delayed indefinitely (The Irish Times, 27/03/2008).81 See also the chapter on day care centres above.46

Review of Services for Older People in South Tipperary (2008)The lack of sufficient public long-stay beds for the elderly who may not be able toafford private residential care has been highlighted in the political context, 82 but willbe partially addressed by the revised Nursing Home Subvention Scheme (see above).The voluntary organisation “Friends of Cluain Árann” operates in the context of thepublic residential care system. The work of the group offers a model of good practicethat could be adopted by communities hosting private nursing homes in an effort toaddress the social needs of nursing home residents mentioned above. The mainobjective of “Friends of Cluain Árann” is to provide a social outlet for residents ofCluain Árann Residential Welfare Home in Tipperary, by way of visiting, playingsocial games, organising musical entertainment and hosting festivities such asChristmas parties. While the group faces obstacles that are characteristic of thevoluntary sector (i.e. lack of funds, succession of volunteers and support/recognitionfrom the statutory sector), their work is quite valuable and with integrated, joined-upthinking could easily be expanded in a cost-effective manner (i.e. occasional use ofthe other organisations’ minibuses to save transport costs).Elder Abuse ServiceA social work service for people aged 65 and over who may be suffering from abuse(physical, sexual, financial, emotional) is currently provided in South Tipperarythrough a Senior Case Worker for Elder Abuse employed by the HSE. The recent setupof the service follows the implementation of the report Protecting our Future andis overseen by an Elder Abuse National Implementation Group under the auspices ofthe Department of Health and Children.Clients are referred through Public Health Nurses, members of the community orthrough acute medical services, although self-referrals are also possible. 83 Eachreferral is assessed by means of a case conference. In the six months between October2007 and March 2008, 35 clients were referred to the service. Estimates in thenational and international context would suggest that between 300 and 500 olderpeople in South Tipperary could be suffering from abuse. 84 Reported elder abuse inSouth Tipperary most commonly involves financial abuse, domestic violence, selfneglect,isolation and depression. Cuan Saor Women’s Refuge can confirm incidencesof domestic violence experienced by older women who access their services.According to this service, older women constitute a particularly vulnerable group oftheir clients as they have often suffered from domestic violence all their married lifeand find the time following the decision to leave the family home especially isolatingand lonely.82 Repeatedly by former TD Seamus Healy. Comp. Dáil Éireann, Volume 624, debate on 28/09/2006.83 Self-referrals should contact the Senior Case Worker for Elder Abuse at the Community Care Centrein Clonmel. The service will be further publicised in connection with the “World Elder Abuse Day2 on15 th June 2008.84 This estimate is based on information from the Irish Nurses Organisation 2004 [Source: ###] andAnne O’Loughlin et al.: Abuse, Neglect and Mistreatment of Older People: An Exploratory Study.Dublin: NCAOP 1998 (Report No. 52), point 2 of the Council’s Comments and Recommendations:“The international literature suggests that around three per cent of older people in the community sufferfrom some form of domestic abuse, neglect or mistreatment at any one time.”47

Review of Services for Older People in South Tipperary (2008)Abuse experienced by an older person in their home can present a difficult situation;particularly, if circumstances prevent the person from leaving. Depending on ability,residential care or external services to support the person in their home areconsidered. Referrals to the Care of the Aged Psychiatric Team are also common.Measures to address elder abuse in South Tipperary are reportedly made moredifficult due to the following issues:• There is no dedicated psychologist or counselling service in South Tipperaryfor people aged 65 and over. Mental health problems experienced by olderpeople are therefore often left untreated.• There is a lack of short-term emergency beds for older people who suffer fromabuse and are in a time of crisis. Hospitals are likely to offer suchaccommodation only on an overnight-basis, which is often too short to providethe necessary time and safety to address the crisis situation.• A new “Adult Care Order” is awaited to address the legal situation of olderpeople who do not have a psychiatric disorder or suffer from dementia and thepower of authorities to remove them from an abusive situation. At present,human rights legislation prevents authorities from acting in such cases.A submission received from a member of the general public, which refers to elderabuse in the setting of acute medical services (hospitals) due to a neglect of basiccleanliness of facilities and staff, could not be validated within the remit of this report.Active Listening Service for Older People“Good Morning South Tipperary” is a free and confidential telephone service forolder and vulnerable people in South Tipperary which is currently operated in theNewcastle area. The objective of this service is to address the health and social needsof older people who live alone in rural areas of the county. At present, telephone callsare made to registered older people one morning per week to check on their health andwellbeing. It is hoped that the service would expand to other areas in the county in thefuture.Personal AlarmsIssues have been reported in relation to personal alarms that are supplied to olderpeople by voluntary groups. Under the “Scheme of Community Support for OlderPeople”, which is administered by the Department of Community, Rural andGaeltacht Affairs, voluntary groups can access grants to provide small-scale securityequipment or socially monitored alarm systems (such as the “panic button” pendantwhich is worn around the neck or wrist and operated via the telephone) to olderpeople in their community. The grant scheme is taken up by a range of voluntarygroups in South Tipperary including The Carer’s Association, Muintir na Tire,Neighbourhood Watch and Community Alert groups, as well as day care centres.Access to personal alarms consequently varies greatly in different parts of the countyas it depends on the nature and location of the group that availed of the scheme.Public Health Nurses play a pivotal role in mediating between people in need of apersonal alarm and the voluntary groups who are in a position to provide them.48

Review of Services for Older People in South Tipperary (2008)However, this is leading to complex issues in relation to responsibility for thesealarms. A lack of maintenance and follow-up support once the alarms are supplied isalso problematic. It is therefore essential from the perspective of the older person whouses a personal alarm system that a more co-ordinated approach is adopted at countylevel to accessing the Scheme of Community Support for Older People, supplyingalarms and providing the necessary level of continued (maintenance) support.Support for Carers of the ElderlyCarers of the elderly can avail of various entitlements open to all carers (Carer’sLeave, Carer’s Benefit, Carer’s Allowance, Respite Grant, etc.) and are also supportedby a small number of voluntary organisations such as the Carers Association, theAlzheimer’s Society and the Clonmel Stroke Club. The South Tipperary branch of theCarers Association, which is based in Clonmel, represents family carers and offersthem training, information, advocacy, and emotional support and respite services. TheAlzheimer’s Society aims to provide people with all forms of dementia, their familiesand carers with the necessary support to improve their quality of life. The ClonmelStroke Club offers social activities for stroke victims and their helpers as well asemotional support and information.ConclusionsIt was outlined in the chapter on “Older People and National Policy” that the vision ofgovernment is to support older people in maintaining their health and wellbeing, inliving active and full lives, independently in their own homes and communities for aslong as possible. The health and social care services in South Tipperary which werereviewed in this chapter contribute significantly to the realisation of this vision fromthe perspective of the older person.The review of nursing, home help, day care, meals, therapeutic, respite/convalescenceand long-stay care services focused on the role of the HSE as the main statutoryagency involved in the provision of these services and surveyed a large number ofvoluntary organisations which deliver part of these services with the support of theHSE. Acute medical services were outside the scope of this research.Public Health Nurses are found to play a pivotal role in the accessibility of health andsocial care services from the perspective of the older person who is in need of theseservices. Public Health Nurses, alongside other medical professionals such as GP’s,will refer potential users to day care, meals and community care services and assessthe need for home supports.While the locations of 21 local health centres offer widespread access to Public HealthNurses across South Tipperary, some of the other primary care services are providedwith notable geographic variance. This is particularly true for meals and communitycare (i.e. therapeutic) services, but also applies to day care centres and home helpservices. Efforts should go toward addressing such imbalances to ensure thatgeographical residence does not determine the availability and accessibility of49

Review of Services for Older People in South Tipperary (2008)services for potential users. It is understood that the HSE is currently in the process ofrestructuring primary care services to address some of these issues. 85Those services predominantly provided by the voluntary sector (i.e. day care andmeals services) are proving particularly important in achieving the visions set out forolder people in the National Action Plan for Social Inclusion and other policydocuments. These services were also found to be most vulnerable with regard to theirsustainability and their capacity to meet growing demand. The example of the daycare centres showed complex funding issues (particularly in relation to Section 39 ofthe 2004 Health Act), which can only be overcome if the HSE is lobbied at executivelevel to either increase funding for such services in South Tipperary or initiate theirprogression into mainstream service provision.In the meantime, the delivery of voluntary services in South Tipperary can beimproved by better networking, sharing of resources, improved support andrecognition from statutory agencies at local level, removing restrictive service userguidelines, equipping voluntary committees with adequate information on publicservice delivery, promoting voluntary services and working toward their coveragecountywide.Finally, this chapter showed a substantial need for services that address the socialneeds of older people who are nursing home residents or who live in isolation. Thiswill be explored further in the chapter on social activities and recreation as well as inthat on transport. In many cases, the lack of adequate transport represents the solebarrier to older people participating in social life. In other cases befriending/visitingservices and listening/telephone services constitute innovative models that addressthese needs. Voluntary organisations such as “Friends of Cluain Árann” and “GoodMorning South Tipperary” certainly provide good working models in South Tipperaryin this regard and should be adequately supported and possibly adopted on acountywide basis.85 This is taking place in the context of implementing a health strategy entitled “Primary Care. A NewDirection. Quality and Fairness – A Health System for You” (DOHC 2001).50

Review of Services for Older People in South Tipperary (2008)Social & RecreationalServices51

Review of Services for Older People in South Tipperary (2008)Social Interaction and ParticipationIt was highlighted earlier in this report that terms such as social exclusion, povertyand deprivation has strong monetary connotations while the discourse on health andsocial care is commonly based on strictly medical perspectives. This means that otherfactors adding to the quality of life of older people are easily overlooked. Socialinteraction and participation are such factors, the importance of which is oftenunderestimated. They lie outside the concept of public service delivery, particularlywhere it is understood to be the sole responsibility of an individual. It is alsoovershadowed by the common perception that social isolation is irrevocably linked toincreasing age. Yet, it can have a significant impact on a person’s quality of life,health and, generally, his or her social inclusion.Research has repeatedly challenged suggestions that older people are per se at agreater risk of social isolation than the rest of the population. 86 Several studies haveshown, to the contrary, that older people in Ireland enjoy great social support – muchgreater than, for example, their European contemporaries. They are less likely to livealone and even those, who do live alone, do not show lower levels of interaction withpeople outside the home than those who live among kin. 87 HeSSOP showed, inaddition, that 80 per cent of older people are in receipt of emotional support, 85 percent informational support and 75 per cent practical support, 88 which would confirmthat the vast majority of older people enjoy high levels of social support. This isfurther supported by a study in 2004, according to which 73.2 per cent of respondentsindicated that they availed of locally integrated support networks and closerelationships with family, friends and neighbours. 89 Participation in church andcommunity activities was also high, with 90 per cent of older people regularly oroccasionally attending religious services and over half of the sample attendingcommunity groups. 90It is nevertheless true that an estimated 7 to 15 per cent of older people experiencesocial isolation and/or loneliness. HeSSOP II found that one in ten older peoplereported finding it very difficult or impossible to visit others or attend social eventsoutside of their homes. 91 Seven to 15 per cent of older people reported feeling lonelyquite or very often, while living alone increased the likelihood of loneliness at leastthreefold. 92 It has also been shown that older people in rural areas are at a greater riskof losing contact with friends, neighbours and relatives than urban dwellers. Similarly,rural elderly are less likely to participate in social activities and organisations. 93Contrary to common perception, increasing age does not in itself constitute a barrierto social participation. Age merely links with gender, income, education, health andtransport to form more complex impediments. Lower educational attainment and86 See Layte (1999), point 40 of the Council’s Comments and Recommendations.87 Ibid.88 HeSSOP II, p. 115.89 Treacy, Pearl et al.: Loneliness and Social Isolation among Older People. Dublin: NCAOP 2004 (=Report no. 84), p. 16.90 Ibid.91 HeSSOP II, p. 114 and 221.92 Ibid., p. 115.93 Layte (1999), point 42 of the Council’s Comments and Recommendations.52

Review of Services for Older People in South Tipperary (2008)lower income, for example, have been proven to increase an individual’s risk ofexperiencing social isolation. 94 Research has also shown that older women living inrural areas are less likely to have contact with others than older rural men. 95 Finally,limitations in physical capacity, which are likely to increase with age, can constitute asignificant barrier to social participation, particularly when mobility becomesrestricted. 96The link between age, transport and social participation is possibly the mostsignificant from the point of view of public service delivery. This link is most evidentin the lower levels of engagement of older people in rural areas and has beenconfirmed repeatedly by surveys that cite the lack of access to suitable transport as themost critical factor in the social lives of older people. 97A recent NCAOP study on Loneliness and Social Isolation among Older People 98 hasprovided valuable insights into the different concepts of social isolation and lonelinessthat may result from the existence of participation barriers. 99Loneliness can be categorised as social, family or romantic loneliness (absence of afriend or partner), with the latter being found to be most prevalent among olderpeople. Ways to prevent and alleviate loneliness, as highlighted by this study, includeavailing of opportunities to get out of the home (i.e. to shop, walk, travel or simplyinteract with other people), but also employing specific strategies aimed atmaintaining healthy social networks. 100Social isolation is different from, but may include feelings of loneliness. It is alsocharacterised by vulnerability to injury and damage of personal belongings,insufficient company, poor relationships and lonely times, particularly at times whenit is hard to attain or maintain social interaction. Social isolation can be effectivelyalleviated by communication and safety technologies, such as personal alarms andtelephones. 101In addition to exploring the concepts of loneliness and social isolation, the NCAOPstudy highlighted necessary economic, social, information and personal resources that94 Older people with post-primary level of education are thought to be three times less likely to besocially isolated than their contemporise with solely primary level of education (HeSSOP II, p. 114f.).Income poverty is though to be linked to a greater risk of losing contact with friends and family afterage 69 (Layte [1999], point 41), not, however, with neighbours.95 A Social Portrait of Older People in Ireland, p. 31.96 HeSSOP II, p. 114.97 HeSSOP II, p. 114. See also Layte (1999) and Treacy (2004:4). Please note that transport isexamined in a separate chapter as part of this report.98 Treacy, Pearl et al.: Loneliness and Social Isolation among Older People. Dublin: NCAOP 2004 (=Report no. 84).99 The NCAOP recommends in this report that an “At Risk of Loneliness and Social Isolation Index” bedeveloped that could be used in conjunction with the Primary Care Strategy to identify vulnerable olderpeople (comp. Treacy [2004], p. 3).100The following four strategies to prevent and alleviate loneliness were identified by the study: (1)have family and friends involved in either caring or visiting, (2) engage in church-related activities, (3)participate in organised clubs and activities and (4) pursue personal hobbies (although these are likelyto be home-based). Comp. Treacy (2004), p. 17.101 Ibid., p. 17f.53

Review of Services for Older People in South Tipperary (2008)support older people in maintaining meaningful social networks and interaction.These are summarised in Table 12 below. 102Type of Barrier Barrier Recommended MeasuresPhysical Restricted mobility • Senior Help Lines• Home visits by voluntary organisations,• Advocacy servicesEnvironmental Lack of transport • Expand rural transport (Ring-a-Link)Inaccessible transport • Implement recommendations of theNational Disability Authority with regard toaccessibility of public transportLack of opportunities forsocialisation within thelocal community• Address lack of funding, premises andpeople with the necessary skills todevelop a programme of activities (utilisethe capacity of South Tipperary VolunteerCentre)• Address public liability insurance costissue for community groups for olderpeople• Inform community groups about fundingsources at local, regional and nationallevel• Develop a “National Falls PreventionStrategy”Restricted mobility after afall or fear of fallingPsychological Lack of motivation • Encourage older people to develop theirpersonal resources (incl. self-perceptionand positive thinking)• Support older people in transition times(i.e. bereavements)• Develop mental health services for olderpeople• Utilise health promotion practitioners toraise awareness of mental health for olderpeople at community levelInformationLack of information to planfor transition times• Pilot an Action Plan for informationprovision to older people as developed bythe NCAOP 103Table 12: Barriers to "Getting out of the house"For the purposes of providing adequate public services, the measures presented inTable 12 can also be summarised in a number of intervention strategies whichgenerally seek to improve people’s social networks with the aim of increasing theirlikelihood of social interaction. These are: 104• To facilitate social interactions and individual-level coping mechanisms usedby older people to prevent and/or alleviate loneliness (visiting and befriendinginterventions, interventions that enable people to stay in their homes,interventions aimed at providing alternative, suitable accommodation)• To improve older people’s access to public transport in order to enhancemobility thereby improving social networks (rural transport initiative or fundsto finance taxi services)102 Ibid., p. 4-7 and references throughout the report.103 In: Ruddle, Helen et al.: Meeting the Health, Social Care and Welfare Services Information Needs ofOlder People. Dublin: NCAOP 2002.104 Comp. Treacy (2004), p. 18f. and 144ff.54

Review of Services for Older People in South Tipperary (2008)• To promote the development and organisation of group social activities forolder people within their community (group activities, day centres, socialcentres, etc.)• To provide information on local services through a range of mediaCo-ordinated public services that adopt these principles and encourage the socialparticipation of older people will not only benefit the individual’s quality of life, butwill also decrease the number of older people at risk of social exclusion.Some of the measures which address issues of loneliness and isolation among olderpeople in South Tipperary and/or which actively encourage social participation(including recreational and educational activities) are explored in the followingsections. Others (such as rural transport initiatives, day care centres, measures toenable people to stay in their homes for as long as possible) were considered in otherchapters, and should considered in the context of social integration in mind.Active Retirement Associations and Social ClubsActive Retirement Associations and Senior Citizens’ or similar Social Clubscontribute significantly to intervention strategies that are based on group activities.These organisations are generally controlled by older people themselves. Theirobjective is to establish a range of activities for older people in areas such as sports &leisure, education, art & culture, and travel. As opposed to Senior Citizens’ andsimilar Social Clubs, Active Retirement Associations are affiliated with and activelysupported by Active Retirement Ireland (formerly: The Federation of ActiveRetirement Associations).There are currently ten Active Retirement Associations in South Tipperary. The exactnumber of Senior Citizens’ and other similar Social Clubs for older people is difficultto establish as these are more likely to be run on an informal basis, or as part of otherstructures (i.e. Church parish, Community Council, etc.). However, figure 11illustrates that these groups exist only sporadically and are not available in all areas ofthe county. In how far this can be influenced by strategic service provision is notclear, as the setup of such groups relies heavily on the initiative of the local (older)community. At the same time, social groups in rural communities are experiencing aparticularly competitive environment for community and voluntary work, which isexpressed in conflicts over membership and funding.In order to explore these and other issues in the provision of group activities for olderpeople, a survey was undertaken as part of this research, which included 25 voluntarysocial groups. The sample comprised of 8 Active Retirement Associations, 7 SeniorCitizens’ (or similar) Clubs, 7 ICA 105 Guilds and 3 Ladies’ Clubs. Although the IrishCountrywomen’s Association does not restrict membership to older people andwelcomes members 18 years and older, it was found to have a large proportion offemale members from older age groups. Ladies’ Clubs are similar in this regard. Inaddition, they often provide services to older people in their communities.105 Irish Country Women’s Association.55

Review of Services for Older People in South Tipperary (2008)Figure 11: Map indicating Active Retirement Associations and Social Clubs for Older Peoplein South TipperaryThe groups varied significantly in size (based on membership numbers which rangedfrom 12 to 250) and geographical remit. These variances were consistent among thesubgroups also: membership numbers in the Active Retirement Associations (ARAs)ranged from 20 to 116, in the Senior Citizens’ Clubs from 25 to 250, in ICA guildsfrom 14 to 46 and in the Ladies’ Clubs from 12 to 37. Those groups that are open toboth males and females had a large majority of female members. The participationrate of men in the ARAs and Senior Citizens’ Clubs typically ranged from 0 to 25 percent (in only one case were male and female members equally represented) andaveraged around 10 per cent. Small numbers of non-Irish nationals were found to bemembers in four of the 25 groups and these were UK nationals only.The bottom age limit that applied to membership of the ARAs and Senior Citizens’Clubs ranged from 50 to 65 years of age. Senior Citizens’ Clubs showed the largestproportion of members in the older age brackets (32% average 80 years and oldercompared to 13% in ARAs). ICA Guilds also tended to have larger proportions ofolder members with an average 33 per cent being aged 70 years and over and 10 percent 80 years and over.Active Retirement Associations were generally in existence for a lesser period of timethan any of the other categories. ICA Guilds were, on average, in existence thelongest. Membership fees, where applicable, ranged from €5 to €36 annually.Asked to name any issues in relation to the composition of their groups, 40 per centstated they did not have enough members, 20 per cent would welcome youngermembers (most of these were ICA guilds), 12 per cent reported difficulties inattracting male members (all of these were ARAs), and 8 per cent stated that spacerestrictions had forced them to introduce waiting lists for people interested in joiningthe group. Twenty-eight per cent of the groups had no difficulties relating tomembership. Issues also emerged that are experienced by many voluntary groups ofall types. These included the difficulty in sustaining membership numbers (i.e.“keeping people interested”), in encouraging members to take up responsibilities, andin encouraging inactive members to get involved in activities. The public image of a56

Review of Services for Older People in South Tipperary (2008)group and competition among groups for members were perceived as the greatestbarriers to increasing and/or sustaining membership numbers.The activities offered by the four types of groups were found to be quite similar andfrequently involved social games, physical exercise, musical entertainment,educational activities (lectures/guest speakers and courses), festivities and travelling.The frequency and consistency of these activities, however, varied significantly withsome groups offering several activities per week and others offering a limited numberon a monthly basis. In addition to the social activities mentioned, ICA guilds andLadies’ Clubs were also involved in fundraising for other charities or providingservices to the community, such as visiting older or bereaved people. In some areas,there was an overlap of activities and groups, which may have an impact on themembership issues referred to above. Such overlaps and associated public imageissues can also be seen in the example of one group which progressed from being aWidow’s Association to being a Ladies Club in an attempt to open up to newmembers.The survey also found significant differences in respect of the funding situations ofthese groups. With the exception of groups that could not avail of a public meetingplace (i.e. due to a lack of a community hall such as in Golden), 85 per cent of thegroups were paying rental charges ranging from €10 to €35 per meeting. One quarterof the groups had never received formal public funding; most of these groups reportedto have no need for funding as their costs were covered by membership subsidies andminimal fundraising efforts. A further one quarter of groups was in receipt of fundingfrom multiple sources. Twelve per cent of the groups reported failed fundingapplications or the loss of a funding source.Of those groups in receipt of single or multiple-sourced public funding:• 74 per cent received funding through the “Go for Life”-Scheme administeredby the South Tipperary Sports Partnership• 26 per cent received funding from the VEC• 21 per cent received funding from the HSE under Section 39• 21 per cent received funding from other sources (including business donationsand funding from affiliation bodies)Almost half of the groups (44 per cent) reported fundraising activities on their ownbehalf. ARAs were less likely to be engaged in fundraising than Senior Citizens’Clubs. ICA guilds were most likely to fundraise, but often do so on behalf of othercharities and the community.The issues experienced by the groups in respect of funding are two-fold: informationon how and where to access funding is most needed; this is followed by an expressedneed for specific items or activities (which include room hire, outings, transport,chiropodist services, and insurance).Social groups for older people would appear to lack networking opportunities andstatutory supports to operate to their full capacity. ARAs and ICAs were most likelyto network amongst their own (due to the support from their national structures),while Senior Citizens’ Clubs and Ladies’ Clubs tend to operate in isolation from57

Review of Services for Older People in South Tipperary (2008)similar-minded groups. For example: 75 per cent of ARAs stated they were in regularcontact with other ARAs (partially through regional networks) compared to 29 percent of Senior Citizens’ Clubs. Only 40 per cent of all surveyed groups were incontact with other voluntary groups in their communities or with providers of servicesfor older people (day care centres, nursing homes, health centres). Just over half (56per cent) stated that they were members of the South Tipperary Community &Voluntary Forum.When asked what could be done to support their group better, the following needswere expressed• A strategy to promote social groups for older people to help them attractmore/younger/male members• Improved information provision on rights and entitlements• Improved support structures (incl. transport to and from activities, affordableand safe public meeting places, help with public liability insurance issues)• Better funding to enable groups to offer a variety of activities and coverrecurring costs in a bid to minimise fundraising activities• Support to maximise the voluntary capacity of groups (skills training,recruitment of new volunteers, administration etc.)It would appear that the voluntary groups providing social activities for older peopleare particularly vulnerable to the current changes in the community and voluntarysector. Most of these groups are run from the perspective of a voluntary ethos that isunlikely to be passed on to younger generations. At the same time, these groups arefacing issues experienced by many voluntary groups in respect of a growingexpectation of professionalism, higher costs and inadequate infrastructure.Visiting and Befriending InterventionsVisiting and befriending services for older people are even more sporadicallyavailable in the county than social activity groups, and in addition lack any formal orstrategic basis. With the exception of “South Tipperary Befriending”, a relativelyyoung group offering this type of service to people who suffer from mental ill-health(regardless of age), there is no formalised dedicated visiting and befriending serviceavailable to older people in South Tipperary. The telephone service “Good MorningSouth Tipperary”, as discussed in the chapter on health and social care services, –whilst welcome – can address social isolation only on an acute, but basic level.The need for strategic visiting and befriending interventions in South Tipperarymanifests itself not only in its distinct absence in the light of research findings andnational best practice, but also in the views of local service providers and voluntarygroups in the surveys undertaken as part of this research. Anecdotal evidence wouldsuggest that such interventions take place in an uncoordinated and ad-hoc manner,largely as part of religious care or the efforts of various voluntary groups.Visitation programmes are run on the basis of various working models elsewhere inthe country. These typically operate on the basis of referral systems by statutorypersonnel or designated persons in the community (e.g. community wardens).58

Review of Services for Older People in South Tipperary (2008)Initiatives that provide a secondary purpose for a visitation programme (i.e. youngerpeople visiting older people to “hear their story”) can offer alternatives in the shorterterm.Lifelong LearningEducational activities and lifelong learning are a valuable part of the group activitiesenjoyed by older people. Schemes of this nature are readily taken up by voluntarygroups who provide social activities as is evident in the proportion of groups that availof funding from the VEC.The Co. Tipperary (SR) Vocational Education Committee plays an important role inproviding funding for educational opportunities for older people in the county. Mostavail of such opportunities through the Community Education Programme, andsmaller numbers through the Adult Learning Scheme. In 2007, the CommunityEducation Programme offered language classes (French and Irish) and courses onart/art therapy, flower arranging, tai chi, yoga, stress and relaxation, jewellery,computers, cookery and basket making to 768 older people, three quarters of whomwere women. These classes were largely delivered through ARAs, day care centres,public nursing homes, and various community groups and were held in Tipperary,Cashel, Cahir, Carrick-on-Suir, Clonmel, Cappawhite, Fethard, Ballynonty andNewcastle. While funding under this programme is available on a countywide basis,its uptake and the availability of these educational opportunities for older peopledepends on local initiatives and voluntary organisations.Educational opportunities for older people in 2007 were also provided in SouthTipperary with the help of funding from the ASC (Access, Skills and Content)Initiative of the Department of the Taoiseach which was established in 2006 “toencourage and support the participation of late adopters of technology in an inclusiveinformation society” 106 . Knockanrawley Family Resource Centre, SlieveardaghC.I.T.E., Spafield Family Resource Centre and the South Tipperary Community &Voluntary Forum received a combined total of €30,500 for ICT equipment andtraining courses. The South Tipperary Community & Voluntary Forum used the fundsto develop two cycles of “Practical IT Skills” courses for older people that weredelivered in Clonmel, Carrick-on-Suir, Cahir, Cashel, Killenaule, Ballingarry andGortnahoe. The continued provision of such ICT courses is uncertain as details for a3 rd ASC call for proposals are still awaited 107 and the role of South TipperaryCommunity & Voluntary Forum needs to be reviewed on the basis that it accessedASC funding in the absence of a dedicated host.The importance of the scheme should nevertheless be noted in the context of olderpeople’s inclusion in today’s information society. The extent of access to and usage ofICT is an important aspect of interaction with service providers and with socialcontacts. In 2005, only 14 per cent of people aged 65 to 74 had used a computer andonly 9 per cent of people in this age group had used the internet. 108 This figures106 Comp. the relevant sections on http://www.taoiseach.gov.ie.107 An enquiry with the Department of the Taoiseach in March 2007 found that the Department is likelyto announce further funding under the initiative for 2008. No further details were available at this time.108 QNHS June 2005 as quoted by A Social Portrait of Older People in Ireland, p. 32.59

Review of Services for Older People in South Tipperary (2008)increased in 2006 to 18 per cent and 12 per cent respectively. 109 Training andencouraging more older people to use these technologies not only involves a socialactivity, but improves the capacity of participants to access information. 110Tipperary Libraries also offer ample opportunities for older people to socialise, readand inform or educate themselves based on the principles of lifelong learning. Olderservice users with vision impairments, for example, can avail of books in large printor audio books, use specially adapted computers with assistive software (screenmagnification, text to speech output, scanning and voice reading) or access thebrowse-aloud facilities on the website. Tipperary Libraries have also organised aseries of IT, art and music classes in the past. These were part of the BealtaineFestival which celebrates creativity in older age. Older people also avail ofopportunities such as the book clubs, women’s group and “Music in the Library”programme in Clonmel.Sport and Physical ExerciseSport and physical exercise play an important part in maintaining good physical andmental well-being in older people. The HeSSOP II finding, where three quarters ofolder people stated that they believe they take enough physical exercise, wouldindicate that the majority of older people pursue active lifestyles. 111 However, actualrates of participation in physical exercise and sports indicate that the likelihood ofphysical activity decreases significantly with age (see figure 12). A CSO survey in2006 showed that participation rates dropped from 71.9 per cent in the 15 to 24 yearage group to 41.8 per cent in the 65 and over age group. 112 Male participation wasslightly higher in the over 65’s age cohort.Age was stated as a reason for non-participation in sports and physical exercise by 14per cent of inactive people. It ranked fifth on the list of the most common reasons fornon-activity for all groups. Within the 65 and over age group, however, age was statedas the most common reason for non-participation (55.2 per cent), followed by“disability, illness or injury” (27.1 per cent), “never participated” (13 per cent) and“lack of motivation” (5 per cent). 113Although the majority of inactive respondents in this survey (73.9 per cent) stated thatadditional facilities would not encourage them to participate, the 55 to 64 and over65’s age groups felt more strongly that public walkways would promote moreactivity. 114 Walking constituted the most common physical activity pursued by 39.3109 CSO: Information Society and Telecommunications 2006. Dublin: Stationary Office 2006, p. 38.110 The percentage of older people who own a computer has increased significantly since 2000. In2000, 8.5 per cent of households with a reference person aged 65-74 years had a computer. In 2006,this figure had risen to 27.4 per cent. It is still significantly lower than in other age groups which rangefrom 49.7 per cent (55-64 years olds) to 71.5 per cent (35-44 year olds). The availability of internetconnections is slightly lower, but has increased along the same lines. CSO: Information Society andTelecommunications 2006. Dublin: Stationary Office 2006, p. 34.111 HeSSOP II, p. 115.112 QNHS. Sports and Physical Exercise. Quarter 3/2006. Dublin: CSO 2007, p. 1.113 Ibid., p. 6f (Table 2).114 A submission received in the context of this research confirms the necessity for better publicwalkways from the local perspective. According to it, little is done to encourage walking and activity60

Review of Services for Older People in South Tipperary (2008)per cent of all active persons. 115 This figure increased to 67.0 per cent for the 65 andover age group. The importance of proper walkways for older people in pursuingphysical activity is further reinforced by the finding that active persons, in general,participated in their main sport or exercise activity most frequently in public placessuch as in parks, paths or roads (47.2 per cent), compared to 24.1 per cent who usedsport clubs and 14.8 per cent who used gyms.Figure12: Participation in Sports by Age Group (QNHS, 2006)Table 13 shows that the intensity with which physical exercise and sports arepractised is likely to decrease with age and that the majority of older people preferlight to moderate exercise. The frequency of exercise does not necessarily decreasewith increasing age. On the contrary: the proportion of people aged 65 and over whoengaged in physical exercise five times per week or more was higher than that in the55-64 age bracket. However, the duration of sessions is likely to shorten with age.This would suggest that active older people compensate for the lower intensity andshorter duration of sessions by more frequent exercise.Although some opportunities for older people to engage in moderate physical exerciseare delivered through the Community Education Programme of the Co. Tipperary(SR) VEC (see above) and by voluntary and community organisations, the recentformation of the South Tipperary Sports Partnership will facilitate the strategicpromotion of physical activities among older people, being one of the LSP’s as onetheir target groups. As part of its Strategic Plan 2007-2010, The Sports Partnership isplanning to deliver an “Older Adults Activity” Programme which will comprise of anumber of sub-programmes for older people to “get them more active”. 116among older people in South Tipperary. A lack of proper (and safe) walking areas and cycle lanes wasdiscouraging older people who want to be active.115 QNHS. Sports and Physical Exercise, p. 2.116 South Tipperary Sports Partnership: Strategic Plan 2007-2010, p. 27.61

Review of Services for Older People in South Tipperary (2008)Participation 55-64 65+By intensity Extremely hard effort 0.8% 0.3%Hard effort 7.7% 4.4%Moderate effort 44.7% 37.2%Light effort 32.4% 41.5%No effort 14.4% 16.8%By frequency 5 or more times/week 32.4% 40.2%3 to 4 times/week 28.8% 26.6%1 to 2 times/week 31.1% 25.3%Less than once/week 7.7% 7.9%By session duration 60 minutes or more 39.7% 32.5%30 to 60 minutes 47.4% 44.0%Less than 30 minutes 12.8% 23.4%Table 13: Active Persons aged 55 and over classified by intensity, frequency and sessionduration in the previous 4 weeks (Source: QNHS QTR 3/2006)“Go for Life” is one of these sub-programmes and has already been rolled out in thecounty with some success. 117 Its objective is “to involve more older adults in allaspects of sport and physical activity more often”. 118 “Go for Life” is funded by theIrish Sports Council and administered by Age & Opportunity. So-called PALs’(Physical Activity Leaders’) workshops provide training to members of ARAs andother community groups to lead peers into more physical activity, thereby eliminatingthe need for commissioning external trainers and coaches. The programme consists ofeight workshops, the first four of which were run in South Tipperary in October 2007.The next series of workshops will commence in April 2008. A grant scheme is alsoavailable as part of the “Go for Life” programme to enable voluntary groups topurchase equipment. Older people can also avail of other programmes offered by theSports Partnership. A once-off workshop on “Walking for Health”, for example,would be expected to have specific appeal for people aged 65 and over in the light ofthe CSO findings highlighted above.The issues highlighted by the South Tipperary Sports Partnership and variouscommunity and voluntary organisations in relation to the promotion of physicalactivity among older people are manifold and include the following:• The lack of adequate transport is perceived as the greatest barrier to olderpeople (particularly in rural areas) availing of organised physical activities• The lack of adequate and safe public places to pursue light and moderatephysical exercise (i.e. walking and cycling) is discouraging for those olderpeople who want to remain active. Public walkways and cycle lanes aredesirable, while projects in other parts of the country where older people canavail of equipment that is placed in public playgrounds are examples ofinnovative measures in this context.• Although the rollout of the Go for Life programme has provided greatopportunities for older people in the county, it is still in its infancy. Issueshave arisen in relation to the suitability of the person that is trained as the117 Compare also the chapter on Active Retirement Associations and Social Clubs.118 The Go for Life Programme. Factsheet 1. Age & Opportunity (see http://www.olderinireland.ie).62

Review of Services for Older People in South Tipperary (2008)Physical Activity Leader, which can compromise the success of programme ina specific group and setting.• Physical activities are not always offered at times that respect the needs ofolder people. Knowledge of other key activities in the daily routines of olderpeople (i.e. religious routines) is vital in this respect.• The example of a women’s group in Clonmel which uses a private gym at lessfrequented times may provide a useful model of good practice. A widerpromotion of this model coupled with concessions or subsidies could prove anadvantage for both the older service users and the private facilities.ConclusionsSocial isolation and loneliness among older people in Ireland is well researched, butcommon perception persist that increasing age is irrevocably linked to social decline.This is not the case. The majority of older people enjoy active social lives and are inreceipt of emotional, practical and informational support from friends, family,neighbours or, in some case, voluntary organisations. It is nevertheless estimated thatone in ten older people in Ireland do experience social isolation. Rural dwellers are ata greater risk in this regard. However, it is not older age that gives rise to socialisolation, but its link with an increased risk of losing mobility, the capacity to useprivate forms of transport and perhaps other health restrictions. Income, gender,educational attainment, and whether or not a person lives alone also influence the riskof an older person experiencing social isolation and/or loneliness.The importance of providing accessible opportunities for social contact, education andphysical activity that meet the needs of older people is easily underestimated in thediscourse on the quality of life, health or social inclusion of older people atcommunity level. Yet, they can have the biggest impact on an individual’s ability toage “successfully” and to cope at times of transition.Community and voluntary organisations that involve and/or are run by older peopleplay a pivotal role in providing social activities. However, they were also found to bethe most vulnerable in the current volunteering climate. A survey of ActiveRetirement Associations, Senior Citizens’ (and other such social) Clubs, ICA guildsand Ladies Clubs revealed their struggles to sustain membership numbers, sourcefunding for varied activities, and meet the challenges presented by the increasingprofessionalism expected from the voluntary sector on the one hand, and a changingvolunteer ethos on the other. It also showed that organised social opportunities forolder people exist only sporadically in South Tipperary and depend substantially onthe presence of an active older community in any given locality. It is hoped that therecently formed South Tipperary Volunteer Centre may be in a position to assist withsome of these issues and work with the affected groups in a bid to ensure theircontinued existence.While social groups such as the Active Retirement Associations and Senior Citizens’Club can provide important intervention/prevention strategies for people at risk ofsocial isolation, visiting and befriending programmes are found to be more effectivefor those who are experiencing loneliness and social isolation already. Unfortunately,their provision in South Tipperary lacks any formal basis and organisation. Whilevisiting services are undoubtedly operational in some communities, these tend to be of63

Review of Services for Older People in South Tipperary (2008)an ad-hoc, informal nature and typically are part of religious care or casual voluntarycommunity work. A strategic and co-ordinated provision of visiting and befriendingservices is highly desirable and should be considered on the basis of a referral systemby key persons in the community, both from the statutory and voluntary sectors.Educational opportunities for older people in South Tipperary were found to be quitereasonable on account of the Community Education Programme of the Co. Tipperary(SR) VEC and considerable efforts by other organisations to access funds at nationallevel (i.e. ASC Initiative by the Department of the Taoiseach) and to use these todeliver targeted educational programmes in the county. Again, the actual provision ofeducational opportunities at community level depends on voluntary organisations andthese should be actively encouraged to avail of funding opportunities at local andnational level.The Tipperary Libraries provide an important secondary service for older people whowant to pursue the principles of lifelong learning with widely accessible readingmaterials and information technologies. They also offer opportunities for socialcontact through their book clubs, women’s group and music programme. It may beuseful to promote these services and educational opportunities in the communities ona joint basis.Older people were found to be a distinct group in respect of their participation insports and physical exercise. Safe, accessible public places such as parks, walkwaysand cycle paths are particularly important to older people who tend to enjoy morelight to moderate activities that can be easily incorporated into their lives. Organisedexercise and physical activity were equally important for older people. The recentformation of the South Tipperary Sports Partnership and the inclusion of a programmein its strategy that is specifically aimed at older adults is particularly welcome in thisregard. The “Go for Life” programme administered by the Partnership is wellperceived among voluntary groups and has been rolled out in the county with somesuccess. Co-operation with privately-run sports facilities may also be feasible in thecontext of a strategy to provide wider opportunities for physical activity to olderpeople in the county.The most common barriers to older people in availing of social, educational orphysical activities in their communities is lack of adequate transport and possibly lackof sufficient information about them. Both will be addressed separately in the chapterson transport and service delivery infrastructure.64

Review of Services for Older People in South Tipperary (2008)Housing and HousingSupports65

Review of Services for Older People in South Tipperary (2008)Housing and Older PeopleIreland has traditionally had a very high proportion of older people who own theirhomes (an estimated 80 to 90 per cent 119 ), particularly when compared to othercountries in the European Union. 120 In addition, very few older people have anoutstanding mortgage. Debt-free property therefore represents a significant asset formany older people in Ireland. 121A small minority of older people live in rental accommodation, most of them in localauthority housing. Figures vary in this respect, but it is thought that between 8 and 13per cent of people aged 65 and over rent accommodation from a local authority and 2to 4 per cent rent in the private sector. 122While local authorities are the largest provider of social housing for older people, thecontribution of the voluntary housing sector has grown substantially in recent years.At the same time, demand for social housing provided by voluntary housing sector isincreasing and older people now compete with other target groups (e.g. people withdisabilities and homeless people) for this type of accommodation. 123 Voluntaryhousing units can consist of sheltered housing aimed at persons who are toovulnerable to remain in their homes, but do not need long-stay residential care orhospitalisation. However, voluntary housing does not necessarily provide the caresupports found in sheltered dwellings. In some cases, it merely comprises affordablehousing.0-14years15-64years65+yearsNo bath/shower 0.4% 1% 2.5%No central heating 6.7% 7.6% 17.7%No hot water 0.9% 1.5% 4.2%No running water 0.6% 0.9% 1.3%Damp walls 13.1% 13.2% 15.5%Too dark 6.9% 6.0% 5.4%No toilet 0.4% 0.6% 1.2%Table 14: Housing deprivation by age group (Source: EU-SILC 2004) 124The quality of housing owned or rented by older people presents the greatest concernin relation to older people’s housing. The 2004 EU-SILC 125 confirmed that olderpeople not only show lower levels of housing-related amenities, such as showers, hot119 A Social Portrait of Older People, p. 26 and Brian Nolan: Poverty and Older People in Ireland. TheCensus 1991 was the last Census to provide this information. According to it, 86.2 per cent of olderpeople (excluding those in residential care), lived in owner-occupied homes. 81.6 per cent of themowned their home outright. (NCAOP Factfile No. 5 “Housing”, p. 1).120 NCAOP Factfile No. 5: “Housing”. Dublin: NCAOP 2001.121 A Social Portrait of Older People, p. 26 and Brian Nolan: Poverty and Older People in Ireland.122 Brian Nolan: Poverty and Older People in Ireland; compare also: A Social Portrait of Older People,p. 26. Layte (1999) suggested this figure was 10.0 per cent.123 The “Capital Assistance Scheme for Older People” by the Department of the Environment since1998 has contributed significantly to the growth in the voluntary housing sector and to the provision ofa large number of social housing units for older people. ((NCAOP Factfile No. 5 “Housing”, p. 2).124 Prunty (2007), p. 27f.125 EU Survey on Income and Living Conditions. CSO (various years running).66

Review of Services for Older People in South Tipperary (2008)water and central heating. Compared to other age groups, they also have the highestrates of housing deprivation (which would include the lack of these amenities as wellas houses in bad states of repair indicated by damp walls, a leaking roof or rottingdoors and windows – see table 14). 126 Rural older people are particularlydisadvantaged in this regard as they are considerably more likely than urban dwellersto lack central heating, hot water or a bath or shower. 127 The high levels of housingdeprivation are generally explained by the fact that older people tend to live in olderhouses (particularly owner-occupiers) which require higher (and often more costly)levels of maintenance and repair after some time. 128 Older people are also thought tobe “less likely to engage with the inconvenience of having home improvementscarried out”. 129 An analysis of the 2004 EU-SILC concludes in respect of the housingdeprivation levels experienced by older people:The current policy position is to support older people who wish to remain living in thecommunity for as long as they wish as opposed to entering full-time residential care. Theseresults seem to suggest that the schemes that have been put in place to improve living conditionsappear to be inadequate. It seems that, despite home improvement schemes aimed specificallyat this age group, many older people still do not have basic housing amenities. 130Housing support schemes and other strategies to improve the housing conditions ofolder people must respect the needs and wishes of older people, who tend to bereluctant to leave their homes even when sub-standard in favour of otheraccommodation. A study in 1994 found that only 20 per cent of older people wouldconsider moving in such circumstances. 131Finally, it should be noted that poor health is linked to poor living conditions, such asdampness, pollution, grime or lack of central heating, so much so that improvementsin accommodation are thought to reduce health care costs leading to long termbenefits and savings. 132 Besides obvious health risks, sub-standard housing can alsolead to accidental falls, fire and vulnerability to crime. 133Housing Support SchemesThe housing support schemes referred to above are:• Special Housing Aid for the Elderly. This scheme aims to improve the livingconditions of older people living alone or in poor conditions. It covers worksuch as the provision of heating, water and sanitary facilities and fitting ofsecurity devices.• The Housing Aid for Older People Scheme comprises of a local authoritygrant to improve homes which are below basic standards. It is targeted mainlyat older people living in rural areas.126 Prunty (2007), p. 27.127 A Social Portrait of Older People, p. 27.128 Compare Prunty (2007), p. 27.129 Ibid., as stated by Layte (1999).130 Prunty (2007), p. 27f.131 Fahey and Murray (1994:170) as quoted by Prunty (2007), p. 28.132 Stratton, D#: The Housing Needs of Older People, Dublin: NCAOP 2004, p. 42 as cited by Prunty,p. 46.133 NCAOP Factfile No. 5 “Housing”, p. 5.67

Review of Services for Older People in South Tipperary (2008)• The Housing Adaptation Grant for People with a Disability is aimed atthose whose homes need to be adapted to enable them to continue to live there.Incidentally, the schemes have been reviewed by Government and are in the processof being re-introduced by the Department of Environment, Heritage and LocalGovernment as the• Housing Aid for Older People Scheme (an amalgamation of the EssentialRepairs Grant and the Special Housing Aid for the Elderly scheme). Thescheme aims to make the homes of older people habitable and will offer grantsup to €10,500 for structural repairs or improvements, wiring, repairs orreplacement of windows and doors, provision of water and sanitary services,heating, cleaning, painting and such similar works. The scheme will beadministered by the local authorities.• Housing Adaptation Grant for People with a Disability. The revisedscheme will assist with the provision/adaptation of accommodation to meet theneeds of people with a disability and will include the provision of ramps,downstairs toilet facilities, stair-lifts, accessible showers, etc. The maximumgrant available will be €30,000.• Mobility Aids Housing Grant Scheme. This scheme proposed to fast trackgrant aid to cover a basic suite of works to address mobility problems,primarily associated with ageing and will include the provision of grab-rails,access ramps, level access showers, stair lifts etc. The maximum grantavailable will be €6,000.All of these schemes will be administered by the local authorities. 134 The HSE willpreserve a small brief in managing housing supports for older people through theCommunity Welfare Office which has discretionary powers to carry out emergencyrepairs to houses of older people (e.g. during periods of hospitalisation) or based onexceptional needs. In addition to the supports that are available to individuals throughthe local authorities and Community Welfare Office, the following national schemesare available to voluntary organisations to support older people in their community:• The Warmer Homes Scheme under which community-based organisationsprovide services, such as attic insulation and draught-proofing to low-incomehouseholds.• The Scheme of Community Support for Older People which is run by theDepartment of Community, Rural and Gaeltacht Affairs to provide funding forinitiatives that are aimed at improving the security and social support ofvulnerable older people. Under the scheme funding for the provision ofsecurity measures such as door locks and socially monitored alarms isavailable.The Scheme of Community Support for Older People will be referred to in the section“Safety & Security below.134 The Special Housing Aid for the Elderly scheme was previously administered by the HSE.68

Review of Services for Older People in South Tipperary (2008)Standard of Housing in South TipperaryThere is little information available on the standard of older people’s homes in SouthTipperary. A survey carried out in 2007 by Muintir na Tire as part of an ICT projectfor older people entitled e-Volve might be indicative for the urban centres in thecounty. 135 According to this, people aged 65 and over in the Cahir area enjoy goodhousing standards and housing-related amenities. The survey found that allrespondents had a telephone, hot water supply, indoor toilet, bath or shower, adequatelighting and cooking facilities. Ninety-three per cent of respondents stated they feltsafe in their own homes, while 80 per cent had adequate security systems in place.Two out of three respondents had socially monitored pendant alarm systems in theirhomes. None of the respondents had access to a computer. In respect of servicesavailable to older people in the Cahir area, respondents expressed a need for• Chiropody services (38 per cent)• Opportunities for crafts/hobbies (25 per cent)• Educational courses (19 per cent)• Exercise to keep fit (12 per cent)• Community outings (12 per cent)None of the respondents required home visits or community-based care services suchas laundry, meals, personal care or hairdressing. However, 50 per cent of themattended the day care centre in Cahir and may therefore have their needs in thisrespect met.While the e-Volve survey provides some baseline information, it cannot present anadequate picture of the whole county. It is likely that housing deprivation is asprevalent in South Tipperary as elsewhere in the country, and far more likely to befound in rural and isolated parts. The need for community-based care services andvisiting/befriending services was not identified in the e-Volve survey, but is expressedin numerous submissions received in the context of this research and has beenhighlighted in the previous chapters.The Role of the Local AuthoritiesThe role of the local authorities in respect of housing for older people lies primarily inthe provision of social housing and general support to its tenants. The local authoritieswill also shortly become responsible for administering all of the revised housingsupport schemes for older people. 136South Tipperary County Council adopted a policy document in 2006 which presents aframework in relation to the accommodation needs of older people in the county. The“Policy Document Elderly Accommodation – Meeting the Needs” addresses thespecific design of council houses for the elderly, assistance to local authority and135 Unpublished data provided by Muintir na Tire. It is the intent of Muintir na Tire to public thecomplete results of the e-Volve survey in the near future.136 I.e. the above mentioned “Housing Aid for Older People Scheme”, “Mobility Aids Housing GrantScheme” and the “Housing Adaptation Grant for People with a Disability”.69

Review of Services for Older People in South Tipperary (2008)private tenants and owner-occupiers as well as the cooperation with the voluntaryhousing sector and, as part of this, with the Safe Home Programme 137 .At the time of the introduction of the policy document, the Council had no dwellingsdesigned specifically for older people. In June 2005, people aged 65 and overconstituted 2 per cent of the people on waiting lists and 2 per cent of the applicantsunder investigation. 138 Although this figure would appear to be relatively low, theCouncil committed to designing purpose-built units for the elderly and excludingthese from the Tenant Purchase Scheme in order to retain these units in their housingstock into the future. As regards older tenants, the Council has put in place guidelines,whereby Liaison Officers call on tenants aged 60 years and over at least once a year,referring them on to other agencies and supports where a need is identified.Amongst the various local authorities, Tipperary Town Council would appear topursue the most progressive housing policy in respect of older people. Whereas olderpeople have access only to the standard housing stock elsewhere in the county, 8 areaswith up to 8 units (in each) exist in Tipperary Town with designated houses for olderpeople. This housing stock is not available to any person under the age of 65 (with theexception of 55-64 year-olds who have specific medical conditions or disabilities) andis filled with the help of a separate priority list for older people. Older people mayalso refuse local authority housing up to three times before being removed from thehousing list.The exact number of older tenants availing of or approved for local authority housingand the overall number of specifically designed units for them was not ascertained aspart of this research. An investigation into housing for older people in the county,which would include a social housing survey and which would establish the quality ofhousing in general as well as the need for any secondary supports in this area, wouldbe an appropriate project in the future.The Voluntary Housing SectorThe voluntary housing sector in South Tipperary is relatively small with four housingassociations currently providing dwellings for older people in the county. Their outputof units (with aid from the Capital Assistance Scheme administered by SouthTipperary County Council) is quite substantial, however. In 2005, for example, thevoluntary sector provided 40 units of accommodation for the elderly. 139 Similar toother organisations that operate on a voluntary basis, these groups experienceincreasing pressures to maintain existing service levels. Ageing committees and thelack of succession by younger volunteers are a common concern, while access toinformation that would equip the groups to support their tenants more adequately areperceived as problems. The housing units provided by voluntary housing associationsare predominantly filled by older persons who are on a local authority waiting list orreturning emigrants (although direct access outside of these circumstances is alsopossible). In order to maximise capacity, voluntary housing associations depend onthe speedy processing of potential tenants. In this respect, the groups expressedconcerns over the lengthy periods involved in transferring potential applicants from137 The Safe Home Programme addresses the needs of Irish emigrants who wish to return home.138 “Policy Document Elderly Accommodation – Meeting the Needs”, p. 5.139 Ibid., p. 22.70

Review of Services for Older People in South Tipperary (2008)local authority housing lists to voluntary sector tenancy. Voluntary housingassociations are also facing increasing financial pressures in furnishing newly-builtaccommodation units without the immediate availability of grant aid for this.Supports for Repairs and MaintenanceThe need for small repairs and maintenance services aimed specifically at olderpeople has been expressed in a number of submissions received in the context of thisresearch. It is substantiated further by anecdotal evidence gathered in the CitizensInformation Centres across the county which receive frequent queries in this regard.One contribution summarises the concerns of many people in this regard:“I just wanted to say that I and my friends find we have very little money to spare […]. I findrunning a car very expensive. I also think that VAT on personal alarms for the elderly should bescrapped. I would love it if the Council could produce a list of reliable tradesmen who will notrip me off for any work I need done. Finally, fuel allowance should be paid all year roundbecause older people still need their heating during the summer months and because of theincrease in the price of oil. I suggest that a voucher system could be used.”Concern about the cost, reliability and quality of service provided by tradesmen whoare not know to them personally, is particularly common among older people and maycontribute significantly to the reluctance of many to carry out necessary maintenanceworks to their homes. A new project planned for South Tipperary is hoping to addressthis issue. Muintir na Tíre is in the process of setting up a “Community Safety VanProject” which will entail carrying out small-scale security repairs to older persons’homes and other similar tasks. While this is a very welcome and innovative initiative,the introduction of a quality/price control mechanism similar to that suggested in theabove submission, may alleviate some of the concerns of older people in themeantime. At the same time, it must be recognised that minor repair services may notbe cost-efficient from the perspective of private tradesmen and that these may have tobe delivered on a voluntary and community-basis.Safety & SecuritySafety and security issues also form an important aspect of housing for older people.Older people in isolated rural areas are, understandably particularly apprehensive inthis regard. Feedback from day care centres, for example, would suggest that securityconcerns can act as barriers to someone’s participation in day care centre activities,particularly where transport follows strict timetables and outsiders can easily ascertainwhen an older person leaves their property (i.e. “when the day care centre busarrives”). Reports from Neighbourhood Watch and Community Alert groups inpredominantly elderly areas also emphasise safety and security issues. These arecoupled with the inability of many older people to meet the cost of alarm systemssupplied by private businesses.The Scheme of Community Support for Older People can address some of theseissues, provided a voluntary organisation exists that can access the scheme andprovide (i.e. install and, if necessary, monitor and maintain) equipment such as smallscalephysical equipment (i.e. window and door locks), socially monitored alarmsystems, smoke alarms and security lighting in the person’s community. While asignificant number of organisations in South Tipperary are in receipt of funding under71

Review of Services for Older People in South Tipperary (2008)the scheme, the provision of security equipment and services under the scheme isgeographically inconsistent and therefore unreliable from the perspective of theindividual older person in need of same.“Helplink South” (based in Athlone, County Westmeath) is an example of a voluntaryservice that offers affordable socially monitored alarms for the elderly in a moreaccessible and consistent manner. Scheme such as the Community ServicesProgramme under the Department of Community, Rural and Gaeltacht Affairs may bea vehicle to establish a similarly dedicated service in South Tipperary. In the absenceof a dedicated body, it may be advisable to make the provision of alarm systemsthrough community groups more transparent from the perspective of the individualolder persons by devising a basic service directory that also outlines alternativesecurity measures.Neighbourhood Watch and Community Alert Groups as well as Residents’Associations provide a good model of how multiple housing problems experienced byolder people can be effectively alleviated. These groups organise communal propertyupkeep, maintain safety & security, and provide individuals with social contacts. Mostwork in close cooperation with An Garda Síochána and other community(development) organisations, although feedback from some of the groups wouldsuggest that the extent of the support offered to them depends largely on individualliaison officers. It may also be worth noting that no reliable database exists ofNeighbourhood Watch groups in South Tipperary. Community Alert Groups, on theother hand, would appear to benefit to a high degree from the structural supportoffered by Muintir na Tíre.ConclusionsIssues in relation to housing present possibly the most fundamental difficulties forolder people in Ireland. These issues include – amongst others – higher levels ofdeprivation, the need for home adaptations with increasing age, rising concerns inrespect of safety and security, and the need for small repairs and maintenance servicesthat cannot necessarily be met by private business.While sufficient information is available on the levels of housing deprivationexperienced by older people in Ireland, other areas, such as the extent of their need forsocial housing (and the availability thereof), the adequacy of housing support schemesand the actual need for support services necessary to maintain their homes, lacksufficient or recent data. Similar to the health and social care services, the publichousing service sector is currently undergoing certain changes, which adds to thedifficulties in developing an adequate statement of need.The revision of the housing support schemes for older people is generally welcomeand the administration of all schemes by the local authorities in the future shouldimprove delivery of these schemes from the perspective of the service user. The“Policy Document Elderly Accommodation – Meeting the Needs” adopted by SouthTipperary County Council and the progressive approach by Tipperary Town Councilin providing dedicated social housing units to older people are also examples of goodpractice and a “step in the right direction”. Cooperation with the voluntary housingsector and access to information were found to be two areas in need of improvement.72

Review of Services for Older People in South Tipperary (2008)Equipment and services that meet the safety and security needs of older people, whichwould be a concern particularly for people living in rural areas, would appear to bewidely available in the county (largely on the basis of the Scheme of CommunitySupport for Older People by DCRAGA), but depend on the existence of proactivecommunity and voluntary organisations to access the necessary funding. The supportprovided by Neighbourhood Watch/Community Alert groups and ResidentsAssociations in this regard is quite significant. This support is not available in all partof the county or with consistent organisational efficiency.The lack of private services that meet the needs of older people with regard to smallrepair and maintenance jobs will be addressed to some extent by a new and innovativeproject under the auspices of Muintir na Tire. The “Community Safety Van Project”will entail carrying out small-scale security repairs to homes and similar tasks. Amechanism by which private tradesmen could perform these jobs, but with asafeguard for quality, cost and reliability in place for the client, is also an avenue thatcould be explored.In general, the housing (support) needs of older people in South Tipperary requirefurther in-depth investigation and before proceeding to develop a strategic serviceresponse, it should be ascertained to what exact extent the issues highlighted aboveprevail in the county and whether the data available at national level adequatelyreflects the local situation.73

Review of Services for Older People in South Tipperary (2008)Transport74

Review of Services for Older People in South Tipperary (2008)The Need for Public Transport among Older PeopleThe fact that older people rely more heavily on the availability of public transport isclearly linked to age. Reduced car mobility – due to the loss of a driving licence(based on medical reasons) or due to income changes that impact on an individual’sability to afford a private motor vehicle – is much more likely to occur with increasingage. The likelihood of experiencing restrictions in physical mobility that will prohibitthe use of other modes of transport such as walking or cycling is also a significantfactor in this context.Current legislation in respect of driving licences restricts people aged 60 and over toshorter term licences than those that are available to drivers below the age of 60 andalso makes provisions for stricter medical controls. 140 It is estimated that between 44and 50 per cent of people aged 65 and over are car drivers or have access to a car. 141One in ten older people are thought to have no access to any mode of transport(including cars or public transport). 142Policy-makers recognise the higher dependency of older people on public transport,and schemes such as the Free Travel Pass for people aged 66 and over, which entitlesthem to free travel on certain bus, road, rail and DART services including servicesoperating under the Rural Transport Programme, are addressing the affordability ofthese modes of public transport. 143 The actual provision of accessible and adequatepublic transport (particularly in rural areas) would appear to be a greater challenge forGovernment.Transport has been a recurring theme throughout the previous chapters and is vital inenabling older people to access health and other services, to maintain social networksand lead active lives. Public transport schemes such as the Rural TransportProgramme (formerly: Rural Transport Initiative), where in place, are a key support infacilitating older people in remaining in their own homes in their own communitiesfor as long as possible. However, where the provision of these services is inadequateor non-existent, this becomes the principal barrier to community-based, independentliving. 144A sub-group of the Public Transport Partnership Forum, which was established in2000 under the National Agreement Programme for Prosperity and Fairness, hasexamined the transport needs of older people, particularly in rural areas. This includedan evaluation of the impact of the Rural Transport Initiative and of other strategieswhich might meet the needs of older people in rural areas (such as the use of school orother specialised transport services and the introduction of a voucher scheme for taxi140 People aged 60 to 67 may apply for a driving licence that expires at the age of 70 or for a three-yearlicence(as opposed to the 10-year licence available for people up to age of 59). People aged 67 or overcan only apply for a three-year licence, and from the age of 70 are required to provide a medical report.One-year licences may be issued at any time on the basis of medical reasons. There are also othercircumstances, such as specified diseases, disabilities or drug use, that require medical reportsregardless of age. Renewing a driving licence if free of charge for persons aged 70 years or older.141 HeSSOP II, p. 178 and Treacy (2004), p. 14.142 Ibid. (Treacy).143 See also the chapter on income supports.144 Compare NESF: Care For Older People. Dublin: NESF 2005 (= Report no. 32), p. 48.75

Review of Services for Older People in South Tipperary (2008)and hackney services for older people to access scheduled and other services). 145While this sub-group has not yet published any findings in their own right, the PublicTransport Partnership Forum has explicitly recognised the importance of ruraltransport for older people in a discussion paper entitled Progressing Rural PublicTransport in Ireland where it says that “National policies in the area […] of elderlycare […] are currently a major focus for Government investment [and] can only besuccessful if transport links facilitate access to services and facilities.” 146 It alsoacknowledges:In a rural context, conventional bus-based scheduled services typically link rural areas toimportant urban centres or link major urban centres while also serving rural areas situated ontheir routes. Conventional services operate on fixed routes, with fixed departure and pick-uppoints, which can often be inaccessible for people who have difficulty getting to these points,e.g. people with mobility, sensory and cognitive impairments, older people. 147These and other findings may have contributed to a revision of the Rural TransportInitiative which was re-launched in February 2007 as the new Rural TransportProgramme (RTP) putting the former pilot scheme on a permanent mainstreamedbasis with increased funding. 148Rural Transport in South TipperaryAs a county with a predominantly rural character, the Rural Transport Programme andits predecessor have played and will continue to play an important role in SouthTipperary in addressing the challenges of providing adequate public transport. Olderpeople in rural areas in the county have benefited in particular from this scheme.There are currently two services operating in South Tipperary, which are funded bythe RTP: The Kilcommon/Upperchurch Rural Transport Initiative, which isadministered by the Tipperary LEADER Group and Ring-a-Link, operated by Carlow,Kilkenny and South Tipperary Rural Transport Ltd. The latter covers most of theSouth Tipperary area, while the Kilcommon/Upperchurch RTI is a cross-borderservice with North Tipperary and extends only into the north-western part of SouthTipperary.Established in 2002, Ring-a-Link combines the concepts of conventional bus and taxiservices to allow people in rural areas in South Tipperary, Carlow and Kilkenny toaccess public transport from their homes. 149 Customers have to pre-book the servicesby phoning a LoCall number at least two hours (preferably a day) before their plannedtravel. Free Travel Passes are valid for Ring-a-Link journeys. Otherwise, fares rangefrom €3 to €5 return. A timetable providing specific routes and operating times (seetable 15) enables the service users to plan connecting trips with other modes of publictransport (rail or conventional bus).145 Ibid.146 Department of Transport: Progressing Rural Public Transport in Ireland. Dublin 2006,p. 43.147 Ibid, p. 2.148 The increase of funding, however, is perceived to be marginal in the light of increasing costs and thenational coverage of the programme.149 The company also offers a car-pooling service.76

Review of Services for Older People in South Tipperary (2008)In 2007, Ring-a-Link carried out 38,691 door-to-door trips in three counties SouthTipperary, Carlow and Kilkenny. Approximately sixty per cent of users used theirFree Travel Pass.RouteCarrick-on-SuirTipperary-ThurlesTipperary Town ITipperary Town IIFethard-CashelTipperary- CashelClonmelSlieveardaghConnectingservices toWaterford,Clonmel,Kilkenny CityLimerick,WaterfordLimerick,WaterfordLimerick,WaterfordKilkenny,Clonmel,ThurlesAreas servedNorth of Carrick-on-SuirCappawhite, Hollyford,Donohill, Dundrum,Knockavilla, Boherlahan,Ballagh, Gooldscross,Clonoulty, HolycrossTipperary, Dundrum,Donohill, Donaskeigh,Hollyford, Cappawhite,KnockavillaTipperary, Dundrum,Donohill, Donaskeigh,Hollyford, Cappawhite,Toem, Knockavilla,Monard, Limerick Junction,Sologhead, Lattin, Cullen,Emly, Lisvernane, Aherlow,Bansha, KilkeakleFethard, Drangan,Cloneen, Mullinahone,Killenaule, DuallaAlong N7, Kilfeakle,Thomastown, GoldenClonmel, Ardfinnan,Kilmanahan, Glogheen,Ballyporeen, Ballylooby,Castlegrace,Ballymacarbery, Grange,Burncourt, Newcastle,Goatenbridge,SkeheenarinkaBallingarry, Killenaule,Drangan, Mullinahone,Cloneen, Fethard,Glengoole, Gortnahoe,UrlingfordTable 15: Routes operated by Ring-a-LinkService timesMon – Sat(8 am to 6 pm)Wed(from 10 am)Fri(9 am to 6 pm)Mon – ThuSat(9 am to 6 pm)Thu/Sat(from 1 pm)Mon – Fri(9 am to 4 pm)Mon – Sat(9 am to 6 pm)Wed/Fri(8 am to 6 pm)Anecdotal feedback from service users is overwhelmingly positive, although the lackof the RTP in places such as the Cahir, north Clonmel and Cashel town areas has beenhighlighted as an issue by many. Figure 13 illustrates the areas covered by the twoRTP services and compares them to the older people populations in the county’sElectoral Divisions. 150 It clearly confirms two central gaps in rural transport serviceprovision that were also highlighted in the feedback from the general public. Theseare:• Cahir and surrounds (note that there is a high number of older people in andaround the town)150 See also the Statistical Profile in this report.77

Review of Services for Older People in South Tipperary (2008)• Clonmel hinterlands north of the town (particularly the EDs Clonmel Rural,Inishlounaght) as well as east as far as Kilsheelan and northwest toward NewInnFigure 13: Areas covered by the RTP in South Tipperary in relation to older people populationBesides a lack of resources that would enable the operators under the RTP to expandinto these areas, an overlap with conventional bus service routes may have inhibitedthis from happening in the past.Rural transport providers have raised two main issues in respect of service provision:• A lack of awareness of the existence of the service and, in particular, of itsdistinct nature (i.e. door-to-door) among the general public and thereforepotential services users• An apparent reluctance of older people to use itThe promotion of the service using examples of where it has significantly enhancedthe quality of life of older people, may be a worthwhile strategy in this regard.A final aspect that should be noted in relation to the importance of rural publictransport is the changing infrastructure in rural Ireland. Feedback from older people inSouth Tipperary would suggest an increasing reliance on transport due to the closureof rural shops, post offices and other such services/amenities. Having to travel toclaim pensions or shop for groceries is perceived as being particularly difficult forolder people who were used to independently accessing such service locally withoutthe need for transport.78

Review of Services for Older People in South Tipperary (2008)Rail and Conventional Bus Services in SouthTipperaryThe adequacy of transport provision in respect of rail and conventional bus services isnot within the scope of this research. The structure, suitability and accessibility ofthese services may present specific obstacles for older people, but this would requirefurther investigation.ConclusionsAccess to public transport is an essential gateway for older people in availing ofhealth, care, social and recreational and other services, as the likelihood of themlosing access to other (private) modes of transport increases with age. It is particularlyimportant for older people in rural areas who have to travel greater distances to publicservice centres and opportunities for social contact.While conventional public transport in South Tipperary (i.e. rail and national busservices, bus services offered by private operators and hackney services) do not fallwithin the remit of this report, rural public transport delivered via the Rural TransportProgramme was examined in closer detail.It appears that the nature of the two services operating under the RTP in SouthTipperary more than adequately meets the needs of older people (door-to-doorservice, user friendliness and easy access), but that an expansion of the service isurgently required to meet the needs of older people in the Cahir and Clonmel (north)areas. The exclusion of the service from town areas and areas that are serviced byprivate operators gives rise to a regrettable disadvantage for older urban dwellers, aview which was particularly expressed by service users in the Cashel town area.As the Rural Transport Programme has recently been launched as a mainstreamprogramme by Government, it would be necessary to examine at a later stage of thisprocess how far additional funding and mainstreaming can contribute to an expansionof the service to the identified areas in the county. Meanwhile, a more strategicpromotion of the service among older people is desirable, particularly among thosewho are reluctant to use it on the basis of misinformation or misperceptions of itsnature.It is understood that community buses owned and operated by day care centres andother voluntary organisations make a considerable contribution to the transport needsof older people. 151 It requires further investigation to establish how these could beused to supplement the RTP and serve a wider community. Possible barriers mayinclude a lack of qualified drivers as well as insurance, coordination and otherpractical issues.151 As do, on a smaller scale, ad lib subvention schemes for the use of hackney services.79

Review of Services for Older People in South Tipperary (2008)Service Infrastructure80

Review of Services for Older People in South Tipperary (2008)Improving the Quality of Public Services at LocalLevelThe National Economic and Social Forum published a report in December 2006which addresses shortcomings in the current delivery of public services and makespractical proposals for improvement. It also highlights the importance of good qualitypublic services for social cohesion and states the European position on wellfunctioning,accessible, affordable and high-quality public services, access to which isseen as a fundamental right of a citizen. 152Whilst the public sector in Ireland has seen substantial changes in recent years, whichare reflected in the ongoing implementation of quality standards both in governmentand in the wider (i.e. semi-statutory and partly voluntary) public service, 153 Ireland isno exception with regard to a growing discontent in EU countries with the overallquality of public services. 154 A lack of investment in public services and the existenceof old-fashioned administrative procedures will undoubtedly have to be addressed atnational level, but service deliverers at a local level may be in a position to address thediversity of needs amongst service users in spite of the fact that the local coordinationof services inevitably depends on integrated strategic planning at national level.The “lifecycle approach”, which is considered to be part of a paradigm shift from the“Welfare State” to the “Developmental Welfare State” has been adopted by Towards2016 and the National Action Plans, but is yet to be implemented in service delivery.This approach suggests that for each age group (i.e. children, people of working ageand older people) a combination of income supports, services and social innovation onthe basis of “tailored universalism” should be adopted. This would mean that servicesare equally open to everybody and adapted to suit individual needs rather than thoseof target groups. 155 It is anticipated that the recommendations of the NESF in thisregard will be adopted by the Irish government in the medium to long term.Meanwhile, the delivery and coordination of services for older people at a local levelcould attempt to follow the strategic direction set out by the Forum Report, and striveto: 156• Put the service user at the centre of the design and planning of services. Auser-centred approach will ensure that people’s needs are better met and thattheir dignity and independence are respected.• Focus on early intervention/prevention in an attempt to seek a balance betweenprevention and intervention• Make service deliverers accountable for outputs and quality, i.e. develop an“evaluation culture”. This will also help to determine what is or is not workingon a more practical level.152 Improving the Delivery of Quality Public Services. Dublin: NESF 2006, compare p. 1 and 2.153 Such as the 12 Quality Customer Service Principles approved by the Government in 2000, thedevelopment of Customer Charters and Customer Action Plans within Government departmentsbetween 2001 and 2004, and the provisions in the Local Government Act 2001.154 Improving the Delivery of Quality Public Services, p. 14.155 Compare ibid., p. 11.156 Compare ibid., p. 14ff and 19.81

Review of Services for Older People in South Tipperary (2008)• Develop integrated services and/or generally improve the coordination ofservices• Involve professionals, non-professionals and users’ representatives in thedelivery of services• Promote a public service ethos among all service deliverers (including thecommunity and voluntary sector)• Move from a one-size-fits-all approach to assuming a need for diversity (i.e.services should be wrapped around people’s needs and circumstances)• Accept competition as part of public service delivery as this ultimately resultsin choice for the service users• Improve access to services in disadvantaged urban and isolated rural areas• Recognise the role of the community and voluntary sector in delivering publicservices• Provide comprehensive information on services and what users can expect ofthem• Map existing service provision and related infrastructure against demographictrends as this would greatly aid service planning• Identify a single lead agency in each sector with clear responsibility for theoverall design and coordination of services to address either specific localisedproblems (i.e. homelessness) or more generic areas (i.e. care services for olderpeople)• Collaborate with other service providers to provide a continuum of support tobetter match the needs of their share clients• Adopt a case management approach to service delivery where serviceproviders work with vulnerable clients and those with multiple needs 157Delivering Public Services to Older PeopleThe NESF report coincidentally explored services for older people as one of the twoexemplary areas of public policy for its research. The findings of the report in thisrespect are summarised in the following in order to provide a comprehensive templateagainst which the South Tipperary experience can be evaluated. 158The group of older people is generally constituted by normal life cycle processes (asopposed to socio-economic processes) and, at the risk of over-simplifying, could bedivided into three categories:1. Those who are capable of living full and independent lives in their own homesin their own communities. Their need is for public services to underpin,reinforce and prolong their independence and wellbeing.2. Those who require some support in enabling them to live independently orquasi independently. This may range from limited supports to stay in their own157 Also Improving the Delivery of Quality Public Services, p. 105-117.158 Compare ibid., p. 120-125. This summary concurs with the findings of another NESF report entitledCare for Older People. Dublin: NESF 2005 (= Report no. 32) which examines in more detail: ageismin our society, making living at home possible, legal bases for community care services, co-ordinatedapproaches to the planning and delivery of services, responses for the most vulnerable andmarginalised older people and quality of services.82

Review of Services for Older People in South Tipperary (2008)homes and communities to more significant supports to maintain a degree ofindependence, i.e. in sheltered housing.3. Those who require full-time residential care because they cannot liveindependently or quasi independently.It is recognised that the HSE and the local authorities are the main statutory serviceproviders for older people in the context of current policy frameworks, which arelargely based on the premise of the Welfare State, i.e. having not yet made thetransition to the Development Welfare State. It is also recognised, that serviceprovision to older people at a local level is significantly assisted by the communityand voluntary sector, i.e. by groups that are funded to provide services to older peopleand by local branches of NGOs. Whilst statutory service provision predominantlyfocuses on housing and medical needs, the community sector has a strong social andrecreational dimension.The provision of services to older people in a rural county, such as South Tipperary,faces four major contextual difficulties,• The limited infrastructure in rural areas, which results in provision beingclustered in urban areas.• Inadequate public transport, which contributes to the concentration of servicesin urban areas which causes problems for older people themselves and thosewho care for them.• Ongoing socio-economic developments, which continue to dismantle socialnetworks. This, in turn, increases the reliance of older people on publicservices to maintain independent living.• The experiences, expectations and characteristics of older people, which caninhibit their capacity to draw support from public service providers.All of these difficulties were expressed to varying degrees throughout this report.According to the NESF they result in a number of issues in relation to serviceprovision for older people, including:• Older people may have difficulty with conventional forms of informationdissemination including new technologies, which, in addition to isolation,keeps them out of the information loop.• Service providers are perceived as lacking flexibility, timeliness and courtesyin dealing with older people (statutory more so than voluntary sector servicedeliverers).• Lack of good information and the location of services combined with a lack oftransport act as barriers to accessing services.• The potential of older people is not being recognised by service providers.• Service provision tends to impose dependency rather than be enabling.• Services tend to react to problems rather than proactively support wellbeing.• The continued use of medical models to the neglect of more social models ofservice provision to older people. This results in under-provision of servicesfor the needs of independently living older people who do not have medicalneeds.83

Review of Services for Older People in South Tipperary (2008)• A growing reliance of older people on private sector provision, which poses asignificant risk of social exclusion of older people on low incomes.• The diversity among older people tends to be ignored within care settings.• The level of consultation of older people on the need for and delivery ofservices is insufficient.• Ageism is reflected in stereotypes of dependency and lack of capacityoverrides service provision in many areas.• There is a strong perception that older people are afraid to use complaintsmechanisms provided as part of the Quality Customer Service principles dueto a fear that this may impact on the ability to secure services in the future.• Attempts at local level to ensure coordination of service appears to be moreconcerned with procedural issues than with meeting the needs of older people.While not all of these issues were examined by this report they represent commonexperiences and shortfalls and can therefore be helpful in planning and coordinatingservices for older people in South Tipperary in the future.Examples of Good PracticeThe NESF acknowledges that coordination of services can, indeed, take place amongservice providers at local level despite the need for strategic planning at nationallevel. 159 This stance also forms the foundation of this report, which is why a briefreview at examples where the above issues have been addressed successfully isincluded at this point. A coordinated local response would consider the followingthree principles:• Dedicated rather than generic structures of coordination (the example of theHomeless Agency is useful – a partnership structure, bringing together thevoluntary and statutory agencies responsible for planning, funding anddelivering services to people who are homeless in Dublin)• Case management and advocacy, whereby a key worker assists the serviceuser to navigate the system in the role of an advocate (this may be appropriatein the case of individuals with multiple needs)• Client-centred approaches, which involve the client in identifying problemsthrough needs assessment and, identifying the services and supports requiredto address those needsEffective measures to address the particular needs of older people in the context ofpublic service provision have been identified by the NESF as follows:• Leaflet drops directly into people’s homes are considered to be particularlyeffective in reaching the most vulnerable and marginalised older people.• Community Links Workers as employed by Congress Information Centreunder the auspices of FÁS in Co. Westmeath offer an effective model ofoutreach, advocacy and support in ensuring that older people are not left outof the information and service provision loop.159Compare Improving the Delivery of Quality Public Services, p. 132; see also the section: “Improvingthe Quality of Public Services at Local Level” in this chapter.84

Review of Services for Older People in South Tipperary (2008)• The pilot programme “Ageing with Confidence” has been evaluatedpositively as promoting social and psychological wellbeing.• The intergenerational programme “Dream a Little Dream of Me” seeks toaddress the social needs of people in residential care and involves youngpeople in a programme to combat ageism.• The “Dementia Rights Service” developed by the Alzheimer’s Society mayprovide a self-advocacy model for services to include people who havedifficulty in articulating their needs.• The complaints mechanism of the Carers Association has been identified as aproactive mechanism that encourages people to provide feedback includingcomplaints.• Needs assessments represent an approach that centres on the client and allowsfor comprehensive needs identification.The Role of the CDB’s in Co-ordinating ServicesAlthough this report has been compiled in the context of the cohesion process, it isuseful in a last step to consider the findings of a study conducted by the NCAOP in2005 which identified the role of CDB’s in the coordination of services to andultimately, the social inclusion of older people primarily in a promotional andstrategic capacity. 160 Part of the CDB’s role may fall onto the new integrated localdevelopment company.According to the above study, the CDB is given responsibility for including olderpeople and their representatives in local level planning and decision-making whileensuring that older people’s needs are addressed in county strategies and actionprogrammes. Based on its findings, the NCAOP recommends in the report that theCDB’s would:• Launch an awareness-raising programme targeted at CDB members thatpromotes positive attitudes towards ageing and older people at local level• Utilise the measures that were developed to broaden and reinforce the role ofthe Community & Voluntary Fora as an opportunity to increase older people’srepresentation• Develop a programme which focuses on capacity-building among olderpeople’s organisations at local level in order to increase their participationwhenever opportunities arise• Develop the degree of inter-agency coordination needed to provide joined-upservice and supports for older peopleIn the absence of directives from national level, the CDB’s could also explore meansto:• Utilise documentation on the concerns of older people and how these can beaddressed• Address the gaps in service provision by innovative measures, i.e. pilotprojects that utilise international best practice, and160 Delaney, Sarah et al.: The Social Inclusion of Older People at Local Level. Dublin: NCAOP 2005,p. 25.85

Review of Services for Older People in South Tipperary (2008)• Examine key interagency issues that are most pertinent to the concerns ofolder peopleIt should do so on the basis of acknowledging the main barriers for older people inaccessing services, as highlighted throughout this report and supported by a range ofresearch. They are:• Ageist attitudes on the part of service providers• Low levels of outreach and advocacy services• Local variations in the levels of service provisionCurrent Coordination of Services in South TipperaryThe current coordination of public service delivery to older people in SouthTipperary, as outlined in this review, is characterised by a number of factors whichwould appear to have an adverse effect.1. The prolonged absence of the Elderly Services Coordinator in the HSE whichis regarded as the most important and most influential statutory serviceprovider for older people.2. The co-existence of a number of partially overlapping local coordinatingbodies (such as the Elderly Service Review Group under SIM, the SouthTipperary Older Peoples Network under the South Tipperary Community &Voluntary Forum and the Older Peoples Steering Group under ClonmelCommunity Partnership), which co-exist without structures to facilitate cooperation.3. The lack of an integrated county strategy for the service delivery to olderpeople.Conclusions and RecommendationsTaking into account all of the arguments (re-)presented in this chapter and thefindings of the services reviews throughout the report, there is an evident need for apartnership structure in South Tipperary to facilitate the coordinated delivery of publicservices for older people at local level.This partnership structure should bring together all relevant statutory agencies andvoluntary organisations. Existing coordinating bodies (see “Current Coordination ofServices in South Tipperary”) should either be integrated into the partnership structureor disbanded to avoid duplication and overlap of responsibilities. Provided that therole of the County Development Board in coordinating services at local level remainsunchanged in the future, the partnership structure should operate under its auspices.The partnership should assist the Elderly Services Coordinator in the HSE from aninteragency perspective and facilitate the development of an integrated strategy for thedelivery of public services to older people in the county and ensure that a coordinatedapproach is adopted in implementing this strategy. It may also have a role ininfluencing national policy, where possible.An integrated strategy for the delivery of public services for older people in thecounty should86

Review of Services for Older People in South Tipperary (2008)• Acknowledge the diverse needs and the potential of older people as part ofnormal life-cycle processes• Recognise the contribution of the community and voluntary sector• Be founded in a social model of community care and support national policyin enabling older people to stay in their own homes in their own communitiesfor as long as possible• Prioritise information provision and the resolution of issues around servicelocation and transport as these are gateways for accessing existing services• Attempt to influence both intra-organisational and interagency aspects ofservice delivery• Be based on the participation of older people (i.e. allow for the inclusion ofolder people in the design and planning of services)• Include provisions for an “evaluation culture” among all service providers• Allow for and support innovative measures and pilot projects• Integrate relevant national policy and strategic plans at local level• Address the specific needs and issues highlighted by this and other reportsThe needs and issues highlighted by this and other reports are summarised in thefollowing tables. 161Income SupportsSummaryWhat could be improved?How could this be achieved?What is working well?Income supports are largely administered at national level andresearch shows that social transfers have a significant effect on thereduction of income and consistent poverty among older people inIreland. It is estimated that 2 per cent (n = 215) of older people inSouth Tipperary are experiencing consistent poverty and 10 per cent(n = 1,065) are at risk of poverty.• Information provision and advocacy services in respect of incomesupports, rights and entitlements• The inconsistent basis for concessions for older peoplecountywide (i.e. refuse charges, access to cultural providers, etc.)• High costs in certain areas such as transport, funerals• Identify and utilise information access points (such as PHN andGP services)• Support information provision with a generic, localised publication(based on “Entitlements for Over Sixties” or “Life after Work”)• Coordinate outreach presentations between CICs, CommunityWelfare Office and other relevant organisations• Establish where concessions are available and work towardcountywide uniformity and commitment from private serviceproviders• Investigate the impact of funeral costs on the lives of low incomeolder people and find ways to address these• Social Policy Feedback Process within Co. Tipperary CitizensInformation Service161Consideration is also given to issues highlighted in the 2007 Development Plan of the ClonmelOlder People’s Steering Group, the submission made to SIM by the South Tipperary Elderly ServicesReview Group and the findings of the Report on the Needs of the Community Sector in relation to the2007-2013 National Development Plan based on a Consultation Process with the Community &Voluntary Sector in South Tipperary (CDB 2006).87

Review of Services for Older People in South Tipperary (2008)Health and Social Care ServicesSummaryWhat could be improved?How could this be achieved?What is working well?The provision of health and social care services is currentlyundergoing changes as a result of the implementation of a newPrimary Care Strategy. In South Tipperary, the coordination of theseservices is adversely affected by the prolonged absence of theElderly Services Coordinator employed by the HSE as the mainstatutory provider in this regard. A lack of available funds for SouthTipperary under Section 39 of the 2004 Health Act and a lack ofrecognition and support for the voluntary sector present additionalchallenges. There are significant service gaps in respect ofcommunity-based services (chiropody, day care and meals services).• The countywide availability of community-based services• Access to community-based services, particularly in respect ofservices user groups who avail of a service and are thereforeprohibited from the use of other services (example: nursing homeresidents who cannot access of day care centre activities)• The coordination of voluntary services and support for theorganisations providing same (i.e. funding, administration,volunteering, etc.)• Information on and promotion of these services• Improve the coordination and provision of community-basedservices (possibly strengthen lobbying process in this regard)• Review of service user guidelines preventing the maximisation ofresources in the interest of the service user• Utilise voluntary supports (such as those offered by the SouthTipperary Volunteer Centre and South Tipperary Voluntary &Community Forum)• Introduce a forum/network/partnership structure for voluntaryhealth and social care service• Introduce community links workers as piloted elsewhere• Issue an up-to-date service directory (based on publications suchas “Services for the Older Person: A Guide – SEHB)• “Friends of Cluain Árann” and “Good Morning South Tipperary” asmodels of good practice in respect of visiting and emotionalsupport programmes• “South Tipperary Befriending” as a mental health service thatshould be promoted among older people• Access to Public Health Nurses and GP services and referralsystems in place• Day care and meals services, where availableSocial, Educational and Recreational ServicesSummaryWhat could be improved?How could this be achieved?The importance of social, educational and recreational activities forolder people’s quality of life and consequently their health status andcapacity to live independently is frequently underestimated while theunfounded perception persists that large proportions of older peopleexperience loneliness and isolation. The latter affects no more than10 per cent of the people aged 65 years and over. Whileinterventions for this minority of older people are highly important, thewidespread provision of social, educational and recreational activitiesmust be pursued more vigorously. Transport is the greatest barrier toolder people, particularly in rural areas, in participating in and availingof opportunities in this respect.• The framework in which voluntary organisations operate and offersocial, educational and recreational activities• The sporadic provision of such activities resulting from itsdependency on an active local community groups• Public spaces to enable older people to pursue non-organisedactivities in safe environments (walking, cycling)• Strategically provide supports to voluntary groups in this area tohelp sustain membership and activities (information on funding,88

Review of Services for Older People in South Tipperary (2008)What is working well?skills training, knowledge on the changing nature of volunteeringand how to cope with this, etc.)• Countywide promotion of these groups among the general public(as well as particular target groups such as men) to encouragebetter participation and influence the public image of these groups• Promote educational opportunities and library services as part ofthe life long learning concept (consider expanding these to thirdlevel education based on European models of “Senior Citizens’Academies)• Improve public infrastructure to include walkways, cycling lanes,etc. to accommodate those who wish to lead active lives• Go for Life Programme administered by the South TipperarySports Partnership• Community Education Programme administered by the Co.Tipperary (SR) VEC• The Bealtaine Festival organised by Tipperary Libraries• Ad hoc arrangements with private service providers (i.e. gyms) forthe use of facilities by older people• ICT courses delivered through various voluntary providersHousing and Housing SupportsSummaryWhat could be improved?How could this be achieved?What is working well?The provision of housing supports for older people is predominantlyaimed at maximising their capacity to remain in their own homes andlive independently. National support schemes have recently beenrevised and will in future be exclusively administered by the localauthorities. The review of services has shown that the provision ofhousing and housing supports to older people is not consistentacross the county and varies by local authority. There is also animmediate need for maintenance services that address the specificneeds of older people who – as research has shown – are more likelyto experience housing deprivation while at the same time being morereluctant to invest in home improvements. Finally, safety and securityissues are of a particular concern to older people who live on theirown in rural areas.• Inconsistencies in housing policies and housing supports acrossthe county (both in relation to statutory and voluntary services)• The availability of sheltered dwellings for older people• Lack of safety and security equipment for older people or its highcost• The coordination of Neighbourhood Watch groups, some of whichreport lack of support• Cooperation between local authorities and the voluntary housingsector• Agree a countywide policy on elderly accommodation between alllocal authorities and implement same• Muintir na Tíre is in the process of setting up a “Community SafetyVan” project which may serve as a model of good practice• Introduce a panel/quality control system that addresses concern ofolder people to avail of unfamiliar tradesmen• Designated housing stock for older people in each local authorityhousing area• Consider the creation of dwellings based on European models ofretirement villages or sheltered living in conjunction with theprivate sector• Promotion of “Support for Older People in the Community” schemeby DCRAGA among voluntary organisations• Coordination of provision of safety and security equipment andprovision of information on same for the service user• Consider introduction of a fund to help older people with the costof monitored house alarms• Older people’s housing policies and practices in South TipperaryCounty Council and Tipperary Town Council• Coordination of Community Alert Groups89

Review of Services for Older People in South Tipperary (2008)• General take-up of “Support for Older People in the Community”schemeTransportSummaryWhat could be improved?How could this be achieved?What is working well?Adequate transport and information are the key enablers for olderpeople in maintaining active and independent lives. While informationis almost equally important to all parts of the population, transportgains particular significance among older people as reliance on publicmodes of transport is likely to increase with age. A county with largerural parts, such as South Tipperary, faces greater challenges thanpredominantly urban areas in providing adequate public transport.The Rural Transport Programme is therefore seen as an invaluableinitiative. Two services operate in the county under the RTP, of whichRing-a-Link provides greater county coverage.• The lack of RTP provision in parts of the county (i.e. around Cahirand north of Clonmel)• The lack of a similar service in towns that provides door-to-doortransport• Awareness of the RTP services• Expand Ring-a-Link into the identified areas, if funds becomeavailable as part of the mainstreaming process of the RTP• Promote the joint use of community buses by voluntary groups andseek ways to address issues that have prevented this in the past(lack of qualified drivers, insurance, funding requirements).• Examine the viability of a RTP-based service in towns• Examine ways of addressing specific needs of older people inrelation to public transport (i.e. transport to and from eveningmeetings, cultural activities)• Promote the RTP services acknowledging the hesitation of somepotential clients to use them• RTP services where available• Transport services attached to day care centres etc., particularlywhere the older person is settled into their home not “just droppedoff”The provision of adequate public transport, housing supports and information on allservices are perceived to be priority areas in this report. The current changes in theprovision of community-based health services and national housing schemes maynecessitate a further review of services in these areas in due course.90

Review of Services for Older People in South Tipperary (2008)Appendix91

Review of Services for Older People in South Tipperary (2008)Statistical AppendicesLocal Authority Area% of65+livingalone% ofmale65+livingalone% offemale65+livingaloneLeitrim 34.7 31.5 37.6Dublin City 32.4 23.7 38.4Cavan 32.4 29.4 35.1Longford 31.7 28.2 34.8Sligo 31.6 25.9 36.5Mayo 31.5 27.5 35Roscommon 31.3 28.2 34.2Limerick City 31.1 21.7 38.4Waterford City 31 23.6 36.9Monaghan 30.8 23.9 36.6Ulster (part of) 30.7 25.8 34.9Cork City 30.4 20.9 37.4Connacht 30.2 26 33.9Clare 30.1 25.1 34.6Donegal 29.8 24.9 34.2South Tipperary 29.6 24.3 34.3Kerry 29.5 25 33.6Westmeath 29 21.8 34.9Munster 29 22.6 34.3Waterford 29 22.2 34.9Limerick 28.8 22.2 34.3Louth 28.7 20.8 35.1State 28.7 21.9 34.3Dublin 28.5 18.9 35.6Cork 28.5 21.3 34.4North Tipperary 28.2 21.1 34.3Laoighis 27.9 22.2 32.9Leinster 27.8 19.7 34.3Galway County 27.8 24.4 30.9Cork County 27.7 21.4 33.1Galway 27.7 23.4 31.5Limerick County 27.6 22.5 32.2Waterford County 27.6 21.3 33.4Offaly 27.5 21.5 32.8Galway City 27.4 19.3 33.5Carlow 27.2 21.7 32.2Wexford 27.2 20.6 33Kilkenny 27 21.3 32Dún Laoghaire-Rathdown 26.6 14.6 35.5Wicklow 26 18.2 32.6Kildare 25.3 18.5 31.1Meath 25 18.4 30.6Fingal 23.2 14.8 30.5South Dublin 22.1 13 29.6Table 16: Percentage of persons 65 years and over living alone by local authority (SourceCensus 2006, Vol. 3, Table 14)92

Review of Services for Older People in South Tipperary (2008)65-69 70-74 75-79 80-84 85+ TotalCahir 535 413 317 229 180 1,674Cashel 561 496 412 343 279 2,091Clonmel 772 627 506 362 253 2,520Fethard 684 540 494 341 219 2,278Tipperary 605 560 424 317 182 2,088Total County 3,157 2,636 2,153 1,592 1,113 10,651Table 17: 65+ Population in South Tipperary by Local Electoral Areas (LEA’s)65-69 70-74 75-79 80-84 85+ TotalCarrickbeg Urban 52 46 42 32 20 192Carrick-on-Suir Urban 149 117 114 78 64 522Cashel Urban 110 90 100 85 67 452Clonmel East Urban 158 150 135 89 47 579Clonmel West Urban 274 244 215 144 119 996Tipperary East Urban 101 99 81 75 49 405Tipperary West Urban 77 83 53 54 20 287Carrick-on-Suir Rural 21 5 12 9 7 54Garrangibbon 23 21 20 14 4 82Kilmurry 11 7 9 3 3 33Newtown 15 17 10 6 3 51Ardmayle 28 20 14 9 5 76Ardsallagh 6 16 13 11 11 57Ballysheehan 22 15 17 21 35 110Cashel Rural 46 35 38 25 10 154Clogher 8 11 7 3 7 36Cloneen 13 15 10 10 5 53Clonoulty East 30 20 17 6 5 78Clonoulty West 23 23 18 19 13 96Colman 16 9 4 2 2 33Cooleagh 13 18 18 8 6 63Drangan 28 23 19 11 9 90Fethard 36 34 37 29 15 151Gaile 20 35 20 20 17 112Graigue 9 3 8 1 1 22Greystown 28 8 12 8 8 64Killeenasteena 30 21 17 10 6 84Killenaule 41 37 31 24 26 159Kilpatrick 43 30 20 18 9 120Knockgraffon 26 22 13 10 9 80Magorban 14 20 12 15 22 83Nodstown 18 17 8 9 7 59Oughterleague 17 21 19 24 21 102Peppardstown 43 34 22 10 7 116Tullamain 28 25 7 6 4 70Ardfinnan 49 34 12 13 7 115Ballybacon 14 11 4 7 2 38Ballyporeen 29 20 34 13 16 112Burncourt 17 12 9 5 5 48Caher 63 55 40 31 38 227Clogheen 52 44 29 30 15 170Coolagarranroe 23 8 11 15 8 65Derrygrath 31 13 13 13 4 7493

Review of Services for Older People in South Tipperary (2008)65-69 70-74 75-79 80-84 85+ TotalKilcommon 88 59 58 29 12 246Kilcoran 14 20 10 2 4 50Mortlestown 24 19 16 7 8 74Newcastle 18 21 17 17 9 82Tubbrid 20 15 8 7 8 58Tullaghmelan 35 33 22 11 13 114Tullaghorton 10 5 7 7 4 33Ballyclerahan 21 12 17 5 8 63Clonmel Rural 101 49 39 31 10 230Inishlounaght 105 66 53 40 35 299Kilcash 21 29 10 9 8 77Kilsheelan/Killaloan 39 39 17 26 10 131Kiltinan 8 11 5 12 12 48Lisronagh 20 15 3 3 1 42Anner 18 10 10 4 1 43Ballingarry 33 19 17 10 3 82Ballyphilip 17 15 12 5 3 52Buolick 23 12 14 15 5 69Crohane 12 11 3 4 3 33Farranrory 16 11 13 8 4 52Fennor 24 13 16 15 5 73Kilcooly 9 6 9 5 6 35Kilvemnon 17 8 6 4 3 38Modeshil 12 16 13 3 7 51Mullinahone 32 26 21 14 7 100New Birmingham 19 12 10 10 1 52Poyntstown 7 7 6 10 2 32Ballycarron 11 17 9 0 3 40Ballygriffin 10 10 7 4 2 33Ballykisteen 30 32 24 12 6 104Bansha 33 22 23 17 6 101Bruis 15 11 8 8 4 46Cappagh 35 33 23 19 14 124Clonbeg 31 22 9 16 11 89Cullen 13 19 11 4 1 48Curraheen 10 6 18 5 5 44Donohill 27 24 17 21 5 94Drumwood 14 9 7 11 6 47Emly 25 31 26 8 11 101Glengar 8 16 8 5 6 43Golden 44 23 29 10 14 120Kilfeakle 21 30 12 11 4 78Killadriffe 22 22 14 12 18 88Kilmucklin 20 17 15 6 9 67Lattin 11 12 12 12 3 50Rathlynin 18 15 3 11 2 49Rodus 10 15 6 2 4 37Shronell 14 11 17 20 12 74Solloghodbeg 13 4 5 5 1 28Templeneiry 23 16 9 4 3 55Thomastown 11 8 18 7 2 46Tipperary Rural 70 64 47 24 11 216Total County 3,157 2,636 2,153 1,592 1,113 10,651Table 18: 65+ Population in South Tipperary by Electoral Divisions (ED's)94

Review of Services for Older People in South Tipperary (2008)Town 65-69 70-74 75-79 80-84 85+ TotalCahir 120 95 81 57 43 396Carrick-on-Suir 201 163 156 110 84 714Cashel 110 90 100 85 67 452Clonmel 556 467 406 265 179 1,873Fethard 48 40 37 32 17 174Tipperary 178 182 134 129 69 692Total Towns 1,213 1,037 914 678 459 4,301Variance to Aggregate Town Area 2 2 -10 -11 -6 -23Total Rural Area 1,942 1,597 1,249 925 660 6,373Total County 3,157 2,636 2,153 1,592 1,113 10,651Table 19: 65+ Population in South Tipperary by Towns and Aggregate Rural Area95

Review of Services for Older People in South Tipperary (2008)AbbreviationsARA Active Retirement AssociationASC Access, Skills, ContentsCDB County Development BoardCIT Community Intervention TeamCPA Combat Poverty AgencyCSO Central Statistics OfficeDCRAGA Department of Community, Rural and Gaeltacht AffairsED Electoral DivisionEU-SILC EU Survey on Income and Living ConditionsFRC Family Resource CentreGP General PractitionerHeSSOP Health and Social Services for Older PeopleHSE Health Service ExecutiveICA Irish Country Women’s AssociationICT Information and Communication TechnologyLA Local AuthorityLA Local AuthorityLEA Local Electoral AreaNCAOP National Council on Ageing and Older PeopleNDP National Development PlanNESF National Economic and Social ForumNGO Non-governmental organisationNQHS National Quarterly Household ServicePALs Physical Activity LeadersPHN Public Health NursePR Public RelationsQTR QuarterRTI Rural Transport Initiative (now RTP)RTP Rural Transport Programme (formerly RTI)SR South RidingVEC Vocational Educational Committee96

Review of Services for Older People in South Tipperary (2008)Organisations Consulted55 Social Club (Clonmel)Aherlow ICA GuildAnnacarty Active Retirement AssociationBailey House Nursing Home (Killenaule)Ballingeary ICA GuildBansha/Kilmoyler Ladies’ ClubCahir Active Retirement AssociationCahir Day Care CentreCahir Development AssociationCahir Ladies’ ClubCaislean Nua Voluntary Housing Association (Newcastle)Cappawhite Day Centre for the ElderlyCarrick-on-Suir Active Retirement AssociationCarrick-on-Suir Day Centre for the ElderlyCashel and District Active Retirement AssociationCashel Day Care Centre for the ElderlyCashel Lions ClubCashel Town Council (Housing Section)Clonmel Borough Council (Housing Section)Clonmel Community Resource CentreClonmel Day Care Centre for the ElderlyClonmel Older Persons Steering Group (Clonmel Community Partnership)Clonmel Voluntary Housing AssociationCo. Tipperary (SR) VECCo. Tipperary Citizens Information ServiceCuan Saor Women’s Refuge (Clonmel)Drangan and Cloneen Active Retirement AssociationElderly Services Review Group (South Tipperary SIM)Emly Tuesday ClubFaugheen ICA GuildFethard & District Day Care CentreFethard ICA GuildFriends of Cluain Arann (Tipperary)Glengoole Senior CitizensGlengoole Senior Citizens’ ClubGlenview Square Neighbourhood Watch (Tipperary)Golden/Kilfeacle ICA GuildGolden/Kilfeacle Senior Citizens’ ClubGortnahoe Senior Citizens’ ClubGreenhill Nursing Home (Carrick-on-Suir)Health Service Executive (South) – Key personnel in Elderly Services andCommunity WelfareKillenaule Active Retirement AssociationKillenaule ICA GuildKillenaule Senior Citizens ClubKnockanrawley Family Resource Centre (Tipperary)Knockavilla Active Retirement AssociationMary Aikenhead Meals on Wheels (Clonmel)97

Review of Services for Older People in South Tipperary (2008)Meals on Wheels (Fethard)Muintir na Tíre (Head Office)Muintir na Tíre (Newcastle)Mullaney Gardens Neighbourhood Watch (Cahir)Mullinahone Community CouncilNano Nagle Family Resource Centre (Carrick-on-Suir)Oliver Plunkett Terrace Residents’ Association (Clonmel)Padre Pio Nursing Home (Holycross)Powerstown Road/Davis Road Neighbourhood Watch (Clonmel)Rathkeevin ICA GuildRing-a-LinkSouth Tipperary Community & Voluntary ForumSouth Tipperary County Council (Housing Section)South Tipperary Sports PartnershipSpafield Family Resource Centre (Cashel)St. Anne’s Nursing Home (Cashel)St. Joseph’s Nursing Home (Tipperary)St. Mary’s Ladies’ Club (Clonmel)St. Patrick’s Dwellings for the Elderly (Cashel)St. Vincent’s Day Care Centre for the Elderly (Tipperary)Stroke Club (Clonmel)Suir CDP (Carrick-on-Suir)Three Drives Family Resource Centre (Tipperary)The Carer’s Association (Clonmel)Tipperary Active Retirement AssociationTipperary LEADER GroupTipperary LibrariesTipperary Town Council (Housing Section)Tuesday Club for Senior Citizens (Fethard)Vee Valley Day Care Centre (Clogheen)Willowbrook Lodge Nursing Home (Fethard)Woodlands Nursing Home (Dundrum)As well as Tom Hayes, TD and members of the general public.98

Review of Services for Older People in South Tipperary (2008)ReferencesFact Sheets & Information MaterialsCarers. Dublin: National Council on Ageing and Older People 2001 (= Ageing inIreland Fact File No. 9).Community Care Services. Dublin: National Council on Ageing and Older People2001 (= Ageing in Ireland Fact File No. 6).Housing. Dublin: National Council on Ageing and Older People 2002 (= Ageing inIreland Fact File No. 5).Income Supports for Older People. Dublin: Citizens Information Board 2007.Income. Dublin: National Council on Ageing and Older People 2001 (= Ageing inIreland Fact File No. 3).Long-Stay Care. Dublin: National Council on Ageing and Older People 2001(= Ageing in Ireland Fact File No. 7).The Go for Life Programme. Fact Sheet 1. Age & Opportunity 2004.Work and Retirement. Dublin: National Council on Ageing and Older People 2002(= Ageing in Ireland Fact File No. 4).Research StudiesAge and Change. A Community Development Approach to Working with OlderPeople. Dublin: Area Development Management 2005.Care for Older People. Dublin: NESF 2005 (= Report no. 32).Connell, Peter and Dennis Pringle: Population Ageing in Ireland. Projections 2002-2021. Dublin: National Council on Ageing and Older People 2004 (= Report no. 81).Delaney, Sarah/Kevin Culland and Petrina Duff: The Social Inclusion of Older Peopleat Local Level. The Role and Contribution of CDBs. Dublin: National Council onAgeing and Older People 2005 (= Report no. 90).Fahey, Tony and Helen Russell: Older People’s Preferences for Employment andRetirement in Ireland. Dublin: National Council on Ageing and Older People 2001(= Report no. 67).Fahey, Tony/Bertrand Maitre/Brian Nolan and Christopher T. Whelan: A SocialPortrait of Older People in Ireland. Dublin: The Economic and Social ResearchInstitute 2007.Hodgins, Dr. Margaret/ Verna McKenna and Maureen d’Eath: “Enhancing theQuality of Life on Older People in Poverty with Particular Reference to Those LivingAlone”. Health Promotion Research Centre/NUI Galway 2007 (Presentation to theCombat Poverty Agency Research Seminar 30/01/2007).Improving the Delivery of Quality Public Services. Dublin: NESF 2006 (= Report no.34).99

Review of Services for Older People in South Tipperary (2008)Layte, Richard/Tony Fahey and Chris Whelan: Income, Deprivation and Well-BeingAmong Older Irish People. Dublin: National Council on Ageing and Older People1999 (= Report No. 55).Making a Difference. Social Inclusion in a Changing Rural Ireland. ConferenceReport. Dublin: Pobal 2007.Nolan, Brian: “Poverty and Older People in Ireland”. October 2005 (Presentation)O’Hanlon, Ann/Hannah McGee/Maja Barker/Rebecca Garavan/Anne Hickey/RonánConroy and Desmond O’Neil: Health and Social Services for Older People II(HeSSOP II). Changing Profiles from 2000 to 2004. Dublin: National Council onAgeing and Older People 2005 (= Report No. 91).O’Loughlin, Anne and Joseph Duggan: Abuse, Neglect and Mistreatment of OlderPeople. An Exploratory Study. Dublin: NCAOP 1998 (= Report no. 52).Prunty, Martina: Older People in Poverty in Ireland. An Analysis of EU-SILC 2004.Combat Poverty Agency 2007.Ruddle, Helen/Geraldine Prizeman/Deirdre Haslett/Ray Mulvihill and Edwina Kelly:Meeting the Health, Social Care and Welfare Services Information Needs of OlderPeople. Dublin: National Council on Ageing and Older People 2002 (= Report no.69).Stratton, David: The Housing Needs of Older People. Dublin: Age Action Ireland2004.Treacy, Pearl/Michelle Butler/Anne Byrne/Jonathan Drennan/Gerard Fealy/KateFrazer and Kate Irving: Loneliness and Social Isolation among Older Irish People.Dublin: National Council on Ageing and Older People 2004 (= Report no. 84).Watson, Dorothy/Christopher Whelan/James Williams and Sylvia Blackwell:Mapping Poverty: National, Regional and County Patterns. Dublin: IPA and CPA2005 (= CPA Research Series no. 37).Policy Documents & ReportsAnnual Report of the Elder Abuse National Implementation Group (2005).Annual Report of the Elder Abuse National Implementation Group (2006).Department of Health and Children: Primary Care. A New Direction. Quality andFairness – A Health System for You (2001).Department of the Taoiseach: Towards 2016. Ten-Year Framework SocialPartnership Agreement 2006-2015. Dublin: Stationary Office 2006.Department of Transport: Progressing Rural Public Transport in Ireland (2006).Houses of the Oireachtas: Health Act 2004. (= Act no. 42 of 2004)Ireland: National Development Plan 2007-2013. Transforming Ireland. A BetterQuality of Life for All. Dublin: Stationary Office 2007.Office for Social Inclusion: National Action Plan for Social Inclusion 2007-2016.Dublin: Stationary Office 2007.100

Review of Services for Older People in South Tipperary (2008)Office for Social Inclusion: Social Inclusion Report Ireland 2006-2007. Dublin:Stationary Office 2007.Protecting our Future. Report of the Working Group on Elder Abuse. Dublin:Stationary Office 2002.South Eastern Health Board: Towards the Golden Years (1994).South Tipperary County Council: “Policy Document Elderly Accommodation –Meeting the Needs” (2006).South Tipperary County Development Board: South Tipperary County DevelopmentPlan 2003 (2003).South Tipperary County Development Board: South Tipperary County Strategy forEconomic, Social and Cultural Development (2002).South Tipperary County Development Board: Review of 2006 and Target for 2007.(2007).South Tipperary County Development Board: Report on the Needs of the CommunitySector in relation to the 2007-2013 National Development Plan based on aConsultation Process with the Community & Voluntary Sector in South Tipperary(2006).South Tipperary Sports Partnership: Strategic Plan 2007-2010 (2008).Statistical SourcesCentral Statistics Office: Census 2002 (various reports)Central Statistics Office: Census 2006 (various reports and Small Area PopulationStatistics)Central Statistics Office: EU Survey on Income and Living Conditions 2006. Dublin:Stationary Office 2007.Central Statistics Office: EU Survey on Income and Living Conditions 2004. Dublin:Stationary Office 2005.Central Statistics Office: Information Services and Telecommunications. Dublin:Stationary Office 2006.Central Statistics Office: Quarterly National Household Survey Quarter 3 2006 –Module on Sports and Physical Exercise. Dublin/Cork: Central Statistics Office 2007.Central Statistics Office: Quarterly National Household Survey Quarter 4 2005 –Module on Pension Provision. Dublin/Cork: Central Statistics Office 2006.Central Statistics Office: Quarterly National Household Survey Quarter 2 2003 –Module on Lifelong Learning. Dublin/Cork: Central Statistics Office 2004.Websiteswww.ageaction.ie (Age Action Ireland)www.fara.ie (Active Retirement Ireland)www.muintir.ie (Munitir na Tíre)101

Review of Services for Older People in South Tipperary (2008)www.ncaop.ie (National Council on Ageing and Older People)www.olderinireland.ie (Age & Opportunity)www.pobail.ie (Department of Community, Rural and Gaeltacht Affairs)www.pobal.ie (Pobal)www.socialinclusion.ie (Office for Social Inclusion)102