CPPC 2012 Spring Workshop Quality and Content in Repair Firm Reports.
Mental Health Supports for Older People...
Transcript of Mental Health Supports for Older People...
Mental Health Supports for Older People needed.
Sage makes submission to the Joint Committee on the Future of Mental Health
Care
The submission highlighted the mental health challenges for vulnerable adults and older people, and the challenges a person with a
primary mental health condition can encounter as they age.
Issues highlighted include:
the impact of loneliness, social isolation and loss experienced by many older adults
the under-diagnoses and under-treatment of depression and anxiety
the prevalence of polypharmacy for older people and people with an intellectual disability with a mental health condition
the current lack of legislative safeguards to prevent the use of sedation purely for the management of a person’s behaviour for
convenience
Amongst Sage’s recommendations is recognition of the role and practice of independent advocacy, the right to access and be represented
by an independent advocate, and for the establishment of a National Council for Support and Advocacy.
Read Sage's submission in full
Sage Casework on Contracts of Care – Notice to Quit
In October 2017 The Ombudsman launched Sage’s discussion document Contracts of Care for Nursing Home Residents – Issues of Policy
and Practice Sage has highlighted residents in long-term care have limited rights relating to security of a placement in a long-term care
facility, and due to the lack of security and protections in the Contract of Care are at risk of receiving a limited period of notice to quit or
notice that a contract of care is being terminated.
A recent review of Sage’s case records showed that Sage has engaged in 59 cases where a resident of a care setting was issued with a
notice to quit, a notice to quit was imminent, or a notice to quit was referred to as a course of action to be taken by the care setting.
Many of these cases concerned a notice to quit being given when the care setting could no longer meet the person’s care needs, with many
cases referring specifically to the residents’ behaviour and in some of these circumstances the resident had a dementia.
In three cases a notice to quit was issued following a complaint from family members regarding charges in the care setting or quality of care
for the resident.
There were five cases recorded which relate to a notice to quit being issued by a care setting where the basis for the action was in
response to behaviour of a resident’s family member, and was not related to the resident, who is party to the contract of care and the
person directly impacted by a notice to quit their home.
Sample Case: Notice to Quit: No longer able to meet needs of resident with dementia
Patricia is 85 years old and has been residing in the nursing home for three months. Patricia has a diagnosis of dementia, and has
displayed behaviour which is considered aggressive towards staff and residents. She has been given a notice of discharge from the nursing
home to leave in 28 days, this notice was given to Patricia’s daughter. The nursing home sent Patricia to the local A&E by ambulance on
three occasions following incidents of aggressive. On one occasion Patricia was sent by ambulance in the evening, and was discharged
back to the nursing home in the middle of the night.
Read a Sunday Independent article on the issue
Competition and Consumer Protection Commission (CCPC) begins
Public Consultation on contracts of care in long-term residential care
services for older people.
The CCPC has announced a public consultation seeking views from those who have entered contracts of care in long-term residential
services for older people. This consultation will inform the CCPC’s ongoing project which is developing a set of guidelines for those who
provide standard form contracts in long-term residential services.
Fergal O’Leary, Member of the CPPC said,
“For older consumers the decision to enter a care home is significant. In addition to the personal implications there are significant financial
commitments attached to this care. For many this is the most significant contract that they, or their families, will sign up to in their lifetime".
The CCPC is encouraging submissions from residents, their families or representatives, who have at any time been involved in organising a
contract of care in long-term residential services in Ireland. Service providers in the sector are also invited to make a submission and
provide information about the care contracts they offer.
A copy of the CCPC’s consultation paper is available here and the closing date for submissions is the 23rd
of February 2017.
Case Example 3: Person experiencing mental health difficulties being
transferred from hospital to a nursing home
Peter was in hospital, having been admitted there following a fall. A family member was informed while visiting that Peter was being
transferred to a nursing home and was asked to sign the Nursing Home Support Scheme (NHSS) application form to facilitate this process.
The family member refused to sign the applicaton as they felt the State was abdicating their responsibility and that Peter was 'being written
off'. Peter had the right to be afforded a better quality of life.
As a result of Sage support the following Key Outcomes were achieved:
Peter moved from acute hospital to a nursing home setting, supported by both hospital staff and family working collaboratively
Peter's voice will lead the process of providing for his needs from now on
The family is actively involved in ensuring that this principle will continue to inform the process
Sage's intervention resulted in a more holistic and respectful approach being taken to Peter's care and support needs
Read the full case details (P55)
National Safeguarding Committee (NSC) calls for urgent
commencement of the Assisted Decision Making (Capacity) Act 2015.
A review of the current practice in the use of wardship for adults in Ireland published by the National Safeguarding Committee (NSC) found
that there is substantial public confusion and lack of understanding around the Wards of Court system, and that it relies too much on the
integrity of family members and professionals.
The NSC, suggests therefore that the guiding principles contained in the 2015 Decision-Making (Capacity) be commenced immediately.
The report also points out that there is no system of review or appeal for wards (and non-wards) who are the subject of de facto detention
and makes a number of recommendations.
Download the report.
We must help vulnerable people to make the best decisions
New legal measures will bolster rights of those with diminished decision capacity Independent 4 January 2018
Áine Flynn, Director, Decision Support Services
“Do you know where you are?”
“Do you know what date it is?”
“Can you name the Taoiseach?”
“Can you spell ‘world’ backwards?”
These questions are from the traditional mental status examination. They are an example of how not to assess the decision-making
capacity of someone with an intellectual disability, mental illness, dementia or acquired brain injury.
A person whose decision-making capacity is in question should be as free as anyone else to make decisions. The legal starting point is a
presumption that every person has the capacity to make decisions about their resources and personal affairs free of intervention, until the
contrary is shown.
This approach is set out in law in the Assisted Decision-Making Capacity Act that was passed by Oireachtas at the end of 2015. It will
introduce far-reaching changes to the way that we support adults who have difficulties with their decision-making.
Instead, the 2015 Act introduces a test of capacity to make a specific decision at a particular time. This functional test of capacity is new in
law but it has been used before.
What then if you are found to lack capacity to make the decision in question? The 2015 Act provides for a graduated system of supports, or
“interveners” to assist the relevant person.
There are steps which any adult can take while they have full capacity to prepare for the possibility that at some future point they will not.
The 2015 Act develops new procedural measures in relation to:
Enduring powers of attorney: these allow an adult who has full capacity to appoint a trusted relative or friend to step in and
make important decisions on their behalf if this becomes necessary in the future;
Advance healthcare directives: introduced for the first time, these enable an adult with capacity to state their wishes with regard
to future medical treatment, including life-sustaining measures, and to appoint a representative to ensure that these wishes are
observed.
Responsibility for much of the implementation of this will rest with a new office within the Mental Health Commission called the Decision
Support Service (DSS). Intensive work is under way to make the DSS fully operational
The changes brought about by the 2015 Act and the Decision Support Service will have significance for all those caring for and advising
vulnerable people and their families. It will affect the work of healthcare and social care providers, lawyers and financial professionals.
We are an ageing population, with longevity and levels of age-related cognitive impairment increasing all the time, so these are changes
which could reach into every home in Ireland.
Áine Flynn is the recently appointed first director of the Decision Support Service
Read the full article
National Medical Card Online service goes live.
Sage was among the groups that actively contributed to the detailed consultation process that was undertaken to develop a new and more
equitable approach to the processing of medical card applications.
On 15th January the HSE launched its new National Medical Card Online service, www.medicalcard.ie. This new service enables people for
the first time to apply online for a Medical Card quickly and easily using a step by step guide.
Almost 440,000 applications were received by the National Medical Card Unit in 2017, so this new, streamlined service will bring great
benefits for people in terms of turnaround times, convenience and security.
Users can find out if they are eligible for a Medical Card immediately, and if they are their application will be processed in 15 working days.
This online service conveniently allows applicants to scan and upload documents and other information, and no longer requires a visit to a
GP to stamp paper forms.
Full details are available at www.medicalcard.ie
Review of 25,000 in care required as law on consent changes?
Irish Examiner 8th January 2018
Thousands of elderly and vulnerable people in nursing homes and other residential facilities are being detained without legal authority and
will have to have their cases reviewed by the courts or specialist tribunals.
The anomaly - thought to involve 25,000 nursing home residents and thousands more in other residential settings - came to light during
preparations for the implementation of new laws giving people with restricted decision-making capacity more say in their care.
A new State agency, the Decision Support Service (DSS), is being set up to oversee the Assisted Decision-Making (Capacity) Act, which
appoints formal decision-makers or decision-making assistants to adults whose capacity to make decisions is diminished by mental or
physical illness or disability.
Under the act, 2,800 wards of court will have to have their cases reviewed, while people entering care for the first time will have a more
robust examination of their own wishes. However, one of the issues the act has thrown up is the status of adults already in residential care
who have not given their express consent to be there.
Newly-appointed head or the DSS, Áine Flynn, said Deprivation of Liberty Safeguards (DOLS) would be added to the act for those entering
care but they would also have to be applied retrospectively.
The Department of Health is seeking submissions from the public and interested groups by next March.
The act has implications far beyond nursing homes. When fully commenced, it will end the ad-hoc arrangements put in place by many
families making decisions for loved ones and it will require healthcare, legal, financial, and other professionals to satisfy themselves that a
client or customer has full capacity to make decisions and to call in the DSS where that capcity is in doubt.
Read the full article
New Primary Care Reimbursement Services (PCRS) Publications
Repository
PCRS Publications is a new repository for reimbursement and medical cards reports, data and information. The publications webpage
showcases a multitude of Primary Care Reimbursement Services (PCRS) reports, trends and analyses.
The PCRS is responsible for reimbursing all GPs, dentists, pharmacist and other contractors who provide free or reduced-cost services to
the public. The National Medical Card Unit (NMCU) in PCRS processes all medical card and GP visit card applications.
For many years PCRS has compiled statistics and trend analyses through its annual reports. This new offering provides up to date
information for the general public, service users, researchers, the media, people working in the health services and government
departments. As the platform will be refreshed on a rolling basis, visitors will have access to the most up-to-date, publicly available
information.
Benefits to you:
· Access to the most up-to-date, publicly available reports, trends and analyses;
· Ability to download and reuse this information;
· Statistics available within the areas of High Tech Drugs, Optical, Dental, Pharmacy, GP, Medical Card and GP Visit Card eligibility,
with further areas under development;
· Links to the latest PCRS annual reports.
As part of the Public Service Reform agenda to improve data sharing in the public service, PCRS Publications is also published to the
eHealth Ireland Open Data Portal. The portal provides citizens with ease of access to raw Public Sector data in an open, free and reusable
format.
For more information visit www.hsepcrs.ie
Volunteers
Sage are currently recruiting for Support Person volunteers
Support People are people who promote awareness of Sage and our services at local level, who provide general support to Sage clients to
enable them make their voice heard and who refer on to an advocate where necessary. Support People will interact with various key
audiences, including service providers and relevant community and voluntary organisations.
Information events are held nationally. The next events coming up are:
February
Galway – February, Thursday 8th, 6pm
Cork – February, Thursday 22nd, 5pm
March
Dublin – March, Thursday 29th, 6pm
Training dates for the first half of the year are as follows:
Dublin February Fri 2nd Fri 9th Fri 16th
Wexford February Fri 9th Fri 16th Fri 23rd
Cork March Thurs 1st Thurs 8th Thurs 15th
Galway April Thurs 5th Thurs 12th Thurs 19th
Dublin May Fri 4th Fri 11th Fri 18th
If you are interest in volunteering with Sage contact Helen Fitzgerald for more information
10th International Dementia Conference
Dublin
16 & 17 April, 2018 Featuring Irish and international speakers, plenary sessions, parallel sessions, workshops and masterclasses. Further information
Sage Volunteers The work carried out by Sage volunteers makes a great difference in the lives of their clients as can be seen by this lovely text Sage Volunteer, Pat Fullam received from a cousin of one his clients. "Just to wish you a very Happy Christmas and all the best for the new year. The work you did for [client] right down to his toenails, was terrific! He is very thankful and in great form. Needless to say the family greatly appreciates all you have done. Please pass on our best wishes to SAGE."
Public Age Project Screening
Dún Laoghaire-Rathdown County Council Arts Office
23rd February
The Public Age project sought to reveal how important well designed public space is to health, well-being and positive ageing in Dún Laoghaire-
Rathdown County.
The Decorators and artist Joe Coveney researched and developed the concept of The Meeting House - a mobile structure that toured the County in
2017 hosting shared public conversations between diverse groups.
The Meeting house was intended as both a research methodology and as a prototype for a new social space. It was a place to collect lived
experiences and affect change by informing and empowering participants.
This screening will give some insights into the project and will be followed by a short Q&A by the team, all are welcome.
More information