Project Description

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8. Community Support & Health Services

While health inequality is evident across different groups of older people, in general older people in Carlow self reported as being healthier than in other areas. 55% of over 70s reported good or very good health v 59% in other counties. 72% of the 55-69 age group reported their health as good or very good.
However we know that the age group over 80 and over 90 has significantly increased care needs. Almost 50% of those surveyed over 55 had received a diagnosis of arthritis while another 46% suffered from high blood pressure. 91% of over 70s had visited their GP in the last 12 months while this figure dropped to 78% for the 55-69 age group. Only 8% of 55-69 year olds used the service of their Public Health Nurse, while 33% of over 70s did. Of the services that they did not receive those surveyed said Chiropody (40%) Dental (30%) and Physiotherapy (26%) were the services they felt they needed most.

5.4% of people in Carlow over 55 smoke (national average 14%). Older smokers (65 and over) are the least likely to attempt to quit (just 37% have tried in the past year) despite being the most vulnerable to the harmful effects of smoking. 69% of the 55-69 age group did 150 minutes of exercise
per week, and 49% of the over 70s group. 73% of older adults cared for another person and this was equal across both age groups.

Issues raised by older adults

“Small procedures should be available in the local areas”
“Signage needs to be improved in the new section of the Hospital (St. Luke’s)”
“Men’s Health check up service needed locally”
“More people living on their own need to take responsibility for their own health”
Breast check age limit should be expanded”
“Buddy Bench – a seat to healthy chat”
Health Service is excellent once you get in; the Care Doc service is very good.
Providing your own transport from St. Luke’s A&E to Waterford is not easy for an older person

Short Term Actions ( 2017 )

The Health Service Executive Older Persons Service will implement a revised model of Homecare in collaboration and consultation with the National Clinical programme for Older Persons, National Older Person’s office and other divisions within the community Health Organisation, hospital groups and older people. This is directly in response to the National Positive Ageing Strategy 2013 goal 3 “enabling people to age with confidence, security and dignity in their own homes and communities for as long as possible”

The Health Service Executive Older Persons Service will build capacity and reform existing Service Providers by reviewing unmet need in local communities in the areas of Day Care, Meals on Wheels and other community support services.

The Health Service Executive will continue to support the development the Day Hospital and Memory Clinic at Sacred Heart Hospital to ensure that older people from Carlow can have access to a comprehensive geriatric service.

St. Luke’s General Hospital will continue to provide its Geriatric Emergency Medicine (GEMS) team whose aim is to:

 To provide access to Comprehensive Geriatric Assessment (Multidisciplinary) for patients over 75 years old presenting to ED and AMAU (Acute Medical Assessment Unit).
 To improve functional outcomes for older people attending the hospital
 To increase discharges from acute floor and reduce numbers of patients admitted
 To reduce re-attendance rates of non-admitted patients
 To reduce Length of Stay of admitted patients
 To reduce readmission rates
 To reduce the institutionalisation of older people

The Health Service Executive will support, directly and indirectly, through the Service Providers Forum, the roll out of the national advocacy programme,
SAGE (Sage Support and Advocacy Service for Older People) into the community to ensure older adults have access to supports and information and an independent advocate volunteer that will support their independence and wellbeing.

Carlow Volunteer Centre will continue to support organisations by the referral of volunteers, provision of information, training and capacity building in the area of effective Volunteer Management. Carlow Volunteer Centre continues to promote volunteer opportunities and promote the positive impacts of volunteering via traditional media to reach older people. Carlow Volunteer Centre provides this service to a range of existing organisations which support older adults for example Day Care Centres, Carlow Libraries, Meals on Wheels, St. Fiacc’s House. Carlow Volunteer Centre supports other organisations across the Disability, Mental Health and Social Inclusion sectors.

Carlow County Development Partnership will continue to operate the Care and Repair programme. They will also continue to support the Carlow Older Persons Forum in its work with the Health Service Executive and other stakeholders

St. Catherine’s Community Services, and other providers in Carlow, will continue to coordinate the provision of Monitored Alarms to older people in Carlow enabling them to feel secure and remain in their homes independently.

Kilkenny & Carlow Contact Befriending and Support Service will form partnerships with local Public Health Nurses and community groups who provide alarms in Carlow Town and County to ensure that older people will be able to access Socially Monitored Alarms and any additional telecare devices to encourage ongoing independent living.

St. Catherine’s Community Services Centre and other Meals on Wheels providers, will help meet the need of older people to live independently through the provision of Meals on Wheels. St. Catherine’s will do so directly and via Outreach services such as Leighlinbridge and Fenagh in collaboration with Public Health Nurses. They will also promote and support other Meals on Wheels services in Carlow to adopt the Quality Standard framework to help services develop and benchmark their service.

The Health Service Executive will progress the Respiratory COPD (Chronic Obstructive Pulmonary Disease) and Asthma Integrated Care initiative across
Carlow / Kilkenny with the aim of providing support for up to 24 GP practices across the two areas.

The Health Service Executive will establish and maintain a register of patients with COPD / Asthma within the Clinical Nurse Specialist caseload and facilitate the development of registers within GP practices in Carlow.

The Health Service Executive will deliver a Clinical Nurse Specialist (CNS) led clinic COPD / Asthma clinic. The CNS will focus on patients over 16 with a confirmed diagnosis of COPD/Asthma who are poorly managed as evidenced by their attendance with an Asthma exacerbation, GP/Out of hour’s service, Emergency Department and or admission to hospital in the previous 6 months. Each patient will have a comprehensive assessment including a spirometry test and in conjunction with MDT individual care plans will be developed. Patients with specific symptoms will be provided with specific symptom management strategies.

The Health Service Executive will deliver 4 physiotherapy pulmonary rehabilitation programmes weekly for people with COPD in Carlow and Kilkenny. Each programme will provide for 10 people attending, this will include 2 groups attending twice weekly in Carlow over an 8 week period. Each group has an excerise session twice weekly and one educational session. Pre and post programme assessments are done on an individual basis for each person and every person has an individualised plan.

The Health Service Executive will enhance the Respiratory Integrated Care programme in Carlow through the provision of Occupational Therapy education on fatigue management and energy through the delivery of one session on each of the 2 pulmonary rehabilitation programmes to be delivered in Carlow.

The Health Service Executive will progress the Heart Failure clinical programme with the aim of providing support to up to 24 GP practices as follows:

 The Health Service Executive will provide a point of care testing for natribretic peptide and ECG within GP practices.
 The Health Service Executive will set up referral pathway for heart failure patients for the Virtual Heart Failure Clinic in St Luke’s Hospital which will provide support and guidance to GP in managing heart failure patients.

The Health Service Executive will assist participating GP practices in setting up a register for Heart Failure patients.

The Health Service Executive will complete recruitment of a second Clinical Nurse Specialist post in Carlow / Kilkenny in 2017

Carlow Older Persons Forum will continue to collaborate with service providers, particularly the Health Service Executive, to help provide information of services to the older population and to those who are most isolated. Carlow Older Persons Forum will continue to work with all service providers, particularly the Health Service Executive to improve facilities.

Short-Term Actions ( 2017 )

Medium Term Actions ( 2017 )

Medium Term Actions ( 2017 )

Carlow Older Persons Forum will continue to participate on and develop its links with the patient partnerships in Kilkenny and Waterford, to advocate for Hospital Link and to put older person’s needs at the front of the Health Service Executive agenda.

The Health Service Executive Older Person’s Service will develop guidelines to integrate physical activity into long-term care in both Sacred Heart Hospital and
Carlow District planning and practice in all residential care centres in collaboration with Physiotherapy. These guidelines will be available to private nursing homes in the area also. This is in line with the National Guidelines for Physical Activity for Ireland which recommends that older people (aged 65+) engage in at least 30 minutes a day (or 150 minutes a week) of moderate physical activity, with a focus on aerobic activity, muscle strengthening and balance. Regular physical activity reduces the risk of chronic diseases such as coronary heart disease, Type 2 diabetes, stroke, cancer, osteoporosis and depression. In addition for older people in particular, regular physical activity reduces the risk of falls and resulting injuries as well as improving cognitive function. Nursing home residents are at the highest risk of falls, fractures and osteoporosis (CARE Pals)

The Health Service Executive will ensure the provision of counselling services to those that require it via:
1) Counselling in Primary Care Service which is a free confidential HSE professional counseling service offering short term counselling for medical card
holders. Referrals are made through Carlow GPs.

2) The Self-Harm Intervention Programme (SHIP) which is a free confidential Health Service Executive professional counselling service offering short term
counselling to individuals aged 16 and over who are experiencing suicidal ideation or the impulse to self-harm. Referral is through a person’s GP or other
medical professional.

3) Bereavement Counselling for Traumatic Deaths. Referral is from a G.P. or other Health Professional e.g. Psychiatrist, Psychologist, Social Worker or other
Counselling Service. It is for age 16 and up with or without medical card and the individual can avail of 12 sessions. There is no charge. The individual must
however be bereaved through the following circumstances: suicide, homicide, road traffic accident, industrial/agricultural/domestic accident or drowning.

The Health Service Executive through the Carlow /Kilkenny Service Providers Forum will promote positive mental health for older people and provide guidance and support on how best to look after your mental health in line with research which shows that there are five key issues that can impact on the mental wellbeing of older people being discrimination, participation in meaningful activities, relationships, physical health and poverty.

The Health Service Executive will deliver Audiology services which are responsive to local needs which will include: a) Deliver a weekly minor hearing aid repair clinic in Waterford and b) Deliver a weekly ear mould clinic in Waterford both of which are accessible to residents of Carlow.

Carlow County Development Partnership will continue to explore ‘Hospital Link’ and other innovative options to assist older people.

The Service Providers Forum supported by the Health Service Executive will review  possible community projects including dementia and age specific spaces and activities using available networks and resources, in gardens and secure spaces which are accessible and cater for all ages and are dementia friendly.

The Health Service Executive will ensure clear integrated care pathways for all older persons who require health services including those living with dementia is available, and assistance is provided to GPs and to those living with dementia and their families and carers to identify and access local service and supports.
The Health Service Executive through the community dietetic services in Health Promotion will deliver a structured patient education for people with Type 2 diabetes (Xpert Programme) which is usually late onset and therefore more prevalent in older adults.

The Health Service Executive Older Persons Service will progress the Health Service Executive national plan for the local designated care centre for older persons within the community in line with Capital expenditure Plans for 2021 and in line with Health information and Quality Authority (HIQA) Standards and Health Act 2007 (registration of designated centres for older people) Regulations 2015.

The Health Service Executive Older Person’s Services will build capacity of older people to maintain their health and wellbeing through existing structures such as Service Providers Forum and Carlow Older Persons Forum. They will also continue to implement the actions from the National Dementia and the National Carer’s Strategy through existing processes and structures within Carlow.

The Health Service Executive acute services and community services will continue to work collaboratively to support earlier discharge from hospital
supported by rapid response community teams, to minimise hospital stays for older adults.

St. Luke’s Hospital Health Service Executive will establish a Frailty Unit in the acute hospital to ensure older vulnerable adults are fast tracked through Accident and Emergency though a “comfort clinic” setting, reducing hospital admissions and supporting assessment and treatment in an appropriate way.

Long Term Actions ( 2017 )

Carlow Older Persons Forum will continue to promote active participation in age friendly health and recreational facilities and activities that local services provide. OPF assisted by Carlow County Development Partnership will develop a regional forum to agitate on behalf of older persons.

Long Term Actions ( 2017 )