Mental Health Supports for Older People needed.louthppn.ie/wp-content/uploads/2018/02/The-Sage-Page-Jan-2018.pdf · Fergal O’Leary, Member of the CPPC said, “For older consumers

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