When discussing development of community-based services, it is usually about people with disabilities, mental health problems or children deprived of parental care. However, the majority of institutions in Europe provide care for older people (in average 3.3% of Europeans over 65 reside in long-term stay residences). With that in mind, the members of the ESN working group on Developing Community Care (DCC) decided to dedicate their meeting on 7-8 December in Dublin to discuss the availability of community services for older people, their sustainability and cost in relation to residential care.

Historically, older people were cared by their relatives, sometimes neighbours and the parishes where they lived. Nowadays, community care still plays a key role in the provision of support, even though institutional and community alternatives are now widespread. This evolution in patterns of care for older people was illustrated by Cate Hartigan, from Ireland’s Health Service Executive, an ESN member.

Today, older people in Ireland have a number of options to choose from. The group visited Claremont Residential and Community Services (north Dublin), which provides a whole spectrum of services, ranging from intensive nursing to day-care to respite.

Technology has strong potential for supporting older people to live at home for longer. Both research and the experimental so-called ‘aware homes’ are now piloted in Dundalk. Read more about the ‘Nestling project’ in Dundalk.

Cooperation between health and social services is crucial in elderly care. The issue, introduced by Radka Soukupova, from the Czech Republic’s local government association (SMOCR), raised questions around the difficulty of bringing together different streams of funding and centralizing information when evaluating the cost effectiveness of services. Interestingly, her presentation prompted the debate on how older people’s residential homes are perceived across Europe: in some countries the culture is to avoid them, in others they are a natural choice for the final stage of life. In some countries, meanwhile, they are considered a safe place guaranteeing shelter, food and clothing, thus a decision to move into a care home is generally seen as responsible.

The cost of care for older people was very much part of the group’s discussions. Klaus Schumacher, group member from Team without Walls in Austria explained that while it is generally acknowledged that good quality services in the community are not necessarily more expensive than those in institutions, there are regional variations across Europe. It was acknowledged that the lack of appropriate methodology to assess the cost of community-based services makes it hard to compare them with residential care. However, it was strongly asserted by the working group that the choice for community-based alternatives should not be measured by cost-effectiveness only as this model of care offers unquantifiable advantages such as: a better quality of life for users and more inclusive communities for all.