Committee Reports::Interim Report - The Elderly, The Family and the State in Ireland::23 January, 1997::Report


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TITHE AN OIREACHTAIS

Tuarascáil Eatramhach ón gComhchoiste um an Teaghlach

Daoine Scothaosta, an Teaghlach agus an Stát in Éirinn

HOUSES OF THE OIREACHTAS

Interim Report of the Joint Committee on the Family

The Elderly, The Family and the State in Ireland

January 1997

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JOINT COMMITTEE ON THE FAMILY

ORDERS OF REFERENCE

ORDER OF DÁIL OF 9 MARCH, 1995

(1)Go gceapfar Roghchoiste de Dháil Éireann ar a mbeidh 15 chomhalta de Dháil Éireann a bheidh le comhcheangal le Roghchoiste de Sheanad Éireann chun bheith ina Chomhchoiste um an Teaghlach chun breithniú a dhéanamh ar an tionchar atá ag athruithe sóisialta agus ag beartais Stáit ar an teaghlach, faoina chlónna núicléacha agus forleathnaithe araon, go háirithe i dtaca le cosaint agus neartú leasanna leanaí agus daoine scothaosta agus leis na bearta is féidir a ghlacadh chun tacú leo, go háirithe i dtaca le cúram leanaí, oideachas, ceartas don óige, agus cúram daoine scothaosta, agus chun tuarascáil a thabhairt air sin do dhá Theach an Oireachtais. Cuirfidh an Comhchoiste a thuarascáil deiridh i láthair laistigh de dhá bhliain de dháta an ordaithe lena gceaptar an Comhchoiste.

(1)That a Select Committee of Dáil Éireann consisting of 15 members of Dáil Éireann be appointed to be joined with a Select Committee of Seanad Éireann to form the Joint Committee on the Family to consider the impact of social change and State policies on the family, in both its extended and nuclear forms, with particular reference to the protection and enhancement of the interests of children and the elderly and measures which can be taken to support them especially with regard to child care, education, juvenile justice, and care of the elderly, and to report thereon to both Houses of the Oireachtas. The Joint Committee shall present its final report within two years of the date of the order appointing the Joint Committee.

(2)Go mbeidh an chumhacht ag an gComhchoiste Fochoistí a cheapadh agus aon ní a chuimsítear le mír (1) a tharmligean chun Fochoiste.

(2)That the Joint Committee shall have the power to appoint sub-Committees and to delegate any matter comprehended by paragraph (1) to a sub-Committee.

(3)Go ndéanfaidh an Comhchoiste agus gach, Fochoiste, roimh thosach gnó, duine dá chomhaltaí a thoghadh mar Chathaoirleach, agus gan aige nó aici ach vóta amháin.

(3)That the Joint Committee and each sub-Committee, previous to the commencement of business, shall elect one of its members to be Chairperson, who shall have only one vote.

(4)Go gcinnfear na ceisteanna go léir sa Chomhchoiste agus i ngach Fochiste trí thromlach vótaí na gcomhaltaí a bheidh i láthair agus a vótálfaidh agus, i gcás comhionannas vótaí, go gcinnfear gur freagra diúltach a tugadh ar an gceist.

(4)That all questions in the Joint Committee and in each sub-Committee shall be determined by a majority of votes of the members present and voting and in the event of there being an equality of votes, the question shall be decided in the negative.

(5)Gur 5 is córam don Chomhchoiste agus gurb é is córam do gach Fochoiste líon a chinnfidh an Fochoiste nuair a bheidh an Fochoiste sin ceaptha.

(5)That the quorum of the Joint Committee shall be 5, and the quorum of each sub-Committee shall be a number to be decided by the sub-Committee when such sub-Committee is appointed.

(6)I gcás comhalta ar comhalta de Dháil Éireann é a bheith as láthair ó chruinniú áirithe den Chomhchoiste nó d'Fhochoiste dá chuid, go bhféadfaidh comhalta eile de Dháil Éireann, arna ainmniú ag an bPáirtí nó ag grúpa de réir bhrí Bhuan-Ordú 90 lena mbaineann an comhalta atá as láthair, páirt a ghlacadh sna himeachtaí agus vótáil ina ionad nó ina hionad: Ar choinníoll i gcás ionadaí a ainmneoidh Páirtí ar Páirtí Rialtais é, gur féidir comhalta de Pháirtí Rialtais eile a bheith san ionadaí sin.

(6)That in the absence from a particular meeting of the Joint Committee, or of a sub-Committee thereof, of a member who is a member of Dáil Éireann, another member of Dáil Éireann nominated by the Party or group within the meaning of Standing Order 90 to which the absent member belongs may take part in the proceedings and vote in his or her stead: Provided that in the case of a substitute nominated by a Party which is a Government Party, such substitute may be a member of another Government Party.

(7)Go bhféadfaidh comhaltaí de Dháil Éireann, nach comhaltaí den Chomhchoiste, freastal ar chruinnithe agus páirt a ghlacadh in imeachtaí an Chomhchoiste agus a chuid Fochoistí gan ceart vótála a bheith acu.

(7)That members of Dáil Éireann, not being members of the Joint Committee, may attend meetings and take part in the proceedings of the Joint Committee and of its sub-Committees without having a right to vote.

(8)Go mbeidh an chumhacht ag an gComhchoiste fios a chur ar dhaoine, ar pháipéir agus ar thaifid agus, faoi réir thoiliú an Aire Airgeadais, seirbhísí daoine ag a bhfuil saineolas nó eolas teicniúil a fhostú chun cabhrú leis nó le haon cheann dá Fhochoistí le linn aon ní a chuimsítear le mír (1) a bheith á bhreithniú acu.

(8)That the Joint Committee shall have the power to send for persons, papers and records and, subject to the consent of the Minister for Finance, to engage the services of persons with specialist or technical knowledge to assist it or any of its sub-Committees in their consideration of any matter comprehended by paragraph (1).

(9)Go mbeidh cumhacht ag an gComhchoiste miontuairiscí na fianaise a ghlacfar os a chomhair mar aon le cibé doiciméid ghaolmhara is cuí leis a chlóbhualadh agus a fhoilsiú ó am go ham.

(9)That the Joint Committee shall have power to print and publish from time to time minutes of evidence taken before it together with such related documents as it thinks fit.

(10)Go bhféadfaidh an Comhchoiste nó Fochoiste dá chuid aighneachtaí i scríbhinn a lorg ar dhaoine nó ar chomhlachtaí leasmhara maidir le haon ní a chuimsítear le mír (1), más gá sin dar leis an gCoiste nó leis an bhFochoiste, de réir mar is iomchuí.

(10)That the Joint Committee or a sub-Committee thereof may invite submissions in writing, if considered necessary by the Committee or sub-Committee, as may be appropriate, from interested persons or bodies on any matter comprehended by paragraph (1).

(11)Nach ndéanfar aon doiciméad a bheidh faighte ag Cléireach an Chomhchoiste nó Fochoiste dá chuid a choimeád siar, a aistarraingt ná a athrú i ngan fhios don Choiste nó don Fhochoiste, de réir mar is iomchuí, agus gan toiliú uaidh.

(11)That no document received by the Clerk to the Joint Committee or a sub-Committee thereof shall be withheld, withdrawn or altered without the knowledge and approval of the Committee or sub-Committee, as may be appropriate.

(12)Go ndéanfar gach tuarascáil a bheartóidh an Comhchoiste, a thabhairt,arna glacadh ag an gComhchoiste, a leagan faoi bhráid dhá Theach an Oireachtais láithreach, mar aon le haon doiciméad a bhaineann leis an gcéanna a bheartaíonn an Comhchoiste a fhoilsiú, agus as a aithle sin go mbeidh ar chumas an Chomhchoiste and tuarascáil sin agus an doiciméad nó na doiciméid sin, de réir mar a bheidh, a chlóbhualadh agus a fhoilsiú.

(12)That every report which the Joint Committee proposes to make shall, on adoption by the Joint Committee, be laid before both Houses of the Oireachtas forthwith, together with any document relating thereto which the Joint Committee proposes to publish, whereupon the Joint Committee shall be empowered to print and publish such report and the said document or documents, as the case may be.

(13)Go mbeidh an chumhacht ag an gComchoiste tograí a phlé agus a dhréachtú le haghaidh athruithe reachtaíochta agus le haghaidh reachtaíochta nua lena moladh d'Airí, ar tograí iad is iomchuí do na nithe a chuimsítear le mír (1).

(13)That the Joint Committee shall have the power to discuss and draft proposals for legislative changes and new legislation for recommendation to Ministers which are relevant to the matters comprehended by paragraph (1).

(14)Go bhfreastalóidh gach duine a cheapfar chun ard-oifige sa Stát ar chruinnithe den Chomhchoiste, de réir mar is iomchuí, agus faoi réir srianta dlíthiúla a n-oifige, chun saincheisteanna is iomchuí do na nithe a chuimsítear le mír (1) a phlé.

(14)That all appointees to high office in the State shall attend meetings of the Joint Committee, as appropriate, and subject to the legal constraints of their office, to discuss issues which are relevant to the matters comprehended by paragraph (1).

(15)Go láithreoidh Airí agus Airí Stáit os comhair an Chomhchoiste chun beartais reatha is iomchuí do na nithe a chuimsítear le mir (1) agus cur chun feidhme na mbeartas sin ina gcuid Ranna a phlé. Féadfaidh Aire nó Aire Stáit a iarraidh go gcomórfaí an Comhchoiste chun go bhféadfaidh seisean nó sise beartas reatha nó beartaithe a mhíniú nó diospóireacht a thionscnamh ar an gcéanna.

(15)That Ministers and Ministers of State shall appear before the Joint Committee to discuss current policies relevant to the matters comprehended by paragraph (1) and the implementation of such policies in their Departments. A Minister or Minister of State may request the Joint Committee to convene to enable him or her to explain current or proposed policy or to initiate a debate thereon.

JOINT COMMITTEE ON THE FAMILY

ORDERS OF REFERENCE

ORDER OF SEANAD OF 13 MARCH, 1995

(1)Go gceapfar Roghchoiste de Sheanad Éireann ar a mbeidh 4 chomhalta de Sheanad Éireann a bheidh le comhcheangal le Roghchoiste de Dháil Éireann chun bheith ina Chomhchoiste um an Teaghlach chun breithniú a dhéanamh ar an tionchar atá ag athruithe sóisialta agus ag beartais Stáit ar an teaghlach, faoina chlónna núicléacha agus forleathnaithe araon, go háirithe i dtaca le cosaint agus neartú leasanna leanaí agus daoine scothaosta agus leis na bearta is féidir a ghlacadh chun tacú leo, go háirithe i dtaca le cúram leanaí, oideachas, ceartas don óige, agus cúram daoine scothaosta, agus chun tuarascáil a thabhairt air sin do dhá Theach an Oireachtais. Cuirfidh an Comhchoiste a thuarascáil deiridh i láthair laistigh de dhá bhliain de dháta ab ordaithe lena gceaptar an Comhchoiste.

(1)That a Select Committee of Seanad Éireann consisting of 4 members of Seanad Éireann be appointed to be joined with a Select Committee of Dáil Éireann to form the Joint Committee on the Family to consider the impact of social change and State policies on the family, in both its extended and nuclear forms, with particular reference to the protection and enhancement of the interests of children and the elderly and measures which can be taken to support them especially with regard to child care, education, juvenile justice, and care of the elderly, and to report thereon to both Houses of the Oireachtas. The Joint Committee shall present its final report within two years of the date of the order appointing the Joint Committee.

(2)Go mbeidh an chumhacht ag an gComhchoiste Fochoistí a cheapadh agus aon ní a chuimsítear le mír (1) a tharmligean chun Fochoiste.

(2)That the Joint Committee shall have the power to appoint sub-Committees and to delegate any matter comprehended by paragraph (1) to a sub-Committee.

(3)Go ndéanfaidh an Comhchoiste agus gach Fochoiste, roimh thosach gnó, duine dá chomhaltaí a thoghadh mar Chathaoirleach, agus gan aige nó aici ach vóta amháin.

(3)That the Joint Committee and each sub-Committee, previous to the commencement of business, shall elect one of its members to be Chairperson, who shall have only one vote.

(4)Go gcinnfear na ceisteanna go léir sa Chomhchoiste agus i ngach Fochoiste trí thromlach vótaí na gcomhaltaí a bheidh i láthair agus a vótálfaidh agus, i gcás comhionannas vótaí, go gcinnfear gur freagra diúltach a tugadh ar an gceist.

(5)Gur 5 is córam don Chomhchoiste agus gurb é is córam do gach Fochoiste líon a chinnfidh an Fochoiste nuair a bheidh an Fochoiste sin ceaptha.

(5)That the quorum of the Joint Committee shall be 5, and the quorum of each sub-Committee shall be a number to be decided by the sub-Committee when such sub-Committee is appointed.

(6)I gcás comhalta ar comhalta de Sheanad Éireann é a bheith as láthair ó chruinniú áirithe den Chomhchoiste nó d'Fhochoiste, go bhféadfaidh Comhalta eile de Sheanad Éireann, le húdarás an chomhalta a bheidh as latháir, páirt a chlacadh sna himeachtaí agus vótáil ina ionad nó ina hionad.

(6)That in the absence from a particular meeting of the Joint Committee, or of a sub-Committee of a member who is a Member of Seanad Éireann, another Member of Seanad Éireann may, with the authority of the absent member, take part in the proceedings and vote in his or her stead.

(7)Go bhféadfaidh comhaltaí de Sheanad Éireann, nach comhaltaí den Chomhchoiste, freastal ar chruinnithe agus páirt a ghlacadh in imeachtaí an Chomhchoiste agus a chuid Fochoistí gan ceart vótála a bheith acu.

(7)That members of Seanad Éireann, not being members of the Joint Committee, may attend meetings and take part in the proceedings of the Joint Committee and of its sub-Committees without having a right to vote.

(9)Go mbeidh cumhacht ag an gComhchoiste miontuairiscí na fianaise a ghlacfar os a chomhair mar aon le cibé doiciméid ghaolmhara is cuí leis a chlóbhualadh agus a fhoilsiú ó am go ham.

(9)That the Joint Committee shall have power to print and publish from time to time minutes of evidence taken before it together with such related documents as it thinks fit.

(12)Go ndéanfar gach tuarascáil a bheartóidh an Comhchoiste a thabhairt, arna glacadh ag an gComhchoiste, a leagan faoi bhráid dhá Theach an Oireachtais láithreach, mar aon le haon doiciméad a bhaineann leis an gcéanna a bheartaíonn an Comhchoiste a fhoilsiú, agus as a aithle sin go mbeidh ar chumas an Chomhchoiste an tuarascáil sin agus an doiciméad nó na doiciméid sin, de réir mar a bheidh, a chlóbhualadh agus a fhoilsiú.

(13)Go mbeidh an chumhacht ag an gComhchoiste tograí a phlé agus a dhréachtú le haghaidh athruithe reachtaíochta agus le haghaidh reachtaíochta nua lena moladh d'Airí, ar tograí iad is iomchuí do na nithe a chuimsítear le mír (1).

(15)Go láithreoidh Airí agus Airí Stáit os comhair an Chomhchoiste chun beartais reatha is iomchuí do na nithe a chuimsítear le mír (1) agus cur chun feidhme na mbeartas sin ina gcuid Ranna a phlé. Féadfaidh Aire nó Aire Stáit a iarraidh go gcomórfaí an Comhchoiste chun go bhféadfaidh seisean nó sise beartas reatha nó beartaithe a mhíniú nó díospóireacht a thionscnamh ar an gcéanna.

JOINT COMMITTEE ON THE FAMILY

LIST OF MEMBERS

DEPUTIES	SENATORS
AYLWARD, Liam	BURKE, Paddy
CONNAUGHTON, Paul	BYRNE, Seán
COUGHLAN, Mary [Vice-Chairperson]	KELLY, Mary
FITZGERALD, Frances	MCGENNIS, Marian
FLOOD, Chris
HUGHES, Séamus
MCGRATH, Paul [Chairperson]
MOYNIHAN-CRONIN, Breeda
O'DONNELL, Liz
SHATTER, Alan
SHORTALL, Róisín
SMITH, Brendan
TIMMINS, Godfrey
WALLACE, Mary
WALSH, Eamon

0. Report Structure

This sets out the result of the Joint Committee's commissioned research and discussions on the elderly, the family and the State in Ireland.

Firstly the background to the Joint Committee's interest in the area is described, together with a brief description of the consultant's study and the Joint Committee's deliberations on its content.

Secondly, the Joint Committee draws on the research done and sets out its recommendations.

The results of the commissioned research are included in Appendix A.

The Minutes of Evidence of the Committee of 14 March, 1996 are included in Appendix B.

1. Introduction

Background

The Joint Committee, in pursuance of its Orders of Reference, invited submissions from interested individuals and groups.

Arising from the submissions received, the Joint Committee decided to hold a public meeting on 14 March 1996, at which a number of groups were invited to give evidence on caring for the elderly in society (Appendix B). It was subsequently agreed that research should be undertaken on the relationship of the family and the elderly and the manner in which social change and State policies impact on that relationship and how this impacts on the elderly.

The researcher appointed was instructed to take account of existing research and submissions received by the Committee. Access was also given to the minutes of evidence of the above mentioned public meeting.

The Researcher's Study

The Joint Committee has now considered the content of the researcher's study. The Joint Committee considers this study to be a comprehensive and wide-ranging examination of the issues affecting the elderly currently and in the future, and, for this reason, it is reproduced in full in Appendix A.

Of particular significance are the far reaching implications of the projected demographic changes. These would indicate a much more optimistic outlook for the dependency ratio (economically active versus economically inactive) than that considered heretofore. This taken with the good quality of life enjoyed by the majority of older people, suggests that a unique opportunity exists to improve the quality of support and care for the minority identified as being in need.

The Joint Committee's recommendations, arising out of its deliberations on the study, are contained in the next chapter.

Readers should note that this report deals only with that element of the Joint Committee's Orders of Reference which is concerned with the protection and enhancement of the interests of the elderly. The Joint Committee will present a further and final report on its remaining concerns shortly.

Acknowledgements

The Joint Committee wishes to thank its consultant, Dr. Tony Fahey of the Economic and Social Research Institute for his valuable input to it's deliberations on this topic and his preparation of the annexed studies. The Joint Committee also wishes to express its gratitude to those individuals and groups who submitted their views to it.

Recommendations

2.1. In making its recommendations, the Joint Committee wishes to emphasise that its approach is not one where the older person is seen as a burden on the State, but one where they are people, who through their service and economic activity in the past have contributed towards the well-being of the State, and where the State has an obligation to ensure that they are supported, where necessary, in their later years.

2.2. The Joint Committee wishes to stress that the recommendations it makes in this chapter are based on current economic and demographic trends. While recognising that strategic plans have been compiled in the past in respect of the interests of the elderly, such as that from the Working Party on Services for the Elderly entitled “The Years Ahead… A Policy for the Elderly” (1988), the Joint Committee recommends that this report be used to review and update such plans. It also recommends that, as with any such “business” plan, the findings be reviewed at predefined intervals in order to ensure the continuing validity of government policy in this area.

2.3. In this context, the Committee feels that consideration should be given to the appointment of a Minister of State with responsibility for Family Affairs, who would be attached to the Department of the Taoiseach and Finance and be responsible for the co-ordination of Government policy in this area, and oversee the Family Affairs Unit as proposed in the Joint Committee's First Report on “The Impact of State Tax and Social Welfare Schemes on the Family” (February 1996). Details of the proposed portfolio will be developed further in the Joint Committee's final report.

Demographics

The researcher has indicated that as “in all countries of the western world, including Ireland, an increasing share of the population is accounted for by old people. However, in Ireland, this trend is weaker than in other countries and its significance is altered by the content of population recovery that is taking place. The most striking and socially most important feature of that recovery is the continuous and impressive growth in the number of active age adults which has occurred …”. He argues that on present trends, while old people will become a larger share of the population, our unique demographic history places Ireland in a favourable position as regards the age-dependent population.

The nation is tending towards a “middle-heavy” (economically active) population which contrasts to the situation prevailing in the pre-1960s which “yielded a population structure which … was both top heavy and bottom-heavy” (economically dependent).

The Joint Committee notes the Final Report of the National Pensions Board (1993) and the reference to it in the researcher's study, and, in particular, to his disagreement with its projections. The Committee recommends that the report be reviewed.

Dependency Ratio

The consequence of this trend will be to improve the dependency ratio, should current economic trends continue. The Committee feels that the opportunity presented by a scenario of a proportionally lower dependent and economically inactive population, should be used to improve the quality of care for those older persons who require it (for example, those without a supporting family network).

A particular drive should be made to improve the quality of life to that small proportion of older people identified by the researcher as requiring this attention.

Family Patterns among older people

The Joint Committee is concerned with the serious weakness in family patterns among older people in Ireland which is identified in the consultant's report - the very large proportions who have never married and who as a result have inadequate family networks to provide them with social contact and support in old age, especially at times of illness or infirmity. This weakness in elderly family patterns is a legacy of the low marriage rates and high emigration rates which prevailed in Ireland when the present elderly were in their more active years. Health and social services in Ireland up to now have not been sufficiently conscious of the challenges posed by this particular defect in the circumstances of older people in Ireland. As a result, they have not been sufficiently creative in devising and providing substitute support mechanisms which would compensate for the weakness of family structures among certain categories of older people and enhance their prospects of living out their old age within their communities. While community-based services have been expanded, they have done so in a piecemeal and inadequate fashion and without a clearly formulated understanding of the nature of the underlying social problem. There still continues to be a too ready recourse to institutionalisation for frail elderly people in these circumstances, a remedy which is always expensive and is often not the best way of meeting the needs of older people. The Joint Committee considers that a more explicit and concerted focus on this problem is required in future planning of services for older people and that a more creative, inter-agency approach is needed in devising effective solutions.

It is not advocated that the State should substitute for family networks, but where such are found to be lacking or non existent, the State support should be such as to ensure support at community level, where the older person is more likely to feel at home and a contributing member of that community.

Homes and Support Services

Particular reference is drawn to the researcher's comments:-

“… homelessness in the general sense defined by the 1988 Housing Act is much more prevalent among older people than is generally recognised. Little of it takes the form of elderly households who lack a roof over their heads. Rather, it primarily takes the form of otherwise unwarranted institutionalisation among older people who, with a more supportive social and housing environment, could continue to live in the community.

A more complete solution will require greater cooperation and integration between housing services, as provided by the local authorities, and community care services as provided by the Health Boards, along with more intensive development of such community care services. This requires not so much an addition to existing levels of funding and provision as a redirection of resources away from the bottomless pit of the institutional sector towards the Cinderella services of the community-based sector.”

The Joint Committee endorses this view.

Consideration should be given to a means of upgrading homes of the elderly to a minimum standard where it is accepted that many elderly prefer to remain in their own house, and indeed should be encouraged to do so. A concerted drive should be made to establish whether domiciles inhabited by older people are up to standard in terms of the overall housing stock and whether there are special needs which, if addressed, would allow an older person to remain in their own home. Such needs may be in terms of minor modifications to the property, security and/or the provision of support services in the home.

Where a choice is made not to remain in the current home, custom-built community based individual housing should be considered. Where such housing is provided in small urban centres, older people could be assured of maintaining their independence (where required) whilst also being assured of consistent support services at minimal cost. Optimum standards of care and housing would be assured, whilst ensuring that the client remains within his or her own community. There should be a mechanism also where the original home can be “translated” into such accommodation, where that home is not suitable to current needs.

Local communities should be supported where they wish to provide such housing, through, for example, land and/or monetary grants.

Consideration should be given to involving the private sector in the provision of such community-based accommodation. Experience in other jurisdictions has shown that such an approach can lead to high-support residential centres for the elderly at community level. This may take the form of private sector construction, supervised (by local services) private sector management and subsidised rents.

In this respect, particular attention would appear to be required in the predominantly rural and western health board areas which are shown to have the greater proportion of elderly and elderly who have not married (and are consequently without a supporting family network).

Relationships and Dependency

In considering support for older people, such as that suggested above, account must be had for their desire for independence. This requires particular attention to the interaction between the client (the older person) and the service provider (be they formal or informal). Attention has been drawn to the conflicts and structural weakness of family life in (particularly rural) Ireland in the earlier part of this century and a comparison made with the urban relationship model. The researcher feels that the latter was more beneficial in terms of family relationships, since the “reduction in conflicts of power and economic interest between the generations” opened up a “more equalitarian and companionable approach” to these relationships. Reference is made to a quality of life which “was not overshadowed by tensions and conflicts over economic resources”.

While socio-economic changes have led to offspring less dependent on their elderly parents, pensions have provided elderly parents with a similar independence. In this respect, it is noted that State pensions form such an important income source for the elderly (“received by 83.2 per cent of elderly persons in 1995…” and “accounted for just over half of income averaged over the whole elderly population…”).

The emphasis on care is thus more based on the norms of obligation than economic dependence. It is felt that where this fails in a family context, the community has a similar obligation, which must be supported and be sensitive enough to balance supportiveness with the elderly persons desire for independence. In as much as the State encourages care by the family, it should similarly support the community where necessary. It is likely that where family interaction is lacking, the most beneficial support will be that of those around them whom they know in their own community.

The researcher states:-

“Problems of isolation and withdrawal do arise, however, for small but significant segments of the elderly population. In some instances, this may reflect long-standing problems of social marginalisation, rural isolation or poor family networks. However, the crucial contributory factor seems to be the onset of illness and physical decline. The transition to ill-health is the main disruptive transition in older people's lives, and greatly exceeds the transition to old age as a cause of reduced social contact and increased psychological distress. Other risk factors, such as living alone, being single or being far removed from neighbours, come into play by virtue of the loss of coping ability which the onset of ill-health and physical decline gives rise to. While older people are physically and mentally well, they seem able to find ways of dealing with whatever problems of social contact they may be faced with. But that capacity declines as the physical or mental abilities which underpin it begin to give way.”.

The Committee recommends that a focus be made on the services which address these difficulties rather than general income supports, such as home nursing help and general care visits (e.g. home help and meals-on-wheels), which should occur, where possible at community level. The resources available for, the co-ordination of and the possible need of expansion of these services should be examined.

Isolated Rural Areas

Where an elderly person lives in an isolated rural area where the provision of services, such as transport, presents difficulties, that person should be facilitated in moving into the village/town where their social contacts reside, should they so choose.

Health

On the question of health and the elderly, one of the major challenges facing State health provision is the advancement of technology and its implications in terms of extending life spans and the cost of same. The Committee feels that further studies should be carried out on the relationship between family status/background and the health of the elderly, and the relationship between health spending on the elderly and their quality of life and life expectancy.

Primacy of the Family and Informal Care

The Joint Committee is pleased to note the researcher's conclusion that there is “… evidence on the continuing primacy of the family as a source of informal care for frail elderly people…”.

The Committee notes the uncertainty of public policy towards informal care of frail elderly by their families. It is recommended that the principles which underlie the relationship between State provision and informal care and the supports which might be necessary to sustain or enhance the quantity and quality of informal care be defined.

Reference should also be made to the Joint Committee's First Report (“The Impact of State Tax and Social Welfare Schemes on the Family”, February 1996), on the question of State support for voluntary carers.

Lifestyle Choices

There is a clear case and opportunity identified in this report for improving the support infrastructure for older people. In this respect, there is a need for an information and marketing service to explain the options and entitlements available. Each Health Board or Local Authority should establish such an information service. This would enable people to make informed decisions about their future lifestyles based on the choices available.

Approved by the Joint Committee on 23 January 1997.

Paul McGrath T.D.,

Chairman.

Appendix A

Report to the Joint Committee

Appendix A

Consultant's Report

The Elderly, the Family and the State in Ireland

Tony Fahey

The Economic and Social Research Institute 4 Burlington Road, Dublin 4

1:INTRODUCTION	A.5
Aims of Study
International Context — the ‘Old Age Crisis’
Is There Really a Crisis?
Distinctiveness of The Irish Case
Themes of Study
Structure of Study
2:DEMOGRAPHIC CONTEXT	A.11
Introduction
Population Ageing
Marital Status
Regional Variations
Conclusion
3:FAMILY CIRCUMSTANCES OF THE ELDERLY	A.31
Introduction
The Impact of Socio-Economic Development
Family Networks of the Elderly
What Difference do Families Make?
Conclusion
4:FINANCIAL SUPPORT AND LIVING STANDARDS	A.57
Introduction
Families and Financial Support of the Elderly
Incomes of the Elderly
Poverty
Aggregate Expenditure on Elderly Incomes
Future Affordability of Pension System
Conclusion
5:HEALTH AND SOCIAL CARE	A.79
Introduction
Trends in Health and Dependence
Family as Determinant of Older People'S Health
Families as Providers of Care
Families and The Financing of Care
Conclusion
6:HOUSING AND SOCIAL INTEGRATION	A.103
Introduction
Housing Circumstances
Housing Quality
Homelessness
Community Integration and Leisure
Conclusion
7:CRIME AND SECURITY	A.115
Introduction
Experience of Crime
Perceptions of Crime
Elder Abuse
Conclusion
8:SUMMARY AND CONCLUSIONS	A.125
Introduction
Demographic Context
The Role of the Family
Policy Implications
REFERENCES	A.139

Chapter One

INTRODUCTION

Aims of study

The aims of this study are:

1.to examine the role of the family as a support and resource in the lives of the elderly in Ireland;

2.to assess how state policy affects that role;

3.to consider what improvements might be made in policy in this area in the future.

The study pursues these aims by means of a broad review of the historical and social context in which the elderly, the family and the state have interacted in twentieth century Ireland and by a more detailed look at particular issues in recent times. It draws largely on existing published research and does not aim to present new information on the topics it deals with.

International context — the ‘old age crisis’

The study takes place against a background of concern and uncertainty in many western countries about the implications of population ageing and the future sustainability of the social and economic ‘burden’ represented by the fast-growing elderly population. A widely quoted study by the World Bank, for example, speaks of an emerging ‘old age crisis’ in poorer as well as in richer countries and depicts that crisis as a threat to economic growth and social solidarity on a global scale (Word Bank 1994). The key problem identified by the World Bank, as by many other commentators, is that of providing incomes and sustaining living standards for the old, especially in a context where the growing size of the elderly population is likely to strain the capacity of welfare states to sustain traditional pensions systems. The Bank recommends that in poorer as well as richer countries systems of mandatory private pensions be introduced alongside basic public pensions as a means to build up the resources necessary to secure future streams of income for the old.

Alongside these concerns about the future of pensions and the ability of the welfare state to provide for older people, a parallel set of anxieties focus on the willingness and capacity of the family to support older people in the future. In particular, the rising numbers of older people who live alone leads many people to conclude that ‘this is the result of weakening family ties, that family obligations are no longer recognised and old people are left to cope on their own or be cared for by professionals’ (Clarke 1995, p. 29). These concerns tie in with more general assumptions about the decline of the extended family, the weakening status of the elderly in modern, nuclear-type families and the overall loss of family solidarity. According to this view, more and more older people face the gloomy prospect of a lonely, family-less old age where care and attention will be provided by paid strangers rather than by relatives in the intimacy of their own families. In addition, there are concerns about the pressures on health and social care services which these trends will give rise to. The burden on these services caused by population ageing, it is felt, is likely to be exacerbated by the declining role of the family in providing care for older people and the consequent shift in demand from informal to formal care services.

Is there really a crisis?

These pessimistic forecasts of the implications of populations ageing have considerable plausibility and are widely reflected in public opinion. However, there is no consensus among researchers that they are reasonable or valid. Rather, many researchers have criticised the pessimistic scenarios as alarmist, ill-founded and having as much to do with ideology and vested interest as with a dispassionate analysis of real trends. Nobody denies that population ageing will be a continuing trend in the future, but many consider that when a number of other trends are taken into account (such as growth in economic output and productivity, the fall in the child population, the fall in unemployment consequent on a stable or shrinking labour force), the consequences of population ageing appear much less threatening.

Johnson (1996), for example, argues that the World Bank view on the ageing crisis is poorly founded in evidence and that its negative predictions about the sustainability of the welfare state is heavily influenced by its anti-state, neo-liberal ideology. The International Labour Organisation, in contrast with the World Bank, continues to favour public provision for social security, including old age pensions (ILO 1984, 1992; see Llyod-Sherlock 1996 for a critical analysis of both the World Bank and ILO approaches to old age pensions). Studies of individual countries where population ageing is already well-advanced have likewise been sceptical of the crisis literature. These show that those countries which are already far advanced in population ageing show little sign of the very negative effects predicted by the pessimists (Schulz et al.1991, Guillemard 1991). A recent review of the implications of population ageing by the European Commission concludes that while there is universal agreement that population ageing is taking place, there is no agreement whatever on what impact it will have on economic growth and public expenditure (European Commission 1994).

Similar scepticism has been expressed about the supposed decline in the capacity of the family to provide support for older people. As Evason and Robinson (1996, p. 49) say, ‘all the evidence indicates that, far from withdrawing from caring in favour of an all-pervasive welfare state, the family remains the most important source of support for elderly persons’. Finch (1989, p. 85) concludes from a review of long-term trends in Britain that the ‘idea of the golden age in which family responsibilities were stronger than they are today is clearly a myth, without foundation in historical evidence’.

In fact, some researchers point to ways in which the capacity of the family to care for older people has been strengthened. The proportion of elderly who have never married has declined steadily since the nineteenth century. There has also been some increase in recent years in the joint survival of spouses on account of a narrowing of the age-gap between husbands and wives coupled with some reduction in the life-expectancy gap between men and women (Crimmins and Ingegneri 1990). These developments have increased the likelihood that older people will have family networks available to provide support to them. Furthermore, while elderly people may have fewer children on average than in the past, the proportion who are completely childless (either because they never had children or because their children have pre-deceased them) is also declining (Grundy 1995). As a result, a larger proportion of older people have at least some children. This is significant in that, as Grundy (1995, p. 8) says, as far as the availability of children to old people is concerned, the ‘difference between having, for example, 4 as opposed to 3 or 2 children, is minimal compared with the difference between no and 1 or 2 children’. Other trends which are often assumed to weaken the capacity of the family to care for older people, such as the increased participation of married women in the labour force, also turn out on examination not to have any clear effect in that direction: there is ‘little evidence to support the hypothesis that women working outside the home are less likely to provide care to an elderly parent’ (Grundy 1995, p. 10).

In short, despite fears about the weakening of family supports for older people, hard evidence in support of those fears is scarce. The evidence, if anything, points as much in the opposite direction and indicates at a minimum that, even in the most developed western societies, the family retains its role as a central element in the lives of older people.

Distinctiveness of the Irish case

Anxiety about the impact of population ageing expressed in other countries has found some echoes in Ireland and has given rise to some pessimistic predictions about the future social and economic burdens which the elderly population is likely to impose (the most notable recent example is found in the final report of the National Pensions Board — see National Pensions Board 1994). However, there are a number of grounds for arguing that anxiety and pessimism along these lines are not warranted, at least for the foreseeable future. This is so in the first instance for reasons already mentioned: there is no consensus that population ageing is having or will have negative effects of the kind predicted even in those countries where that trend has gone much farther than in Ireland. If countries with a much more advanced degree of population ageing than Ireland seem to be coping reasonably well with the consequences, there would seem to be no reason for Ireland to be particularly worried on this count.

However, the present study will focus on a somewhat different set of arguments in favour of a more optimistic approach. These suggest that ageing in Ireland, especially as far as relationships between the elderly and the family are concerned, is taking place against a distinctive historical background which casts present and future developments in a different light than that found in other countries.

The differences are not total, since there are many things in common between Ireland and other countries as far as the elderly are concerned. Neither are the differences wholly positive, since some of them are favourable only by comparison with the adverse circumstances of older people in Ireland in the past rather with present-day circumstances of older people in other countries. Long-term population decline in Ireland, for example, had negative implications for older Irish people which had no real parallels in other countries. However, recovery from past adverse circumstances, including population decline, has been a feature of the past thirty years in Ireland and is continuing with new vigour in the 1990s. This recovery is likely to yield positive results for the elderly population, both in the short-term and the long-term. The trend in circumstances for older people in Ireland is thus more consistently upward, even if on some important counts the levels attained still fall short of those in other countries.

Themes of study

The theme of continuing vitality in the family as a resource for older people thus dominates the present account of the elderly in Ireland in recent years, and is intended to displace the themes of crisis and threat which abound in the international literature on the same subject. The positive tone of the picture presented is not meant to deny the existence of real problems for policy in regard to the elderly, nor to lead to complacency. But is intended to put a more hopeful gloss on the context in which policy problems have to be addressed. It implies that the challenge for policy in this area is not so much to avert crisis (á la the World Bank) as to manage a positive overall trend to the best advantage.

The elderly and their families have fared reasonably well in recent years and are likely to continue to do so for the foreseeable future. The improvements which have occurred have been due in part to broad social and economic change and in part to developments in public provision. There are constraints on the forms and levels of resources which the state can provide for the elderly in the future but these constraints are not as severe as they have been in the past in Ireland or as they may well be at present in other countries.

As far as the elderly and the family are concerned, therefore, the policy problems which now arise are not of a radical or fundamental kind. The need, rather, is for gradual, incremental improvements in keeping with general economic progress and in the context of substantial demands on public spending which arise not only in the social services generally but more particularly in other areas of family life (especially in the case of families with dependent children).

Structure of study

Following this introductory chapter, Chapter 2 of the study outlines the demographic context of interactions between the family and the elderly in Ireland. Chapter 3 turns to the family circumstances of older people, looking at both the long-term impact of socio-economic development on the role of old people in family life in Ireland and the present-day family networks of older people. Chapter 4 deals with financial support and living standards among older people, looking especially at the relative roles of family support and state provision in maintaining elderly living standards. Chapter 5 takes up the question of the health of the elderly, with particular reference to the multiple role of the family in elderly health — as an influence on the health of old people, as a source of informal care for frail elderly, and as a possible source of financial contributions towards the costs of the institutionalised elderly. Chapter 6 deals with housing and social integration, while Chapter 7 deals with crime and other issues affecting older people. Chapter 8 provides a summary of the report and draws out the implications for policy.

Chapter Two

DEMOGRAPHIC CONTEXT

Introduction

This chapter examines key aspects of the demography of the elderly in Ireland. It points both to the positive nature of population trends in Ireland as far as the elderly are concerned and to certain issues which pose problems for the future. The account focuses on three issues in particular:

1.The extent and nature of population ageing. Under this heading, the focus is on the distinctive demographic context in which population ageing is now underway in Ireland and on the generally favourable demographic balance at present emerging between old people and the rest of the population.

2.Marital status of the elderly. Here we turn to what, from the viewpoint of the present report, is the central weakness in demographic patterns among the elderly — the exceptionally high proportions who have never married and thus who have no procreative families of their own. While the incidence of older people who are family-less in this sense is on the decline, it is likely to remain significant for the foreseeable future.

3.Regional variations in elderly demography. This issue is dealt with by reference to variations across Health Board areas, since it is of particular policy relevance to Health Boards.

Mortality trends, another aspect of population patterns of central interest to the elderly, will not be dealt with in this chapter but will be taken up in Chapter 5 in connection with the health of the elderly.

Population Ageing

The context — population recovery

The pattern of population ageing now underway in Ireland is strongly influenced by the distinctive population history from which present trends have emerged.¹ Most western countries are now emerging from a long era of demographic expansion and are entering a new period of possible zero population growth and rapid population ageing. Ireland, by contrast, is on quite a different population trajectory. It missed out on the demographic expansion which occurred in other countries since the mid-nineteenth century and instead suffered a unique population decline up to the mid-1960s. This decline was determined mainly by a long history of massive emigration. The era of decline came to an end in the mid-1960s with the onset of a period of population recovery. That recovery faltered in the late 1980s as heavy emigration briefly reappeared, but it has revived in the 1990s. Population performance in this era of recovery has been by no means spectacular, but it has been enough to set Irish population trends on a more positive course than at any other time in its modern history.

Since demographic change shows its full effect only over the longer term, Figure 2.1 places overall population performance since 1960 in the context of demographic history since 1926 and of projections up to 2026. The projections contained in this figure are those of the CSO (1995), using the low migration, high fertility scenario. This scenario is adopted for the present report as subsequent developments, especially as revealed by the Preliminary Report on the Census of Population 1996 (CSO 1996), have shown it to be most accurate of the scenarios used in the 1995 projections.²

As this figure shows, demographic decline prior to the 1960s had a particularly damaging character, in that it consisted mainly in a contraction of population in the active age-ranges (due to emigration). The demographic recovery in the 1970s turned that pattern around, in that the active-age ranges showed the greatest growth, fueled in part by a net inward migration of almost 50,000 35–54 year olds between 1971 and 1981. Those in-migrating adults also brought some 50,000 children with them and that, combined with a marriage surge and a consequent fertility surge, raised the population of children from 877,000 in 1961 to above the million mark from the mid-1970s to the mid-1980s.

The record since the mid-1980s and projections for the coming decades suggest that growth in the numbers of active-age adults will continue to dominate Ireland's demographic performance, to a degree which is unprecedented in Ireland's modern history. It is also unique among present-day western countries, where relative (if not absolute) decline in the size of the active age group is the norm. Having grown by half a million from 1961 to 1991, the population of 15 to 64 year olds in Ireland is projected to grow by a further half a million up to 2026, amounting to an increase of almost two-thirds over the whole period. The child population by contrast, having shown strong growth in the 1970s, is projected to decline from the mid-1980s peak of over one million to between 600,000 and 700,000 by 2026 (the extent of the projected decline depends on the fertility rates one assumes for the future).

The elderly

It is in the context of this strong overall population performance, and especially the growth in the number of active age adults, that the nature and extent of population ageing in Ireland should be judged. Figure 2.2 shows that, after some decades of little or no growth, the elderly population is projected to grow from 402,900 in 1991 to around 700,000 by the year 2026, an increase of 70 per cent.³Likewise, the elderly as a percentage of the total population, having hovered under 12 per cent for decades, is projected to increase to about 17 per cent in 2026. This upward trend has not yet really got under way, since most of it will not take place until after 2006, but that simply means that the rate of increase will be all the sharper after than date.

A further important aspect of the growth in the elderly population is the changing age-profile within the elderly population itself. The greatest absolute increase is projected to occur among the younger elderly, but the greatest relative increase occurs among the older elderly (Figure 2.3). Thus, for example, the age-group 65–69 is projected to grow by 80,000, compared to less than 40,000 among the age-group 85 and over. However, in relative terms, the increase among the 65–69 age-group, at 60 per cent, is only half that among those aged 85 and over, which is 120 per cent. This indicates that, alongside the ageing of the population as a whole, a certain degree of ageing is likely to occur within the elderly population over the coming decades.

Age Dependency Rates

These trends suggest that, although population ageing has been slow to occur in Ireland up to now, it is likely to occur more rapidly over the next thirty years. However, there are a number of important qualifications on this picture which place Irish trends in quite a distinctive light. The first is that, while the elderly population is due to grow substantially relative to the rest of the population, much of the changing age balance is due to the decline in the numbers of children rather than of active age adults. In fact, as already mentioned, the number of active adults has been increasing steadily over recent times and is due to continue to do so for the future. The consequence is that the ratio between old people and those in the active ages is likely to change to an only modest degree over the next thirty years.

Figure 2.4 illustrates this favourable trend by converting the absolute numbers shown in Figure 2.1 into age-dependency ratios. Looking at the total age-dependency ratio (those aged under 15 plus those aged 65 and over as a percentage of those aged 15–64), there is a quite pronounced peaking of the trend in the 1960s, and at a very high level. Total dependency reached 73 per cent in the 1960s, having risen from 60 per cent in the 1930s. This arose from the contraction of the active population which had been caused by the emigration of the 1950s. By 1991, total dependency had fallen back to the level of the 1930s and, according to the CSO's projections, it will continue a steep decline until the middle of the next decade. By 2006, the forecast is that total age dependency will have fallen to the unprecedentedly low level of about 50 per cent.

Thereafter it will begin to rise again, but by 2026, it is projected to be at 54 per cent, still well below the levels which prevailed throughout most of the present century. As far as total age-dependency is concerned, therefore, the next thirty years will be far more favourable than the last thirty years.

Figure 2.4 also shows that movements in youth dependency are the main contributors to the trend in total dependency over the period 1926–2026. The child population had begun to expand in the 1950s as the active population was contracting, thus sharply altering the balance between them and raising the overall age dependency ratio. This movement was reversed in the 1980s: the child population began to contract while the active population expanded, so that young dependency fell well below the previous lows of the 1930s and 1940s. The projections are that the child population will fall even further in the early decades of the next century as the active population continues to expand, thus reducing young dependency to very low levels by Irish standards. It is notable also that in 1981, there were almost three times as many children as old people (just over one million children compared to 368,000 old people). By 2026, the CSO forecast shown in Figure 2.3 is that the numbers of children and old people will converge at around 700,000 each (alternative fertility scenarios considered by the CSO show the child population falling below 600,000 by 2026).

Old dependency, by contrast with youth dependency, shows an increase after 2006. However, the increase is quite modest since the rather large growth in the numbers of old people is counter-balanced by a substantial increase in the numbers of those in the active ages, thus preserving a reasonably favourable balance between older people and those in the active ages.

Economic dependency

Age-dependency ratios are a relatively crude indicator of the support burdens associated with a particular population structure since they make the somewhat unrealistic assumption that all those in the ‘active’ age-range (conventionally defined as 15–64) are in fact active, while all those under 15 and over 65 are dependent. An alternative indicator is the economic dependency ratio, which treats all of those recorded as ‘at work’ as economically productive and the rest of the population as dependent.

Figure 2.5 sets out the trend in this measure for the period 1961–2010 for Ireland, with comparative data for the EU for the years 1971, 1981 and 1991. Because of the large number of factors which affect the size of the labour force, each of which are difficult to predict on their own, the CSO has not made labour force forecasts beyond the year 2006. Forfás (1996), on the basis of projections prepared by the ESRI, has gone slightly further and made projections of the labour force out to 2010. These provide the projections for the year 2010 included in Figure 2.5.

These data show that economic dependency in Ireland has been declining sharply since it reached a very high peak in the mid-1980s. It is projected to continue on a downward slope into the next century. The extent of the transformation in economic dependency is dramatic. The number of dependents per 100 workers exceeded 220 in the mid-1980s — a uniquely high level in the EU at the time. It is expected to fall below 160 in 2006 and (according to Forfás projections) to about 133 in 2010.

Trends in economic dependency differ in one respect from the trends in age dependency described earlier in that economic dependency levels peaked in the 1980s while age dependency levels peaked in the 1960s. In the 1980s, declining age dependency was more than counterbalanced as far as economic dependency was concerned by a rise in the proportion of those in the active age ranges who were either unemployed or in full-time education.

Of particular interest to us here is the component of overall economic dependency represented by the trend in elderly economic dependency, that is, the ratio between the elderly and the numbers at work (Figure 2.6). CSO projections indicate that this ratio is due to decline up to the year 2006 from a peak reached in the mid-1980s (the Forfás projections referred to in Fig. 2.5 do not provide the necessary detail to calculate the elderly economic dependency ratio for 2010). In 1986, there were 35 elderly per 100 workers, compared to a projected figure of 31 per 100 workers in 2006. Thus, the growth in the numbers at work in the next decade is projected to outstrip growth in the numbers of older people.

It might be felt that these projections are overly optimistic. However, more up-to-date data indicate that, if anything, they may understate the downward trend in economic dependency. Labour force growth in the three years up to 1996 has been more rapid than predicted (Labour Force Survey 1996). As a result, economic dependency has already fallen below the forecast trend-line set out in Figure 2.5 and may continue to do so over the coming years.

International comparisons

We can get an indication of the internationally distinctive character of dependency trends in Ireland from Figure 2.7, which compares Ireland's old dependency ratios in 1960 (actual) and 2020 (projected) with those of a number of other European countries (the projections used here are those of the United Nations, 1995). In 1960, Ireland had the highest old dependency ratio among western countries. By 2020, it is projected to have the lowest, despite a small absolute increase. The increase in the old dependency ratio in Ireland over this period (which is about a quarter) is strikingly small compared to the large increases in other countries, which range from two-fold to four-fold.

Marital Status

Single elderly

Aside from falling population totals, one of the most notable weaknesses of Irish population patterns prior to the 1960s was the low marriage rate. Among its many effects, this weakness has special significance for older people. The elderly in Ireland today entered adulthood from the 1930s to the 1950s, a period when marriage rates were among the lowest recorded in any society that we know of. As a result, the proportion of the adult population which failed to form procreative families of their own was uniquely large (Coale and Watkins 1986).

The legacy of this background is still with us in the 1990s. It takes the form of a uniquely high proportion of elderly people who have never married and are childless, and who have little or no substitute kin to provide them with effective family networks (the family networks of single elderly are examined further in the next chapter). Figure 2.8 shows that, in the mid-1980s, the rate of singlehood among older people in Ireland was far in excess of that found in any other western country. At that time, 25 per cent of older Irish men and 22 per cent of older Irish women were single. The comparable rates in other countries rarely exceeded 10 per cent (the rates of singlehood in Norway and Sweden, which are above or close to 10 per cent, are misleadingly high, since they do not take into account the high incidence of informal marriage in Scandinavian countries).

The positive side of this situation is that the rate of singlehood among older people has been declining since the peak of the early 1970s and is likely to do so more sharply in the decades ahead (Figure 2.9). The decline already evident by 1991 is due to the rise in marriage rates in the 1950s. The marriage surge of the 1960s and 1970s has hardly yet begun to feed through into the elderly population but will do so over the next ten to fifteen years. Projections of the elderly population up to 2011 prepared for the National Council of the Elderly (referred to here as the Connell projections⁴ forecast that the proportion of elderly men who are single will decline to less than 18 per cent by that year while the corresponding proportion for elderly women will fall to less than 12 per cent. These rates of singlehood are still quite high by the standards of other countries but they are a good deal lower than those of the past and present in Ireland. They thus represent an improvement on what was an historically poor marital status profile among older people in Ireland, even if at a level that is not particularly positive by the standards of other countries.

From the point of view of the present report, where the main concern is with the relationship between the family and the elderly, the present downward trend in singlehood among older people is of major significance. The very high levels from which that decline is taking place indicates that, in the past, the family as a social resource was unevenly distributed among older people — many elderly were seriously lacking in that resource since they had neither spouses nor children. Today, falling fertility may well mean that family networks among older people will become smaller on average, though falling emigration may have a counter-balancing effect in that more family members will be close at hand. In any event, the more widespread incidence of marriage and child-bearing will mean that fewer old people will be entirely without close family networks. (The significance of this development is considered further in Chapter 4 below.)

In spite of improvements in this area, however, present trends will by no means eliminate singlehood among older people. Projections of the proportions of older people who are unmarried in fifteen to twenty years time indicate only that Ireland will have come closer to standard European patterns on this issue, though even then it will be at the upper edge of those patterns. Therefore, the absence of procreative families among significant minorities of older people will continue to be a feature of the family circumstances of the elderly in Ireland in the years ahead.

Married, widowed and separated

Since the proportion of the elderly who are single is on the decline, the proportions in other marital statuses are inevitably on the increase. Indeed, one of the notable features of the growth of the elderly population is the concentration of that growth among the married (Figure 2.10). In relative terms, by far the greatest increase will occur among the married, both male and female, while single females will show a quite sharp decline (Figure 2.11).

Marital breakdown has been growing as a feature of family life in Ireland in recent years but has not yet emerged as a substantial influence on the marital status profile of older people. In the Census of Population in 1991, less than four per cent of all ever-married people reported themselves as separated or divorced, and the vast majority of these were found among the non-elderly. The incidence of separation among the non-elderly is still low enough for it not to become a major influence on marital status among the elderly in the decades ahead. Even if marital breakdown were to increase rapidly, one would need to take into account the impact of re-marriage before drawing any conclusions on the resulting implications for future cohorts of older people. In the United States in the mid-1980s, for example, although about one in every two marriages was then ending in divorce, only five per cent of the elderly reported themselves as divorced (Myers 1994). Undoubt-edly, a much larger proportion had been divorced at some time in the past, but had subsequently formed second unions and so entered old age as either married or widowed

Living alone

One of the effects of the improved distribution of marriage among older people is the dampening effect it has on the otherwise upward movement in the proportions of older people living alone. According to the Connell projections, the percentage of elderly people living alone is projected to grow by only a modest amount — from 24 per cent in 1991 to 26 per cent in 2011 (Figure 2.12). This is so because the increase in the number of widowed and in the likelihood that the widowed will live alone is almost fully counterbalanced by the increase in the number of couples and the decrease in the number of single persons. Given that the rate of living alone among older people in most European countries is already higher than in Ireland and is increasing quite steadily, Ireland is likely to be even further below the European norm on this indicator by 2011 than it is now.

Regional Variations

Population patterns in Ireland have long been marked by regional unevenness. The western half of the country, and especially rural areas in the western half, have had a weaker population record in the present century than have eastern regions and urban areas. While the population patterns reviewed in the preceding sections have pointed to the overall positive character of demographic trends affecting the elderly population, we now need to consider the range of regional differences within this overall picture. It is beyond the scope of the present report to do so in any detail, but it will be useful to examine some of the key patterns. Variations across health board areas are especially relevant, since it is mainly at health board level that health and social care services for the elderly are funded and delivered

Figure 2.13 shows the number of elderly persons in each of the eight health board areas in 1991, with projections for 2011. The Eastern Health Board area has by far the largest number of elderly persons in 1991 (at 117,443, or 29 per cent of all elderly). It also has the largest projected increase up to 2011 (reaching 176,034, an increase of over 58,000). This dominance of the Eastern Health Board reflects the general population imbalance in the country — the Eastern Health Board area accounted for 35.3 per cent of total population in 1991. The number of elderly persons in the other health board areas in 1991 ranges from a low of 24,450 in the Midland Health Board area to a high of 65,382 in the Southern Health Board area.

At the same time, however, as Figure 2.14 shows, although the Eastern Health Board has by far the most older people, it has the youngest population. In both 1991 and 2011 it has the lowest proportion of the population aged over 65 of any Health Board area (9.4 per cent in 1991, 12 per cent in 2011). In 1991, the North-Western and Western Health Board areas have the oldest populations, with almost 15 per cent aged over 65, even though they have relatively small numbers of older people.

The unevenness in the absolute and relative size of the elderly population across health board areas is carried over into a third aspect of the demography of older people — the proportions who have never married. On this issue too, the predominantly rural and western health board areas fare worst. Slightly over 25 per cent of the elderly in the North-Western Health Board area are single, compared to 18.8 per cent in the Eastern Health Board area. However, even in the Eastern Health Board area, the proportion single among the elderly is high by the standards common in other countries (see above).

Conclusion

This chapter has examined a number of key aspects of the demography of the elderly in Ireland. The picture to emerge from the analysis is quite positive in the overall, both by comparison with the past in Ireland and with the present and future outlook for other western countries. Thirty years ago, Ireland's population, paradoxically, was both young and old — it had disproportionately large numbers of children and elderly and relatively few people in the active ages. This was the consequence of Ireland's unique history of population decline, and especially of the emigration hemorrhage among young adults in the 1950s. In the years which followed, population recovery created new strains on population structure, especially in the form of a large population of children. In the 1980s, these strains were exacerbated by the surge in unemployment, which added to dependency burdens in the population.

It is only in the 1990s that population recovery has begun to mature and produce a new and more favourable overall population structure. We now have a population that is neither young nor old but is dominated by the expansion of numbers in the active age ranges. Even in thirty years time, Ireland's population structure is projected to be one of the youngest in the western world. At the same time, economic growth and declines in unemployment have meant that the potential benefits of this population structure have begun to be realized to a degree that had not been achieved before. While unemployment is still high in Ireland, it is on the decline and is doing so in the context of rapid growth in the labour force. As a result, Ireland is now experiencing an unprecedented expansion in the economically active population.

The consequence of these developments is that while the elderly population in Ireland is projected to grow rapidly in the early decades of the next century, the overall population context in which that will occur will be much more favourable than it has been up to the recent past. Population ageing will occur at a modest rate by the standards of other western countries, and the support base for the elderly in the rest of the population will be strong and will be such that Irish society should be well capable of absorbing any strains which might result from population ageing.

Against this overall positive background, the present chapter has identified two problematic aspects of population structure affecting the elderly. The first is the exceptionally high proportion of the elderly population who have never married and who therefore lack procreative families of their own. This feature of the elderly population is a legacy of the very low marriage rates which prevailed in Ireland in the early parts of the present century. It is likely to decline in the years ahead because of the post-1960s improvement in marriage rates. However, even in the early decades of the next century, the proportions single among older people, though lower than today, will still be high compared to other countries and will mean that a substantial minority of older people will be family-less.

The second problem is the regional unevenness in population structures in Ireland, an issue which has been examined in this chapter by reference to variations in elderly demography across health board areas. While the bulk of the elderly population is concentrated in the demographically more vigorous areas (especially the Eastern Health Board area), the elderly in the more rural and western areas find themselves in a comparatively weak demographic position. Though small in absolute numbers, the elderly in areas such as the Western and North-Western Health Boards form a larger than average proportion of total local population and are disproportionately likely to be single. Given that these areas are also poorer and more rural than average, these patterns point to the need for a strong regional dimension in policy on the elderly. This is an issue we will return to later in the present report.

Chapter Three

FAMILY CIRCUMSTANCES OF THE ELDERLY

Introduction

The previous chapter has shown that, as far as numbers are concerned, the elderly in Ireland have a reasonably strong support base in the younger adult population. Moreover, in so far as demographic patterns give rise to weaknesses in areas such as kin availability, these weaknesses are on the decline, though they still remain significant. In general, therefore, while demographic problems remain, changes in population structure now underway in Ireland are broadly favourable to older people and to the capacity of Irish society to cope with a growing elderly population.

This leaves the question as to what the available numbers of younger people mean as far as the family circumstances of older people are concerned. If the trend in aggregate population numbers is reasonably favourable as far as old people are concerned, can we say the same about the family structures and networks of older people? The lament for the ‘decline of the extended family’ and the weakening of filial devotion is common in discussions of the present family circumstances of older people. Does this lament reflect real trends, or is it a fabrication of nostalgia?

The present chapter tries to answer these questions by examining trends and patterns in the family circumstances of older people in Ireland. It first examines the impact of socio-economic development in the twentieth century on family structures and on the role old people play in family life. This issue is especially interesting in the Irish case since family life in Ireland (especially rural Ireland) has only recently emerged from a system in which old people played an exceptionally dominant role. This role was based on the possession of economic power within households by old people, especially by ageing fathers, which in turn centered on control over production, income and inheritance in family production units. This power in effect gave rise to a form of gerontocracy in rural Ireland, as it gave ageing parents a great deal of control over the lives of their adult children and a position of great influence in the wider community. It fostered a pattern of inter-generational relations which is quite remote from those which prevail today. Rural gerontocracy had entered a sharp decline by the middle of the present century. It rapidly gave way to new, more egalitarian and more independent relations between the generations which were already established in urban areas.

Having described the broad structural changes which these developments entailed, the chapter then turns to description of the present-day family circumstances of older people. The account focuses on the household structures of the elderly, the extent of their family networks and the kinds of contacts they have with family members.

The chapter then considers the significance of these family circumstances for the well-being of the elderly by asking ‘what difference do families make’. The answer is that in some ways they make less difference than one might think, or sometimes make as much a negative as a positive contribution to the well-being of older people. The key to understanding the value of families to older people lies in the tension between norms of independence and norms of obligation which govern the way both older people and their younger relatives approach each other. Norms of obligation require high levels of support and interaction, norms of independence require, if not the opposite, then at least a more modulated approach and a sensitivity to the kinds of interaction older people require. Support which trammels the independence of older people can be as unwelcome as no support at all. One of the key obligations of younger relatives, in this view, is to support and respect the independence of older people.

The Impact of Socio-economic Development

General issues

Social and economic development of the type which has been underway in Ireland since the 1960s have often been said to be detrimental to the social standing and general well-being of older people. In an influential statement of this view, Cowgill and Holmes (1972) argued that modernization reduced the status of the elderly — ‘primitive agrarian’ societies accorded higher status to the aged than do ‘modern’ societies. More recently, in an overview of patterns of ageing around the world, Cowgill (1986) asserted that ‘the status of the elderly is high in societies in which the extended form of the family is prevalent and tends to be lower in societies which favour the nuclear form of the family’ (quoted in United Nations Secretariat 1994, p. 95).

However, many researchers reject Cowgill's judgment on the effect of modernisation and family nuclearisation on the status of older people (see United Nations 1994, pp. 95–96, for a brief overview). Some have argued that present-day rosy images of extended families and the veneration for the elderly in the past have more to do with nostalgia than historical fact. In this view, the myth of the ‘golden age of ageing’ in the pre-modern era (Quadagno 1982) is part of the ‘great nostalgia of the western tradition’ for the supposed extended family of earlier tradition and the ‘world we have lost’.

Part of the problem in arriving at the truth about the impact of modernisation on the status of the elderly is that ‘status’ and ‘modernisation’ can be defined and measured in different ways. The relationship between them as far as the elderly are concerned depends greatly on which set of definitions and measures one chooses. The approach advocated by Finch (1989) is to recognise that the status of the elderly is a complex, multi-dimensional thing which certainly changes over time but which does not necessarily rise or fall in any simple, linear fashion. Finch's own analysis of historical developments in family obligations in Britain denies that any generalised decline in the position of the elderly within the family has occurred. But she also argues that, rather than apply any simple yardstick of rise or decline in the status of the elderly, it is more illuminating to try to grasp the shifting meaning of old age and of the family obligations which go with it, and to try to see how these have been transformed over time. In her view, the elderly relate to their families today in the context of a radically different family system and it is necessary to appreciate that system in its full complexity rather than to rush into hasty judgements about whether it is good or bad for older people.

The Irish case

Ireland provides a good illustration of the complex effects which socio-economic development and changes in family form can have on the way older people relate to their families. Family structures in Ireland have undergone changes in the course of the twentieth century which are often thought to have occurred much earlier and over a longer period elsewhere. The recency and swiftness of these changes in Ireland makes them more visible to modern social research. Such research has focused especially on the ‘stem family system’ found in small farm households in rural Ireland in the first half of the present century.¹ For many researchers, the stem family in early twentieth century Ireland was a late survival of a family form that had been widespread in Europe before the industrial revolution but that had long ago disappeared from most areas. It thus offered a means of insight into family patterns in the past that had relevance well beyond the Irish countryside in which it was found. For our present purposes, the place of the elderly in the stem family system in the first half of the present century, and the consequences of its decline in the second half, can throw light on the particular circumstances of older people in Ireland today as well as on more general processes of family change which affect the position of the elderly in developed countries.

While there is no generally agreed definition of the ‘stem family’, it centered on a particular system of transmission of prepay across generations, which in turn yielded distinctive household structures and marriage patterns. The main features found in the Irish version of that system included the following: preferential inheritance of the main family holding by a principal heir; the selection of that heir at the sole discretion of the father; delayed devolution of the family property by the father until he was very old or after his death; three-generational household structures at certain phases of the family cycle (mainly after the marriage of the heir, when his new wife and their children shared the family home with one or both of the elderly parents, perhaps also with some unmarried siblings of the heir staying on in the household); and the settlement of smaller inheritances on at least some of the other children to enable them to ‘disperse’ away from the main holding (these settlements could range from dowries for daughters to enable them to marry neighbouring inheritors, or funding for an education or for emigration). The system of marriage which accompanied the stem family system in Ireland entailed delayed marriages (as heirs had to wait to receive their inheritance before marrying), ‘made matches’, dowries, and the use of dowries as a revolving fund which, having been received by the groom from the bride, was used to fund settlements or dowries for the groom's siblings.

Gerontocracy and the stem family

Our interest in the stem family here is in the place it accorded to the elderly in family life and the impact this had on the relationships between the old and the younger generations.

The stem family was strictly hierarchical and patriarchal: men held authority over women and the older generations held authority over the younger. Economic power, represented by ownership of property, control over production on the family holding, and control over inheritance lay at the centre of this hierarchy. Property law and social custom, combined with the owner-occupier system which had been created by the land acts from the 1880s to the 1920s, placed this economic power largely in the hands of male household heads — and allowed them to retain it into old age, and until death if they so decided. For the most part, women held substantial property only as widows, or as heirs where no suitable male heir was available.

The power over adult children which this system placed in the hands of older people was extensive. As Humphreys says of rural family life in this period, ‘the total structure of family relationships [in farm families] concentrates the maximum of power in the hands of the aged and in effect makes the Irish rural community a gerontocracy’ (1966, p. 22). This gerontocracy was epitomised in the 45 or 50 year old ‘boys’ on family farms who depended on their ageing parents for every penny of their spending money and who were forced to wait long years for their inheritance before gaining the chance of an independent family life — often leaving it too late to find a wife and have children.² More generally, it reflected the harsh reality of a family-centered production system based on the exploitation of family labour: ‘sons were an important resource that enabled a man to avoid paying for labour’, while ‘many of the strategic decisions in the family, such as the choice of an heir and the postponement of marriage, were designed to maxims the availability of the free labour of children’ (McCullagh 1991, p. 204).

McNabb (1964, pp. 229–31) describes the determination of fathers in rural Limerick in the 1950s to hold on to this kind of power for as long as possible and to the sense of subordination and alienation it created in their children, especially their sons. Many young men claimed as a result that they never spoke to their fathers about anything of importance, despite sharing the work and daily routines of the family farm with them (McNabb 1964).

Daughters were placed in an even more subordinate position. They normally had no likelihood of becoming main heirs. They were expected to be deferential to their brothers as well as their fathers, and to contribute to the work of the household with little entitlement to personal reward. If they did receive a share in the family patrimony, it was likely to be in the form of a dowry which was normally handed over at marriage to the groom or the groom's parents.

In the face of the alienating effect of patriarchal rule, the main counteracting force which tended to hold the family together was the love and affection of the mother. The pull towards the mother was the main guarantee that at least some children would remain on the family holding and that those who emigrated would maintain contact with home. Her ‘strong, preferential love’ for the son helped ‘mollify the constant rub of his subordination to his father’ and so keep him on the land (Humphreys 1966, p. 20) — though the mother's love for her daughters often led her to encourage them to emigrate so as to escape the drudgery and restrictions of the country-woman's life (Shortall 1991, p. 324).

As the mother aged, however, the drawbacks of her ‘domination by affection’ could begin to show, especially where sons were concerned. The main drawback was her frequent resistance to the marriage of her son, and the conflicts which could arise with a daughter-in-law if the son did marry and ‘bring another woman in on his mother’ (Humphreys 1966, p. 21). Waiting for the mother to die and make room for another woman was a widespread an obstacle to marriage among sons as waiting for the inheritance from the father. It gave rise to numerous farm households consisting of aged widowed mothers and their middle-aged or near-elderly bachelor sons.³

Conflict in the stem family

While family life in Ireland, and especially in rural Ireland, was routinely lauded and held up as a symbol of pride in the early decades of independence, it was in fact widely marked by internal conflict and structural weakness (see McCullagh 1991 for an overview of the anthropological and literary evidence on this question). Patriarchy and gerontocracy were central to these defects. Harmon's (1977) review of the fictional literature of time, in which family conflict was one of the major themes, sums up the commonly painted picture by saying that ‘the choice facing children of such harsh, authoritarian fathers, short of killing them with a blow of the loy, is to knuckle down to the brutalizing servitude of the small farm or to leave home’ (quoted in McCullagh 1991, p. 207). Though the inheriting son was privileged in some ways, he also ‘in effect became a captive’ to his ageing parents, while the other children faced a stark choice — ‘either to be marginal and unfulfilled at home or to emigrate’ (McCullagh 1991).

The resulting tensions, frustrations and antagonisms which welled up in young people, according to Humphreys, was a ‘centrifugal mechanism’ which drove families apart: it constituted ‘a powerful motive for sons, often enough all of them, to take life in their own hands, to leave the land and its frustrations, and, as so many do, to make their own way in Dublin or Boston’ (1966, p. 20).

The culture of family cohesiveness in rural areas undoubtedly often papered over such tensions within households and reconciled subordinate members to a life of loyal submissiveness and restricted opportunity. It might often also succeed in producing impressive levels of solidarity and support between family members. But equally, it often failed to hold the family together. Conflicts might sometimes be expressed in open confrontation but they were more often resolved by exit, as dissatisfied children took themselves off on the emigration trail. Even those who stayed behind were frequently stultified, if not destroyed, by what they accepted as normal and tolerable in family life. Mental illness, nervous breakdown and stunted personality growth among young and middle-aged adults figure prominently in the negative accounts of rural communities in Ireland which began to emerge in the post-war era. Much of the causation for these pathologies was traced back by the observers concerned to the culture and structures of family life.⁴

As so often is the case in authoritarian regimes, therefore, control and stability in family life was often accompanied by tension and rumbling discontent. In many cases, systematic repression and a culture of submissiveness succeeded in containing discontent but even then it did so at considerable human cost. At least some of this cost fell on those in authority. For all their economic power, the rural elderly were always vulnerable to family crisis — rejection or abandonment by children, economic devaluation of the family holding, and thus of their source of power, as a result of broader economic crises. There was also the problem that power and status was tied to property ownership, meaning that those elderly who lacked property also lacked status, and also frequently lacked an alternative means of support.

The decline of gerontocracy

The stem family system was in a vigorous condition in the 1930s when Arensberg and Kimball found it in Co Clare, but within two to three decades it was in serious decline. It was undermined not only by the stagnation of the rural economy, though that was a real influence. It was even more forcefully threatened by the ever-widening contrast between poor living standards, limited employment opportunities and the repressive social life of rural areas on the one hand and the attractions of good pay and the bright city lights in the post-war booming economies of Britain and elsewhere abroad. The contrast struck rural women especially, and they fled in their thousands to escape the fate of their mothers. But young men also found it hard to withstand the liberating promise held out by the holidaying ‘Yanks’ or London emigrants who had money in their pockets and the freedom to go as they pleased.

The principal measure of decline which Hannan (1979) points to is the rapidly increasing incidence of farm holdings which lacked a direct heir. The sluggishness of the rural economy in the 1950s and the massive emigration which accompanied it meant that the farm was rapidly losing its appeal for the younger generation and was equally losing its force as an instrument of economic power in the hands of the older generation. The growing scarcity of heirs on family farms in this period was in part a consequence of poor marriage rates of a generation earlier — growing numbers of rural households simply lacked a married couple who had produced children. In addition, inheritance of the family farm, and the duty of care to aged parents which went with it, was increasingly coming to have the character of a burden which children yearned to escape rather than a prize which they would compete to win.

By the 1960s and 1970s, the warm and somewhat romanticised tones of Arensberg and Kimball's account of family and community life in Co Clare in the 1930s had given way to a gloom and doom literature about the Irish countryside. Works such as John Healy's Death of an Irish Town (1967), John Messenger's Inis Beag (1967), Hugh Brody's Inishkillane (1973) and Nancy Scheper-Hughes’ Saints, Scholars and Schizophrenics (1979) catalogued the seemingly relentless decay of the rural way of life. These accounts portrayed a society which not so much gerontocratic as geriatric — a society that was wasting away from social and cultural degeneration. Older people were left stranded by the flight from the land of the younger generations, marriages and births were scattered rarities rather than routine events, the integrity of cultural traditions was falling apart for want of a vigorous social base. As other countries grew anxious about social problems and the loss of community arising from rapid urbanisation and the growth of individualistic affluence in big cities, Ireland found that its social crisis lay in the countryside. It was a crisis of implosion rather than explosion, as communities fell in on themselves and decayed rather than struggled with the consequences of growth and change.

By the late 1970s, Hannan had begun to see signs of successful adaptation to new circumstances both in the agricultural economy and in the family patterns of a new breed of commercially successful small farmers (Hannan and Katsiaouni 1977). Paradoxically, strong kin networks and attachment to family were by then found not in the lingering vestiges of ‘traditional’ farm households but among the younger, more entrepreneurial farmers. These had abandoned old-style patriarchy in favour a more egalitarian and communicative approach to their families, but in doing so had injected new life into the family and community networks of rural areas.

The urban alternative

In the late 1940s, the American sociologist and Jesuit priest, Alexander J Humphreys, conducted a detailed examination of life among ‘new Dubliner’ families, that is, families who, for the most part, had originated in the rural areas and migrated to the city. He wanted to see how family and community life for these newly urbanised families differed from that described for rural communities by Arensberg and Kimball some ten years earlier.

His account of the differences (Humphreys 1966), centered on one fundamental contrast — the family production unit which was so characteristic of the farm household was absent in the city and was replaced by wage or salary work outside the home, for men and single women if not for married women. From this fundamental contrast flowed a whole series of social and cultural consequences, not least of which was the weakening of parental control over adult children and, with that, the disappearance of gerontocracy. Only in the managerial and professional class was there anything like the degree of parental oversight of the social and economic lives of young-adult children which was commonplace in rural areas. Even then, however, the intensity and oppressiveness of those social controls were much less pronounced and less tension-ridden than in their rural counterparts.

Writing in the early 1960s, the folklorist Caoimhín Ó Danachair lamented the spirit of indifference towards older people which was already evident in the cities and which he feared would soon be widespread throughout Ireland (Ó Danachair 1962; see also O'Higgins 1990) In a certain sense, the characteristics of urban family life which Alexander Humphreys had described confirmed Ó Danachair's view. The more relaxed and democratic character of relationships between the generations pointed to a loss of power and status on the part of older people both in the family and the wider community.

However, the contrast was positive in more ways than it was negative, for older people as much as for younger. The central positive aspect was the reduction in conflicts of power and economic interest between the generations which was a key struc-tural feature of farm family life. The availability of independent means of livelihood for members of the rising generation as they entered adulthood was a key element in that new regime.⁵ That independence could be thought of as having a negative effect on the standing of older people: it weakened the relationship between young and old by greatly reducing the degree of instrumental involvement they had with each other, while also undermining the hierarchical controls which formerly lay in the hands of older people.

On the other hand, the more egalitarian and companionable approach to family life opened up the possibility of a less fraught and conflictual relations between older and younger people. It thus enhanced the prospects for enhanced affective interdependence and for a quality of emotional life which was not overshadowed by tensions and conflicts over economic resources. This trans-formation made the multigenerational family into a community of affection rather than a hierarchy of domination and subordination. That model of family life was itself prone to stresses and conflicts, since the course of true love, even between generations, rarely runs smooth. To say that the affective quality of family life improved in general is not to say that it was good in all cases, or that is always succeeded in providing real emotional support to older people. In many cases, in fact, as we will see below, failure in the ideal could be a serious source of stress for the elderly. Nevertheless, the emergence of new ideals of about what was good and valuable in intergenerational relations shifted the focus of family interactions into areas previously left untended and thereby opened up new possibilities for both young and old within the family circle.

Recent changes

The urban family model described by Alexander Humphreys in Dublin in the late 1940s has evolved a great deal in the intervening years, though in directions which, as far as the elderly are concerned, are reasonably consistent with the earlier models. As far as the economic underpinnings of older people's role in family life are concerned, the main development has been the growth of the pension system. This development has more or less completed the trend towards mutual economic independence between adult generations which is implicit in the wage/salary system of household support (this theme is examined further in Chapter 4 below).

The growth of affluence has contributed further to the reduced instrumental significance of family members for older people. One important consequence of affluence is the decline in the frequency with which parents and adult children co-reside with each other after the adult children have married. The greater availability and affordability of independent housing renders it unnecessary for adult family members to crowd together under a single roof. The growth in the number of old people who live alone or in elderly-couple households is one of the most characteristic features of family life in all countries in recent decades, including Ireland. It is often pointed to as a sign of abandonment of older people by family members. However, the consensus from research is that, alongside the preferences of younger people, such independent living is what old people desire and strive to achieve:

The decline in multigenerational households is not a result of declining family responsibility towards older generations, and their abandonment to old-age homes and institutional care, but rather a symptom of increasing independence on the part of the older population in most countries. (United Nations Secretariat 1994, p. 89)

As far as adult children are concerned, the counter-part to the instrumental independence between them and their ageing parents is the greatly increased dependence of their own young children and the greater demands this places on their resources. The increased emphasis on education as the basis of children's future life-chances has intensified parental investment in children. Childhood dependence now extends to the end of secondary schooling, if not to the end of third level education, and is vastly more demanding on parents' resources. This development both reflects and reinforces the cultural ideal that resources should flow from parents to children rather than vice versa. This in turn is both cause and consequence of the lack of instrumental involvement between adult children and their own parents. The priority of young and middle-aged adults is towards their children rather than their parents, and this is a priority which those children in turn will expect to carry into their own adult lives (see Chapter 4 below).

Family Networks of the Elderly⁶

Household structure

The previous section has suggested that the structural and qualitative changes in family life that have accompanied socio-economic development have transformed the way older people relate to their families. It has also suggested that while this transformation has in some ways reduced the power and standing of older people, it has also opened up the possibility of a much higher affective quality in family life as far as the elderly are concerned.

We now turn to a further concern which often arises in discussions of family life for the elderly — the quantitative extent of family networks and the degree to which older people have family members available to them. Chapter 2 above has already touched on an important aspect of this issue in its references to the high incidence of singlehood among older people in Ireland and the consequent lack of their own procreative families among substantial minorities of the elderly population. We now return to this issue by means of a more detailed examination of family networks among older people in Ireland today.

The first question to consider in dealing with this issue is household structure — the patterns of co-residence between old people and family members. Table 3.1 presents information on household structure among the elderly which is drawn from the 1993 Survey of the Over-65s (Fahey and Murray 1995).

Table 3.1

Elderly Households by Household Type, Sex and Age, 1993

Household type	Sex		Age				Total
	Male	Female	65–69	70–74	75–79	80+
			Per cent
Lone person	20	31	20	23	33	32	26
Couple	42	26	42	36	29	20	33
Couple + unmarried children	21	4	19	13	7	5	12
Widow(er) + unmarried children	3	16	8	11	10	11	10
Couple or widow(er) + married children with or without grandchildren	2	11	3	6	5	13	7
Siblings	7	7	4	7	9	9	7
Other	6	5	4	3	7	10	5
Total	100	100	100	100	100	100	100

Source: Survey of Over-65s (Fahey and Murray 1995, Table 5.1)

This shows that one in four old people in Ireland live alone, which is an increase from one in ten in 1961. Despite this increase, the incidence of living alone among the elderly in Ireland is still quite low by international standards (Fahey and Murray 1995, p. 104). As we saw in Chapter 2 above, future projections are that the incidence of living alone among older people will grow more slowly in Ireland than it has done elsewhere because of the declining incidence of singlehood and the growing incidence of married couples among the elderly population.

Even today, the most common elderly household is the married couple. This household type accounts for one in three of the 1993 sample of older people and is the household type which is likely to grow most rapidly in Ireland over the coming decades. The various forms of two or three generational households accounted for a further 29 per cent.

We can also see from Table 3.1 that men aged over 65 are more than twice as likely as women aged over 65 to be living with their spouses: couples and couples with unmarried children account for 63 per cent of men compared to 30 per cent of women, while 31 per cent of women live alone. This reflects the higher rate at which men pre-decease their wives, partly because they are usually older than their wives and partly because women have longer life expectancies. The distribution of household type by age of the elderly person shows that the incidence of living alone increases with age, largely because of the increase in the incidence of widowhood with age. The incidence of widows or widowers living with their own children also increases with age.

Extended family networks

Family members outside the household — the extended family network — can be as important to older people as the family members they live with. Certain aspects of the demographic patterns which prevailed at the time the present elderly were in the family-formation stages of their family cycles would lead one to expect that older people in Ireland today would have large extended families.

The present elderly married and formed their families for the most part in the pre-1960s period. This period of demographic history in Ireland represented an unusual conjuncture in that marital fertility remained high but infant and early adulthood mortality fell to unprecedentedly low levels (Fahey and Murray 1995, pp. 99–104). As a result, today's elderly parents have not only had relatively sizable families but they have also avoided the wastage through early death which would have ravaged such families in the past.

In addition, the worst of the post-war emigration was over by the time the children of today's elderly reached the brink of adulthood (which in most cases would have occurred from the early 1960s onwards). While we would expect to find some dispersal abroad among the children of today's elderly, this is likely to have been on a smaller scale than that experienced by most generations of older people since the mid-nineteenth century.

While the combination of high fertility, low infant and early adult mortality and low net emigration is conducive to large extended families among older people in Ireland today, we have to recall the distinctive circumstance of the never-married elderly. The elderly in this category stand out in that they more or less universally lacked procreative families of their own. We would expect their family circumstances to be of quite a different order than those of the elderly who married and had children. They are particularly important in the Irish case because, as noted in the previous chapter, they account for an exceptionally large proportion of the elderly population in this country.

The data in Table 3.2 confirm the generally large size of extended families among the elderly in Ireland. According to the 1993 Survey of the Over-65s, old people in Ireland on average had 3.4 children, 6.5 grandchildren and 2.6 siblings. In addition, the majority of these relatives were close to hand. An average of 2.5 children were either in the same household as the elderly person or living within ten miles. Similarly, well in excess of half of older people's grandchildren and siblings were living within ten miles.

Among the never-married elderly, by contrast, the picture was quite different. Table 3.2 includes data on the never-married living alone (who accounted for half of all the never-married elderly), alongside data on the other main category of the elderly living alone, the widowed. These data show the very small family networks of the never-married living alone — no children or grandchildren (as one might expect) but also fewer siblings, either locally or elsewhere. This in turn would be likely to mean that the unmarried elderly would often have relatively few nieces and nephews, though we have no data on this question.

The contrast between the never-married who live alone and the widowed who live alone is also quite striking. Though the latter have no family members living with them, the extended families living locally around them and elsewhere are generally as large, if not slightly larger than, the average for all elderly. This indicates that, as far as family networks are concerned, living alone has quite a different significance for the widowed than it has for the single elderly.

More detailed analysis of this information shows also that there are some urban/rural and social class differences in the size of extended families (Fahey and Murray 1995, p. 111). The urban elderly are likely to have more children living locally and fewer children living elsewhere in Ireland or abroad, and so too are the skilled and semi-skilled working class.

Table 3.2

Extended Families of Elderly in Ireland, 1993.

	Elderly living alone		All elderly
	Never married	Widowed
Resident in household
Children	–	–	0.4
Grandchildren	–	–	0.1
Siblings	–	–	0.1
Total	–	–	0.6
Within 10 miles
Children	–	1.8	1.6
Grandchildren	–	4.4	4.0
Siblings	0.8	1.0	1.0
Total	0.8	7.2	6.6
Elsewhere in Ireland or abroad
Children	–	1.6	1.4
Grandchildren	–	3.0	2.4
Siblings	1.0	1.3	1.5
Total	1.0	5.9	5.3
Total children	–	3.4	3.4
Total grandchildren	–	7.4	6.5
Total siblings	1.8	2.3	2.6
Total all kin	1.8	13.1	12.4
Sample size	70	163	909
% of total sample	7.7	17.9	100

Source: Survey of the Over-65s 1993 (Fahey and Murray 1995, Table 5.3)

Family contacts of elderly

Data from the 1993 Survey of the Over-65s also provides a picture of the levels of social interaction between the elderly and those relatives who live outside the household (we can assume high levels of contact between the elderly and children or other relatives who live in the same households). That picture shows high levels of kin contact (Fahey and Murray 1995, pp. 112–14). Almost half of elderly women and over a third of elderly men have daily contact with non-resident relatives, either in the form of visits or telephone contact. Between 80 and 90 per cent have at least weekly contact. Among the single elderly, kin contact is lower than for other categories of elderly — only 18 per cent have daily contact with relatives. However, it is not completely lacking — over half the single elderly have some form of contact with relatives at least once a week.

The only identifiable factor which consistently relates to the frequency of kin contact is the local availability of relatives. Relatives living elsewhere in Ireland or abroad do contribute to kin contact to some extent, but their role is limited compared to those living in the immediate vicinity of older people (Fahey and Murray 1995, p. 115).

What Difference do Families Make?

The family networks of older people are usually thought to merit examination on the assumption that family members are a major support without which the elderly would be more likely to find life dull and empty, if not intolerable. This assumption has been reflected in the account given earlier in this chapter of the changing significance of family life for older people over recent decades in Ireland. That account suggested that while the instrumental significance of family members for older people had declined, their affective significance had increased and had introduced a new and positive dimension to inter-generational relations in family life in Ireland.

While there is a great deal of truth to these views, it is important not to carry them too far. Families are undoubtedly important in the lives of older people, and we will see an instance of this in connection with family care for frail elderly people in Chapter 5 below. There are few old people today who feel abandoned or unloved by family members or who deny the value of family links (Fahey and Murray 1995, p. 95). However, families are by no means vital for older people in all circumstances and indeed in many cases they are not nearly as positive in their effects as one might think. Many elderly people make do very well without families and many others might well be better off if they could divest themselves of some of the family relationships they are caught up in. It is necessary, then, to take a more discriminating view of what it is that families do for older people, and how it may happen that they can sometimes be a source of stress as well as of support.

In examining the contribution of family members to older people, it is necessary first to recognise that different family members have different significance. This is evident at a general level in the differing roles of children and spouses in the lives of the elderly.

Adult children

The evidence on the impact of adult children on older people's welfare is generally quite ambivalent — while children's contribution is often positive, it is often also neutral or sometimes may be slightly negative. As a way of examining this issue, Rempel (1985) focused on the elderly who were childless and asked, ‘What are they missing?’ The answer she gave, in effect, was ‘much less than one might think’. While acknowledging that children often provide ageing parents with material, financial and emotional support, she found that ‘today's childless elderly have levels of well-being that match and sometimes exceed those of parent elderly’ (Rempel 1985, p. 346). The main reason she gave for this was the life-long adjustments made by those who are childless: ‘the knowledge that children are not available as a fail-safe resource produces capable, self-reliant elderly’ (ibid. p. 347). Apart from the reasonably high levels of well-being among the childless, a further indication that there are limits to what children provide for older people is the relief parents experience when their children grow up and leave the family home: ‘the “empty nest” marks an increasingly positive time of life for older people’ (ibid., p. 344).

These findings about the ambivalent benefits of adult children to ageing parents has been replicated in some studies conducted in Ireland. A study of the quality of life of the retired in Ireland found no consistent relationship between enjoyment of life among the retired and interaction with their children (Whelan and O'Higgins 1985, Whelan and Whelan 1988). Indeed, it appeared that some kinds of contact with children — especially visits from children — correlated negatively with elderly parents' enjoyment of life. Fahey and Murray (1995) likewise could find no link between contact with children and levels of morale or psychological distress among the elderly. Neither, indeed, was there any clear link between household structure and these measures of well-being among older people. The elderly who lived alone were no more likely to suffer from loneliness or psychological distress than those living with family members. The only aspect of family circumstances that seemed to have any bearing on older people's state of mind was a slight link between widowhood and an increased sense of loneliness on the older person's part. That effect seemed to be present irrespective of the current living circumstances of the older person — the widowed living with family members were as prone to loneliness as the widowed living alone.

Spouses

If there is one family relationship which does seem to be important to well-being among older people it is the relationship with the spouse. The most compelling piece of evidence which points in this direction is the well-documented impact of marital status on mortality. The married have longer life-expectancy than the single, the widowed or the divorced. This is true for both men and women, though, as far as mortality is concerned, the benefits of being married seem to be slightly higher for men than for women (Hu and Goldman 1990, Rogers 1995). Apart from the impact on mortality, the marriage relationship usually seems to serve as a more general support for the health and well-being of older people, including their mental health (see Chapter 5 below).

In interpreting this line of research in an Irish context, it is worth keeping in mind that it relates to countries (such as the United States) where divorce may have an effect in weeding out bad marriages and leaving intact only those which have real benefits for the spouses. Likewise, the option of second marriages gives those who made a bad choice the first time around the opportunity to do better the next time. It certainly seems to be the case that, while marriage in general may be good for older people, bad marriages are not (Dean et al. 1990). These factors together may well mean that, in countries with high divorce rates, surviving marriages among the elderly are not representative of all marriages, but are a self-selected sub-set of healthy and beneficial marriages. Those who are divorced, on the other hand, suffer not just from having a bad marriage in the first instance but also from having gone through the trauma of marital breakup.

The possible role of divorce in weeding out unhappy marriages before people reach old age has some significance for a country such as Ireland. Because the self-selection mechanism of divorce has not really been available to the present generation of older people in this country, bad or unsatisfying marriages may be more common among them. This might mean that the positive effects of marriage may be less pronounced than in other countries which have a longer tradition of reasonably accessible divorce. However,

this is a matter of speculation since no research has been carried out to compare the quality of family life among older people in Ireland with that in other countries.

Obligation and independence

In trying to understand the different roles of spouses and adult children in old people's lives, and the uncertain contribution of family members to older people's welfare, it is worth focusing on the tension between norms of obligation and norms of independence which frame relationships between the elderly and their family members. This tension arises in the relationship with adult children in a way that it does not with the elderly person's spouse. As Lye says,

On the one hand, norms of obligation mandate that adult children and parents should assist and care for each other over the life course. On the other hand, norms of independence mandate that adults should assume responsibility for their own well-being, that nuclear families should maintain themselves independently of wider kin networks, and that outsiders, including kin, should respect the privacy of nuclear families. (Lye 1996, p. 95)

One might expect that these norms are essentially in conflict with each other: if supportiveness is emphasized, interactions will be regular and positive in their effect, while if independence is emphasized, interactions will be fewer and weaker.

However, this may be a simplistic way of viewing the adjustments which are possible between the two sets of expectations and one which does not accord well with how they co-exist in real life (Lye 1995, pp. 95–97). An alternative approach is to consider that norms of supportiveness and independence can mould each other in a positive way rather than simply pull in opposite directions. For example, support might well be provided in such a way that its main purpose is to sustain the independence of the family member receiving it.

As far as older people are concerned, such an orientation might mean that support is shaped and provided in such a way as to avoid the creation of dependence and to minimise unnecessary intrusions into the older person's privacy and dignity. In practical terms, that might mean that family members help the older person to acquire what they need rather than providing it directly themselves. For example, an adult son or daughter might help an older person find a home help and keep an eye on how that home help works out, rather than stepping in to do the work of a home help themselves. Likewise, adult children might do all they can to enable an elderly parent to continue live a satisfactory life alone rather than pressure him or her into coming to live with them.

This way of understanding supportiveness recognises that adult children rarely have the close, round-the-clock intimacy with their ageing fathers or mothers that ageing fathers and mothers might well have with each other. For adult children to be genuinely supportive, therefore, requires not just a willingness to expend time and energy in interacting with parents but also a sensitivity to the boundaries which are present between their independent lives. Breaches of those boundaries might well be motivated by good intent on the part of children, and might well be likely to occur where children are most committed and concerned about their parents. But they are not necessarily what the older person requires or what would be of most benefit to his or her well-being. Rather, the requirement of independence on the older persons part may dictate that, in many areas of life, especially those having to do with practical assistance rather than emotional support and companionship, the ‘principle of least involvement’ should rule. That principle would indicate that knowing where and when to stand back is as important in the provision of genuine support as the readiness to provide help when it is required.

Conclusion

This chapter has examined the family circumstances of older people in Ireland, referring both to longer-term developments in structural aspects of family life for older people and to the family networks of the elderly today.

Over the longer term, the key development in family life as far as older people are concerned has arisen from the transformation of the economic context in which families operate. Elderly parents in Irish families in the past, especially rural families, held an extraordinary degree of power over adult children. This power was largely economic in character, in that is was founded on the system of property holding and inheritance and the control over children's lives which that system placed in the hands of parents. The extent of that control was such that, prior to the 1960s, rural Ireland has been referred to as a ‘gerontocracy’. Control by the elderly of this kind was less prevalent in towns and cities, though forms of it occurred among certain social classes there also.

The nature and effects of this system of family control fascinated outside observers. This was particularly so on account of its pathological effects on the rising generations, the tense, resentful relationships between ageing parents and adult children which it often gave rise to and the resort to escape (in the form of emigration) which it often provoked in younger people. In a certain sense, the economic power possessed by older people may have been a benefit for them, since it enhanced their status in their families and the community. However, it exacted a price in the form of strained relationships between the parents and children, the fragmentation of families through the departure of children, and a frequently disrupted system of generational succession. The pull towards the mother among grown-up children often counteracted these disruptive influences and helped hold families together. But even this pull towards solidarity had its negative side-effects. It often placed obstacles in way of the marriage among children, especially among the inheriting sons who would have to ‘bring another woman in’ on their mothers.

In recent decades, the ‘rule of the aged’ has all but gone from Irish family and community life. The economic well-being of the elderly is now determined mainly by pensions rather than by possession of productive property such as farms or small businesses and so does not depend on or imply economic control over their children. In addition, property inheritance has ceased to be of central significance in determining the life chances of children. Its place has been taken by education, in that education is now the key income-generating resource which parents secure for their children.

These changes mean that ageing parents and their adult children become economically independent of each other, thus removing the issue of economic control and dependence out of the relationship between them. This in turn removes a major source of strain from the relationship between the generations and enables interactions between them to take on a more relaxed, non-calculating character. It allows for an easier transition to independence for children and enhances the affective quality of relationships between generations. In important ways, therefore, while it reduces the extent of instrumental interdependence between older and younger family members, it enhances affective interdependence and preserves the role of the family in providing social and emotional support for older people.

Looking at the present-day family networks of older people within which these relationships take place, we find that those networks are typically large and strong. This reflects the peculiar demographic history of today's older people: the majority formed their families at a period around the middle of the present century when family sizes remained reasonably high and when infant and early adult mortality levels had fallen to unprecedented lows. In addition, their children, for the most part, came to adulthood in the post-1950s period when emigration had fallen to comparatively low levels. Together, these factors mean not only that most older people typically have large extended families of children, grandchildren and other relatives but also that larger proportions of those family members live close to hand, or at least somewhere else in Ireland, than would have been the case for previous generations.

As well as having large extended families, most old people have high levels of contact with those families. The vast majority have at least weekly contact with relatives living outside their households, while substantial minorities have daily contact.

One significant group of older people presents an exception to this pattern of large extended families — the elderly who never married. They not only lack spouses and children but also seem to have smaller numbers of siblings (and thus of other associated kin) than the average for older people in Ireland. Family contacts among the single elderly are by no means entirely absent — over half have at least weekly contact with relatives — but it is of a much lower order than among those who married and formed procreative families of their own.

In assessing the significance of the presence or absence of family networks among older people, it is easy to overstate matters. Family members undoubtedly play an important role in the lives of the elderly but it is not necessarily always an irreplaceable or benign role. Research on the impact of adult children on the lives of older people is surprisingly ambivalent — those who have no such children, or who have less contact with their children than others — do not always seem to be worse off on that account. Spouses, in general, are far more important than children for older people's welfare. Much of the explanation for the limited significance of children may lie, not so much in the reluctance of children to be supportive as in the desire of older people to preserve their independence. The value of independence looms large in older people's lives. That value requires, not that children stay away, but that they respect the boundaries of their parents' independent lives and do all they can to sustain those boundaries in a positive fashion. This means that what the elderly require from younger relatives is not indiscriminate ‘help’ but respect for their independence and assistance in maintaining that independence for as long as possible.

Chapter Four

FINANCIAL SUPPORT AND LIVING STANDARDS

Introduction

The introduction of old age pensions in 1908 was the first major step away from the Poor Law system of poor relief in Ireland and marked the beginning of modern forms of state welfare provision in this country. Since then, old age pensions have become a central pillar of the Irish welfare state and the dominant source of income for older people. In more recent years, a range of benefits-in-kind such as free public transport, free electricity and free television licenses have been added to social welfare pensions and have enhanced social provision for old people. In addition, private occupational pensions have also entered the picture and added a new plank of financial support for substantial minorities of the elderly.

Among the many consequences of these developments, not least is the contribution they have made to a transformed, and greatly reduced, role for the family in the financial support for the elderly. Family members outside of the elderly husband-wife couple have largely ceased to be relevant to the question of financial support for older people.¹ Pensions generally, and social welfare pensions in particular, have been major causes of this outcome. They have made possible an unprecedented degree of mutual economic independence between old people and other family members. This economic independence in turn has fundamentally altered the nature of the relationship between the elderly and their relatives, especially their own adult children. The rise of pensions thus represents a major, and largely taken for granted, part of the context which shapes the meaning which the family has for older people.

Chapter 3 above has already made some reference to this topic in connection with the declining significance of productive property (especially land) in the economic underpinnings of Irish households and the consequent decline in the importance of property inheritance in the relationship between older people and their descendants. However, the sharp decline in economic inter-dependence between older and younger generations does not mean that it has absolutely disappeared. Certain residual forms remain, and the present chapter begins with an examination of them, both in other countries and in Ireland. The chapter then turns to the main income sources of the elderly and trends in those sources over recent years. That is followed by an assessment of living standards among older people, with reference especially to the extent of poverty among older people.

Families and Financial Support of the Elderly

General patterns

In legal terms, financial obligations between kin in western countries arise only among a narrow range of family members. In family law and in social welfare law, the concept of the family in practice refers largely to the married or cohabiting couple and their dependent children. Correspondingly, the only intra-family financial obligations which have legal recognition are those arising between marital or cohabiting partners and between parents and dependent children.

No such obligations exist between adult children and their ageing parents. Despite occasional attempts in social policy to hold adult children or other relatives liable for at least some of the costs involved in the support of dependent elderly people,² the legal and constitutional bases for doing so at best slight. No western country in modern times has anything similar to legal provisions found in some eastern countries today which prescribe extensive financial obligations between a range of kin other than spouses and parents of dependent children.³

As we saw earlier, social practice in countries such as Ireland in the past meant that, while statutory obligations between adult generations were largely unknown, customary obligations of family members towards older relatives had considerable force. These were often backed up by formal contractual agreements drawn up by family members at major turning points in the family cycle. For example, marriage settlements typically took the form of formal legal agreements which, among other things, often spelled out how elderly parents or other relatives were to be supported in the household of the newly married couple.

Today, formal agreements of that kind are unheard of, and the attitudes and customs within which they existed have largely disappeared. It is now rarely assumed that children should give major financial support to parents in old age, the dowry and the marriage settlement have all but disappeared (at least in the form in which they occurred in the past), and inheritance has ceased to play the crucial role in opening up adult roles to the rising generation which it previously held (at least in rural Ireland in the first half of this century).

Nevertheless, inter-generational transfers of wealth or financial supports have by no means disappeared completely from family life and it is worth examining their extent and nature today. A lack of information means that it is not easy to establish a clear picture on these issues. This is so at least in part because resources transfers within families are difficult to quantify with any completeness. Such transfers are often informal or difficult to value, such as gifts in kind, lending of household equipment (e.g. a car), or taking a family member on as a partner in a business. This informality is especially likely to occur where adult children and older relatives co-reside and share in common household consumption. In such circumstances, it is often difficult even for those directly involved to know who gives what to whom or in what direction the net flow of resources runs.

However, in spite of the uncertainties involved, there seems to be a considerable degree of consensus in the international research literature on at least some aspects of inter-generational financial support. One area of agreement is on the direction of flows of support, which appears to run more from the older to the younger generation rather than the other way around. As Warnes (1994, p. 134) says, ‘elderly people probably provide more financial and practical support to their adult children than vice-versa’. Finch (1989, p. 22) arrives at a similar conclusion:

The common pattern seems to be that there is an uneven flow of support across the generations, with a net transfer from older to younger which continues throughout the life cycle, and indeed after death in the form of inheritance… Parents give to their children, and continue to give more than their children ever give them in most cases, though one situation where this flow is often reversed is where children have emigrated to a more affluent country and expect to send money back to their parents.

While it is obvious that post mortem inheritance will normally flow from the old to the young, the same direction of flow seems on balance to occur in transfers between the living. In the United States, Rosenzweig (1994) has examined two major forms of resource transfer from living parents to adult children — residence sharing and financial transfers to non-co-resident children. He reports that such resource transfers occur fairly commonly while the parents are still of working age — over the period 1967–1980, about 13 per cent of white parents aged 55–59 in the US either shared their residence or provided financial transfers to adult children. The timing of such transfers appears to be strongly influenced by the timing of adverse events occurring to the younger generation — divorce, income loss, unemployment. However, inter vivos transfers of this kind, especially financial supports, become a good deal more unusual as parents pass the age of 60 and as adult children pass the age of 30. This is in contrast with post mortem transfers which occur later in the life cycle, not only in that parents have died but also in that children are typically in middle age, if not early old age. Rosenzweig makes the following further comparisons between inter vivos and post mortem transfers:

Inter vivos intergenerational transfers appear to involve a higher proportion of families than do transfers occurring at the death of the parents, to be of the same order of magnitude as inheritance transfers, but to be timed more in relation to the life-cycle events of the adult children. (1994, p. 199)

Thus, while inheritance at death may still be a significant form of resource transfer between parents and adult children, ‘the assets of parents appear to represent a source of emergency funds for the adult children’ while parents are still alive (ibid.).

Family transfers in Ireland: inheritance

Nothing systematic is known about inheritance practices in present-day Irish families. That inheritance retains some significance, however, is shown by the numbers of elderly households which possess significant wealth. Almost nine out of ten of the elderly in Ireland are home owners, a higher proportion than is normal in western countries. A small minority of these (about one in ten — Nolan 1991, pp. 39–40) carry small outstanding mortgages, but the vast majority are owned outright. Housing is the most significant form of wealth owned by older people in Ireland, just as it is the most significant form of household wealth in Ireland as a whole. Farmland follows at a distant second, and deposits at an even more distant third. On the basis of imperfect data,⁴ Nolan (1991, p. 28) estimated that in 1987 housing accounted for 56 per cent of wealth owned by 65–74 year-old household heads in Ireland. Farm land accounted for a further 25 per cent, deposits 7 per cent, with the balance (12 per cent) accounted for by a mix of business holdings, other property, gilts, equities and such like. Incidentally, it is worth noting also that the mean reported wealth of elderly households was above the average for all households (£42,000 for the former compared to £37,400 for the latter), even though the mean incomes wealth of elderly households was below the national average (Nolan 1991, pp. 27–29).

Given the extent of the assets owned by the elderly, substantial bequests are likely to be a common consequence of the death of older people. In the case of elderly married couples where both partners have died, children or grandchildren are likely to be the most common beneficiaries of these bequests. The obligations and commitments which lead up to and shape those inheritance outcomes are undoubtedly a complex part of the life of many families, and even today may have a great bearing on how older people relate to their younger relatives. The knowledge on old people's part that they can leave something of value to relatives after they die may figure quite strongly in their sense of how they fit into their families as they age, especially if they become incapacitated and dependent on others for help with daily activities. We lack hard information on this issue, but it nevertheless it is something which must be kept in mind as we consider patterns of social care for older people later in this report (see Chapter 5 below).

Financial support

The question of financial transfers between living elderly persons and their relatives is also important in considering the economic dimension of family relationships among the elderly. We have marginally more information on these transfers than we do on post mortem inheritance. This information comes from the Survey of the Over-65s in Ireland carried out by the ESRI in 1993 on behalf of the National Council for the Elderly (Fahey and Murray 1995).

In that survey, economic transfers within families in which the elderly might have participated were divided into two categories — occasional large gifts either in money or in kind which might have been made at any time over the previous five years (‘large’ in this context meant over £200 in value) and more routine day-to-day support which might be occurring at the time of the survey. Elderly respondents were asked whether they had either given or received transfers of either kind. Friends as well as family members were referred to in the questions as possible givers and receivers of transfers, but since practically all respondents referred to family members only in connection with transfers, we can discount the reference to friends here and focus only on transfers to and from family members.

Table 4.1 shows that both large gifts and routine financial support do occur, and in both directions, between older people and other family members. However, they are not common. Less than four per cent of elderly persons reported that they had received a large gift over the previous five years and less than 7 per cent had received more regular day-to-day support. The percentage of older people who gave a large gift was somewhat higher, at almost 10 per cent, while the percentage who gave routine support was only a little over half that, at 5.5 per cent.

Table 4.1.

Economic Transfers within Families Given or Received by Persons aged 65 or Over

	Type of transfer
	Large gift*	Routine support
Percentage of elderly receiving transfer from family member	3.7	6.6
Percentage of elderly giving transfer to family member	9.6	5.1

*exceeding £200 in value

Source: Survey of the Over-65s, 1993

Since the total sample of elderly persons in the 1993 survey was 909, the sub-samples involved in these transfers contain too few cases to allow for further detailed breakdowns. However, we can say something very approximate about the value of the transfers as reported by the elderly respondents. In the case of the 34 elderly respondents who reported giving large gifts, almost half had given gifts less than £1,000 in total value, while a small minority (5 cases) had given gifts over £10,000 in total value. Large gifts received were reported to be somewhat larger, in that the majority were valued between £1,000 and £10,000. In the case of more routine support, the value of what was given and received was generally less than £20 per week.

As far as the family members involved are concerned, the majority of both givers and receivers of transfers to or from older people were the sons or daughters of the older people, though in certain cases siblings also played a role as givers of transfers to older people.

These figures, then, tend to confirm two general points made earlier. The first is that inter vivos financial transfers between elderly people and their adult children (or any other relatives) are very much the exception rather than the rule. The second is that the flow of transfers runs from the elderly to younger relatives as much as, if not more than, vice versa.

The fact that adult children give so little financial support to parents might be taken as a sign of selfishness on the part of children and as evidence of a decline in the sense of family obligations. However, there are other ways of looking at it. One is that adult children, as workers and tax-payers, provide much of the resources necessary for state support of older people. In that capacity, they give quite extensively to older people, though through the machinery of public revenues and expenditures rather than by means of direct personal gift.

In addition, non-giving to older relatives by adult children frequently co-exists with extensive giving to their own young children. This means, not that generations are becoming increasingly selfish but rather that, as far as inter-personal transfers are concerned, each generation now gives to the one coming after it rather than to the one which has gone before — family resources consistently flow down the generational ladder. State and private pensions could be thought of as the public contra-flow which provides older people with incomes. As such, pensions facilitate the downward flow of resources within families by providing a non-family based means of providing elderly incomes which is supported by active adults generally — those who do not have young children to support as well as those who do. To understand inter-generational support relations fully, therefore, we have to place family obligations to older people (or the lack of them) in the context of the broader set of commitments reflected by welfare state provision. In this view, it is not the case that elderly parents participate only as givers in the generational pact but rather that what they receive from the younger generations takes on a different form and is organised in a different way than what they give.

Incomes of the Elderly

Income sources

We now turn to the non-familial incomes and income sources for older people. Data assembled by Hughes and Whelan (1996)

indicate that the average income per week of persons aged over 65 in Ireland, in current values, increased from £23.57 in 1977 to £95.29 in 1995 (Figure 4.1). Adjusting current values to 1995 values, this represented a real increase from just over £80 in 1977 to £95.29 in 1995.

Table 4.2 gives a detailed breakdown of the sources from which elderly incomes were drawn. State pensions were by far the most important source. They were received by 83.2 per cent of elderly persons in 1995, compared to 79.1 per cent in 1977, and accounted for just over half of income averaged over the whole elderly population in both years. In 1977, farming was still quite an important income source: while it provided incomes to less than 12 per cent of the elderly, it accounted for 27.5 per cent of the average income of the whole elderly population. Occupational pensions in 1977 were received by a substantial minority of old people (15 per cent) but accounted for only 12.2 per cent of total average income. Since 1977, farming as a source of income has unambiguously declined but occupational pensions have risen sharply. The latter are now received by over 22 per cent of older people and account for a similar share of total average income. These data understate the significance of occupational pensions because they do not take account of lump-sum payments on retirement which often are a major component of occupational pensions, nor do they take account of pensions to the numerous retirees who are aged under 65.

Table 4.2

Income Sources of Persons Aged 65 and Over, 1977 and 1995

	Data for 1977			Data for 1995
	% with income from this source	Average weekly income		% with income from this source	Average weekly income
		£	% of total income		£	% of total income
State pension or allowance	79.1	12.1	51.4	83.2	52.58	55.2
Pension from previous employer	15.2	2.87	12.2	22.7	22.05	23.1
Farming	11.8	6.49	27.5	6.9	8.17	8.6
Non-farm self-employment	1.4	0.23	1.0	1.1	2.54	2.7
Employment	2.2	0.59	2.5	2.1	4.74	5.0
Interest, dividends	15.8	0.88	3.7	23.5	2.96	3.1
Other sources	5.5	0.39	1.7	4.6	2.25	2.4
All sources	–	23.6	100	–	95.3	100

Source: Hughes and Whelan (1996), Table 3.4; based on data from Reports of the Department of Social Welfare for 1977 and 1995, Labour Force Surveys 1979 and 1995, Whelan and Vaughan (1982), Living in Ireland Survey 1995.

Distribution of income

Turning from average incomes and their sources to the distribution of income, Figures 4.2 and 4.5 give an indication from two different sources of the degree of diversity in household incomes among the elderly.

Using data from the 1993 Survey of the Over-65s, Figure 4.2 classifies households containing elderly persons by household income band. These data differ from those used in Table 4.1 above in that they refer to household net income rather than to gross income averaged over elderly individuals. To allow for comparisons across households of different size and composition, household incomes are standardised using an equivalence scale in which the first person in the household is counted as 1, each additional adult is counted as 0.66 and each child is counted as 0.33 (Fahey and Murray 1995, p. 134). These data show that the net household incomes of elderly households are heavily clustered in the £51–100 range — two-thirds of elderly households are in this range. Low-income households (below £50 per week) do exist, but they form a minority (13.3 per cent).

Figure 4.3 gives another view of the same issue by setting out the distribution of elderly households across the income deciles for all households in Ireland as measured in the ESRI's 1987 Poverty Survey. These data refer to net household income standardised by reference to the same equivalence scale used for Figure 4.2.

This distribution shows that elderly households are over-represented in the third, fourth and fifth deciles, that is, just on or below the middle of the range of incomes for all households. They are under-represented in the bottom of the income range (the first and second deciles) and in the top (the ninth and tenth deciles). In other words, elderly households in general are neither very well off nor very badly off but cluster just below the average income for all households.

Poverty

The income levels among the elderly in the late 1980s and 1990s described in the last section have been enough to keep the majority of older people out of serious poverty. In the early 1970s, by contrast, the elderly were highly vulnerable to poverty and were a major segment of the population in poverty.

The reduction in elderly poverty between the early 1970s and late 1980s is illustrated in Figure 4.4. This figure shows the risk of poverty at the 40 per cent, 50 per cent and 60 per cent relative poverty lines among households headed by elderly persons for the years 1973, 1980 and 1987. At all three relative poverty lines, poverty among the elderly has declined sharply since 1973. At the 40 per cent line, the main decline occurred in the first period referred to in Figure 4.4 (1973–1980), while at the 50 and 60 per cent lines, the main declines took place in the second period (1980–87). Given that the elderly depend so much on state pensions, this outcome is very much the result of increases in the real value of such pensions since the 1970s, along with the entry into the ranks of the elderly of new cohorts of younger elderly with benefits from occupational pensions (Callan et al. 1989, pp. 98–100).

While the improvement in incomes and reductions in levels of relative poverty among older people indicated by these figures is undoubtedly real, it is important to note also that some older people are still poor. In 1987, at the 50 per cent poverty line, one in ten elderly-headed households were below the poverty line. While this is a major improvement over 1973, when over one-third of elderly headed households were below the same poverty line, it indicates the persistence of substantial pockets of poverty in the elderly population. Given the widespread, and largely accurate, perception that older people are now reasonably well off, it may be easy to forget the variations which exist within the elderly population and the poor circumstances which a minority of elderly still find themselves (O'Shea 1993, p. 39; Fahey and Murray 1995, pp. 149–150).

The decline in the extent of poverty at the 50 per cent poverty line among older households is compared with the trend for all households in Figure 4.5. In 1973, households headed by the elderly were almost twice as likely to be poor as the average for all households (33.8 per cent poor among elderly-headed households compared to 17.7 per cent poor among all households). By 1987, this relationship was reversed in that elderly headed households had only slightly more than half the average poverty risk for all households. Although the proportion poor among all households had remained unchanged (at 17.5 per cent), the corresponding proportion among elderly households had dropped to 9.7 per cent.

The same story of progress in the material standards of older peoples' lives is revealed by other indicators of living standards. Figure 4.6 compares the proportions of elderly households which possessed a number of consumer durables and household amenities in 1977 and 1993. All of these indicators show a substantial advance. The greatest jump is in telephone ownership, which went from 31 per cent of elderly households in 1977 to 84 per cent in 1993. Car ownership showed the smallest increase: in 1993 only half of the elderly reported having the use of a car in their households.

Aggregate Expenditure on Elderly Incomes

As we have seen, state pensions are the mainstay of elderly incomes and the improvement in state pensions has made a major contribution to the reduction in poverty among the elderly. Progress on this front at the level of the elderly household has been matched by a great increase in expenditure at the national level in support of elderly incomes and living standards.

Social welfare pensions

Figures 4.7 gives an indication of what has occurred in overall state spending in this area by plotting real growth in total expenditure on social welfare pensions (panel A) and in such expenditure as a percentage of GNP from 1960 to 1995 (panel B).

Total expenditure increased five-fold in real terms over the period, with much of the increase occurring in the 1970s and early 1980s. Expenditure as a percentage of GNP has been less consistent. It remained largely unchanged from the 1960s to the mid-1970s, at around 2 per cent of GNP. It then almost doubled to just over 4 per cent between the mid-1970s and mid-1980s. Since 1985, it has fallen back, and dropped to 2.8 per cent by 1995. This means that, following the very sharp growth of the late 1970s and early 1980s, welfare expenditure on old age pensions has continued to grow since the late 1980s but has not kept pace with general economic growth.

Looking at the period 1972–1993, Figure 4.8 traces the growth in real value of two common payment rates under the scheme of non-contributory old-age pensions — that for a lone person aged 80 or over and that for a person aged under 70 with one adult dependent. These show that the period 1977 to 1983 was one of rapid growth in the real value of pension payments. Since 1983, however, improvements in payment rates have for the most part simply kept pace with inflation, though there were also some real increases in the early 1990s.

In addition to pension payments, ‘free’ benefits-in-kind provided to the elderly under the social welfare code have made a substantial contribution to the material well-being of elderly households. The most important of these (free travel, free electricity and free television license) were introduced in 1967 and 1968 (Commission on Social Welfare 1986, pp. 478–82). These benefits are available to certain groups other than the elderly (for example, widows and the disabled) and it is not possible from published data to isolate the share of relevant expenditure which is devoted to older people. However, the trend in overall expenditure on these benefits gives some indication of their significance. Expenditure has risen rapidly in real terms over the years and in 1995 amounted to over £91 million, which is the equivalent of about one-tenth the expenditure on social welfare old age pensions (Figure 4.9). Roughly estimated, this would mean that these free schemes would a further £8 per week or so in non-cash benefits to the average income of elderly persons.

Occupational Pensions

As we have seen above, household-level data on elderly incomes indicate that occupational pensions (that is, pensions which retired persons receive from a previous employer, whether in the public or private sector) have become a significant source of income for older people in recent years. Information on the amount of payments made to beneficiaries are not as readily available as in the case of social welfare pensions, and it is difficult to trace trends in the total value of payments over time. However, figures quoted by Hughes and Whelan (1996, p. 8) indicate that total payments to beneficiaries of occupational pensions schemes in 1994 amounted £1 billion. Of this total, £460 million was accounted for by private schemes, while £540 million was accounted for by pensions for civil servants and other public sector retirees. The total of £1 billion is very similar to the total spend on social welfare pensions in the same year, which was £949 million. However, the former is not fully comparable to the latter in that it includes substantial lumpsum payments to employees on retirement and pension payments to retirees aged under 65 as well as to those aged 65 and over.

Future Affordability of Pension System

One of the most commonly voiced concerns arising from growth in the size of the elderly population is the future affordability of the pension system. This concern has been raised on a number of occasions in Ireland, most notably by the National Pensions Board (National Pensions Board 1993). A particular object of the National Pensions Board's concern was the social welfare pension system, which is funded on a pay-as-you-go basis out of public revenues rather than out of an accumulated pension fund. On the basis of projections of future trends in the number of claimants of social welfare pensions compared to the numbers of workers making social insurance and income tax contributions, the Board forecast that the balance between the two would worsen sharply over the next thirty years, thus raising ‘serious questions about the capacity of present financing arrangements’ to meet the costs of the growing old age pensions burden (National Pensions Board 1993, p. 47).

While the National Pensions Board's report was quite pessimistic about the future sustainability of social welfare pensions, a number of factors raise doubts about the plausibility of the Board's views on these questions.⁵ One is the pessimistic nature of the population and labour force projections on which the Board's forecasts were based. These were mainly derived from demographic and labour force data of the 1980s, a period of high emigration, high unemployment and no growth in the labour force. The Board worked on the assumption that the negative demographic and labour force patterns would persist over the coming decades and as a result forecast that total population would decline, unemployment would remain high and the labour force would shrink in the long-term. In fact, the record since then has been much more positive than the Board predicted, so much so that the current demographic and labour force situation is much stronger than the Board had projected for the mid-1990s. The gap between the Board's projections and the actual outturn now seems likely to widen as time goes on. Rather than contract as the Board predicted, the labour force and the number of social insurance contributors has already grown sharply and is likely to continue to do so over the coming years. The Board's projections thus underestimated the expansion of the support base in the working population for social welfare pension schemes.

A further limiting feature in the National Pensions Board's approach was its narrow focus on pensions in isolation, without reference to other demands on the social welfare budget such as those from the unemployed, children, lone parents, the disabled and so on. In reality, the future sustainability of social welfare pensions for the elderly is determined not only by the balance between the numbers of old people and the number of tax payers or social insurance contributors, but also by the size of competing claims on total welfare spending arising from the unemployed, children, lone parents and so on.

In arriving at a more realistic assessment of the capacity of the state to sustain public provision for older people in Ireland in the future, a number of related trends need to be kept in mind. One is the sharp improvement in the ratio between workers and dependents which has been underway in Ireland since the late 1980s and which is likely to continue for at least a further decade. This improvement in economic dependency is due to the declines in the size of the child population and in the numbers unemployed, coupled with increases in the numbers at work. Increases in the numbers of elderly will tend to worsen the economic dependency ratio, but these increases are more than counter-balanced by the declines just mentioned, so that the overall trend in economic dependency is unambiguously favourable. As far as the welfare state is concerned, this trend means that the tax base out of which social services have to be financed is expanding while the size of the total client population for those services is contracting, thus enhancing the overall sustainability of welfare spending.

Of the various shifts in the size and composition of the client population for welfare spending, some have greater significance than others. Children are defined as primarily a private family responsibility which is met by a mixture of informal family care (provided especially by mothers) and financial provision funded by paid work on the part of one or both parents. Support for the elderly, by contrast, is defined as primarily a public responsibility (in terms of pensions and health care). The implication is that a decline in the numbers of children will result principally in savings for families while an increase in the number of old people will result principally in extra costs for the state.

On the other hand, there are further counter-balancing effects which will ease the overall pressure on state spending. A decline in unemployment is the most obvious. At present, the unemployed cost the social welfare budget almost the same amount as the elderly (at about £1,000 million each per year). Present downward trends in unemployment thus form an important counter-weight to growth in the numbers of old people as far as social welfare spending is concerned. In addition, the fall in the number of children has an important indirect effect on the support base for social welfare spending. The decline in fertility will release large quantities of unpaid female labour for participation in the paid labour market. This in turn will form one of the main sources of expansion in the labour force and will help to expand the number of income tax and social insurance contributors who fund the social welfare system. This effect is compounded in the Irish case by the income tax treatment of married couples which means that the entry of married women into the labour force gives a disproportionate boost to state revenues.

It is impossible in the present state of knowledge to quantify all these counter-balancing trends and estimate their net effect on of public income and expenditure and thus on the sustainability of the welfare state. However, the underlying picture in undoubtedly positive. The lesson has sometimes been drawn from rising dependency levels in other countries that the welfare state is becoming unaffordable — there will be too many dependents per worker for current levels of provision to be sustained into the future. The basic premise of this argument simply does not hold in the Irish case. Ireland is now exceptional among western countries in that there will be considerably fewer dependents per workers in the future than there has been in the recent past.

Conclusion

The role of families in the financial support of older people is now negligible. Indeed it appears that, where there are financial support relationships between older people and their younger relatives, the flow of resources may run from the elderly to their relatives as well as vice versa. Otherwise, mutual economic independence is the normal pattern. The growth of the social welfare pension system has been the main contributor to the emergence of this independence, with occupational pensions now also increasing as a source of income for older people. The pension system has thus contributed to the broader transformation of economic relations between the generations which was documented in Chapter 3.

Because of the sharp improvement in social welfare pension rates since the late 1970s, along with the expansion of the ‘free’ schemes (such as free transport, free television license, etc.), material living standards among older people have greatly improved and the levels of poverty among the elderly have declined. The upward trend in elderly incomes has slowed down since the late 1980s. That trend is still sufficient to keep pace with inflation but has fallen somewhat behind the rate of growth of the economy. The elderly may thus have lost something of the advantageous position they held in the late 1980s. In addition, the benefits of the general improvement in elderly living standards have not been evenly spread. Substantial minorities of elderly (of the order of one in ten) are still below a moderately stringent poverty line. This is a much lower rate of elderly poverty than prevailed in the 1970s but still means that many elderly people are living at unacceptably low standards of living.

Patterns of population ageing in Ireland mean that demographic pressures on social provision for older people are less severe than in other countries. In many ways, in fact, given present declines in unemployment and growth in the labour force alongside the relatively slow pace of growth in the size of the elderly population, those pressures are easing rather than worsening. On strictly demographic grounds, therefore, Ireland is not faced with the same questions about the future affordability of social provision for older people as have arisen in other countries. This of itself does not dictate anything about future policy choices as far as the support of the elderly is concerned. But it does mean that demographically imposed constraints on such choices are not as limiting as they were in the past in Ireland or as they are likely to be in the future in many other western countries.

Chapter Five

HEALTH AND SOCIAL CARE

Introduction

Towards the end of Chapter 3 above, which dealt with the family circumstances of older people, the question was asked, ‘What difference do families make?’ The answer turned out to be more uncertain that one might expect — family contacts, while generally important to older people, did not seem to be universally irreplaceable nor even universally as positive as is often thought. The thrust of this conclusion was added to in Chapter 4, where it appeared that family members make little financial contribution to the support of the elderly, and in general receive as much as the give in economic exchanges with ageing parents.

If there is one area where family members are generally acknowledged to have an important role for older people it is in connection with informal care at times of illness or physical frailty. Much modern research has been at pains to point out that, in spite of all the changes which have occurred in the family and in the availability of professional care for the elderly, the largest proportion of caring for frail old people is still provided informally by family members.

The significance of the family for the health of the elderly does not arise solely in connection with the provision of informal care. It has a prior, and perhaps more fundamental, role as a determinant of health. It is now recognized that social support and social isolation have an important causal influence on illness and health. Family relationships are a central source of social support, and thus come into the picture as a means of sustaining good health in the first place as well as in providing care once health has begun to decline.

This chapter examines these aspects of the role of the family in connection the health and care of the elderly. It first sets the context by summarizing the available evidence on trends in health and dependence among older people in Ireland. It then examines family circumstances as a determinant of health and illness among the elderly and the role that public policy might play in influencing those circumstances. Following that, it turns to the role of the family in responding to illness and physical disability among older people, both as providers of care to elderly relatives and as possible sources of finance for long-term care for frail elderly who have become dependent on institutional care. It also looks at the public policy implications of that role. The chapter concludes with a summary of the main findings.

Trends in Health and Dependence

Mortality

The most basic indicator of the health status of any segment of the population is its level of mortality. A most widely used indicator of mortality level is life expectancy, and that is the indicator we will use here to examine mortality trends among the elderly in Ireland.

Overall life expectancy has risen a great deal in Ireland in the present century, as it has in practically all countries of the world. Life expectancy at birth in 1926 in Ireland was 58 years for both males and females. This was a reasonably high life expectancy level by the standards of the time, though it was exceptional in that Irish women had no life expectancy advantage over Irish men (the normal female life expectancy advantage in western countries in the 1920s was about two years — Preston 1976).

By 1991, life expectancy at birth had risen to 78 years for females and 72 years for males (gains of 20 and 14 years respectively). These sizable increases represented a major advance in public health. As far as gender differences are concerned, they also brought Ireland into line with other countries by bestowing a considerable life expectancy advantage on women (the normal such advantage in western countries had risen from around two years in the 1920s to between six and eight years in the 1990s).

While these facts are well-known, their significance as measures of health trends among older people in Ireland is widely misunderstood. They are often thought to indicate that older people's survival prospects have increased and that therefore older people's health has improved in quite a fundamental way. In fact, this is not so. Most of the increase in life expectancy in Ireland since 1926 has been due to declines in infant and early adult mortality rather than to extensions of life at later ages.¹ This means that more people survive to middle age than before, but from middle age onwards their survival rates have improved only slightly, if at all, over the past sixty to seventy years. This is especially true of Irish men, for whom reductions in mortality at older ages have been especially slight. The picture for Irish women is somewhat more positive but is still less than what might be expected in the light of progress in other countries on this front.

These patterns are illustrated in Figure 5.1, which shows the trend in life expectancy at the ages of 50, 65 and 75 for women and men in Ireland over the period 1926–1991. For women, life expectancy at these ages has shown some improvement in that period, especially since the 1950s. At age 65, for example, Irish women in 1961 could expect to live a further 14.4 years on average.² By 1991, this had risen to 16.8 years, an increase of 2.4 years. This was a relatively small increase by the standards of other western countries, and did not reflect especially well on trends in women's health. Nevertheless, it was an increase.

Among older Irish men, there has been scarcely any long-term increase in life expectancy. At each of the ages referred to in Figure 5.1, life expectancy in the 1980s was more or less the same as it was in the 1920s. Indeed, life expectancy among rural men in 1926 was marginally higher than it was for all men in 1986. In 1926, among men in Connaught, one of the longest-lived population groups in Ireland at the time, life expectancy at age 65 was 13.9 years (Census of Population 1926, General Report, pp. 217–20). This was a year greater than life expectancy among all men at age 65 in Ireland in 1986.

If one looks closely at Figure 5.1, one can see that life expectancy trends at older ages took a significant upward turn in the period 1986–1991, that is, at the very end of the trend lines. This is so especially true for men, who registered an historically novel improvement in life expectancy in this period, though even for women the pace of improvement also quickened somewhat. The indications from more recent death statistics are that this improving trend has slowed down again and so may have been only a temporary deviation. However, more detailed age data from the 1996 Census of Population will be required to confirm what recent trends have been.

The striking conclusion to emerge from these figures is that, as measured by mortality statistics, there has been no overall improvement in the health of men of later middle age and old age in Ireland since the 1920s, while the improvement for women at the same ages has been exceptionally modest by international standards.

One of the consequences of this poor record of improvement in health among middle aged and older Irish people is that Ireland has slipped down the international league table of older age life expectancies. In the 1920s, older people in Ireland had among the longest life expectancies in the world (Census of Population 1926, General Report, pp. 217–20). Since then, progress in other western countries has passed Ireland by. Ireland now has among the lowest life expectancies at older ages among developed countries, for both men and women. In the early 1990s, Ireland ranked at the bottom of 23 OECD countries as far as life expectancy at age 65 was concerned, for both men and women (Fahey and Murray 1995).

Morbidity

As we have seen, if we use mortality levels as a measure of health, older Irish people have quite poor health by the standards of other countries, and the lack of long-term improvement in this area amounts to a considerable failure of public health in Ireland. It is more difficult to make a judgement on trends or levels in illness (or morbidity) among older Irish people. Many illnesses are not life-threatening and their incidence in a population can rise or fall independently of death rates. In fact, the relationship between trends in morbidity and trends in life expectancy is a contentious issue in epidemiological research. Some say that illness levels decline as life expectancy rises — people live longer because they enter illness at a later stage in life. Others say that illness levels increase as life expectancy rises — advances in public health and medicine preserve the frail from early death but only to leave them constantly exposed to chronic illness (see Markides 1993 and Crimmins et al. 1994 for reviews of the evidence on this issue).

The difficulty in resolving this question arises from the near-impossibility of arriving at consistent, reliable measures of illness rates in populations over time. This in turn reflects the cultural and subjective dimensions of concepts of health and ill-health.. Illnesses may well be reflected in physically observable conditions, but they often also contain important subjective elements which are hard to pin down. Even the ‘objective’ diagnostic techniques used in clinical medicine do not always produce consistent results (Bowling 1991). Because of these measurement difficulties, it is difficult to say with any certainty what the trend in illness levels in any society has been over recent decades.

Keeping in mind the uncertain nature of the measures that available for tracking trends in illness levels, we can look at some relevant evidence for older people in Ireland. The most useful sources for this purpose are two surveys on elderly persons — one from 1977 and the other from 1993 — which asked respondents both about their health status and their patterns of usage of various health services (Fahey and Murray 1995). The questions on these issues in the two surveys were identical and so provide comparable measures over a reasonable time span. At the same time, they have limitations. The main one is a seasonality factor. The 1977 survey was carried out in early winter (mainly November-December), while the 1993 survey was carried out in the summer (June and July). Seasonal variations in morbidity are undoubtedly large, though not yet precisely estimated, so it is difficult to disentangle seasonal effects from genuine time differences in comparisons between these two survey sources. In addition, while the specific questions on health issues were identical, the two surveys differed from each other in purpose and design, so that the degree of overall replication is far from complete. As a result, while the morbidity measures used here do have a value as approximate indicators of older people's health status, they do not amount precise comprehensive measures of their ‘objective’ health condition (if it is meaningful at all to talk of ‘objective’ health condition) or of trends in that condition over time.

A range of medical utilization and health status measures from the two surveys is presented in Table 5.1. This table focuses on a particular sub-group of the elderly — those aged 70–79 — in order to minimize age-composition effects on the measures compared.

Table 5.1

Comparison of Various Measures of Morbidity Among 70–79 Year Olds in 1977 and 1993

	1977		1993
	Male	Female	Male	Female
Per cent seeing doctor within previous 4 weeks	41	49	43	53
Per cent not seeing doctor in previous 12 months	25	19	16	8
Per cent who took pills or medicine in past 24 hours	56	67	54	65
Mean no. of visits to or from doctor in past 4 weeks	0.6	0.84	0.6	0.9
Mean no. days unable to carry out normal activities in past 4 weeks	1.53	1.77	1.5	1.1
Per cent reporting no functional disability	48	38	68	58
Percent reporting major illness or disability	56	67	43	48
Per cent stating health as ‘good’ or ‘very good’	63	55	71	62

Source: Fahey and Murray (1995), Tables 3.4 and 3.5

The first four items in this table — proportions visiting the doctor in the past four weeks, proportions not seeing the doctor within the past year, taking of prescription medicine over the past four weeks and average number of visits to the doctor over the past four weeks — relate broadly to medical service utilization. These items, at first sight, indicate either little overall change or some increase between 1977 and 1993. The percentages who had seen their doctor over the previous four weeks had increased slightly. Likewise, the percentages who had not seen their doctor for over a year had declined substantially over the period. Both these indicators suggest an increase in medical utilisation. The degree of increase in utilization is probably understated because of the seasonality factor. The 1977 data relate to winter-time usage of the services in question, which would represent a seasonal high, while the 1993 data relate to summer-time usage, which would represent a seasonal low. Corrections for seasonality would thus have the effect of further raising the 1993 measures of utilisation relative to the 1977 measures.

The second set of items in Table 5.1 deal more directly with morbidity and health status. These items include average number of inactivity days due to illness in the past four weeks, percentage reporting no functional disability, percentage reporting a major illness or disability and percentage judging their health as ‘good’ or ‘very good’. The most important finding from these items is that they give no indication of an increase in morbidity between 1977 and 1993. On the surface, in fact, there are signs of a decrease: the percentage reporting no functional disability increases, the percentage reporting a major illness declines and the proportion reporting their own health as ‘good’ or ‘very good’ rises. This surface appearance has to be read with caution given the seasonality influence on the measures which has been referred to before. Nevertheless, the general lack of increase in the morbidity measures is notable. This is especially so since, as we have just noted, there seems to be some indication of an underlying increase in medical utilization. This suggests that older people in 1993 were more inclined to use medical services even though their underlying health status may have changed little.

Functional disability

The notion of functional disability refers to difficulties people might have in the day-to-day tasks of life. Table 5.2 shows that the percentages of old people who report difficulty with key areas of personal care — washing hands and face, dressing, going to toilet — are small at six per cent or less of the total sample in the 1993 Survey of the Over-65s and nine per cent or less of those aged 75 and over. A further set of functions (having an all-over wash or bath, reading, hearing, cooking a meal) pose difficulties for between 10 to 20 per cent of the total sample and 15 to 25 per cent of the over-75s.

The most widespread difficulties arise with a third set of activities which are more demanding of physical strength, agility or stamina. These include climbing stairs, getting on a bus, walking half a mile and, most of all, doing heavy grocery shopping.

On most of this latter set of items, women are considerably more likely to report difficulties than men (for example, almost half of women aged 75 and over report difficulty in walking half a mile, compared to 30 per cent of men in the same age group).

Table 5.2

Functional Disability Among the Elderly, 1993

	Ages 65+		Ages 75+		Total
	Male	Female	Male	Female	Ages 65+
			Percentages reporting difficulty with activity
Have all-over wash or bath	12	16	20	22	14
Wash hands and face	3	5	5	6	4
Dress oneself	5	6	7	9	5.5
Get to and use toilet	4	6	7	8	5
Cook a hot meal	15	13	23	18	14
Get up and down steps	14	22	22	31	18
Do heavy grocery shopping	26	42	38	58	34
Walk half a mile	18	35	30	49	27
Get on a bus	15	31	27	43	23
Hear a conversation (with hearing aid if necessary)	14	14	19	21	14
Read paper (with glasses if necessary)	9	8	15	11	8.5

Source: Fahey and Murray (1995), Table 3.2

Family as Determinant of Older People's Health

Determinants of health

If there is uncertainty about trends in the health status of the elderly over time, there is even greater uncertainty about what determines those trends. ‘Why are some people healthy and others not?’, asked the title of a recent book on this subject (Evans et al. 1994). In the authors' view, present knowledge is neither consistent nor comprehensive enough to provide an answer. While there is an enormous body of research pointing to a wide range of influences on population health, there is no adequate general explanation either for trends in health over time or social variations in health at any given time.

In spite of this uncertainty, it seems possible to draw some pointers from existing research. One is that, in the conditions of advanced western societies, medical care seems at best to have only a secondary impact on population health. The huge increases in spending on medical services which have occurred in all western societies in recent decades have not been rewarded by corresponding increases in public health. The greater the level of spending on medical care, the smaller the marginal returns in public health gain, thus leading to scepticism in some quarters about the wisdom of throwing ever-larger amounts of resources into the medical system (Evans and Stoddard 1994).

This concern applies with some force in Ireland. Although spending on health in Ireland has increased more than four-fold in real terms since the 1960s, the consequent gains in health are hard to find (Fahey 1995). This is so not only in connection with the poor gains in life expectancy among older people which we have just noted. It is also notable that the major advances in infant and childhood mortality which have contributed so much to the overall life expectancy increase took place in the 1940s and 1950s, that is, before the rapid post-1960s expansion of the health services took place.

Another general finding from research on the determinants of population health is that social conditions have a major impact, but that it is not clear which aspects of social conditions are important nor exactly how it is that they affect health. Things like stress, poverty, social inequality and social isolation all seem to make a difference, but again there are numerous anomalies and puzzles which make the links less than clear-cut. For example, as far as social inequality is concerned, not only do those at the bottom of the social scale have poorer health than those at the top — as one might expect — but also those just below the top seem to have poorer health than those at the very top (Evans 1994). Health inequalities between the very well-off and the might well be explained by differential access to resources which affect health, such as nutrition, housing, health care, healthy life-styles, etc. However, health inequalities between those at the top and those on the second rung down are more difficult to explain in these terms since those just below the top of the social hierarchy could hardly be said to be deprived in any of the usual senses.

Our interest here is in the possible impact of family circumstances on health, especially as far as the elderly are concerned. While it is difficult to say anything conclusive about this issue, two lines of thinking which point to quite different kinds of linkages are worth noting.

Social support, marital status and health

The first is the link between ‘social support’ and health. Social support refers simply to the degree to which ‘a person's basic social needs — affection, esteem, approval, belonging, identity and security — are satisfied through interaction with others’ (Aneshensel 1992, p. 17). An abundance of social research indicates that ‘social support, especially socio-emotional support, is related inversely to diverse forms of psychological disorder, physical morbidity, and mortality’ (ibid., p. 17).

Of the possible forms of social support which a person may experience, those connected with family are often identified as most important. Family relationships are more likely than other kinds of relationship to have the closeness and stability which is felt to be important to physical and mental well-being. This is true especially of one particular family relationship — that between husband and wife: ‘the most important form of social (and other) support for older persons is through the conjugal relationship’ (United Nations Secretariat 1994, p. 97). For many researchers, in fact, the marital relationship is of such overwhelming importance as a source of social support that they ‘employ marital status as a complete or partial index of social support’ (Turner and Marino 1994, p. 196).

It is by no means true that all family relationships are supportive simply by virtue of being there. Dean et al. (1990), for example, found that low support from a spouse who was present had a more depressive effect on elderly persons that the loss of a spouse through widowhood. They also found that those who never had children were less likely to be depressed than those whose children had little contact with them. Nevertheless, the links between marital status and well-being which have been identified in international research seem unambiguous: ‘married persons tend to enjoy higher levels of survival, mental health, use of health services, social participation and life satisfaction compared with older persons who are not married’ (Myers 1994, p. 112). This is especially well documented in much research on psychological well-being — the married are in general less prone to psychological stress than the single or previously married (Turner and Marino 1994). It is even clearer in connection with mortality — the lower mortality rates of the married compared to the single, widowed or divorced is one of the most consistent findings of international research on the social correlates of mortality risk (Hu and Goldman 1990, Rogers 1995).

The mortality effect of marital status may in part be a consequence of selection: the healthier may be more likely to marry than the sickly, thus leaving among the unmarried a higher proportion of persons with serious health problems. However, it appears also that marriage has a real protective effect on health (Hu and Goldman 1990). This may occur not only because of the social supports married people provide for each other, but also because of the economic benefits which come from shared household arrangements and income sharing (Rogers 1995). The picture is complicated by the diverse ways in which marital status affects health — for example, the experience of becoming widowed at a young age seems to be more damaging than widowhood at older ages, while for men, becoming divorced seems to have worse effects than either widowhood or remaining single, though this is less true of women (Hu and Goldman 1990).

However poorly its precise mechanisms may be understood, the effect of marital status seems strong. This has a particular interest in the Irish case because of the exceptionally high incidence of non-marriage among Irish adults which was noted in earlier chapters. Could the high rate of singlehood among Irish people (including older Irish people) be a contributor to poor life expectancies at older ages which is now a feature of Irish health patterns? No research has been conducted on this question in Ireland so an answer is not possible at present, but it does present an intriguing possibility.

There is some evidence that the high rate of singlehood may well contribute to certain manifestations of ill-health apart from early mortality. We have already mentioned in Chapter 3 above that the topics of mental illness, alcoholism and other personality problems were often linked to family circumstances in anthropological research on rural Ireland. This was particularly so in connection with the bachelor male who was often trapped into a repressed and limited life of isolation and frustration and was prone to various kinds of pathology as a result. The consequences also seemed to be reflected in the high rates of institutionalization of the unmarried, especially at older ages. In 1981, for example, unmarried men accounted for the two-thirds of the male residents of long-stay geriatric units in Ireland while unmarried women accounted for half the female residents (National Council for the Aged 1985, p. 23). Likewise, the rate of admission to psychiatric hospitals and units among older age groups is typically at least twice as high among the single as among either the widowed or the married (Table 5.3).

Table 5.3

Rates of Admission to Psychiatric Hospitals and Units Among Older Age-Groups in Ireland, 1995 (per 100,000 population)

Age-group	Single	Married	Widowed
55–64	2,555.7	756.6	1,221.5
65–74	1,999.6	783.3	991.4
75 and over	1,291.0	847.5	809.8

Source: Keogh and Walsh 1996, Table 5

This high prevalence of the unmarried among the institutionalized elderly may in part reflect the absence of home-based forms of care which arises from their lack of families of their own. But it probably also reflects a greater susceptibility to illness (whether physical or mental) as a result of the poor support networks which their limited family resources give rise to.

Infant health and life-long health

The possibility of quite a different link between family circumstances and health arises from research on the effects of in utero and infant health on the subsequent life-long health status of adults. The work of David Barker has been especially associated with this view, to the extent that it is sometimes referred to as the ‘Barker hypothesis’ (see Vågerö and Illsley 1995 for an account and critical assessment). This hypothesis says that maternal constitution and health, as determined by social deprivation and other environmental circumstances, leaves a biological imprint on the embryo in the womb. That imprint is reflected in such things as foetal development, placental weight and low birth weight. These in turn lead to elevated risk for many important causes of death in later life, such as respiratory disease, diabetes, various forms of hear disease, stroke and cancer of the breast, ovary and prostate. In short, ‘adult disease is seen as having foetal origins’ (Vågerö and Illsley 1995, p. 228).

The significance of this line of research for present concerns is that it points to the family of origin rather than present family as the major familial influence on health. Findings along these lines are by no means universally accepted: birth circumstances and present circumstances tend to be closely correlated and it is difficult to determine if the former cause the latter or if both reflect broader social forces (Vågerö and Illsley 1995). Nevertheless, the possible significance of foetal and early infant conditions on health in later life should caution us against an excessive focus on the present or recent past in searching for influences on health among older people in Ireland.

Public policy on the family and health preservation

Health policy in Ireland has long been dominated by a concern with the provision of health services rather than with the preservation or improvement of health. It is not that health preservation has been neglected but rather that medical care has been seen as the principal means of preserving health. The growth of a concern with health promotion has altered that picture somewhat, in that it has focused attention on the factors in people's lifestyles which run the risk of damaging their health. However, even health promotion has been limited in scope, in that it has concentrated on individual-level behaviour rather than broader social or environmental factors which might affect health.

The lack of concern for the social and environmental influences on health is reflected in the lack of interest in family circumstances as a possible determinant of health. As already mentioned, it is quite possible that the exceptionally high incidence of unmarried middle aged and elderly people with small family networks in Ireland may be a substantial contributor to poor health and the relatively short average life expectancies recorded for older Irish people. It is certainly in keeping with a large body of international research to expect that that would be so. Yet, there has been no interest among policy makers in this possibility — either in investigating if in fact it does have an impact on health or in devising a policy response in the event that it does.

A new focus on health gain as an object of health policy was introduced in the Department of Health's strategy document, Shaping a Healthier Future — A Strategy for Effective Health Care in the 1990s (1994). Although this point is not explicitly developed in the Department's strategy document, the logic of that focus is to direct a new level of attention on social factors such as family circumstances. Where such circumstances fall short of the ideal, there may be little that public policy can do to rectify the underlying problems — for example, it is not a matter for health policy to try to raise marriage rates in Ireland, however important marriage rates may turn out to be as background influences on the health of the population of Ireland. However, a greater awareness of the constraints on health status which are imposed by such background factors may help avoid a mis-specification of the underlying nature of the health problems faced by Irish people and may help in devising responses that are likely to produce real advances in health.

Families as Providers of Care

Levels of care

Social commentary in the 1960s which suggested that families in advanced industrial societies tended to abandon the elderly has been forcefully countered in recent years by research which shows the continuing importance of family members as providers of informal care for older people.

One general piece of evidence in support of the latter view is that the often-predicted increase in reliance on institutional care among the elderly has failed to materialise in western countries. For the United Kingdom, Evason and Robinson (1996, p. 50) say that ‘the proportion of elderly persons in institutional care of some form in the 1980s was no greater than at the turn of the century’. This seems to be the general pattern in other countries as well, and has been taken to indicate the continuing vitality of systems of informal care for older people (United Nations Secretariat 1994, p. 89).

The relative stability in rates of instutionalisation among the elderly despite major changes up to now in such things the age structure of the population, the structure of the family, female participation in the labour force and the incidence of living alone among older people is evidence not only of the present vitality in informal care. It should also caution against the apparently ever-present prognostications that informal care is about to start declining some time soon in the future.

In Ireland, evidence on the continuing primacy of the family as a source of informal care for frail elderly people has been provided by a number of sources. The studies by O'Connor et al. (1988) and O'Connor and Ruddle (1988) showed that some 17.5 per cent of the elderly population (66,000 persons) were receiving substantial informal care of some kind. Three-quarters of carers were living with the elderly persons. Daughters and daughters-in-law were the most frequent carers, while spouses were the main carers in one out of four cases.

The study by Blackwell et al. (1992) dealt with elderly persons receiving care from family members living in the same household. The focus on co-resident care meant that the study was weighted towards the more severely dependent elderly, since co-resident care is more common for the severely dependent (Blackwell et al. 1992, p. 57). According to their data, co-resident carers provided an average of 47 hours of care per week. Extrapolating from their findings, Larragy (1993, p. 363) estimated that some 8,000 highly dependent elderly were being cared for by family members in their homes, compared with 10,500 highly dependent elderly being cared for in institutional care. Thus it appeared that, even for the most dependent elderly, family care came close to having the same significance as formal institutional care.

The study by Fahey and Murray (1995) found that slightly higher proportions of the elderly were dependent on informal care than had been reported by O'Connor and Ruddle (1988) — 21 per cent in the former case as opposed to 17.5 per cent in the latter. The pattern of care-giving seemed to be generally similar, especially in that the vast bulk of care was provided by family members (Fahey and Murray 1995, p. 127). However, the proportion of the family members providing care who were living with the elderly person was somewhat lower than had been reported by O'Connor and Ruddle (1988). Thus although family care remained dominant, there appeared to be some movement away from co-resident care towards care from outside the household by family members. A study of informal care for both the elderly and the handicapped in the diocese of Kerry likewise found that the family was the main source of care (Clifford 1994).

This accumulation of evidence led O'Shea and Hughes (1994, p. 90) to conclude that the caring commitment of families towards frail elderly people in Ireland remained enormously strong:

There is no substance to the view that family care-giving is declining, or that families are becoming more selfish…. [T]he levels of care which families provide to their dependent kin borders on the heroic in many cases.

Costs and rewards of caring

Although family care for older people remains widespread, there is evidence that it is by no means trouble-free. This has been most clearly documented from the carer's point of view. High levels of care-giving often lead to stress on the care-giver's part, and carers who live in the same household as the care-receiver often get on less well with that person and feel more strain that carers who live outside the household (O'Connor and Ruddle 1988, p. 54). On the other hand, as Clifford (1994) says, families feel that there are rewards as well as costs for caring, and these should be taken into account in assessing the overall significance of caring for family members.

While the strains of caring for care givers have now been well attested, much less is known about the costs of becoming care dependent for those on the receiving end of care. The transition into illness or physical dependence is normally the most traumatic transition in an older person's life. It seems to outweigh other critical life-events, such as the loss of a spouse or the transition into old age itself, as a source of psychological distress for older people (Fahey and Murray, p. 180). Loss of physical capacity and decline in physical well-being is undoubtedly the main component of this trauma. In addition, however, the fact of becoming dependent on others for daily assistance with the routine tasks of life is also likely to depress morale.

This depressing effect is likely to be there irrespective of the source of assistance — whether it come from within the family or without. Indeed, in some ways it may worsen matters if an elderly person has to rely too heavily on family members. Many older people worry about becoming a burden on their families, and they are also often concerned about not being able to return favours and help from people as much as they would like (Fahey and Murray 1995, p. 96). Dependence on informal family care thus often adds to the difficult psychological adjustments which frail elderly people have to make in the face of illness and physical decline.

Public policy and informal care

The attitude of public policy towards informal care of frail elderly by their families is vague and uncertain. Health services provision is built on the assumption that families will provide much of the informal care required by older people. However, that assumption is implicit and ad hoc. Little effort has been given to developing either the principles which should underlie the relationship between state provision and informal care or the supports which might be necessary to sustain and enhance either the quantity or quality of informal care. As O'Shea and Hughes (1994, p. 88) say,

While some form of social consensus exists that looking after ageing and dependent parents is a responsibility of descendants, the state remains circumspect in terms of the amount and type of help it is willing to give to families engaged in caring. The state is more likely to intervene when informal care arrangements are absent or break down than it is to offer support on an ongoing basis to families engaged in caring.

O'Shea and Hughes go on to identify the principal forms of support which the elderly and their carers would hope to get from public provision. These are: financial support, especially in the form of direct payments either to the dependent person or their carers; information and advice about services and welfare entitlements, as well as training or guidance for carers in how to look after frail older people; and respite care of various kinds (O'Shea and Hughes 1994, pp. 93–94).

At present, the only form of direct payment for carers of elderly relatives is the Carer's Allowance (this allowance also extends to carers of non-elderly blind or disabled persons). This is a means-tested payment which is restricted to carers who are living in the same household as the cared for person and who do not have any other social welfare income. In assessing the carer's means, a spouse's income is taken into account, though the first £150 per week of such income is disregarded. In 1995, the Carer's Allowance was received by 6,917 people, at a cost to the exchequer of £20 million (Department of Social Welfare 1996).

Other forms of support for carers are more ad hoc and vary greatly from region to region. In general, apart from the limited provision represented by the Carer's Allowance, public support for home-based care has not been developed in any systematic way.

Families and the Financing of Care

We saw in Chapter 4 above that, in Ireland as in other western countries, the normal financial relationship which prevails between older people and their younger family members is one of independence. Financial or other economic exchanges between the elderly and their families are exceptional. Where they occur, they are as likely to flow from the elderly to their children as the other way around.

Direct financial provision

No information is available to indicate if this degree of independence still holds in the case of old people who become dependent on long-term institutional care. It may be that family members often contribute to the costs of long-term care. On the other hand, family members may consider that the funding of long-term care is a public responsibility which should not be re-directed onto them, or is too costly to contemplate meeting themselves.

While we have no information on how families think or behave in these circumstances, it is clear that the question of family contributions to the costs of long-term care has been and remains a concern of policy makers (see O'Shea et al. 1991 and O'Shea and Hughes 1994 for thorough analyses of the funding issues which arise in connection with long-term care for older people).

The question has arisen in particular in connection with the balance of responsibility between the state and the family in subsidising private nursing home care for frail elderly people who cannot carry the full cost themselves. The Health (Nursing Homes) Act 1990, which became operational in September 1993, sets out the present system of means-tested public susbsidisation of private nursing home care. In principle, the means test which is applied before a subsidy is granted relates not only to the income and assets of the elderly person and his or her spouse. In addition, the income of sons and daughters living in Ireland is assessed to determine what contribution, if any, they should make to the cost of care. However, the precise import of this kind of assessment is hard to determine, since, as O'Shea and Hughes (1994, p. 81) say,

… adult children cannot be forced to pay the amount due since there is no legal or constitutional obligation on family members to support their aged parents. Any pressure that exists is purely moral, buttressed by whatever pressure the administrative bureaucracy can bring to bear on reluctant family members.

Little is known about how these provisions are implemented on the ground, other than that there is a great deal of variation across health boards. However, commentators in Ireland have shown little enthusiasm for strengthening or extending the principle that sons and daughters of older people who can afford to do so should be compelled to carry a share of the financial burden of long-term care. The Report of the Commission on Health Funding (1989), for example, did not include this possibility in its recommendations on the funding of long-term care for older people. The National Council for the Elderly has recommended against further financial impositions on the elderly and their families at the point of heightened stress and vulnerability which the admission to long-term care represents (see the Council's comments in O'Shea and Hughes 1994). O'Shea and Hughes also come down against this approach on the basis that family cost-sharing is cumbersome, expensive and intrusive to administer, could have undesirable effects on equity grounds and fails to recognise the already large contribution in informal care and support which family members already provide to dependent elderly relatives.

Elderly assets as a source of finance

If commentators have been unenthusiastic about the prospect of levying contributions towards the cost of care from the sons and daughters of older people, they have been more interested in the possibility of drawing on the assets of the elderly themselves, such as the wealth represented by their homes, as a means of reducing the financial burden of long-term care on the state. This possibility is significant for the families of older people since the homes and other assets owned by older people typically pass on to younger relatives after their death (see Chapter 4 above). Many old people on low incomes may be in possession of valuable homes or other property which it is not feasible for them to liquidate and convert into income while they are alive but which will remain in place after they die. As mentioned in Chapter 4 above, while elderly incomes are lower than the average for the whole adult population, the wealth holdings of the elderly are somewhat higher than the average because of the high incidence of mortgage-free home ownership among them.

The mechanisms which might be used to draw on elderly assets as a source of finance for long-term care, and the arguments for and against doing so, have been reviewed by O'Shea and Hughes (1994). They judge that it is both justifiable in principle and feasible in practice to introduce measures along these lines. The effect of not drawing on elderly assets in this way is to preserve those assets so that they might eventually form a bequest to pass on to relatives, an outcome which, as a matter of public policy, O'Shea and Hughes feel is defensible neither on equity nor efficiency grounds (ibid. p. 140). At the same time, they argue that it would unduly stress vulnerable older people if their use of state-subsidised long-term care was funded out of their own assets on an on-going basis — thus raising the prospect that their assets would be wholly run down before their death.

In that light, the approach O'Shea and Hughes recommend is a ‘reverse deductible’ mechanism, by which the amount to be deducted from the older person's assets as a contribution to the cost of care would be calculated and collected posthumously. They make a convincing case that such an approach would be fairer, more efficient and less worrisome to older people than any of the available alternatives. It would have a less distorting effect on the incentives to use institutional care, would penalise unhelpful or uncaring offspring and would allow dependent old people to live out their lives without fear of impoverishment or homelessness (ibid. p. 141). As such, it would be preferable to the present system which, in principle, may extract on-going contributions to the cost of care from family members, as well as being better than any mechanism for drawing on elderly assets while the old person was still alive.

Conclusion

This chapter first reviewed trends in the health of the elderly in Ireland. It then examined three aspects of the role of the family in connection with the health of the elderly — family circumstances as a determinant of the health of the elderly, the family as a source of informal care for frail elderly persons, and the family as a possible source of financial contributions to the cost of long-term care for the institutionalised elderly.

Life expectancy data show that there has been little long-term improvement in the health of older people — especially older men — in Ireland over the past sixty years. Overall life expectancy gains which have occurred since the 1920s have been substantial but they have been overwhelmingly due to declines in infant and early adult mortality rather than to extensions in life expectancy at older ages. Older Irish people now have among the shortest life expectancies in the western world, in contrast to the position earlier in the present century when older age life expectancy in Ireland was among the highest in western countries.

Morbidity (or illness) rates are harder to track over time than mortality rates, largely because of the substantial subjective or intangible dimension to illness. The evidence reviewed in the present chapter gives no clear indication of either increase or decrease in illness rates among the elderly since the late 1970s. The conclusion one might draw from the admittedly scanty indications are that morbidity levels have not changed greatly but that there has been some increase in medical service utilisation.

The role of the family in determining the health status of older people arises in the context of increasing awareness in health research of the impact of social support on people's health. In practice, social support often boils down to family support, and central to family support is spousal support. Having a spouse has been consistently shown to have a strong impact on the health and well-being of adults. Married people on average live longer and have better physical and psychological health than the single, the widowed or the divorced. Some of this effect may be the consequence of selection — healthy people are more likely to marry (and perhaps stay married) than those with chronic health problems. But some of it is also due to a genuine protective effect of marriage on health. This protective effect operates for both men and women, though it appears to be stronger for men than for women.

Little attention has been devoted to the relationship between family status and the health of older people in Ireland, though it clearly is important on account of the exceptionally high proportions of older people who have never married. The low rate of marriage may be one of the contributors to the comparatively poor life expectancy of older people in Ireland, though this has not been established in research. It may also help account for the high rate of institutionalisation of single older people which occurred in the past. Single older people not only lacked the family networks which might provide them with informal care when they became ill. Their family circumstances may also have contributed to their greater risk of becoming ill in the first place.

The role of family members in providing informal care for older people is now well recognised. It is also quite robust as it shows no sign of falling off despite extensive changes in family life. The experience of other countries at more advanced levels of economic development does not give any grounds to suspect that informal family care will be less forthcoming in Ireland in the foreseeable future. From a policy point of view, the principal focus on informal family care should be on the provision of support for the caring function, including financial support, respite care and information and training. At present, apart from the valuable role played by the Carer's Allowance in supporting carers who devote themselves full-time to the care of co-resident dependent persons, there is little formal allocation to this important element of provision for dependent elderly persons.

Some attention has been devoted in recent times to the possible role of the family as a source of financial contributions to the cost of long-term care for elderly persons. Current arrangements for subsidising the cost of private nursing home care for elderly residents allow the health boards to take the incomes of sons and daughters into account and calculate an appropriate contribution which those offspring should make. However, the legal basis for compelling such contributions is uncertain, and little is known of the extent to which health boards request them or attempt to convince family members that they should make them. Commentators generally do not seem to feel that this approach has a great deal to recommend it and have tended to avoid any suggestion that it should be pursued more vigorously in the future.

The possibility of drawing on the wealth represented by the homes or other assets of elderly persons as a way of shifting greater share of financial responsibility for long-term care onto family resources has been viewed more favourably. It seems inequitable that the state should subvent long-term care for older people if one effect of such subvention is to preserve their assets so that they might be passed on as a bequest to offspring who might be reasonably well-off in their own right. A ‘reverse deductible’ mechanism — that is, a contribution from an old person's estate which is calculated retrospectively and collected after the old person has died — has been advocated as the fairest and most efficient way of carrying that out.

Chapter Six

HOUSING AND SOCIAL INTEGRATION

Introduction

For most older people, housing requirements differ little from those of the rest of the population — most elderly do not have special housing needs of any kind and indeed are likely to live quite happily in the houses they occupied in the earlier years of their lives. However, for those elderly who are frail or physically dependent, housing often becomes a crucial determinant of their ability to continue living in the community. It is not just a matter of the basic quality of their housing, but of its material suitability for persons with functional disability and its location near to or remote from necessary services and social contacts. Housing which is adequate in these senses at one point in time can become inadequate at the next because of the changing needs of the occupant.

In many cases, the lack of appropriate housing becomes a major factor in the institutionalisation of elderly persons. Strictly speaking, using the formal definition of homelessness which is enshrined in the 1988 Housing Act, people who are institutionalised because they lack appropriate accommodation in the community can be counted as homeless. In that sense, homelessness arises as a significant problem for the elderly. It also arises as an important factor in facilitating or inhibiting the community integration of older people.

The present chapter reviews these aspects of housing for older people. It begins with an overview of the housing circumstances of the elderly. It then turns to the question of homelessness among the elderly. That is followed with an assessment of the community integration of older people, including some reference to leisure patterns. The chapter ends with a conclusion.

Housing Circumstances

Tenure

One of the most favourable aspects of the housing system as far as older people are concerned is the exceptionally high incidence of home ownership which it has given rise to. Home ownership has become the normal tenure in Ireland over the long-term. This arose, first, because of the land reform in the early part of the present century which made home owners of the farming population, and subsequently because of strong government support for home purchase among the non-farm population. By the mid-1940s, 46 per cent of households (and almost three-quarters of rural households) were owner-occupiers. Renting still accounted for the bare majority of households, and since the local authority housing system was still in its infancy, private renting accounted for the bulk of rented housing. By the 1990s, owner-occupiers had increased to account for 80 per cent of households (Fahey and Watson 1995).

The elderly population has benefited fully from this development, and indeed owner-occupation is even more prevalent among elderly households than among the population at large. By 1991, an estimated 82 per cent of the elderly lived in housing that they (or their immediate families) owned outright, while a further 8 per cent lived in housing for which a mortgage or loan was being paid off (Figure 6.1). This meant that nine out of ten elderly were in owner-occupation. This represented an increase from 1977, when the corresponding total was eight out of ten. Local authority renting accounted for 6.6 per cent of the elderly in 1991, compared to 11.5 per cent in 1977, while private renting accounted for under 3 per cent in 1991 compared to almost 6 per cent in 1977.

The decline in local authority renting is especially significant since it points to one of the more important features of the development of housing tenure in Ireland since the 1930s — the role of tenant purchase of local authority housing as an avenue to home ownership. By 1961, 21 per cent of the housing which had been built by local authorities had transferred to tenant ownership, while by the 1990s that proportion had increased to two-thirds (Fahey and Watson 1995). Of the 300,000 houses which had been built by the local authorities since the initiation of the local authority housing programme in the 1930s, 200,000 had transferred to tenant ownership by the 1990s. These 200,000

houses amounted to a quarter of all houses in private ownership. In Ireland, therefore, in contrast with Britain and continental Europe, local authority housing has been significant as an alternative route to home ownership, in addition to its more typical role as subsidised rental tenure for the working class.

Housing Quality

Housing standards

Along with the promotion of home ownership, housing policy in Ireland has long been concerned with raising standards of housing quality. Appalling housing conditions were an obvious sign of widespread poverty in both rural and urban Ireland in the early part of the present century. The highly interventionist approach to housing provision which has characterised Irish housing policy since then is in part a reflection of the seriousness of the housing problems which prevailed at the time.

Constant improvement in housing standards over the decades has been due both to government supports for private and public housing and to general economic growth. The elderly have generally tended to have a somewhat lower average standard of housing than the population as a whole, principally because the housing they occupy is likely to be somewhat older than the average, to have been built with lesser facilities than newer housing and to require greater maintenance. However, the differences are not very substantial (Fahey and Murray 1994, pp. 224–5). The extent to which elderly housing has shared in the general advance in housing standards is more striking than any differences in housing standards which now arise between the elderly and the rest of the population.

Recent trends in this area are reflected in Table 6.1 which presents indicators of housing standards among the elderly in 1977 and 1993. These show extensive progress, though with small minorities still lacking basic standards and amenities. Over 90 per cent of elderly households now have indoor toilets and baths or showers, compared to two-thirds or less in 1977. Telephone ownership has increased dramatically from 19 per cent of elderly households in 1977 to 81 per cent in 1993. Satisfaction levels with housing have also risen, though less sharply. In 1993, 64 per cent of the elderly reported that they were ‘very satisfied’ with their housing, compared to 55 per cent in 1977, while the proportions who were ‘very dissatisfied’ had fallen from 5.1 per cent in 1977 to 1.9 per cent in 1993. It is worth noting too that the elderly report a general lack of desire to move house, and that this reluctance has increased marginally since 1977.

Table 6.1

Indicators of Housing Standards and Amenities among the Elderly, 1977 and 1993

	1977	1993
Percentage with indoor toilet in dwelling	67	94
Percentage with bath or shower	61	91
Percentage with telephone	19	81
Percentage reporting that dwelling was dry and damp-free	n.a.	95
Percentage reporting that they were ‘very satisfied’ with accommodation	55	64
Percentage reporting that they were ‘very dissatisfied’ with accommodation	5.1	1.9
Percentage reporting that they would not like to move house	87	91

Source: Fahey and Murray (1995), Tables 7.5 and 7.6

Housing need

While housing standards among the elderly have improved sharply, unmet housing need is still present in the elderly population. This is evident in the proportions who lack basic housing standards as indicated in Table 6.1. However, the concept of housing need goes beyond defects in housing in an absolute sense. It refers also to housing which might be adequate for most kinds of households but which is unsuitable for those with special needs (for example, a two-storey house might be unsuitable for those who were too infirm or disabled to mount a stairs). Among the many characteristics of a house that might cause problems as a person ages, location can often be important. If a house is too far removed from relatives or necessary services, social support may be difficult to provide and may result in an elderly person being placed in an institution. In such an instance, the underlying problem might best be thought of as a housing need, in that if a better located house were available to the elderly person, the question of institutionalisation might not arise.

A partial measure of housing need among the elderly is available from the assessment of housing need periodically carried out by the local authorities. This measure is not comprehensive since it relates only to those who require housing from the local authority. It may miss out on substantial numbers in hidden need who do not bring their cases to the attention of the local authorities. More importantly in the case of the elderly, it provides uncertain coverage of those who are resident in institutions simply because they lack adequate accommodation or adequate social support in the community — a topic we will return to below in considering homelessness among the elderly.

In 1993, according to the returns to the Department of the Environment made by the local authorities, 8 per cent of the 28,624 households counted in the local authority assessment of housing need (that is, the households included in the housing waiting lists) were classified as ‘elderly’. This amounted to some 2,290 households. However, the basis on which housing need is classified in the local authority assessments is somewhat haphazard, reflecting the imprecise and overlapping nature of the classification system which is laid down in the 1988 Housing Act (Fahey and Watson 1995). A more detailed analysis of applications for local authority housing in 1993 showed that 16 per cent of household heads on the housing waiting list were aged 65 or over (ibid. p. 48). This is the equivalent of 4,600 households, which in turn is the equivalent of 1.86 per cent of the total of 246,311 households headed by persons aged 65 and over in the 1991 Census of Population.

The household types of elderly-headed households on the local authority housing waiting list is shown in Table 6.2, along with data which places those households in the broader context of the waiting list as a whole and the national total of households. The majority were accounted for either by lone person households (39 per cent) and couple households (20 per cent). There was also a large mixed category of ‘other’ household types which included three-generational households and households with relatives other than children (such as elderly siblings). This table also suggests that housing need is disproportionately low among elderly-headed households — they represent only 16 per cent of the housing list compared to almost 24 per cent of all households nationally.

Table 6.2

Household Type of Elderly-Headed Households on Local Authority Housing Waiting Lists, 1993

	%
Lone person	39
Couple	20
Couple plus children (any age)	7
Lone parent plus children (any age)	6
Other	31
Total	100
(Estimated number of households)	(4,600)
Elderly headed households on waiting list as percentage of all households on the waiting list	16
Elderly headed households on the waiting list as percentage of national total of elderly headed households	1.86
National total of elderly headed households as percentage of all households	23.9

Source: Fahey and Watson (1995), Table 3.2; Census of Population 1991

Among elderly-headed households on the waiting list, as Table 6.3 shows, the majority have no special needs. In other words, they have the same kinds of housing problems (unfitness, overcrowding, inability to afford rents, etc.) which affect the general run of housing applicants. However, substantial minorities have special needs, arising from physical health problems (19 per cent), mental health problems (11 per cent) or from the general decline associated with old age (9 per cent).

Table 6.3

Special Housing Needs Among Elderly Headed Households on Local Authority Housing Waiting Lists, 1993

	%
No special needs	64
‘Elderly’	9
Physical disability or illness	19
Mental disability or illness	11
Other	6
Total	100

Source: Fahey and Watson (1995), Table 4.9

Homelessness

The quantification of homelessness is a contentious issue, in Ireland as in other countries. Estimates of the numbers of homeless in Ireland vary widely, ranging from the 2,667 homeless persons enumerated in the 1993 assessment of housing need by the local authorities, to the estimate of 5,000 reported by Daly (1994) based on counts of the flows of homeless persons through voluntary agencies during 1993. The local authority count is undoubtedly too low, since it appears to be restricted to the homeless who wish to have local authority housing and who would be able to cope in such housing on their own. However, it is not clear what a realistic count would amount to (Fahey and Watson 1995).

In a recent profile of 179 homeless households contacted through local authorities and voluntary agencies, 3 per cent were accounted for by lone persons aged 65 or over (ibid. p. 108). This too understates the true incidence of homelessness among older people since it does not take account of what is probably the most important category of homeless elderly — those in long-term institutional care who are there because of the lack of suitable accommodation for them in the community.

The 1988 Housing Act provided a definition of homelessness which extended the concept to apply beyond those without a roof over their heads to include those ‘living in a hospital, county home, night shelter or other such institution’ and were so living because they lacked suitable or affordable alternative accommodation. While there is general agreement with the principle underlying this definition, it has proved difficult to arrive at a way of operationalising it which is widely understood and generally accepted, either inside or outside the housing authorities.

The ambiguities which arise apply with particular force to the elderly. It has long been recognised that much institutionalisation of the elderly is due to the lack of suitable housing and social support in the community rather than to physical or mental health problems. In 1994, for example, according to the Department of Health's survey of patients in long-stay units, 14.9 per cent of such patients were reported as being there for ‘social reasons’ rather than because of problems of disability or ill-health (a small proportion of these were aged under 65) (Department of Health 1994(a), Table B7). This amounted to 2,558 persons. This total alone is almost as large as the official count of elderly homelessness produced by the local authorities but it refers to quite a different group of people.

In trying to link this group to concepts of homelessness and housing need, is not clear what precisely is meant by the term ‘social reasons’ as a cause of institutionalisation in the data produced by the Department of Health. In general, however, it refers to the lack of family and social supports, perhaps along with problems of physically inadequate accommodation. In the past, large proportions of residents in long-stay institutions were accounted for by the single elderly, reflecting both their poor family circumstances (see Chapter 5 above) and in many cases their material poverty as well. This is likely still to be the case today, though detailed information on the social circumstances of the elderly in long-term care is lacking.

These data on institutionalisation of the elderly indicate that homelessness in the general sense defined by the 1988 Housing Act is much more prevalent among older people than is generally recognised. Little of it takes the form of elderly households who lack a roof over their heads. Rather, it primarily takes the form of otherwise unwarranted institutionalisation among older people who, with a more supportive social and housing environment, could continue to live in the community.

Such institutionalisation reflects a real need, since the problems faced by the older people involved are undoubtedly pressing. But it also reflects an inappropriate response to such need, since the solution which is offered by way of institutionalisation is not the best way of serving the older person's interests, nor does it represent the most efficient use of public funds. In seeking alternative solutions, there may little value in looking to the family as a possible source of support, since the lack of a family network on the part of the old people involved is likely to be one of the sources of the difficulty in the first place. Many local authorities have contributed to alternative solutions by developing special housing schemes for the elderly. These have the advantage of allowing for better targeting and more efficient delivery of support services for old people. The health boards have also played a role by means of services such as home helps and day hospitals. However, coverage of these services is patchy (Lundström and McKeown 1994). A more complete solution will require greater cooperation and integration between housing services, as provided by the local authorities, and community care services as provided by the Health Boards, along with more intensive development of such community care services. This requires not so much an absolute addition to existing levels of funding and provision in the health services as a redirection of resources away from the bottomless pit of the institutional sector towards the Cinderella services of the community-based sector.

The private sector

Mention should be made also of a possible role for private sector provision. The private sector, in the form of private nursing homes, now plays an important role in the provision of institutional care for the frail elderly. However, there appears to have been little private sector involvement in this country in the provision of community-based services for older people such as special housing schemes and associated support services. In other words, there is little by way of a private sector counterpart to the senior citizen housing schemes provided by many local authorities and by some voluntary agencies.

This absence creates a gap in overall provision, since public sector services in this area are by law directed at those who cannot afford to pay for such services themselves. In some ways, therefore, the better-off elderly may have a narrower range of options when it comes to meeting their changing accommodation needs as they become frail. The private housing market may be less responsive to their needs than the public sector is to the needs of the less well-off. This contrast is likely to be especially true in those local authority areas which have developed good housing schemes for older people.¹ The weakness of private sector provision in this area, and the inability of the public sector to offer commercially-costed housing services to older people who can afford to pay for them themselves, combine to leave an important, and growing, segment of housing demand unfulfilled. The extent and nature of such demand, the obstacles which inhibit the market from responding to it and the supports which might be provided by public policy to stimulate provision of this kind deserve to be investigated further.

Community Integration and Leisure

As with so many other aspects of the lives of the elderly, problems of community integration are not widespread but they do affect crucial minorities. Most elderly people have high levels of social engagement, partly through their families (Chapter 3 above) but also through friends, neighbours and participation in social activities (Fahey and Murray 1995).

Little of this social contact arises through activities specifically designed for older people. In the 1993 Survey of the Over-65s, less than 8 per cent of respondents reported participating in senior citizens clubs or active retirement groups, and less than 3 per cent reported attendance at socially oriented day centres. Religious activity, especially attendance at Mass, was much more important as a form of social contact. In the 1993 survey, one in four elderly people reported that they attended Mass at least three or four times a week, while a total of 85 per cent said that they attended at least once per week. Keeping in mind the mobility and health problems which would restrict some older people's attendance at Mass, this is a high total. Mass attendance, in fact, must count as the single most important formally organised avenue of community contact for older people.

In the 1993 survey, Mass as a social outlet was followed at a distant second by the pub (attended by 26 per cent of older people), while card games and bingo came in third (21 per cent). Under 9 per cent of respondents in the survey reported participation in organised sport such as golf, bowling and so on. It is clear from these data that the forms of social contact and leisure activity which the elderly prefer are those which are shared by the community as a whole, rather than those which carry a special senior citizens label.

As might be expected from the high levels of social contact, few elderly report feelings of social isolation or withdrawal. Some elderly, especially the recently bereaved, report feelings of increased loneliness, even when they are still living with children or other relatives, but such feelings are not widespread. In general, older people have high morale, show no greater signs of psychological distress than the rest of the population and say they generally feel wanted and respected (Fahey and Murray 1995).

Problems of isolation and withdrawal do arise, however, for small but significant segments of the elderly population. In some instances, this may reflect long-standing problems of social marginalisation, rural isolation or poor family networks. However, a crucial contributory factor is the onset of illness and physical decline. The transition to ill-health is the main disruptive transition in older people's lives, and greatly exceeds the transition to old age as a cause of reduced social contact and increased psychological distress. Other risk factors, such as living alone, being single or being far removed from neighbours, come into play by virtue of the loss of coping ability which the onset of ill-health and physical decline gives rise to. While older people are physically and mentally well, they seem able to find ways of dealing with whatever problems of social contact they may be faced with. But that capacity declines as the physical or mental abilities which underpin it begin to give way.

Not all older people who have serious health or mobility problems become socially isolated. But the do tend to rely more on their families for social contact. In cases where families are not available, neighbours or wider social networks rarely provide an adequate substitute (Fahey and Murray 1995).

Conclusion

The housing circumstances of older people have improved greatly over recent decades. Overall housing standards among the elderly are now reasonably high and the elderly themselves express high levels of satisfaction with their housing conditions. The elderly also have the advantage of high rates of outright home ownership.

Nevertheless, there are small but important minorities of older people who find themselves in inadequate housing circumstances. Of the order of 5 to 10 per cent of elderly households lack basic amenities such indoor toilets, bathrooms and damp-free dwellings, while something less than 2 per cent say that they are ‘very dissatisfied’ with their dwellings. Just under 2 per cent of elderly-headed households were on the local authority waiting lists for housing in 1993. Of these, one-third had special housing needs arising from physical or mental ill-health or some other disability.

Homelessness, in the broad sense defined by the 1988 Housing Act, is also a significant problem among older people. While a certain amount of it takes the form of homelessness as encountered by those who run hostels and voluntary services for the homeless, the greater part is accounted for by older people who have been institutionalised because of the lack of social supports and appropriate housing in the community. These are the hidden homeless. They come well within the official definition of homelessness but are inadequately represented in official counts of the homeless.

It has long been recognised that inappropriate institutionalisation of old people frequently occurs and is largely caused by the weakness of community-based supports and appropriate housing for those on the margins of independent living. A number of provisions have been introduced to enhance such supports, both in the form of special housing provided by the local authorities and services such as home helps administered by the health boards. However, these have not yet been developed to adequate levels, so that the long-standing bias towards institutionalisation still prevails.

Chapter Seven

CRIME AND SECURITY

Introduction

If there is one area in social life today which goes against the trend towards improvement in older people's lives, it is crime. The general perception is that the trend in crime is relentlessly upward and now constitutes a major threat to the well-being of older people. While this perception is accurate to a degree, it needs to be qualified in some ways. The actual trend in crime, and the sense of danger it provokes in older people, is somewhat more varied than popular perceptions would suggest.

In addition to crime in the usual sense, concern has been raised about less visible forms of threat to the security of older people. The most important of these come under the heading of ‘elder abuse’, a problem which has begun to attract attention only in recent years.

There are difficulties in dealing with these issues in the Irish context because of the lack of comprehensive information and the absence of criminological research in this country. It is in that limiting context that the present chapter reviews what is known about crime, security and the elderly in Ireland. It first summarises the evidence on the direct experience of crime among the elderly. It then turns to older people's perceptions and fears regarding crime. It finally offers some brief comments on the question of elder abuse and on policy responses.

Experience of Crime

Data on crime victimisation by age-group in Ireland are not extensive, and it is not possible to track the direct impact of crime on older people in any detail. However, some information is available, relating both to homicide and to a range of less serious forms of crime, and the present section will summarise that information.

Homicide and the elderly

Homicide rates in the late twentieth century Ireland are low, both by the standards of earlier eras in Ireland and by comparison with practically all other countries in the western world today. The historical data for Ireland assembled by Wilbanks (1996) show that nineteenth century homicide rates in Ireland were far higher than they are now. If the mid-nineteenth century rates of homicide were to recur in the 1990s, we would have from 100 to 150 homicides per year, compared to the actual figure of, for example, 28 in 1993 and 34 in 1994. Ireland's low ranking in the international homicide league is shown not only by its low placing among western countries but also by the fact that its homicide rate is lower than that of ‘low crime’ eastern countries such as Singapore and Japan (Wilbanks 1994).

The perception that homicide is now a much more serious problem in Ireland than in the past derives from comparisons with patterns in the middle of the present century. In the 1940s and 1950s, murder and manslaughter rates fell to exceptionally low levels in Ireland. Between 1951 and the mid-1960s, homicides rarely numbered more than 15 per year, and in some years fell well below 10. In the early 1970s, rates rose suddenly to the range 25 to 35 (the year 1974, with 54 homicides, is exceptional because of two car-bombs in Dublin in that year killed 34 people). Since then, however, as Figure 7.1 shows, rates have stabilised at this new level, so that the numbers in the early 1990s are generally similar to those of twenty years earlier.

Following the longer-term fall from the higher levels of the nineteenth century, the more recent trend in homicide in Ireland has thus been quite distinctive. A rise of about 2.5 fold occurred from the mid-1960s to the early 1970s but no real change has occurred since then.

Turning to the question of homicide and the elderly, Dooley (1995) has studied the total of 509 homicides which occurred over the period 1972–1991. Of those, 20 per cent of victims (101 cases) were aged 60 or over. This is a somewhat higher share of homicides than the relative size of the corresponding population would warrant. However, children are under-represented among homicide victims, and it is this under-representation of children which leads to the slight over-representation of older age-groups among homicide victims.

Dooley's study picked out a number of significant differences between the pattern of homicide victimisation among the elderly compared to the rest of the population (Table 7.1). The largest difference was in the location of the homicide — elderly victims were almost three times as likely to be killed in their own homes as non-elderly victims. They were less likely than other victims to be killed by sharp instruments (usually knives) or guns and more likely to be killed by a blunt instrument. Otherwise, however, the pattern of elderly homicide patterned that of homicides among the rest of the population.

Other crime

The only national-level study of crime victimisation in Ireland is that carried out by Breen and Rottman in 1983 (Breen and Rottman 1985). Crime victimisation in the Dublin area was examined in the Dublin Crime Survey (O'Connell and Whelan 1994). These sources confirm the comparatively low risk of crime in households headed by older people.

A less thorough but none the less informative perspective on crime from the point of view of the elderly is provided by the 1977 Survey of the Elderly and the 1993 Survey of the Over-65s. These two sources have a particular value in that they both included similar sets of items on the direct personal experience of crime and perception of crime risk among older people. They thus allow a comparison between two points in time on these issues.

Table 7.1

Significant Differences between Elderly (60 yrs +) and Other Homicide Victims

	Elderly	Non-Elderly
	(n=101)	(n=509)
	%	%
Location
Victim's home	73.3	26.7
Method
Sharp instrument	14	29.1
Gun	6	21.4
Blunt instrument	21	9.4
Asphyxiation	22	11.0
Motive
Robbery	27.7	9.2
Mental illness/disorder	22.8	6.9

Source: Dooly (1995), Table 5.

Table 7.2 shows that the experience of burglary, vandalism and assault or mugging among older people increased sharply between 1977 and 1993. The percentage of older people who had experienced burglary in the previous three years rose from 1.5 per cent in 1977 to 6.6 per cent in 1993, an increase of more than four-fold. The greatest proportional increase occurred in rural areas (from 0.5 per cent in 1977 to 3.9 in 1993), but the absolute levels were a good deal higher in urban areas, where almost one in ten elderly people in 1993 had experienced burglary in the previous three years. Indeed, despite the rapid relative increase in rural areas, the proportion of rural elderly who had experienced burglary in 1993 was still under 4 per cent, which was only marginally higher than the level in urban areas in 1977.

The experience of vandalism also increased over the period but not so sharply. It had less than doubled compared to the four-fold increase in the case of burglary. Most of the increase had occurred in rural areas — the experience of vandalism in urban areas had hardly changed over the period. Notably, too, vandalism was a somewhat less common experience for older people than burglary.

Table 7.2

Experience of Crime Among the Elderly, 1977 and 1993

	Burglary		Vandalism		Assault/Mugging
	1977	1993	1977	1993	1977	1993
	Percentage who experienced problem in the previous three years
Urban	3.1	9.5	6.0	7.0	1.2	2.1
Rural	0.5	3.9	0.8	2.4	0.0	0.4
All	1.5	6.6	2.8	4.6	0.3	1.3

Source: Fahey and Murray (1995), Table 7.3

The most serious of the types of crime reported in Table 7.2, assault or mugging, was the most uncommon but it too had shown an increase between 1977 and 1993. It remained distinctively low in rural areas, however — the proportion of rural elderly who had been mugged or assaulted in rural areas in 1993 (0.4 per cent) was only one-fifth of the corresponding proportion in urban areas in 1993 and one-third of that proportion in 1977.

Whether one counts these as high or low levels of encounter with crime among older people is a matter of judgement and of the benchmark one takes as a reference. Clearly, crime victimisation is still very much a minority experience among older people, though the minority affected by burglary in urban areas is fairly large. The most striking feature of the data is the scale of the increase over the fourteen years between 1977 and 1993. If this rate of increase were to continue in the future, it would not be long before crime victimisation would become a normal though unwelcome part of the experience of being old in Ireland.

Perceptions of Crime

Alongside the direct experience of crime, an additional and less visible impact of crime is ‘secondary victimisation’ — the knock-on effects of crime on those who do not suffer it directly. Included among such knock-on effects are the anxiety and psychological insecurity caused by fear of crime and the changes in the way people live which they adopt in order to avoid becoming crime victims.

Such secondary victimisation is especially important among the elderly and goes a long way to canceling out any advantages older people might have as a result of their relatively low risk of direct crime victimisation. Fear of crime may well cause old people to impose ‘significant restrictions on the way they live’ and as a result ‘may exacerbate the levels of social isolation to which the elderly are susceptible’ (McCullagh 1996, p. 9). However, the fear itself is the worst outcome:

It would certainly appear to be the case that the elderly suffer to a greater extent from the fear of crime than do others in our society. This can hardly be considered one of the consolations of old age. In this sense the elderly constitute the major group of indirect victims of crime. (McCullagh 1996, p. 9)

Table 7.3 presents data on perceptions among the elderly of the seriousness of crime problems in their neighborhoods in 1977 and 1993. The survey questions from which these data are derived asked respondents if they considered the types of crime referred to as ‘very much a problem’, ‘a bit of a problem’, ‘not much of a problem’ or ‘no problem’ in their neighborhoods. In Table 7.2, for ease of presentation, only the data on the two extremes of these response options — ‘very much a problem’ and ‘no problem’ — are presented (see Fahey and Murray 1995, pp. 158–59 for a more complete tabulation).

The data show a substantial increase in the perception of crime as a problem, particularly in connection with burglary. At the same time, the data do not suggest that old people are over-whelmed with anxiety about burglary or any other crime. The proportions of elderly people who considered burglary as ‘very much a problem’ in their neighborhoods increased from 3.8 per cent in 1977 to 6.8 per cent in 1993. At the same time, however, over half of all elderly, and three-quarters of rural elderly, felt that burglary was ‘no problem’ in their neighbourhood in 1993. Even in urban areas, over one-third of the elderly felt that burglary was no problem in their neighborhoods. These data reveal a less favourable picture than in 1977, but nevertheless that picture is not nearly as gloomy as popular commentary would often lead one to expect. Similar patterns hold for perceptions of other forms of crime reported in Table 7.3. There is an increased concern about vandalism and assault/mugging, but again the levels of such concern are not especially high, especially in rural areas.

Table 7.3

Perceptions of Crime Among the Elderly, 1977 and 1993

	Burglary		Vandalism		Assault/Mugging	>
	1977	1993	1977	1993	1977	1993
			A. Percentage considering item as ‘very much a problem’ in their neighbourhood
Urban	9.0	11.0	8.9	8.2	3.8	4.4
Rural	0.6	2.6	0.8	0.7	0.8	0.4
All	3.8	6.8	3.9	4.2	1.9	2.2
			B. Percentage considering item as ‘no problem’ in their neighbourhood
Urban	60.0	37.0	59.3	40.8	70.3	50.6
Rural	86.3	72.0	88.7	79.6	91.5	86.7
All	76.3	55.4	77.5	61.2	83.3	69.6

Source: Fahey and Murray (1995), Table 7.3

Elder Abuse

Concern with elder abuse has increased in recent years alongside the more general awareness that families can have pathological characteristics which result in abuse and violence towards weaker members. This awareness has focused especially on the victimisation of children within families, but it has extended also to the plight of dependent elderly people who are physically or psychologically abused by those who are charged with caring for them.

Elder abuse can be distinguished from ordinary criminal violence towards older people by virtue of the ostensibly caring relationship within which it occurs. In attempting to grasp its nature, it may be useful to refer to draw on the parallel provided by Johnson's (1995) distinction between two forms of domestic violence against women. One type of male violence against wives is what Johnson calls ‘patriarchal terrorism’, which consists of the sustained, systematic use of violence by men as a means to exercise control over ‘their’ women and which usually goes hand in hand with other means of subordination such as s threats, humiliation and isolation. The other, which he calls ‘common couple violence’, arises from persistent but unsystematic conflict which sometimes gets ‘out of hand’ and occasionally leads to serious outbursts of violence. The two forms of violence appear to have quite different origins and occur at quite different rates (the latter being more common than the former), but it is difficult to establish the prevalence of either.

In the case of older people, in a manner similar to the pattern of ‘patriarchal terrorism’ described by Johnson, abuse may arise as part of a long-term regime of control and subordination, in which case it is likely to be rooted in serious family pathology. It may, alternatively, arise from the stress caused by coping difficulties on the part both of older people and those caring for them when the older person's dependence increases. As such, it would be in the nature of a transitional difficulty caused by the particular set of circumstances arising at a particular point in time. The latter syndrome could be alleviated by appropriate assistance and support from outside, and indeed such assistance might well be sought by either the perpetrator or the victim of the violence. The former syndrome, on the other, is likely to be more carefully hidden, more serious and less amenable to outside intervention.

Reliable data on the incidence of elder abuse in Ireland are not available, and it would require a sustained programme of careful research to generate such data. The 1993 Survey of the Over-65s included a number of items dealing with the experience of abuse by respondents. As part of a general survey of the health and social circumstances of older people, such questions had to be presented very tentatively. They did not make direct reference to elder abuse but referred more generally to the experience of personal violence, whether inside or outside the family home. No checks or controls were included to establish the completeness of the coverage of likely victims or the reliability of the responses. However, the responses to the questions are worth noting briefly.

Twelve out of the 909 respondents (1.3 per cent) in the survey reported that they had personally experienced physical violence since turning age 65, and half of these had experienced that violence outside the home. Given that we would expect elder abuse to occur within the home, that would leave a possible maximum of slightly over half of one per cent as having experienced domestic violence. A similar percentage (1.4 per cent) reported that they had been regularly insulted, sworn at or threatened but three-quarters of these had experienced this verbal abuse outside rather than inside the home. Only one respondent reported having been wrongfully deprived of necessary help with any activities of daily life such as personal care, meals, etc. These data are too uncertain in coverage and reliability to be taken as an adequate indicator of the prevalence of elder abuse which occurs, though they do have some interest as a lower-bound estimate. One would want further investigation of the subject before drawing firm conclusions about its extent among older people in Ireland.

Conclusion

The overall increase in crime in Ireland in recent decades is well-documented. However, there are important variations within this overall increase. In contrast to other forms of crime, the incidence of homicide has remained stable and, by international standards, quite low since the early 1970s. Although the rate which prevailed in the early 1970s represented a sharp and sudden increase over the rate of the 1950s and 1960s, the absence of further increase since then is striking. The elderly account for one in five of the homicide victims since the early 1970s. Child victims of homicide are relatively rare, and the incidence of elderly homicide is more or less in keeping with the proportion of the elderly in the adult population.

Burglarly and other forms of property crime have risen most sharply since the 1960s. The elderly appear to have a lower risk of victimisation from burglary than younger age groups, but that risk has increased substantially in recent years, especially in urban areas.

Quite often the fear of crime, rather than crime itself, is the main negative consequence of rising crime trends on people's lives. Many elderly people see crime as a serious problem in their neighbourhoods, but perceptions of this kind are by no means universal. Thus, for example, more than half the elderly consider that burglary is not a problem in their neighbourhoods, though this proportion falls close to one-third in urban areas. Levels of concern about other forms of crime are even lower. Thus it would exaggerate matters to suggest that the elderly are overwhelmed with anxiety about the possibility of being victimised by crime.

The recent report of the Task Force on Security for the Elderly recommended a number of measures to reduce crime against the elderly. Apart from general strengthening of policing and other aspects of the criminal justice response to crime, the measures which might have a particular value for the elderly consist of a ‘hardening’ of elderly households as possible targets of crime, especially property crime. These consist mainly of improvements to the physical security of houses through the wider use of such things as secure locks and alarms.

Chapter Eight

SUMMARY AND CONCLUSIONS

Introduction

The purpose of the present chapter is to summarise the main findings of the study and to draw out the implications for policy. The chapter is laid out in three sections:

•the demographic context;

•the role of the family in the life of the elderly;

•implications for policy.

Demographic Context

Three main aspects of the demographic context have been pointed to in this study as important for our understanding of the role of the family in the life of the elderly in Ireland. These are: (i) the distinctive pattern of population ageing now underway in this country, with reference especially to the broader context of population recovery within which it is taking place; (ii) the very high incidence of old people who are single and have small family networks (or none at all); and (iii) the uneven regional distribution of population.

Population Ageing and Population Recovery

In all countries of the western world, including Ireland, an increasing share of the population is accounted for by old people. However, in Ireland, this trend is weaker than in other countries and its significance is altered by the context of population recovery in which it is taking place. The most striking and socially most important feature of that recovery is the continuous and impressive growth in the number of active age adults which has occurred since the 1960s and which is set to continue over coming decades. Between 1961 and 2026, the number of 15–64 year-olds will have grown by one million, out of total population growth over that period of 1.2 million. Half of the growth in the number of 15–64 year olds had occurred by 1991 while the other half is projected to accumulate over the coming decades. At all points over the next thirty years, active age adults will represent a larger share of total population than they have at any time over the last thirty years.

This expansion has a strong claim to be regarded as the core demographic development now underway in Ireland and places Ireland in a unique and quite favourable position among western countries as far as population ageing is concerned. However, it has been little noticed and little commented upon, in contrast to the preoccupation with other developments such as falling fertility and the growth in the number of older people. These latter trends are more readily picked out since they are common to all western countries and are widely commented on internationally, while the steadily growing numbers of active adults is peculiar to Ireland and thus is little noticed — even in Ireland.

The pattern of recovery on which this development is based has evolved through a number of stages, some of which created difficulties in their own right. It now takes the form of low fertility, zero net emigration (possibly turning into net immigration) and unspectacular but steady population growth. This regime contrasts favourably with the pre-1960s regime of high fertility, high emigration (and thus high population ‘wastage’) and steady population decline. Pre–1960s demographic patterns yielded a population structure which, quite strangely, was both top-heavy and bottom-heavy — children and old-people were plentiful but active age adults were scarce. Now we are facing a future population structure which is neither top-heavy nor bottom-heavy but, relatively speaking, is becoming ‘middle-heavy’ — it is dominated to an unprecedented degree by active-age adults.

These features of population development give population ageing in Ireland quite a distinctive character. They mean that old people are becoming a larger share of total population but are preserving a more favourable relationship with the number of active-age adults. Furthermore, the total age-dependent population (that is, children and old people combined) is showing a remarkable stability: in absolute terms, it is projected to be about the same size in 2026 — approximately 1.4 million — as it was in 1991. The composition of the age-dependent population is becoming more heavily weighted towards old people — a large increase in the number of old people which is due to occur in the early decades of the next century will be off-set by a corresponding decline in the number of children.

The decline in the number of children might be regarded as storing up trouble for the long-term future since it would seem to threaten population replacement. However, even that prospect has a distinctively Irish twist. High emigration in the past meant that non-replacement of the adult population was more the norm than the exception. If, as now seems quite likely, today's low fertility were to be accompanied by zero net emigration, or even some net immigration, it would be more effective in replacing the adult population than the high fertility, high emigration patterns of the past. Falling fertility, therefore, has a different and less threatening significance for population replacement in this country than it has in other countries.

Demographic trends in Ireland, therefore, present a generally favourable context for old people in the future. While population ageing will take place, it will do so slowly and on the basis of steady expansion in the support base for the elderly population represented by the population of active-age adults.

The single elderly

If demographic patterns reveal a weakness in the circumstances of older people in Ireland, it arises in connection with a key aspect of their family patterns — the uniquely large proportions who have never married and who therefore have no procreative families of their own. Almost one in four elderly men and one in five elderly women in Ireland are single. No other national population among western countries has anything close to this proportion of single elderly. Most other countries have less than one in ten elderly people who have never married.

The high rate of singlehood among older people in Ireland means a high incidence of older people without families. The uneven distribution of the family as a resource for older people thus emerges as one of the most important features of the family circumstances of older people in Ireland — the majority of older people have that resource in reasonable quantity but the large minority who never married scarcely have it at all. This is a distinctive and quite unfavourable feature of family patterns in Ireland as far as older people are concerned, though its full implications for elderly well-being have never been properly explored.

The high rates of singlehood among old people are a legacy of the exceptionally low marriage rates which prevailed in Ireland earlier in the present century. The higher marriage rates which emerged from the 1960s onwards are only now beginning to feed through into a healthier marital status profile among the young elderly, and will do so more strongly in the years ahead. The single elderly will therefore decline as a proportion of the older population over the coming decades and that in turn will yield an important improvement in the overall family profile of older people. However, the single elderly will continue to represent a significant minority, probably in excess of one in ten, in twenty years time.

Regional distribution

A further weakness in the demography of older people is its uneven regional distribution. The heavily urbanised Eastern Health Board area has the largest concentration of older people of all the eight health boards (29 per cent of the total) but it also has the youngest population (only 9.4 per cent of its population are aged 65 or over). Some of the rural health board areas, by contrast, especially in the west, have small populations of older people, but they account for higher than average proportions of the total population in those areas (in the North Western Health board area, for example, the elderly accounted for 15 per cent of total population).The less urbanised health boards also have other weaknesses, in that their elderly populations are thinly spread over wide areas and have disproportionately large numbers who are single. The elderly in those areas are thus exceptionally prone to social and physical isolation.

The Role of the Family

The decline of gerontocracy

The family system which prevailed in rural Ireland earlier in the present century — the stem family system — attached great status and authority to old age, especially to elderly male heads of households. Ownership of family property (in particular, family farms) and control over inheritance were the bases of this elevated position and gave old people such a degree of control over the lives of their adult children that the system has been called a virtual gerontocracy. The family system which resulted has often been idealised as a paradise of stability and accord, but it often also appalled observers on account of its harshness and oppressiveness. The reign of the old, while often accompanied by high degrees of family solidarity and filial devotion, frequently gave rise to tension and frustration among children on account of the limited, subservient roles laid out for them. Social pathologies in the form of high emigration and low marriage rates, combined with personal pathologies the form of a high incidence of alcoholism, mental illness and stunted personality development were the common result.

A family system based on individual wage-earning rather than on joint family production and on pensions as the principal income source for older people has since displaced the stem family system of earlier decades and in doing so has transformed both the economic and emotional dimensions of relations between the generations. The close and often exploitative instrumental interactions between ageing parents and adult children which prevailed in rural Ireland in earlier decades has been more or less universally supplanted by a regime of mutual economic independence. Social support and affective interdependence have replaced instrumental interdependence as the dominant values in relationships between older people and their younger relatives. While this transformation has undermined gerontocracy, and in that sense has reduced the standing of older people, it has had its advantages in the form of easier and emotionally healthier relationships between older and younger people. At the same time, the growth of the pension system has provided an unprecedented degree of economic security and well-being for older people, in place of the more uncertain and more unevenly distributed economic guarantees which the family property system of the past provided to old people.

Family networks today

For the majority of older people, family networks in Ireland today remain exceptionally large. This reflects the unusual combination of relatively high fertility and low infant mortality which was experienced by the present generation of older people during the family formation stages of their life-cycle. Emigration has also had a somewhat less devastating effect on their family networks than was the case for previous generations of older people, so that a larger proportion of family members are to hand today.

There is a substantial minority of older people, comprised mainly of those who have never married, whose family networks are very small. These elderly not only lack spouses and children, but also seem to have fewer siblings than the general run of older people. The large size of this minority indicates again the key weakness of the family system in Ireland as far as older people are concerned — its uneven distribution and the consequent existence of exceptionally large groups of elderly who have little or no family resources.

What difference do families make?

In making judgements on the implications of present family patterns for older people, it is necessary to be discriminating about contribution which families make to older people's lives. In the case of adult children, both the Irish and the international research suggests that their role is often less important than one might think. Children, it appears, even in adult life, have their drawbacks as well as their advantages. They sometimes drain their parents as well as support them, at least in financial terms, and the effect of contact with adult children on the well-being of older people is not always unambiguously positive. Nor is that effect, where it is positive, entirely irreplaceable. Those older people who do not have any children often seem to find ways of substituting for them through other relationships.

The marital relationship has a different order of significance. On average, marriage has a protective effect on people's health and well-being. All other things being equal, married people live longer, are psychologically better adjusted, are less prone to illness and have higher material standards of living than the single, the widowed or the divorced. Spousal support is the most important form of social support, and its absence makes a real difference to the quality of older people's lives. As with children, non-married elderly people often may find effective functional substitutes for the spouses they do not have, but very often they do not and the consequences are reflected in their reduced levels of well-being.

The contribution of marriage to elderly well-being is especially worth noting in the Irish case, given the large proportions of older Irish people who have never married. As measured by life expectancy, older people's health in Ireland has shown little or no improvement since early in the present century (in particular, male life expectancy from late middle age onwards is more or less the same as it was sixty years ago). Family structures and marriage patterns may be one contributor to that poor performance — the high incidence of single older people in Ireland may have reduced average health status and limited the gains that could be made on progress in older people's health. The impact on other areas of well-being may have been substantial also.

Families and the frail elderly

The one area where adult children as well as spouses have provided unambiguous and extensive support to older people is in connection with informal care in times of illness or increasing frailty. In most countries, including Ireland, that aspect of family support has proved quite durable and shows no sign of falling off in spite of major changes in the patterns of family life. Public policy has tended to take the availability of family support for granted. Though health policy in principle has long recognised the value of community-based care for older people, and acknowledges also the role of informal family care as a key element of community care, the bias in actual public provision is towards institutional care for the frail elderly. The Carer's Allowance provided by the Department of Social Welfare has made an important contribution to the support of informal family care. But neither this nor the community-care measures introduced by the health boards has been sufficient to bring about the degree of de-institutionalisation of care services for the frail elderly which is now a widely accepted goal of health policy and which seems attainable from a practical point of view.

Overall position

In general, the family circumstances of older people and the role that the family plays in their lives are as strong as they have ever been. The relationships between older and younger people within families are qualitatively different in many ways from what they were in the past. However, for the most part the changes which have occurred in recent decades are valued by both the elderly and their younger relatives. They have lead to a better balance between independence and supportiveness in relations between the generations and to a greater scope for emotional and social support in place of narrow instrumental dependence. The relationship between spouses is an even more important dimension of family life. Its role is strengthening, if only because the proportions of older people who have married and who co-survive with their spouses is increasing.

Policy Implications

Limitations in the role of the family

Public policy on the elderly has evolved in such a way that there are now many areas of life where public provision for older people is the norm and family provision has little or no role. The most obvious example is in connection with income and living standards. These matters are now widely regarded as a matter for public rather than private responsibility, as reflected in social welfare pensions and other forms of provision for older people. Even private occupational pensions have a substantial public element, since extensive tax incentives are used to promote participation in private occupational pension schemes. Developments in these areas of provision are thus largely independent of questions about the role of the wider family and are likely to continue to evolve in that way.

The demographic context of policy

In many countries, policy debate about social provision for older people has been dominated by the view that the ‘demographic threat’ of population ageing poses massive difficulties for traditional welfare state supports, especially in the fields of pensions and health care. However valid this view may be in other countries, it has little immediate application in Ireland. Population ageing is occurring at a very slow pace in this country and in a context where overall patterns of dependency are improving rather than worsening. Even in the long-term future, it is not at all clear that Ireland will experience anything like the population imbalances it has experienced in the past. As far as the demographic burden on social provision is concerned, therefore, the worst is over and we are now facing into a more favourable environment that we have had at any point over recent decades.

This is not to say that demographic patterns dictate a continuation of existing policy approaches, any more than they dictate a change in those approaches. In general, demography does not dictate policy in a way that often seems to be assumed in discussions about the social policy implications of demographic trends. Rather, population trends and structures impose constraints which may be more or less limiting on policy options but which usually leave room for a great deal of choice. Present favourable trends in Irish demography have the effect of easing those constraints and thus of widening somewhat the degree of flexibility which is open to policy makers. One such choice would be to continue with or expand existing approaches to social provision for older people. There is nothing in present demographic patterns which suggests that we cannot ‘afford’ to do so. Alternatively, the choice may be to reform those approaches in some direction. That may turn out to be a reasonable and desirable thing to do — but the factors which make it so will have to found in something other than population trends.

In examining the policy implications of the population trends regarding the elderly in Ireland, therefore, one of the key conclusions is the necessity of avoiding an excessive ‘demographic determinism’, the view that we can ‘read off’ policy choices from trends in population structure. The reality is that, as far as policy is concerned, population patterns provide a loose limiting context rather a set of determining forces. It so happens in Ireland at present that the limitations involved are now becoming somewhat looser than they have been before. As far as population constraints are concerned, therefore, policy makers are now faced with a somewhat greater freedom of choice. This is not to say that economic or political constraints of a non-demographic nature are similarly relaxedbut simply to point to one set of factors where pressures are not nearly as limiting as they are often assumed to be.

The family context

Though there are long-standing weaknesses in the family circumstances of older people in Ireland, there is no secular trend of decline in the role of the family as an element in the lives of the elderly. Much of the pessimistic commentary on the weakening of the extended family or the decline in filial duty towards the elderly is ill-founded. It underestimates the many problems in inter-

generational relations which prevailed in the past and the continuing strengths of the family as a support system for older people today. Since decline in this sense is not a genuine problem, policy need not concern itself with any radical solutions designed to halt or compensate for it. There may be some scope for measures designed to preserve family involvement in the lives of older people, to extend it at the margins or to improve it in certain qualitative ways, but this does not amount to a need for radical new departures in policy in this area.

Increasing the role of the family?

Neither is there much scope for increasing the role of the family in the lives of the elderly or for expecting that greater reliance can be placed on family supports as opposed to formal supports in caring for the frail elderly. For the majority of older people, the role of family is already great in this area and it is difficult to see that it would be either possible or desirable for public policy to try to extend it in a substantial way. There is no evidence that a substantial pool of otherwise unutilised family resources is readily available to be drawn upon as a source of informal care for older people. Furthermore, informal family care normally has a large component of altruism or sense of obligation born out of past relationships between the care giver and the cared for person. Financial or other external incentives might not have a major impact on such motivations nor on the behaviour that goes with them. Indeed, it might not be desirable that they should have, since the consequence might be to encourage family members to take on the care of elderly relatives for the wrong motives. Care-giving relationships of a lesser quality might thereby be brought into being, thus endangering the standard of care which older people would receive.

At most, therefore, incentives policy changes might be considered which might marginally increase the quantitative extent of family support for older people. However, these changes are likely to be more significant as means to sustain and improve the quality of existing support rather than to increase its extent (see below).

Supporting the quality of informal family care

Rather than being designed as a means to coax reluctant family members into caring for their elderly relatives, supports for informal family care might better be thought of as ways of improving the quality and experience of informal care which is already provided. While caring for relatives may have its rewards, it can also be burdensome and stressful. An over-burdened carer is a hampered carer and the quality of life of both care giver and care receiver can be threatened as a result. It should not be assumed that because care is given informally and altruistically it is self-sustaining and of consistently high quality. Even where family commitment to an older relative's welfare is genuine and freely given, it may be stained by an overly burdensome caring responsibility. External supports, in the form of financial payments, respite care and training and information for the care giver, can ease such stresses. Such supports might also have an effect in reducing the level of institutionalisation of the frail elderly. But that should be regarded as a secondary effect, and in any event may not be large. Priority should be attached to goal of qualitative improvement and sustenance for the informal caring relationship rather than to the transfer of caring responsibilities from formal services onto informal family supports.

Compensating for family absence

Alongside the goal of enhancing the quality of family care for those dependent elderly who have caring families, a further major challenge for policy is to provide compensatory support for those who have no families, caring or otherwise. The large segment of the elderly population in Ireland for whom family networks are small or largely absent derives from a past history of low marriage rates and consequent high incidence of non-formation of families among Irish adults. One can draw some comfort from the knowledge that this is a legacy of the past, and a reducing one at that, rather than a novel problem of the present or an increasing one for the future. Nevertheless, while improvements in marriage rates in recent decades will lead to an easing of this weakness in the future, it is a weakness which will still affect substantial minorities of older people in the years ahead.

Because the proportion of older people without families is much greater in Ireland than in other countries, the policy problem of compensating for their absence is proportionately larger here than elsewhere. Little recognition of this fact has been evident in Irish policy-making up to now. One would scarcely realise from policy discussions concerning the elderly to date that the family circumstances of older Irish people suffered from this major structural weakness. No attempts have been made to establish precisely what defects in social support and well-being among the elderly the extensive absence of families has given rise to. Much less has there been any attempt to design policy interventions which would provide a creative and effective response.

Some of the problems arising from the absence of family supports accumulate over a life-time and are hard to address in old age. The detrimental effect of non-marriage on health is one example. Other problems arising from family weakness, however, are quite specific to the stages of physical infirmity and decline which become more likely in old age. The absence of family supports will be most critical when, because of the onset of disability or ill-health, the old person loses the capacity to cope on his or her own.

Informal family care, often supplemented by formal services, provides the most common solution to such difficulties, even in cases where the old people involved do not co-reside with family members. Spouses and adult children or children-in-law are the typical sources of informal family care. However, for the elderly who have neither spouses nor adult children, alternatives have to be found. Too often in the past, institutionalisation was immediately looked to as that alternative. The challenge now is to put in place formal community-based supports which provide the functional equivalent of informal family care. In principle, this challenge is well recognised, since the goal of reducing the levels of institutionalisation of the frail elderly is now a key objective of health policy. However, a proper appreciation of the nature of the task involved and a concerted attempt to devise means to achieve it have not yet emerged.

Families and the financing of care

Little is known about the impact of recently introduced measures which are intended to induce the adult children of dependent elderly to share the costs of long-stay care in private nursing homes. Commentators have shown little enthusiasm for such measures, on the grounds that they are difficult to implement and may be both inequitable and ineffective. Rather than pursue such measures further, it may be more fruitful and more equitable to explore ways of drawing on elderly assets as sources of partial funding for long-stay care. The fairest and most effective method of doing so is something along the lines of the ‘reverse deductible’ recommended by O'Shea and Hughes (1994). This is a posthumous deduction from an elderly person's estate calculated as an appropriate contribution to whatever costs of care may have been provided out of state funds. As such, it imposes on the old person's heirs rather than the old person himself or herself, is relatively simple to administer and has much to recommend it on grounds of equity.

References

Aneshensel, Carol S., 1992. ‘Social Stress: Theory and Research’ Annual Review of Sociology 18, pp. 15–38.

Arensberg, Conrad and Solon T Kimball, 1940/1968. Family and Community in Ireland. Cambridge, Mass.: Harvard University Press.

Blackwell, J., E. O'Shea, G. Moane and P. Murray. 1992. Care Provision and Cost Measurement: Dependent Elderly People at Home and in Geriatric Hospitals. Dublin: Economic and Social Research Institute.

Bowling, A, 1991. Measuring Health. A Review of Quality of Life Measurement Scales. Milton Keynes: Open University.

Breen, Richard and David Rottman, 1985. Crime Victimisation in the Republic of Ireland. Dublin: Economic and Social Research Institute.

Brody, Hugh, 1973. Inishkillane — Change and Decline in the West of Ireland. London: Penguin

Callan, T., B. Nolan, B.J. Whelan, D.F. Hannan, with S. Creighton. 1989. Poverty, Income and Welfare in Ireland. Dublin: Economic and Social Research Institute

Central Statistics Office. 1995. Population and Labour Force Projections 1996–2026. Dublin: Stationery Office.

Clarke, Lynda, 1995. ‘Family Care and Changing Family Structure: Bad News for the Elderly?’, in Isobel Allen and Elizabeth Perkins (eds.) The Future of Family Care for Older People. London: HMSO.

Clifford, Dermot, 1994. The Social Costs and Rewards of Caring. Aldershot: Avebury.

Cowgill, Donald, 1986. Ageing around the World. Belmont, California: Wadsworth.

Cowgill, Donald and Lowell D. Holmes (eds.), 1972. Ageing and Modernisation. New York: Appleton Century Crofts.

Crimmins, Eileen and Dominique Ingegneri, 1990. ‘Interaction and Living Arrangements of Older Parents and Their Children: Past Trends, Present Determinants and Future Implications’, Research on Aging 12, 1: pp 3–35.

Crimmins, E.M., M.D. Hayward and Y. Saito, 1994. ‘Changing Mortality and Morbidity Rates and the Health Status and Life Expectancy of the Older Population’, Demography 31, 1, pp. 159–75.

Daly, Mary, 1994. The Right to a Home, the Right to a Future. Third Report of the European Observatory on Homelessness, 1994. European Commission and FEANTSA.

Dean, A., B. Kolody and P. Wood. 1990. ‘Effects of social support from various sources on depression in elderly persons’, Journal of Health and Social Behaviour 31, pp. 148–61.

Department of Health, 1994(a). Survey of Long-Stay Units. Dublin: Department of Health.

Department of Health, 1994(b). Shaping a Healthier Future — A Strategy for Effective Health Care in the 1990s. Dublin: Department of Health.

Department of Social Welfare, 1996. Statistical Information on Social Welfare Services. Dublin: Stationery Office.

Dooley, Enda, 1995. Homicide in Ireland, 1972–1991. Dublin: Stationery Office.

European Commission, 1994. ‘Some Economic Implications of Demographic Trends up to 2020’ Study No. 5, pp. 211–225, European Economy, No. 56.

Evans, Robert G, 1994. ‘Introduction’ in Robert G. Evans et al. (1994)

Evans, Robert G. and G. L. Stoddard, 1994. ‘Producing Health, Consuming Health Care’, in Robert G. Evans et al. (1994)

Evans, Robert G., Morris L. Barer and Theodore R. Marmor, 1994. Why Are Some People Healthy and Others Not? The Determinants of Health of Populations. New York: Aldine de Gruyter

Evason, Eileen and Gillian Robinson, 1996. ‘Informal Care in Northern Ireland’, in R. Breen, P Devine, L Dowds (eds.), Social Attitudes in Northern Ireland. The Fifth Report 1995–96. Belfast: Appletree Press.

Fahey, Tony, 1995. Health and Social Care Implications of Population Ageing in Ireland. Dublin: National Council for the Edlerly.

Fahey, Tony and John Fitz Gerald (forthcoming), Welfare Implications of Demographic Trends. Dublin: Oaktree Press in association with the Combat Poverty Agency.

Fahey, Tony and Peter Murray, 1994. Health and Autonomy among the Over-65s in Ireland. Dublin: National Council for the Elderly.

Fahey, Tony and Dorthy Watson, 1995. An Analysis of Social Housing Need. Dublin: Economic and Social Research Institute.

Finch, Janet, 1989. Family Obligations and Social Change. Cambridge: Polity Press

Grundy, Emily, 1995. ‘Demographic Influences on the Future of Family Care’, in Isobel Allen and Elizabeth Perkins (eds.) The Future of Family Care for Older People. London: HMSO.

Guillemard, Anne-Marie, 1991. ‘The Decline of Social Status? Evolution of the Welfare State for the Elderly: the Past Situation and Future Prospects’, pp. 166–190 in J Pacolet and C Wilderom (eds), The Economics of Care for the Elderly. Aldershot: Avebury.

Hannan, Damian F, and L. Katsiaouni. 1977. Traditional Families? From Culturally Prescribed to Negotiated Roles in Farm Families. Dublin: Economic and Social Research Institute

Harmon, Maurice, 1977. ‘Cobwebs before the Wind: Aspects of the Peasantry in Irish Literature’, in Daniel J Corkery and R.E. Rhodes (eds.), Views of the Irish Peasantry 1800–1916, Hamden, Connecticut: Archon Books.

Healy, John, 1967. Death of an Irish Town.

Honohan, P. and B Nolan, 1993. The Financial Assets of Households in Ireland. Dublin: Economic and Social Research Institute.

Hu, Yuareng and Noreen Goldman, 1990. ‘Mortality Differentials by Marital Status: an International Comparison’, Demography 27, 2.

Hughes, Gerard, 1996. ‘Would Privatising Pensions Increase Savings?’ Irish Banking Review, Spring.

Hughes, Gerard and Brendan J Whelan, 1996. Occupational and Personal Pension coverage 1995. Dublin: Economic and Social Research Institute.

Humphreys, Alexander J., 1965. ‘The Family in Ireland’, in M F Nimkoff (ed.) Comparative Family Systems. Boston: Houghton Mifflin Company.

Humphreys, Alexander J, 1996. The New Dubliners. Urbanisation and the Irish Family. London: Routledge and Kegan-Paul

Johnson, Michael P, 1995. ‘Patriarchal Terrorism and Common Couple Violence: Two Forms of Violence Against Women’, Journal of Marriage and the Family 57, pp. 283–294.

Johnson, Paul, 1996. ‘The Anatomy of the ‘Old Age Chrisis‘‘, in Peter Lloyd-Sherlock and Paul Johnson (eds.), Ageing and Social Policy: Global Comparisons. London: London School of Economics

Keogh, Fiona and Dermot Walsh, 1996. Activities of Irish Psychiatric Hospitals and Units 1995. Dublin: Health Research Board.

Larragy, Joseph, 1993. ‘Formal Service Provision and the Care of the Elderly in Ireland’, Journal of Cross-Cultural Gerontology 8, pp.361–374.

Lloyd-Sherlock, Peter, 1996. ‘The Role of Public and Private Sectors in Providing Economic Support for the Elderly’, in Peter Lloyd-Sherlock and Paul Johnson (eds.), Ageing and Social Policy: Global Comparisons. London: London School of Economics

Lundström F. and K. McKeown, 1994. Home Help Services for Elderly People in Ireland, Dublin: National Council for the Elderly.

Lye, Diane N., 1996. ‘Adult Child-Parent Relationships’, Annual Review of Sociology 22, 79–102.

McCullagh, Ciaran, 1996. Crime in Ireland. Cork: Cork University Press.

McCullagh, Ciaran, 1991. ‘A tie that blinds: family and ideology in Ireland’ Economic and Social Review 22, 3.

Markides, K.S., 1993. ‘Trends in the Health of the Elderly in Western Societies’, in A.B. Atkinson and M. Rein (eds.), Age, Work and Social Security. London: Macmillan.

Maeda, Daisaku, 1994. ‘Declining Family Care Versus Expanding Public Services: A Study of Social and Legal Aspects in Japan’, in United Nations, Ageing and the Family, New York: United Nations.

Myers, George C, 1994, ‘Marital Status Dynamics at Older Ages’, in United Nations, Ageing and the Family, New York: United Nations.

National Council for the Aged, 1985. Institutional Care of the Elderly in Ireland. Dublin: National Council for the Aged.

National Pensions Board, 1993. Developing the National Pension System. Final Report of the National Pensions Board. Dublin: Stationery Office.

Nolan, Brian, 1991. The Wealth of Irish Households. Dublin: Combat Poverty Agency.

O'Connor, J., E. Smith and B. Whelan. 1988a. Caring for the Elderly. Part I: A Study of Carers at Home and in the Community. Dublin: National Council for the Aged.

O'Connor, J. and H. Ruddle, with M. O'Gallagher and E. Murphy, 1988b. Caring for the Elderly. Part II. The Caring Process: A Study of Carers in the Home. Dublin: National Council for the Aged.

O'Higgins, Kathleen, 1990. ‘Kinship and Aging in Ireland’, in John Mogey (ed.), Aiding and Aging: The Coming Crisis in Support for the Elderly by Kin and State. Greenwood, CT.: Greenwood Press.

O'Shea, Eamon. 1993. The Impact of Social and Economic Policies on Older People in Ireland. Dublin: National Council for the Elderly.

O'Shea, Eamon and Jenny Hughes, 1994. The Economic and Financing of Long-term Care of the Elderly in Ireland. Dublin: National Council for the Elderly.

O'Shea, Eamon, David Donnison and Joseph Larragy, 1991. The Role and Future Development of Nursing Homes in Ireland. Dublin: National Council for the Elderly.

Preston, Samuel H., 1976. Mortality Patterns in National Populations with Special Reference to Recorded Causes of Death. New York: Academic Press.

Rogers, Richard G., 1995. ‘Marriage, Sex and Mortality’, Journal of Marriage and the Family 57, pp. 515–26.

Rosenzweig, Mark R, 1994. ‘Transfers from Parents to Their Adult Children in the Developed and Developing Countries’, in United Nations, Ageing and the Family. New York: United Nations.

Schulz, James H, Allan Borowski and William H Crown, 1991. Economics of Population Aging. The “Graying” of Australia, Japan and the United States. New York: Auburn House.

Shortall, Sally, 1991. ‘The dearth of data on Irish farm wives: a critical review of the literature’, Economic and Social Review 22

Sundström, G., 1994. ‘Care by Families: An Overview of Trends’, in Caring for Frail Elderly People, New Directions in Care, Paris: OECD.

Turner, R. Jay and Franco Marino, 1994. ‘Social Support and Social Structure: A Descriptive Epidemiology’. Journal of Health and Social Behaviour 35, pp. 193–212.

Vågerö, Denny and Raymond Illsley, 1995. ‘Explaining Health Inequalities: Beyond Black and Barker. A Discussion of Some Issues Emerging in the Decade Following the Black Report’ European Sociological Review 11, 3, pp. 219–241.

Walsh, Brendan, 1996. ‘Some Implications of the Ageing Irish Population’, Department of Economics, University College, Dublin, Working Paper WP2/96.

Warnes, Anthony M, 1994. ‘Residential Mobility through the Life Course and proximity of Family Members to Elderly People’ in United Nations, Ageing and the Family. New York: United Nations.

Whelan, Christopher T. and Brendan J. Whelan. 1988. The Transition to Retirement. Dublin: Economic and Social Research Institute

Working Party on Services for the Elderly, 1988. The Years Ahead … A Policy for the Elderly, Dublin: Stationery Office.

Wilbanks, William, 1996. ‘Homicide in Ireland’, International Journal of Comparative and Applied Criminal Justice, 20, 1, pp. 59–75.

World Bank, 1994. Averting the Old Age Crisis: Policies to Protect the Old and Promote Growth. New York and Oxford: Oxford University Press.

Appendix B

Minutes of evidence of 14 March 1996

(Unrevised)

JOINT COMMITTEE ON THE FAMILY

Déardaoin, 14 Márta 1996.

Thursday, 14 March 1996.

The Joint Committee met at 2 p.m.

Members Present

Deputy P. Connaughton,

“F. Fitzgerald,

“C. Flood,

“S. Hughes,

“R. Shortall,

“B. Smith,

“E. Walsh,

“M. Woods (in substitution for L. Aylward)

Senator P. Burke,

“A. Gallagher.

Deputy Paul McGrath in the Chair.

Caring for the Elderly in Society.

Chairman: We are addressing the section on caring for the elderly in society, looking especially at housing, health, care in the community, social welfare and income maintenance. These headings have been taken from our own structure chart. They are intended as broad headings and may be added to as we proceed. The objective of the debate is to initiate this aspect of our terms of reference, which reads as follows:

…to consider the impact of social change and State policies on the family, in both its extended and nuclear forms, with particular reference to the protection and enhancement of the interests of children and the elderly and measures which can be taken to support them, especially with regard to child care, education, juvenile justice, and the care of the elderly, and to report thereon to both Houses of the Oireachtas.

The committee has been charged with compiling a report taking these terms of reference into account and to report to the Oireachtas by April of next year.

It is considered that a sensible way to start our discussions on the care of the elderly is to invite some of those organisations who work at the coal face to give us the benefit of their experience and to put forward their perspective on what we as legislators should do to protect and enhance the interests of the elderly. Of the organisations invited before us today, three have already sent us submissions arising from our advertisement, the National Council for the Elderly, the Society of St. Vincent de Paul and the Combat Poverty Agency. I became aware of the fourth organisation, Age Action Ireland, while attending on behalf of the committee the international conference on Famine, Ageing and Development in Cork, the proceedings of which will be shortly available.

The documentation which has been circulated to members includes submissions received last year from those organisations already mentioned. Submissions from the Society of St. Vincent de Paul and the Combat Poverty Agency, while not specifically directed at the elderly, are included for completeness. Also included in your documentation are a copy of the report by the National Council for the Elderly on the Health and Social Care Implications of Population Ageing in Ireland, 1991–2011; an extract from an excellent Age Action Ireland Directory of Services for Older People in Ireland; an item from Mr. Michael Creeden, who organised the conference in Cork last year, on possible research; and a paper entitled “Perspectives on Ageing in Ireland” by Helen Duggan and Máire Lane, which I obtained at the Cork conference.

The issue of caring for the elderly in society is very wide. We recognise that the family is the primary unit in society, however, there are ever increasing pressures on this unit. Among those who suffer from these pressures are the elderly. This, combined with increased projections of life expectancy and demographic changes, highlights the need to examine how society relates to the elderly.

The degree to which families as units integrate their elderly members into a caring structure affects their self respect and self reliance. Families are the most important providers of education, health and welfare. When considering care for the elderly, we should primarily consider how much we can support the family in its caring role, and how the State can support that role.

The State may need, and often has to bolster this role, but from a community perspective. Above all, older people are part of the community, as are we all, and should be made to feel a valued and contributing members. It will not be too long before we all enter that phase of life; we too will grow old.

I now call on each organisation to present their experiences in their caring role. I suggest that members hold their questions until we have heard all of the submissions; it will make the running of the meeting more efficient. Introducing the delegations to the committee we have, on behalf the National Council for the Elderly, Mr. Michael White, Chairman, Ms Lilian Sullivan, Dr. John Murphy, Mr. Bob Carroll and Mr. John Brown. Representing the Society of St. Vincent de Paul is Mr. Bill Cleary, National President, and Mr. Gerry Martin, International Vice-President. Representing Combat Poverty Agency is Ms Helen Johnson and Mr. David Silke and representing Age Action Ireland is Mr. Robin Webster, Chief Executive, Mr. Con Murphy, Chairman, and Ms Rosaleen Walsh, board member. We will take delegations in that order.

The members of the committee in attendance are Deputy Frances Fitzgerald, Deputy Chris Flood, Deputy Séamus Hughes and Senator Paddy Burke. Unfortunately there are a number of committee ongoing at the same time and because we are members of various committee we must come and go at times. I ask the National Council for the Elderly to begin proceedings and I call on Michael White.

Mr. White: On behalf of the National Council for the Elderly we are pleased to have received your invitation. We take special satisfaction in the growing level of interest by legislators in issues regarding older people. We are encouraged by this because the National Council for the Elderly was established by the then Minister for Health in 1981. Since then we have been an advisory body to the Minister. In that time we have put together much good research upon which we hope policy makers can develop policy and which will help them make decision on behalf of older people in this country.

Some members will recall that 1993 was the European Year of Older People and Solidarity between Generations. During that year, and with other agencies who were working with and for the elderly, we encouraged the establishment of a committee such as this. The year 1994 was the International Year of the Family. Given that it is only 12 months since this committee was established it is encouraging that you should look on the elderly as an important part of your role.

Most older people in Ireland live as part of a family household. They are healthy and independent and are satisfied with their home. However, as an advisory body to the Minister for Health, we have a specific interest in the health of older people, especially in frail elderly people, and in the maintenance of their health and independence within their families.

To help the committee I brought two staff members, our secretary and research officer who will provide you with information. In addition, Lilian Sullivan is a member of the Alzheimer Society of Ireland, which has a very important role to play in caring for the frail elderly. Mr. John Murphy is consultant geriatrician in Castlebar.

To set a demographic background I will call on Mr. John Brown, followed by some words from each of our members.

Mr. Brown: With regard to the demographic factors involved on the issue of older people in Ireland, report No. 42 of the council makes clear that there is projected to be a very big increase in the elderly population over the next 20 to 30 years. We project that there will be an extra 130,000 people over 65 years of age in Ireland by 2011 and an extra 250,000 by 2021. At the same time, the State population is not projected to grow.

Within that increase, a disproportionate number will be over 80 years of age. This is the population that generally needs the most formal and informal care. In 1991, approximately 80,000 were 80 years of age or over.

By the year 2021 we are projecting 150,000 people over 80. Irish older people, when you look at their demographic situation, have a unique mixture of factors when compared to other countries. There is a very high level of single males and females, especially in rural areas, which you would not normally see in other countries. At the same time there is a very high level of contact with family households. A very high number of older people live in family households and a very low number live alone. Only 24 per cent of older people in Ireland in 1991 lived alone, compared to the OECD average of 40 per cent. There is a strange combination of a high level of people who have never married yet a very low number of people who live alone. That is because in Ireland we have not had any divorce legislation or tradition of separation - that may change because of the new legislation - but also because there is a tradition of continuing family care here. Very large family sizes in Ireland have also facilitated that.

According to our figures, 21 per cent of older people in the community require some form of informal care. That is usually done by a daughter or daughter -in-law, usually someone who is residing with the older person. That is a huge part of community care. Without that aspect of community care, the formal system would be under a great deal of pressure. That demography is changing and there is a very high risk that the pool from which informal carers are drawn at the moment may decline in future. A number of factors may lead to that. The size and number of families in Ireland is falling. Labour force participation among married women is increasing and there is increased urbanisation and geographic mobility among people in Ireland which means that they do not tend to live as close to their older family members as they used to. The Government emphasis is on community care. The health strategy target is that 90 per cent of people over 75 would live in the community. This means there will be no other places for those people to be cared for in.

Mr. White: Ms. Sullivan will speak now. She will deal with caring in the community from her perspective as a member of the National Council for the Elderly and the Alzheimer's Society of Ireland.

Mrs. Sullivan: I am a member of the National Council for the Elderly and the national council of the Alzheimer's Society of Ireland. My particular interest and commitment at the moment is dealing with Alzheimer's patients, as my late husband suffered from this condition for about eight years. At the time, there were very few services or support groups in Limerick. For that reason I became involved with the society after my husband's death. I nursed him at home for about eight years - I am not a nurse - and I encountered many difficulties. It is almost a one to one situation; it is a 24 hour job. We call it the 36 hour day, because you never get away from it. As you are all aware, Alzheimer's patients lose their memory, as well as everything else, eventually. The sad thing is that they look normal and people outside the home do not realise there is anything wrong.

Support is very necessary. It is also very important to keep patients at home for as long as possible because they are better in their own surroundings. It is necessary to have some sort of help.

Because neither myself, my late husband or my elderly mother, who was living with me at the time, had medical cards, I was not entitled to any home help or any support. On one occasion a district nurse called and was very embarrassed because she could not even give me incontinence sheets. It became very difficult and latterly I had to look for support, but I had to pay for it. I did not realise that I did not really need nurses; we have learned since then that a good carer will do. Family will be involved, of course, but normally Alzheimer's happens to people over 65. Children are rearing their own children and are gone from the home, so they cannot really come back and give the necessary support on an ongoing basis, particularly if it is over a long period, so support services are vital.

We were very pleased when the carer's allowance came in; it was very good. Unfortunately the level of payment is not quite high enough. It is also means tested, which is not very helpful. I hope something will be done about that in the near future. Suitable carers need training and I am glad to say that the Alzheimer's society are involved in a pilot scheme at the moment to train carers. Carers are quite different to home help. Most people are useful in the house but if you are minding an Alzheimer patient, the patient has to like you, otherwise they become confused. They become agitated when the carer leaves and they are more of a difficulty to the real minder. You have to marry the carer and the patient, so to speak, so you need a wider range of people to draw from. We hope to extend this scheme around the country in the near future. A sitting service would be tremendous. There is a sitting service in the west, which you will hear about later, which works very well. We would like to extend that all over the country, but all of this involves money, time, energy and people.

As we live longer, more people will suffer from Alzheimer's and we will need more back up services. I am involved in two day-centres at the moment, one of our own which we have more or less funded and set up within the last 12 months, where we take patients for five or six hours a day, five days a week. This is a great help to the patient and the carer. The carer is relaxed to know their patient is being taken care of properly in a very friendly home-like atmosphere. The day centre is not institutionalised. We hope patients would not have to be institutionalised until the latter stages of the disease. Institutional care is excellent where it is available. I could go on, but other people want to talk. We would be grateful for any help we can get for the elderly; the Alzheimer's Society of Ireland deals with the elderly all the time.

Mr. White: Ms. Sullivan represents all that is best in voluntary activity in Ireland; this is very important in caring for the frail elderly. The council is privileged to have her as a member. We also have professional members, one of whom, Dr. John Murphy from Castlebar, is with us today. I would like John to make his contribution now.

Dr. Murphy: The demographic factors have already been alluded to. There will be an increasing number of old people in the community and a disproportionate increase in the very old. They are the group in the community who are likely to suffer the most in terms of illness and disability, so this change in the demography of the population will have huge implications for the whole spectrum of health services. It will have implications for the hospital services. It is a goal of the health strategy document that a Department of Geriatric Medicine be set up in all acute general hospitals and we are moving towards that; we are grateful to the Department of Health for this. It will have major implications for community care; this has already been alluded to. The aspiration is that 90 per cent of the population over the age of 70 should reside in the community. As this population increases, the number of carers will probably decrease. The burden on carers is increasing and this will have to be supported if that burden of care is to be met in the community as is the aspiration.

The other major area of concern is the relatively poor health status of the elderly in Ireland. The average life expectancy of a 60 year old in Ireland did not improve from 1920 to the 1980s. Despite the great increase in the amount of health spending, there was no improvement in life expectancy for the older Irish population. This, if we use the term “health gain” used in the health strategy document, is a very poor health gain for the amount invested in health. In the last number of years we are pleased to report that there is some improvement in the life expectancy of the elderly Irish population but this has only come about since the mid 1980s.

We have the poorest health record compared to any other country in the OECD. In fact, it is poorer than some developing countries, but other segments of our population are up near the top of the OECD health league, such as maternity services, paediatrics, etc. The elderly Irish population has a poor track record in terms of health.

At present, the National Council for the Elderly has a submission with the health promotion unit regarding promoting healthy ageing and we hope that will proceed. Given the projected increase in the population, there must be a focus on the health of the Irish elderly.

Mr. White: We look forward to discussing some of the issues with the committee. The members may wish to discuss one aspect, which is the whole area of co-ordination of services. This involves providing the best co-ordinated service possible where it is most needed. When the committee sent us the invitation, it designated four different areas. I humbly suggest that the most important area is co-ordination. We have learned, particularly in recent months and years, that without co-ordination of the facilities which exist, frailer older people are at risk from all types of neglect. We can discuss this matter later if the committee wishes.

Chairman: I thank the delegation from the National Council for the Elderly. We will move on to the Society of St. Vincent de Paul and I ask that delegation to make a presentation of approximately 15 minutes.

Mr. Bill Cleary, National President, and Mr. Gerry Martin, International Vice-President, Society of St. Vincent de Paul, called and examined.

Mr. Cleary: ‘Sé seo seachtain na Ghaeilge agus cúpla focal ar dtús in ár teanga dhúchais: táim ana bhuíoch díobh mar gheall ar an cuireadh a chur sibh chugham chun labhairt libh inniu.

I thank the committee for its invitation to the Society of St. Vincent de Paul to speak to the members today on the topic of the elderly. At first glance, it might appear that to talk about the elderly to the Joint Committee on the Family is out of place but that is not the case. The Society of St. Vincent de Paul feels it is most appropriate because many of the problems we come across arise from family situations, particularly with regard to the elderly.

It is not so long ago that there was the extended family in this country. It is amazing that, in what we now call developed countries, the extended family is almost gone completely but, in developing countries - Mr. Gerry Martin, the international vice-president, is aware of this as he has visited many of Third World countries - the extended family exists. Families stick together and they know each other, whether they are first or second cousins.

I have first cousins whom I would pass on the street because I would not know them at this stage. This is the way it has developed in Ireland. We are down to what is called the nuclear family. However, even this is now breaking down because children are leaving the family early and the usual family ties which existed in the past no longer exist. The family is the most important social and economic small unit in the world from the point of view of a nation. If there are happy families, there will be happy and successful nations.

I was a member of the steering committee of the Year of the Family in 1994. One of the first things we had to do was find a proper definition of family. The UN had a broad definition, including homosexual families and lesbian families, etc, but the EU was much more restrictive. We even discussed how one could have a one person family. This is possible because one person living alone is a family and one person left after rearing a family is certainly still a family. Having been on that steering committee, I am very glad this committee and the commission on the family have been established and that we will continue to talk about families although the Year of the Family is over.

From the point of view of the elderly, I will outline how the Society of St. Vincent de Paul finds matters. If an elderly person lives with their family, the position is usually fine. We come across occasional cases of hardship but they are unusual. If only two spouses remain, the situation is still quite satisfactory because they have companionship and some element of security. It is fine but occasionally we must do some work in this area. However, problems arise when only one remains or there is a single person who never married living alone.

Given that most of the work of the Society of St. Vincent de Paul involves visitation, I will outline a number of examples, I came across the following case during my time with the society. I visited a lady for years who had four children whom I knew as they grew up. I did not visit them for a while and when I returned the four children were gone. They had married and left the family situation. One was living abroad but the other three lived in Dublin. The lady was in one part of the city while they lived in another part. When I called to her a second time she knew she had two grandchildren at least but she did not know whether she had any more because she had had no contact with her children for two or three years. They left her completely.

Another case involved a lady of 84 years of age whom we visited. She became very ill so we took her out of the house and put her into hospital where she had a major operation. When she was going back to live in the house, we said we would place her in a nursing home rather than send her back to the house. We put her in a nursing home and we decided it would be paid for by the grant from the health board and her pension and that the society would make up the shortfall, which was approximately £30 a week at the time. When we went to get the pension book, she said she had given it to her son who came into the hospital to visit her.

We were surprised because she never mentioned him once during the time we visited her. We asked her where he was and where we could get the book. She gave us his address and we went to him. He said she had signed the pension over to him; he had a document signed by her giving him the right to draw the pension. This was probably fine while she was in hospital because somebody should draw the pension and it was presumed that it was for her. However, he had taken it and spent it himself. He said there was no way he would give back the book because he said he was entitled to draw the pension as she had signed it over to him. We had a heck of a job to get the Department of Social Welfare to straighten out the matter.

I am giving these examples to outline what is wrong in family life at present, which is a lack of filial loyalty. There seems to be no loyalty between children and parents. In some cases, though not all, the children go off and forget completely about the mothers who reared them. The mother I mentioned in the first example was, in my opinion, a saint because she worked herself to the bone for her children. Yet, they neglected her and went off. Filial loyalty is breaking down because it is not being taught to children in schools. The fourth commandment, honour thy father and thy mother, is being neglected. Respect for their parents is not being implanted in students. Some of it arises from the parents in that they do not treat their children well and a friendly atmosphere does not exist within families. In its home management and self development courses, the society is trying to get this going. We are trying to get children to respect their parents more.

Other problems also arise for elderly people, including, for example, accommodation. We come across people in private accommodation and people who own their own homes who are now elderly and living alone. Often these people are in real trouble because they are lonely.

Quite often they do not have the money but are too proud to go to the Society of St. Vincent De Paul. We have to rely on other sources, such as priests, gardaí and social workers, to make them come to the society.

We have people living in private rented accommodation and council housing. I have come across cases in this city of people renting a room in very bad condition with high ceilings - about three times the height of the ceiling in this room - and a small fireplace in a corner. It is impossible to heat such rooms properly. I have seen cases of old ladies who had one or two briquettes in the fire. Many of the council houses also need to be repaired. We must give these people comfort. We in the Society of St. Vincent de Paul are very involved in social housing. We started our first social housing scheme in Castlebar in 1985 and we provide accommodation for 520 old people in 14 estates around the country, and there are more on the way.

Security and peace of mind is very important for these people. I am often asked how we are going to provide security for those people. The State must play a big part in that, which it is not doing at the moment. We must provide security for all people who are living alone.

Hypothermia is another problem. I am amazed we have not had any hypothermia cases this year, at least not that I have heard of. They were a regular occurrence in previous cold spells. A few years ago I was involved with a committee in the Mater Hospital which had a list of all the people over 65 years of age in the surrounding area. They were on a green, red or amber light. As soon as the temperature went below a certain point, those on the red light were visited by the St. Vincent de Paul Society or another agency. If the agency felt they were in danger, they were transferred to their families or put into the Mater Hospital to ensure hypothermia would not set in. Loneliness is a great problem for all the people I have mentioned. Many of these people only talk to the milkman, the breadman and, possibly, the SVP visitor during a whole week.

Nursing homes have recently been in the public eye. Many of those I visited over the years were of very poor quality. We reported many of them, obtained changes and had one or two closed. There are 400,000 people over 65 years in this country and that figure is increasing. There must be an increase in the number of nursing homes. I visited Wovern House in Cork, which has been in the news recently, on quite a view occasions because an old friend of mine lives there. He is quite comfortable and happy in that home. I know there were deficiencies in how Mrs. Nolan ran the home. However, that was because the health board kept pushing cases on her, and because she had a big heart she did not like to refuse them. Therefore, there were too many people in the home. I am not trying to defend her, but it was not the worst nursing home I ever visited. There must be an increase in the quality and number of nursing homes.

We must, above all, have an extensive network of community services and people visiting the elderly. There should be a list available of the people over the age of 65 years in every area, who should be red, green or amber lighted, as I indicated happened in the Mater Hospital.

Chairman: Is Gerry Martin going to speak to us as well? I would like to bring the presentation to a close fairly shortly.

Mr. Cleary: I was almost finished, anyhow. We also deal with a large number of homeless old people in our shelters, as we should.

We must provide adequate incomes for these people, but some things are more important than money for old people - friends, clothes, furniture, fuel and holidays. We provide people with holidays on a regular basis. We have 17 or 18 holiday homes around the country, including one in Naas, County Kildare, where 104 people holiday every week during the summer period. Friendship is very important for these people.

Mr. Martin: We produced a survey ten years ago entitled “Old and Alone in Ireland”. This booklet has featured in all reports on the aged since then. Overcrowding in nursing homes is probably our greatest problem. We improved our night shelter accommodation recently so that every person now has their own private accommodation - there is one single room per person. I have experience of working with the society in Europe and Africa. The definition of a developed country seems to be how badly it can treat its aged. My experience in Africa was quite salutary for someone who had experienced how the aged are treated in Europe.

Chairman: Our next presentation is by Helen Johnson and David Silke from the Combat Poverty Agency.

Mr. Silke: I am a research officer with the Combat Poverty Agency and I will speak to you about caring for the elderly in society. I hope to tell you about the agency and the sources of information we have on the position of the elderly. I want to go through some demographic trends and look at poverty and the elderly, particularly in relation to income support, housing, health and care in the community. I will finish with the topical subject of security.

I wish to make five key points. First, the current demographic trends provide an opportunity to better the situation of older people. Second, social welfare rates should be adequate to prevent older people from living in poverty. Third, access to public services, especially public transport and adequate housing, particularly for those living in rural areas, must be improved. Fourth, the link between poverty and ill health must be broken, and particular priority must be given to the recruitment of care in the community. Finally, security issues need to be addressed.

The agency was established in 1986 and has four general functions. These are to advise and make recommendations to the Minister for Social Welfare on all aspects of economic and social planning in relation to poverty in the State; the initiation of measures aimed at overcoming poverty in the State and the evaluation of such measures; the examination of the nature, causes and extent of poverty in the State and, for that purpose, the promotion, commission and interpretation of research; and the promotion of greater public interest in the nature, causes and extent of poverty and the measures necessary to overcome such poverty.

Poverty is best understood as exclusion and marginalisation from the general standard of living and way of life prevailing in society. People are living in poverty if their income and resources are so inadequate as to preclude them from having a standard of living which is regarded as acceptable by Irish society generally. Such a definition of poverty takes account of the fact that people have social, emotional and cultural needs, as well as physical needs. In particular, it emphasises that poverty is about exclusion, isolation and powerlessness, as well as lack of money. As a result of inadequate income and resources, people may be excluded and marginalised from participation in activities which are considered the norm for other people in society.

The overriding role of the agency is to work for changes that will enhance social justice, build greater equality and fairness, empower individuals and promote social rights and citizenship. On the basis of our work to date and our contacts with community and voluntary groups involved in tackling poverty and disadvantage, the agency has identified four key principles which have informed our approach to tackling poverty. These are: reducing inequality; promoting empowerment and participation; promoting partnership; and advancing social rights and combating discrimination.

The agency has three main sources of information on the position of the elderly. The first is national surveys, most recently the 1987 survey of income distribution, poverty and use of State services carried out by the ESRI. This survey is currently being updated. The second source of information is submissions to the National Anti-Poverty Strategy. At the UN World Summit for Social Development, held in Copenhagen in March 1995, the Irish Government, along with other governments, endorsed a programme of action geared not only to eliminating absolute poverty in the developing world but also to a substantial reduction of overall poverty and inequality everywhere.

Arising from this commitment the Government, following proposals brought by the Minister for Social Welfare, approved the development of a national anti-poverty strategy which is to be put in place by the end of this year. To this end an inter-departmental policy committee, made up of representatives from Government Departments and national agencies with a contribution to make to addressing anti-poverty issues, is overseeing the preparation of the strategy. The secretariat to the committee is in the Department of the Taoiseach and, for the purposes of the anti-poverty strategy, is augmented by the Department of Social Welfare and the Combat Poverty Agency.

To involve people in the development of the strategy the committee asked interested individuals and organisations to make submissions to the committee. Approximately 250 submissions were received and were summarised in booklet form. These came from a range of community groups,

voluntary organisations, women's groups, academics, trade unions and semi-State bodies. Of particular relevance to today's deliberations, submissions to the strategy have been received from the National Council for the Elderly, various chapters of the St. Vincent de Paul, the National Pensions Board and the Irish Association of Older People. I have already circulated copies of the summary of solutions to this committee. The committee has also produced an overview statement on the nature and causes of poverty and a draft document on the institutional mechanisms needed to implement the strategy. These documents have been the subject of consultations with interested individuals and organisations.

The third source of information is agency commissioned work to look at areas of relevance to today's deliberations. Two pieces of work commissioned by the agency are particularly relevant. The first is a study on the welfare implications of demographic trends which is currently underway at the ESRI. The second is a study of older long-term unemployed people. Older is defined as aged 45 years to 65 years. That is being undertaken by WRC social and economic consultants.

In our presentation we would like to look at the current and future trends for older people. In summary, we feel that the situation has improved for older people, but there are substantial numbers of older people still living in poverty or finding it difficult to make ends meet. These groups should not be forgotten in light of a common perception that the elderly are now relatively better off.

The projected growth in the number of older people over the next 20 years is well documented and will only be briefly sketched here. The projections predict a growth in the numbers aged over 65 years, and particularly for those aged 65 to 69 and for those aged 80 years and over. The projections also predict that the growth will be more intense after the year 2006.

There has been much speculation about the expected financial costs of an ageing population. This speculation has tended to be one sided, focusing on dependency and affordability. To help redress this imbalance, we wish to make six points that we believe are worth noting in relation to caring for the elderly in society. We hope to show that the next 20 years are a time of great opportunity to better the situation of older people.

The first point is that over the next 20 years there should be a reduction in the proportion of elderly people who are unmarried - the main increases in the proportion of elderly people will be among married men and women. These trends will increase the capacity of the family to provide informal care in the future and so reduce the pressure on State funded care. Second, the proportion of older people living alone increased sharply between the years 1961 to 1991, from 10 per cent to 24 per cent. This is projected to rise modestly - to 26 per cent - by the year 2011. Ireland is already below the EU norm in this respect and is likely to be even more so in the next 20 years.

The third point is that the largest increase in the numbers of older people will be in the Eastern Health Board area. However, relative to other health boards, the Eastern Health Board area will also have the youngest population over this period. The projections indicate that the North-Western and Western Health Boards will continue to have the largest proportion of older people. Fourth, increased female labour force participation and declining family size may lead to a reduction in the number of traditional carers. However, in practice, smaller families may not reduce the number of potential carers as, in many instances, in larger families this role often falls to one or two specific children.

The fifth point is that the projected growth in the numbers of elderly people will have implications for future spending on social welfare and health, although it is argued that there may be an improvement in the underlying health of the elderly over this period and, in any case, spending on health is more affected by economic growth than demographic considerations. This projected increase should be balanced by the implications of the projected reduction in the number of children over this period which could result in counterbalancing savings in relation to social welfare, education and health care in particular. Sixth, while economic forecasts are notoriously difficult to get right, the indicators are that Ireland's immediate future is bright and this should, in the longer term, have a possible impact on the economic dependency ratio, or the ratio between the numbers at work and the rest of the population. The issue of long-term unemployment among older workers will be addressed later.

I now wish to look at the issue of poverty and the elderly. Research indicates that the risk of elderly people experiencing poverty has declined over the last two decades. However, a recent survey of 909 older people carried out by the ESRI for the National Council for the Elderly found that almost half - 47 per cent - of elderly households reported some degree of difficulty in making ends meet on their current income. Some elderly people find it particularly difficult to manage on a basic pension of £62.50 per week, particularly for extraordinary expenditure such as home maintenance. It is important that these groups are not overlooked in light of a common perception that the elderly are now relatively better off.

Free schemes such as free electricity and free transport have had a positive impact on the situation of the elderly. However, particularly in relation to free transport, these schemes are of little use to many of the rural elderly who do not live near public transport and many of the urban elderly who are unable to access public transport because the bus stop is too far away from their home, the bus service to too infrequent, is not going where they want to go or the steps on the bus are too high. Reliance on private transport can have serious cost implications for some old people. Older people can be particularly prone to social exclusion and marginalisation due to lack of resources, isolation and lack of access to basic services such as transport. Local initiatives such as community based transport, community car schemes or the introduction of transport vouchers as an alternative to the free travel pass could provide fairly low cost solutions to this problem.

In relation to income support, the agency welcomes the trend towards the increased numbers entitled to non-contributory pensions and the reduction in the numbers dependent on means tested benefits. However, the basic rate of non-contributory pension is still seriously inadequate at £62.50 and still below the minimum adequate rate as defined by the Commission on Social Welfare ten years ago. An ESRI study reviewing the adequacy of social welfare rates generally is currently underway and due to report in the autumn.

A second point to which we would like to draw the committee's attention is the growth in the numbers of workers leaving the labour force early, particularly because of the onset of disability or ill health, unemployment or redundancy. People aged over 55 and long-term unemployed are now entitled to draw pre-retirement allowance, so formally withdrawing from the labour market. We must acknowledge that the cost and benefits of restructuring the economy have not fallen equally.

The inadequacy of the current welfare system to compensate those most affected - households headed by long-term unemployed persons - means that the financial and social burdens of these economic changes have fallen on the most vulnerable sectors of the population. We must do everything in our power to ensure that those who are affected are not forced to live in poverty. The agency has commissioned WRC Social and Economic Consultants to examine the situation of older workers and the labour market and their report will be published later this year.

The housing conditions of some elderly are a source of worry, particularly for those who live alone in rural areas. While schemes such as the Task Force on Housing Conditions for the Elderly and increased funding of voluntary housing have helped, many elderly people still live in bad housing conditions. In some cases this may be because an older person wishes to live in this way; they may have become very familiar with their surroundings and may not want them altered. In other cases their expectations may be very low - they grew up without running water, electricity or central heating and do not want them now. However, for others, house maintenance and repair is a major worry and goes undone because of financial constraints. It is difficult to assess the extent of the housing problem experienced by older people. A comprehensive survey of housing need is therefore required.

Access to health care can be particularly problematic for those elderly living in rural areas. Extra public funding of community care services, especially in the areas of home help, care attendant schemes, home nursing, voluntary housing and informal support networks involving voluntary and community groups, is needed. Possible initiatives in this respect could include a mobile hospital day service for old people living in rural areas; locally based flexible provision of community care services; a flexible ambulance service and greater co-ordination between statutory agencies,

voluntary bodies and carers.

A particular worry for many elderly people and their families is the cost of residential and nursing home care. This worry is particularly prevalent in urban centres such as Dublin, where the maximum subvention, together with pension entitlements, are often not enough to pay for nursing home care. Older people are therefore forced to enter nursing homes out of their home area, which leads to increased isolation from their family, friends and familiar environment. Greater priority needs to be paid to the development of community care services, so reducing the need for nursing home care. An assessment of the regional variations in the cost of nursing home care should also be undertaken to evaluate the fairness of the present subvention system. A strategic approach must be taken to the long term financing of care.

Recent attacks on the elderly have increased fears among those living alone and with elderly relations, both in rural and urban areas. Older people's perceptions of what might happen to them should be taken as seriously as the statistics on the number and nature of recent attacks on this group. The development of adequate security systems for the elderly, both in urban and rural areas, should be a priority.

Chairman: The final group to make a presentation is Age Action Ireland. Its representatives here are it chief executive, Mr. Robin Webster, its chairman, Mr. Con Murphy and a board member, Ms Rosaleen Walsh.

Mr. Murphy: Age Action Ireland is a comparatively young group compared to the others. It is a national non-governmental organisation working with a network of organisations and people providing services for older people and their carers. As a development agency it promotes better policies and services. At the moment we have over 200 members, including most of the health boards. The emphasis is on action and our members seek solutions to the problems being presented to the committee today. This is done through various committees and seminars. In the last six weeks we held six seminars, three of which were held outside Dublin - in Cork and Galway. The work we do is very wide and includes volunteering, inter-generational work, life long learning and the development of services in co-operation with the health authorities. Mr. Robin Webster will now deal more fully with our work.

Mr. Webster: I will make some introductory remarks on the note which has been circulated. This is a brief summary document and we will be glad to provide further information, views and supporting references. We want to make three points as a basis for comments. First, the traditional concept of the family is being replaced by a variety of different patterns of relationships which affect all people - children, parents, grandparents, carers and dependants. Secondly, older people, no matter how they are defined, are not a homogeneous group. Diversity is their greater characteristic, based on gender, class, income, disability, location and living arrangements. Therefore, we would argue that it is almost impossible to talk about policies for the elderly because we have to talk about a great variety of sub groups. Lastly, too much stress should not be placed on differences based on chronological age. Younger and older people have the same social and economic needs, not least in challenging ageism, that is discrimination based on chronological age whether it is low or high.

The European Commission's statistical report last week suggested that while Ireland has currently the youngest population, it has one of the fastest ageing populations. There has been a 67 per cent increase in those of the population over 60 years of age. There was only almost 3 per cent of an increase in those aged between 20 and 59 years. There has been a decrease of 25 per cent in those aged up to 19 years. Within this huge increase in the number of older people, there is an even greater increase in the number of older people aged 80 years and over.

On most occasions an ageing population is presented as a crisis and a burden and something to be dealt with. We wish to strongly make the point that an ageing population should be a cause of celebration and is based on social and economic advances of which we should be proud and want to continue.

There are some challenges to be faced. There are more older people living in two person households, often some distance from other generations. In North America this is called long distance caring. People from the UK and America have phoned Age Action Ireland to seek support for parents and older relatives in Ireland.

More older people are living alone, especially women who have a longer life expectancy. Women apparently experience greater chronic illness. The point of having a longer life if it is not of high quality needs to be questioned. More older people are likely to have physical and mental disabilities as they grow older - we had an example of this earlier. There are greater pressures on families, and especially on women, as the main providers of care for older people. This means that families and women will be expected to provide more intensive care over longer periods. There will clearly be greater demands for health and social services, pensions and other social welfare benefits.

Those are some of the challenges and costs. Two important opportunities must be seized in this regard. First, there will be more fit and independent older people who will live longer and be able to contribute socially and economically to society and to their communities. Second - this point was emphasised in the White Paper on employment in the EU - the demand for greater services will provide greater job creation opportunities in new and expanded services such as health, social welfare, housing, transport, education and leisure.

State policies in relation to older people in Ireland have largely focused on health or ill health - a chapter on older people in the health strategy document is entitled “Ill and Dependent Elderly” - and on pensions and other social welfare benefits. Because of this emphasis most concern has been with older people in residential care - about 5 per cent - and with those receiving some form of care in the community - approximately 20 per cent. Too little attention has been given to the majority of older people who are fit and well, living independently and caring for others. For example, 25 per cent of informal carers are over 65 years of age. Older people should not automatically be seen as the recipients of care but also as the providers of care. This narrow focus was seen in the recent Green Paper and White Paper on education which did not mention demographic ageing or the learning needs of older people.

A variety of measures should be considered in relation to the protection and enhancement of the interests of all the people in the family, particularly older people. We believe the main thrust of future policies and measures should be based on the concept of productive ageing, that is, allowing and encouraging older people to contribute positively to society for as long as they are able to do so. We do not see this as being in conflict with the need to provide better services for older people who require increasing levels of support in the future. We see older people as workers, volunteers, carers and, perhaps, most dramatically in the family situation as grandparents.

We need greater support for family and other informal carers, financial support through an extended care allowance scheme for carers at home, greater support by the State and employers for carers in employment and a greater emphasis on respite care for carers and dependent people. We hope to produce a directory on respite care shortly. One of the most disturbing aspects is that many respite care facilities are unavailable to people in wheelchairs and those with dementia. Respite care needs to be broadened and strengthened.

We need a flexible retirement age to allow older people to continue working - perhaps, as was suggested by the National Council for the Elderly, a retirement decade where people could not be excluded from work on grounds of age alone. We also need more resources for a comprehensive and co-ordinated range of services in the community. Our daily experience is that community care services are inadequate. People are stretched beyond limits and are desperate for help. They do not know where to go for help and they cannot get help. That seems to be the extreme for many people.

We need more resources to provide a greater variety of accommodation linked with health and social services. Many older people stay in their homes and their next option is either a nursing home or hospital. There must be a greater variety of accommodation. Close partnership among statutory, voluntary and private sectors and closer co-operation within those sectors is also required. We were glad to be involved in the development of Care Alliance Ireland which brings together 50 organisations which support carers of dependent people of all ages. These mechanisms for greater co-operation are important.

Education and training of the public and of professional and voluntary staff for an ageing society are important. We must place greater emphasis on volunteering by as well as for older people. A research project, for example, is being undertaken in Tallaght to develop the scheme further. Self help groups of older people must be encouraged about the contribution they can make. We have been involved, for example, in the promotion of the university of the third age in Ireland and of research by older people because it is time older people contributed information and views about their needs and circumstances. Our experience is that older people and their carers do not have sufficient information about existing services. They have little information about the availability of alternative services. We emphasise the need for greater information to provide greater choice so that more older people and their families can participate fully in the services they provide and in their local communities.

Chairman: I thank the four groups for their presentations during which they made a number of recommendations and proposals. The one thread running through the presentations was the need for co-ordination of services for the elderly. Should we use the same model to achieve this as was used by the Minister of State at the Department of Health, Deputy Currie, who was given responsibility for child care and who co-ordinated various Departments in that regard? Should voluntary agencies be co-ordinated?

Mr. White: We did two studies on the partnership between the voluntary and statutory sectors and on the workings in two distinct areas. We found there was huge disparity between the level of services provided by different State agencies, for example, housing, health, security and social welfare. They may all go in different directions while working in the same community. Co-ordination must start at the top. Unless someone in the Administration is responsible for co-ordination in the same way as Deputy Currie is responsible for child care, it will not happen at local level. The statutory and voluntary sectors are involved in this regard. It will not be applicable locally, particularly among the State sector, if it does not trickle down from the top.

Mr. Cleary: Every part of the State's structure would need to be involved if we wanted to develop a model such as that devised by Deputy Currie. It would be impossible to do that because family issues are dealt with in every Department. One would need a Department for the family.

It would be possible to do that. Certainly, there must be a greater lead from the State in dealing with elderly. We must deal with them on a better basis and must co-ordinating efforts so that elderly people are protected, secure and comforted all over the country.

Ms Johnson: First, we believe co-ordination is important at both a horizontal and vertical level. We need to have some strategic vision in the longer term also so a Minister or Minister of State with responsibility for the elderly would be useful in terms of trying to create that vision and pull the different threads together.

In addition, something like the strategic management initiative, that is a group of secretaries to try to address cross-departmental issues, within the Civil Service would be a useful forum and needs to be examined too.

Vertically, working at a local level with voluntary organisations is very important also because services can often be discussed at a central level but unless there is also integration at a local level - we have examined this in terms of poverty initiatives, etc., it is difficult. A study in north-west Connemara contained some innovative ideas about trying to provide services in local areas.

Mr. Webster: First, co-ordination should be at every level. The Mitterand administration in the early 1980s had a minister for ageing but it lasted only two years. The difficult is ensuring that whoever is appointed reflects properly and has connections with the both the political and bureaucratic processes. There is the danger that it could be a way to exclude older people from the mainstream of policy.

The other point just emphasises that there should be co-operation in the statutory and voluntary as well as in the private sector. Therefore, we are not saying this is only a problem which faces Government and statutory services. Clearly, voluntary organisations concerned ageing and older people need to co-operate more effectively than we are at present.

Chairman: Thank you for your contributions. It is interesting to note that the new Australian Government's has a Minister for Health and Family Services so this matter is being recognised world-wide. This committee's report recommended that the family strategy group which used exist within the Department of Finance be reformed to examine family issues.

Deputy F. Fitzgerald: I welcome all the contributors. It is a significant occasion when so many groups representing the needs of the elderly make presentations to an Oireachtas committee. It is a reflection on a greater focus on the needs of the elderly. Obviously, the demographics are primarily what push us in that direction.

I am interested in the social attitudes around ageing in this country. I note that reference to this is made in a number of the submissions. Age Action state that an ageing population should be a cause of celebration and I agree. I spent a lot of time fighting sexism, which limits people's contribution, and I think ageism limits individuals contributions hugely. There have been huge barriers to active participation by older people in this country because of attitudes. Do the contributors believe that is changing? I think it is changing slowly but I would be interested in their views on that general question.

As far as caring for the more vulnerable elderly is concerned, I am disturbed by Dr. Murphy's comment that Ireland's elderly are at the head of the poor health league. That is disturbing given the economic position Ireland enjoys in the world. I would like to hear a little more about that. Why does he think that is so? What can we do about it? Planning for old age has not concerned us a great deal and the population at large needs to examine that issue.

Many women have moved from caring for children to caring for elderly parents or relatives. Again, I am struck by something in the National Council for the Elderly's document which warns about an over-reliance on the family, that it may be misplaced and, ultimately, damaging to the real potential as a caring resource. That point is well made because you can push a good thing too far. We must examine the kind of support services necessary to complement the good caring of families. I note that they discuss the uneven development of services throughout the country. Which community care services need development?

I have many more questions but there is not time today. I must say the contributors have given the committee a great data-bank of information which we can go on to use when the committee makes its recommendations.

Deputy Hughes: I welcome the four national organisations to the committee. Perhaps Age Action is the infant of the four but it has been extremely active distributing newsletters, etc., in recent years. All the organisations are doing excellent work.

It is clear to the committee that the role of the elderly is increasingly politicised as the demographics move in their favour. Like Deputy Fitzgerald, the one issue which stuck out in my mind when Dr. Murphy spoke was the health status of the elderly which had not improved for sixty years right up to the 1980s, when one would have thought that we had devoted a lot of resources to the elderly. Since 1985, it has moved in their favour. From his experience, can he indicate the markers which may have reversed that trend? Where would he see the health status of the elderly developing in future?

I could say a lot about housing aid, nursing, home subventions and the variations between various health boards and that may be the subject of a consultant's report when the committee decides to take that course. What is the panel's view on the abuse of the elder? Clearly, there will be an increasing elderly population and one level of society could see this as an increasing burden on the economically active age groups over the next 20 or 30 years. Smaller numbers of people in that age group would be supporting an increasing elderly population and, with the breakdown of respect at different levels of society, I would not like to think that our elderly population would come in for some level of increased abuse.

I have only come across a case of child abuse in eleven years as a public representative yet it is the one subject which we increasingly read about in the newspapers. It has taken up time in the Dáil and at various committees, and huge resources have been devoted to child abuse in all its different forms. However, I have come across elder abuse in its different facets on at least four or five occasions. It involved financial abuse, threats to move the person to a public nursing home, not given them the level of care and treatment which one would normally give to an elderly person unless they adopted a certain attitude or gave up a certain financial asset or even abuse in public institutions. I am not sure there professions are available in the field to identify this abuse taking place and I am satisfied that elderly people are slow to report it. I accept that elderly people are in a different category from young people and that society has a greater duty to protect young people while one would thing elderly people are in a position to protect themselves. Is there much research in this area? Are the groups concerned about its present level? Are they concerned that the trend will not be in favour of the elderly in future? What should we, as legislators, be doing? Should be devote resources to training professionals at health board level?

These would be key people who would have the expertise to detect signs of abuse and would provide a vehicle which elderly people could use if they had difficulties with their families or in their homes. I have come across dreadful situations. While we are focusing on child abuse at present, I have found many elderly people who have been robbed of thousands of pounds which only become apparent on their death.

Mr. Cleary: Deputy Fitzgerald spoke about age celebration. Of course, we should celebrate age. Many older people still have much to offer but they are not allowed to do so. Even people of 35 years of age are not being employed. What chance has a person over 60 years with all their faculties? Elderly people must be given occupations if they want them. People who retired at the same time as I spend their lives doing nothing, which is not good. We must try to provide some form of occupation. Active retirement associations should be supported by the Government.

I have not found any evidence that the health of old people has declined. We must have system of planning for retirement and old age. Retirement is great because you can do what you want in your own time. However, people are not taught how to appreciate it. There is a retirement course in the Civil Service where I worked.

Deputy Connaughton: Our problem is that we may be retired before our time.

Deputy F. Fitzgerald: That is a different problem.

Mr. Cleary: There must be more planning for old age. I attended some of the courses in the Civil Service. While they are good, they are not great. As regard the abuse of the elderly, I have come across few instances of this.

Mr. Martin: Abuse of the elderly should get the same attention given to child abuse when it occurs. There is a danger that could be taken for granted. We do not necessarily take child abuse for granted.

Mr. Cleary: I remember a deaf old lady who opened the door to three young girls who asked her for a drink of water. She gave them a cup of tea but they robbed her of everything, even her burial money. We must be watchful of this. However, I have not seen too many instances of abuse within a family.

Mr. Silke: In terms of planning for old age, for the long-term unemployed planning for old age can be very serious because they are unable to build up contributions for contributory pension and, therefore, they enter retirement in an insecure way. It is downhill from there.

Mr. Webster: I would like to deal with attitude to ageing. There is a lot of talk in other European countries and in the US about intergenerational strife. There is little evidence of this in Ireland. Intergenerational attitudes and contacts are good and, therefore, rather than develop a problem faced by other countries, we should develop more positive attitudes. If we have an ageing society, we should train professionals and voluntary staff to work with older people. Too little attention is given to the education and training of professional groups working with older people. Education about the ageing process should be a life long one rather than leaving it until people are in their 60s or 70s.

Mr. White: Deputies raised a number of issues. Deputy Frances Fitzgerald raised the question of community support. Mr. Bob Carroll has been secretary of the council for some time and he is well briefed on the levels of community support.

Mr. Carroll: I would like to refer Members to our submission which covers some of these issues. A consistent theme of official policy on services for the elderly from the Care of the Aged report through to the Years Ahead report, to which we have not referred and which contains a chapter on co-ordination, has been the desirability of allowing the elderly to live in the community rather than caring for them in institutions. The council endorses the target of the Department of Health in its health strategy, that is, the maintenance of at least 90 per cent of those aged over 75 years in their own homes.

The council recognises, however, that this goal will only be reached through strengthening formal community services and services required to support many elderly people and their families in the home. There is evidence that help and informal care by family members are often treated as a substitute for the formal care services rather than as complements. For instance, old people who live alone or who are very elderly are more likely to be in receipt of the home help service than other categories of older people.

Services such as the home help service, meal on wheels and day care services can and should be designated as core services which are underpinned by legislation and appropriate statutory funding. Core services may be defined as support services which are essential for elderly people to maintain a quality of life and a level of functional autonomy which enables them to live independently in the community and consequently to avoid unnecessary hospitalisation or admission to long stay institutions. It is our objective and national policy that older people should remain at home. The services which enable them to do so are core services. They should not, therefore, be discretionary and they should be available to those who need them, which is important.

Core services would be differentiated from other important community support services provided by voluntary bodies such as social outings, clubs, etc., for the purposes of planning and funding. The home help service, in particular, should become a statutory entitlement. The recommendation of the Years Ahead report that the home help service should be comprehensive enough to assist elderly people with all the tasks of daily living should be implemented in all health board areas.

A co-ordinated approach to models of service delivery for community care services must be developed, especially at national level. Guidelines for eligibility criteria and rules governing charges for services such as community paramedical services, home helps, meals on wheels and day care centres should be developed. The purpose of these guidelines would be the elimination of geographical inequities in service provision.

In terms of the attitudes question, there have been enormous strides in recent years. Much of that has to be put down to the efforts of bodies like Age and Opportunity, which specifically tries to combat negative attitudes to ageing of the elderly. However, we still have a tendency to equate old age with dependency and that is wrong. That thinking is still widespread and the work must go on.

Dr. Murphy would be the best person to answer any questions with regard to health status and why our people have such a bad health record in this country in terms of survival etc. We are concerned that health promotion policies should think about older people. We feel there is a need for a healthy ageing strategy as well as a general health promotion strategy.

Dr. Murphy: The figures for life expectancy are particularly bad for Irish males. The life expectancy of an Irish male in 1961 was 15.8 years, by 1971 it had fallen to 15.6 years. It started to improve in the mid-1980s. The trend for life expectancy in females has been more consistently upwards; Irish males have had a bad track record. However, the projections for both sexes are that male life expectancy will increase from somewhere between 1.7 and 2.5 years by the year 2011, which is at least showing some improvement.

I am not totally sure why the figures are so low and I am not sure anyone else does either. The common causes of mortality would be cardiovascular disease, heart attacks, strokes and cancer; they would cover a vast bulk of that area, which may reflect lifestyles, smoking, diet etc. over years. It is important to promote healthy lifestyles and the younger, the better. However, we should not say it is too late, when people get into later life, to look at promoting healthy lifestyles. The council has a draft submission to the Health Promotion Unit for a strategy on healthy ageing but obviously, the sooner people start to live healthier lifestyles, the better.

Mr. White: In answer to the Deputy's concern about abuse, I agree with Mr. Webster in that there is little evidence that the esteem held by Irish people towards the older members of our community has decreased. Our older people are generally held in high esteem among every generation. Not many studies support that point, with the exception of a small study we conducted in the late 1980s which surprised us. The perception is that young people have very little esteem for older people; that is not correct and there is no evidence to support it. In addition, the communities' anxiety and cause for concern about recent threats to older members of the community is an indication of their real concern for the elderly.

The council has been considering how to deal with the abuse of older people for about 12 months. As the Deputy suggested, it is a very sensitive issue. We consulted widely with all the professional groups involved. Last Monday, we brought together representatives of all these professional categories which would have an interest in, or concern for, abuse of older people. Arising out of that, we will be making a submission to the Minster for Health before the end of the month. On the basis of that, I hope we will make suggestions, for example, for further research and a greater identification of the problems.

It is not a simple issue - we discussed this matter in the council - and there are many different aspects to it. During our beautiful summer, a shopkeeper may have put chairs and a table onto a footpath and a frail, elderly person may have fallen over them. Is that an abuse of an older person? Would abuse also include steps onto public transport or the regime in some homes where old people are made get up at 7,30 a.m. every morning? It is a wide issue. We share the committees' concerns on it and we hope at some future stage to be able to come back and give it a far more thorough briefing on it.

Chairman: When you have that document ready to present to the Minister, could you also send us a copy?

Ms Walsh: I work as a director of Tallaght Welfare Society. We run a day centre for senior citizens in Tallaght, as well as a home help service, with a lot of experience directly on the ground.

We would have to accept that some of the denial mechanisms and secrecy that operates within child abuse, such as family pride, would be at play in senior abuse as well. While it might not be visible, it does not mean it is not there. Around three years ago, Ann McLoughlin of the Irish Association of Social Workers tried to organise a conference on this very topic but it was cancelled due to lack of interest. That would raise the question of whether people are fearful, if they do not want to talk about the topic or are afraid of it etc. One cannot talk about abuse without looking at neglect. In my experience at the day centre, self-neglect in the form of people not eating is a major concern.

While Tallaght is seen as an area consisting of a young population, one of the abuses our senior citizens experience is intimidation within the housing estates and communities they live. Since there are gangs of young people around, older people are afraid to leave their homes or to go shopping and there is a knock on effect there. While I would not have much experience in this area, older persons also abuse their families and carers both emotionally and financially and that also needs to be examined. Often this only comes to light when respite care is offered and the carers in the home get a chance to tell their stories about how they almost felt prisoners in their own home. It is a big area that could do with greater research and exploration.

Deputy E. Walsh: Ms Walsh outlined the intimidation of the elderly that takes place in certain parts of Tallaght. While I do not want to pass any reflection on this, little will be done about it unless we state that it is happening. These old people, who in many cases are isolated and have no connection with their families, are vulnerable to intimidation, live in fear and are virtually prisoners in their own homes.

Does our housing policy contribute to this? Our policy is to house people wherever the need is greatest and wherever the first house becomes available irrespective of whether it is suitable for the person or not. Allocation of accommodation for the elderly is the first area on which I would like to see immediate attention focused because it will set the trend for many other issues, such as their degree of independence, self-sufficiency, health care, access to services and intimidation.

Many things emerge from this. If we decide that enough attention is not being paid to that area, the committee should make immediate contact with the Department of the Environment to discover if the elderly have a special need in the area of housing. I would be interested in the Department's response with regard local authority policy for placing people in housing.

There are many people who live on their own in large, expensive private houses. They have no means of securing their own welfare with the assets in their possession. The maintenance and upkeep of these premises have become a burden to them and they have no way to address this problem. I am sure that the groups represented at this meeting have come across such cases. Are there any suggestions regarding how a mechanism could be created to dispose of such assets in order that the people to whom I referred might acquire the means to become independent?

With regard to Age Action Ireland and the celebration of age, I hope that when I grow older I will be able to do the things I never could in the past. I am looking forward to that time. A positive attitude to, and a celebration of, age are concepts which we must promote. Old age is not something which means putting down the shutters, locking the door and waiting to depart this world, it is a time to do things we have never done before.

I was a teacher in Pearse College and I know of many people over the age of 65 years who returned to school to redevelop their education. They integrated with younger students in doing so. In providing support for the elderly, we are putting people of similar ages together in one place. However, the younger students in Pearse College integrate very well with senior citizens who have returned to their studies. The wisdom of old people is very valuable to their younger counterparts. Unless society is encouraged to integrate in terms of age, a concept will be created that old people are commodities and that they live, work and die together. They should be encouraged to become part of the community in which they live.

The groups represented at this meeting will do valuable work in the future. The Joint Committee on the Family provides parliamentarians with their first opportunity to address the care of the elderly in the 21st century. The groups present are probably at the forefront of that work. I believe that an entirely new charter of how the elderly are cared for will emerge from this meeting. I have not yet prepared for my old age which is wrong, because it will be the most important time in my life and in those of the people closest to me. I have done nothing about it and I am depending on others to do it for me. This is wrong. If we make people aware that they must make arrangements for their old age when they are capable of doing so, we will begin to create a more caring environment. My late father cared for the elderly until the day he died. Following his retirement he began an entire series of jobs he could never do while working, including caring for old people. He did this for as long as possible and hoped that, when he could no longer do it, others would care for him. This is a concept which must be developed.

Deputy Flood: I welcome the distinguished witnesses who have shared their great knowledge on the various issues under discussion. The excellent report and documentation they presented to the committee will be of great help to us.

In so far as these groups are campaigning to develop a co-ordinated approach to the elderly, I strongly advise them to have this placed on a statutory footing. An ad hoc arrangement will not work as it will involve different Departments and suppliers of services. It must be placed on a statutory footing if it is to be effective. It is not beyond the bounds of possibility that such a situation might develop.

I am interested to hear the views of those present in relation to the voluntary sector. In the past I served as Minister of State at the Department of Health. I was the first co-ordinating Minister with responsibility for childcare; the current Minister of State, Deputy Currie, is the second Minister with this responsibility. Therefore, I was responsible for breaking new ground. On entering the Department of Health - I also had responsibility for justice and education - I discovered that the voluntary sector in general was treated as a kind of nuisance. This was not my approach and I brought the voluntary sector into a central role. We should be prepared to move a step further and give that sector a statutory role with regard to consultation and the provision of services, in which it has developed great skill and expertise. I ask the representatives present to request such a role for the voluntary sector in their campaign on this general issue.

I am concerned with the question of filial support to which Mr. Cleary referred. In my work as a public representative, I have become increasingly concerned about the number of elderly people attending my clinic who are seeking accommodation. If Members consult the housing waiting lists of local authorities, they will see that these are becoming increasingly longer. Why is this happening? From confidential discussions I have had with elderly people attending my clinic, I have discovered it is because the family structure has broken down as far as they are concerned. What accommodation did these people use until making applications to their local authorities for alternative accommodation? In many cases, through their own generosity, they have disposed of their homes and moved in with family members in order to support them.

Early in my career as a public representative I adopted a position of strongly advising elderly people not to dispose of their own homes under any circumstances. I believe I succeeded in changing the minds of a considerable number of people attending my clinic. In understand the reasons such people might not be able to continue living alone, but I always strongly advise them against disposing of property over which they have full control. I am concerned about the growing numbers of elderly people on housing waiting lists.

I was disappointed that none of the earlier contributors mentioned elderly people in minority groups. I am particularly interested in elderly people living within the travelling community who are experiencing similar difficulties to their counterparts in the settled community with regard to filial support. It is a major departure for the travelling community that its elderly members are experiencing difficulties in this regard. Have any of the representatives present taken up the issue of the elderly in so far as minority groups are concerned?

I would also like to hear the views of the groups present with regard to housing policy. I am not convinced it is a good thing to construct housing developments to specifically accommodate the elderly in which there are a substantial number of housing units. There is a positive side to this, but there is also a negative side which involves segregation. Such developments may lead to the possibility of providing warden services, etc., but the segregation of elderly people in the community may not be a good thing. I do not I have the expertise to comment on this matter but I would like to hear the views of the representatives present in this regard.

What co-ordination currently exists in the voluntary sector in relation to the elderly? How often do the groups come together and support each other? In my work with the voluntary sector I discovered that there seems to be much inter-group rivalry.

I had to come to a conclusion on that and try to discourage the intense rivalry between the groups. When we got over that and worked in a co-ordinated manner, we found we could be far more productive. I would like to hear about the working of the different groups.

Senator Burke: I welcome the four groups and thank them for their detailed submissions. Somebody mentioned earlier that the elderly should form an important part of our report and, in light of what we have heard today, that is quite right. It has been stated that there will be a large increase in the elderly population over the next 20 years while the overall population will stay much the same. There will be a high level of single males, especially in rural areas, and 21 per cent of older people need some form of community care. Somebody said that a very high percentage of carers are over 65 years of age as well.

I have been dealing with the health board in a number of cases relating to caring. I am not sure whether the health boards are that sympathetic towards carers. I came across one particular case where a person of 80 years of age was looking after a person of 90 years of age. Both needed care. All the health board would provide was five hours of caring per week. That is around 40 minutes per day which is minimal. It was a disgrace to a degree because both people should probably be receiving some form of hospital care because both of them needed substantially more care. In-laws and relatives should qualify to be carers and that line should be followed more vigorously. They know the families better and, where some financial reward would be provided, it may work better.

I agree with much of what Deputy Hughes said about abuse of the elderly, particularly in the rural areas. There is quite a substantial number of houses in rural areas where there is still no running water or bathroom facilities. Deputy Walsh mentioned that this is the case in the cities as well where there is very poor housing. We need to change some of the laws in those areas. I appreciate that it is a broad issue but I ask the groups what are the most immediate steps we should take in relation to the elderly.

Deputy Woods: It is stimulating to meet all the groups today and hear their contributions. There is so much involved that one could spend a long time discussing and debating it. I will just mention one or two points.

As a politician, I have encountered abuse of the elderly. It is an issue which should probably receive more attention. They will not tell anybody because their dignity and pride will be affected and hurt. It is a deeply personal situation when an elderly person is being abused by a close relative, male or female.

I was happy to hear Deputy Flood say he has advised many people not to sign over the house. I have done the same because I have seen so much happen when people sign over the house. I tell them to make other arrangements whereby someone will have it when the elderly person is finished. Very often the elderly person is shoved aside into a little box room and then out. Fortunately, it is not the general standard and I believe we still have a great sense of community and care for elderly people.

The issue of ageism is not being tackled in policies and so on. Bill Cleary covered it. He does not really know what age he is at this stage, which is very good, and to look at him one would not know either. We need to look at the issue of ageism, both up and down as was pointed out. It is very important. It relates to work, what is happening at work and involvement in community and society. One finds it in advertisements, for example, for public service positions. A man brought them to my attention recently. He is 51 and is excluded entirely from jobs that he can do perfectly well, He is as fit as a fiddle and in great health. He could go on working for a long time and he is excluded by the State. That is something well worth examining.

There are many implications to the issue of ageism. We live in a changing society and changes are taking place in the work arena. There is a great deal of part-time work and nobody has the security that these long-term Civil Service pensioners had in their day. Both the situation and challenges are changing. The pensions of the ordinary worker are changing and nobody has said much about it yet. Defined benefit contributions are a thing of the past for anyone in a company or business for occupational pensions. They still exist in the public service and Civil Service and, fortunately, are still there for Deputies. It has been replaced by a defined contribution pension. The pension is defined by one's contributions so age is irrelevant. We must recognise and examine the fact that the basis of the system for ordinary workers is changing.

State pensions are there as a base. There is a problem in that one should not worry about insisting on the share in growth. The elderly are lucky to keep pace with inflation. Everything is growing and we are not keeping pace with the growth. One needs to keep pace with growth in two ways. One should have inflation proofing in pensions so one will share in the growth and have security. One also needs to keep pace with growth in terms of resources. There are many different important resources and they too should share in the growth if people are to be looked after properly.

Housing was mentioned. One of the groups might examine the question of sheltered housing. Dublin Corporation has decided not to have wardens but rather to have mechanical connections and telecommunications link ups. It is a disastrous change and I would be very happy if someone would examine it. It is dehumanising the situation. We talk about fears and perceptions and so on and I believe people will be affected disastrously by it.

The person drawing up the plan thinks it looks efficient but we must look at the totality of the life and surroundings, especially in sheltered housing, which is for people who need support. This is mentioned every so often but someone, perhaps this committee, should look at it comprehensively. I thank the delegations for their contributions.

Chairman: Perhaps we could have a quick response to the comments and questions of Deputies and Senators, starting with the Combat Poverty Agency.

Ms Johnson: There was a range of views on the committee, which reflects the heterogeneity of what we think of as older people, in terms of ages and the celebration of being old. We are concerned with a particularly vulnerable group of older people who may not have the means to support themselves or may become dependent on others. That is not to say the majority of older people do not need that support.

As to the immediate needs of particularly vulnerable people, our main concern is that they should have an adequate income to live on and are able to make choices about what they do. In terms of housing policy, for example, they should be able to live in sheltered accommodation if that is their requirement but there should be other alternatives. That leads on to care in the community, so that people can be supported and enabled to live in their homes, rather than necessarily having to move into institutions. We see that as being an immediate need.

One final point we did not specifically refer to in our presentation was about the elderly in minority groups. We are concerned about such people, particularly in the traveller community. We have not addressed any specific issues under that heading but we have dealt with matters like double disadvantage, meaning that such people are disadvantaged because they are travellers and because they are elderly. We feel such problems should be addressed.

Mr. Murphy: In the future, the range of community services available from the statutory authorities will gradually be reduced because of costs and there will be an increased reliance on voluntary groups. I live in Killester and we calculated recently that in our area alone, the value of the work provided by helpers and volunteers is about £0.5 million in one year and the amount we receive from the health board, apart from payments for meals and home helps, is a few thousand pounds. That is a valuable service and could be increased. I regard our area as fairly good compared with many other districts and there is a need to extend that voluntary service. It is part of official policy for the years ahead and if it could be implemented so that voluntary groups are encouraged, it would meet at least part of the needs for the future.

The other area is housing. Voluntary groups are forced to go to the fringes of Dublin to provide housing at present because sites are bought up by developers in the city area and it is difficult to get a site at a reasonable, affordable cost. If the cost of sites is high, the amounts we receive in Government grants would never cover the total. A range of housing is also necessary. Deputy Woods mentioned wardens, who are needed for certain people, but beyond that there is a need for resident nursing care in certain kinds of housing to bring people a stage further before they need to go to a nursing home.

Mr. Webster: A word of caution; I do not think we have sufficiently consulted older people and the different groups within the elderly population to be sure of some of the trends we are discussing today. In other European countries older people have been consulted and have preferred professional rather than family support. To return to the point about abuse, if an older person and a daughter have no choice about who looks after whom, the daughter who was abused many years ago may be the only form of care for the older person. This is the emphasis on choice. Older people elsewhere have also been consulted about whether they want care in the community or in some form of residential institution and many in the US have opted for residential care. I think we and the committee ought to challenge conventional wisdom quite regularly and the only true way to do this is to consult the people who are at the receiving end of these services.

Mr. White: After my contribution I will give the last word to our secretary, Mr. Carroll. I am encouraged immensely by the level of concern shown by your committee, Chairman. I have met many Members of this committee in different fora over the years. I mentioned at the beginning of the meeting that the council was set up by the Minister for Health in 1981, who was Deputy Woods, so if he was not the father of the National Council for the Elderly he was certainly the midwife.

Deputy Woods: I was very young then.

Mr. White: Very. It would be difficult to address all the issues. One Member asked what our main priority would be. Deputy Walsh mentioned our own ageing but it is not a disease although because we are so concerned about healthy ageing, people listening to us may get that impression. We must promote the concept that the ageing process is from the cradle to the grave, because every age has its own challenges.

As to other priorities, I like Deputy Flood's idea of making statutory provisions and requirements. Mr. Carroll said that having studied the State's various supporting mechanisms for frail older people in the community, the National Council for the Elderly is strongly of the view that certain core services should be available to everyone by statutory right. Examples include home help, meals on wheels and sheltered housing. We would begin with the home help service.

Where housing is concerned, because older people are such a varied group with so many needs, a housing authority must have a variety of responses. At some stage people may prefer individually designed houses but as they become more frail and more in need of services, they may need housing in clusters. We should have an open mind on housing and our response to the issue should be versatile and imaginative.

We have suggested policies to various State agencies for many years.

We find a big jump even when policy is decided upon by the State - and some excellent policies have come from Departments and various State agencies pertaining to the elderly - between policy and practice.

In 1988 the Department of Health brought out a report on policy for the elderly in Ireland. One of the policies suggested was to provide a telephone or radio based alarm to elderly persons living alone and assessed by the district team for the elderly as being at medical or social risk. Did we not hear a replay of that in very recent times? We find a big deficit between policy and practice which will have to be addressed.

Mr. Carroll: The elderly population is very heterogeneous and it is virtually impossible to pick out one issue but we should always look first to those people who cannot defend themselves. They are the most important. Specifically, we are talking about people who are ill on a long term basis, for example with dementia.

We have alluded to a number of changes - changes in life expectancy, increasing numbers of older people. The numbers of some of those groups of vulnerable older people are increasing. the council has also done two other pieces of work which are important in this context. One is that more thought should be given to the economics and financing of long term care. The council has issued a report on that difficult and problematic issue, but we have to address it now while we have a little time on our side. The numbers of the long-term dependent elderly will increase substantially in the not too distant future.

The other matter which is related is that we ran a seminar on dementia services information and development and proposed the need for much more information for older people and their carers. We have recommended that a dementia services information and development centre would be set up. Our submission lists the reasons for it and the requirements of such a centre.

Mr. Martin: Three Deputies referred to the disposal of assets. It is a serious matter which deserves the committee's attention. There was an attempt in Britain for purely commercial reasons for a number of financial institutions to get involved. This involved a selling on of the property to the institution for the protection of the individual in the future. This produced intergenerational problems at a later stage when the person died and the property was secured by the financial institution. It is an important area and it could succeed if there were sufficient statutory requirements and controls around it. As the Deputy suggested, it concerns people; they would like to do it but it causes problems. If there was a scheme it would help.

Deputy Woods made a comment on defining benefit as opposed to defining contribution. The unfortunate thing about that situation which many of us deplored was that this came out of protective legislation - the Pensions Act - which was protecting the position of employees generally. Unfortunately, it has turned things on their head in terms of limiting pension expectation for the non-Civil Service side of things. It is not an ageing thing. It could be to the extent that if one is prepared to start one's pension contributions at a sufficiently early age one should have built up a sufficient nest egg by the time one comes to retire. I appreciate it is a difficult thing to do for any young person.

Deputy Woods: I was trying to say that one will probably build it up in a whole lot of different ways in the future which facilitates different kinds of working.

Mr. Cleary: Deputy Flood referred to putting the role of the voluntary sector on a statutory basis. When Deputy Woods was Minister for Social Welfare he started a voluntary-State partnership. We are still awaiting a White Paper on the matter. Every time I go to see the Minister for Social Welfare I mention it to him. I am told it will be out shortly. A lot hinges on it because it is only in the light of it that we will see where the voluntary sector stands. When that is done and we get the council report on abuse, the statutory and voluntary sectors should get together and set up a help line for the elderly abused.

Deputy Flood also mentioned the segregation of the elderly into communes or housing. We in the Society of St. Vincent De Paul find that is a great success. Bethany House in Sandymount is proof of it. We have 31 people living together there happily. A lot of elderly people want to live together and do not want to have too many children around to annoy them in their old age.

Chairman: You have all given us food for thought in opening up the issues for our consideration. With the agreement of the committee, we will quickly refer your reports to the various Departments and ask them to respond to the items you have raised. We will consider the issues again at a later date.

With the agreement of the committee, we will be recruiting a consultant to help us put together our report on the elderly. An advertisement will appear in the national press shortly - you might bring it to the attention of your members - and from the responses we will select a consultant.

I would refer you to a chapter of the report already published - the impact of State tax and social welfare schemes on the family. We looked at how tax and social welfare affect family units. We brought forward some recommendations some of which relate to the elderly.

I thank the representatives of the four organisations for coming in and giving us the benefit of your expertise. In thanking you we are also thanking the many volunteers around the country in your organisations who, day after day, provide a service to the elderly on a voluntary basis. On the committee's behalf I want to express gratitude to your organisations for your tremendous work. Society could not continue without your efforts. We would like your members to know of our appreciation.

When we have appointed our consultant we hope you will be able to give him or her further information. Thank you attending. We appreciate your help.

The Joint Committee adjourned at 4.30 p.m.

¹ The issues dealt with in this section are explored more fully in Fahey and FitzGerald (forthcoming).

² The 1996 Census showed that net emigration disappeared since 1991. As a result, actual population in 1996 was almost 33,000 (or 1 per cent of total population) greater than the most optimistic projection made by the CSO in 1995 (that based on the low migration, high fertility scenario). The other scenarios used in the 1995 projections produced even lower forecasts of total population in 1996.

³ One factor which has contributed to the slow growth in the elderly population is the lack of improvement in older age mortality. This issue is referred to further in Chapter 5 below.

⁴ These projections were prepared by Peter Connell of Trinity College and are described in detail in Fahey (1995). The assumptions used in disaggregating the projections by marital status were comparatively crude, so that the disaggregations are more prone to error than the aggregated projections (Fahey 1995, pp. 29–30). The same crudeness in assumptions is also present in disaggregations by health board area produced in these projections (see below). Population projections by the CSO do not disaggregate by marital status or region, so we do not have forecasts from that source on these issues.

¹ The seminal work is Arensberg and Kimball's Family and Community in Ireland (1940), a study based on anthropological fieldwork in hinterland of Ennis in Co Clare in the 1930s. This study has inspired a great deal of subsequent work on the stem family, by social historians and sociologists as much as anthropologists (for overviews of this work from different points of view, see Shortall 1991, McCullagh 1991 and Tovey 1992).

² Arensberg and Kimball cite numerous examples of the belittling treatment of adult sons by their fathers, including the refusal to allows sons to carry any cash of their own or the father's insistence of collecting sons' wages when they did some work for the Land Commission (Arensberg and Kimball 1940, p. 53).

³ This syndrome is bleakly evoked in Patrick Kavanagh's often-quoted account of the fate of his sad hero, Patrick Maguire, in The Great Hunger:

Maguire was faithful to death:

He stayed with his mother till she died

At the age of ninety-one.