'I'd prefer to stay at home but I don't have a choice': Meeting Older People's Preference for Care: Policy, but what about practice?

Background: Research indicates that most older people would prefer to live in their own homes and have support services provided to enable them to do so for as long as possible (Barry, 2010). However, there is an evident tension between this objective and the promotion of 'ageing in place', with the consequent heavy reliance on the Nursing Home Support Scheme (NHSS) in the Irish context (Donnelly and O¿Loughlin, 2015). This study set out to explore the perspectives and experiences of social workers in Republic of Ireland working with older people to identify issues/barriers in accessing community supports and to examine older people's involvement in decision-making, including those with a cognitive impairment/dementia. Methods: A mixed methods study design was adapted and the study consisted of two phases: Phase 1 consisted of an on-line survey of social workers using Survey Monkey. Phase 2 consisted of in-depth semi-structured telephone interviews with at least two social workers from each Community Health Office area. Results: Geographical inconsistencies were revealed in social workers ability to access community supports and clear tensions were found as home supports are only delivered within the framework of what is available. A growing emphasis on responding only to those with the most severe level of need, coupled with increased budgetary constraints, means that little or no support can be accessed through home help services to assist older people with domestic tasks.Social workers also reported that many older people with a mental health issue and/or dementia were excluded from decision-making processes related to their care. Conclusions: Older people's preference for receiving care and support in their home and community is not being realised often resulting in unnecessary or premature admission to nursing home care.