Barrett Commission Finds Support Gaps, Not Need, Drive Nursing Home Use

The Irish Commission of Care for Older People released its first module report on Friday, concluding that a majority of older adults enter nursing homes due to deficiencies in community support rather than a preference for institutional living. The report, led by Prof. Alan Barrett of the Economic and Social Research Institute, assessed the current healthcare system and found that services remain fragmented and often operate in isolated silos.

Despite recent progress, the document states that the system is struggling to keep pace with an ageing population and changing household structures. The authors note that a rise in single-person households is likely to reduce the availability of unpaid family carers. If the state continues to rely on volunteer-led services without adequate financial support, the report warns, there is a risk of insufficient resources for those volunteers.

The findings arrive as government policy seeks to shift away from institution-led care and allow residents to stay in their communities longer. However, the commission notes that the number of people living with dementia is expected to double over the next 20 years. This demographic shift will place intense pressure on long-term residential centres, prompting the report to call for earlier intervention in dementia risk and better support for patients to live in their chosen locations.

The report identifies the increasing privatisation of care as a major concern. It criticises the lack of integration between private nursing homes and the wider health and social care services. The authors argue that as large institutional providers consolidate, they may further dominate the market. The commission points to international evidence suggesting that increased dominance by private-equity funded providers can reduce both quality and access to care.

Financial structures also face scrutiny. Currently, 25 percent of nursing home support system costs are derived from the resident's own income and assets, with the family home serving as the primary asset used for funding. The report links declining home ownership rates to a potential future drop in the proportion of costs that residents can bear. As more older people live in rented accommodation, the traditional funding model for the Fair Deal scheme may weaken.

The commission also raised alarms about short-stay residential care, describing it as potentially harmful. It argues that short stays can contribute to inappropriate institutionalisation and draw the system back toward an institutional mindset for individuals who primarily require rehabilitation. Module two of the commission's work, which will develop a strategic and costed care framework, is scheduled for publication next year.