Why does care in the community matter at end of life? The Sláintecare vision of “a universal health system accessible to all on the basis of need” clearly champions integrated care. Prior to Sláintecare the need to shift towards service delivery in the community was well recognised in policy but development of acute and inpatient services continues to garner a large proportion of both resourcing and strategic planning focus. Research, both in Ireland and internationally, consistently notes dying at home as the preferred place of death for the majority of people (approximately 74%). 19 Despite this, hospitals continue to be the place where the greatest proportion of people will die. 20 The reasons for this are wide and complex. As a person approaches end of life, preferences can change as health deteriorates, and needs grow, the realities of providing end-of-life care in the home can be challenging due to the limited resources of healthcare workers and the need for huge levels of investment in time and energy by family and carers. The delivery of community and home care supports is facing ever increasing challenges. Although funding and hours of support provided through the home support scheme have increased in recent years, a statutory scheme has not yet been introduced. There is limited capacity within the existing overstretched primary care network. Waiting lists continue to grow for accessing community supports and there is an alarming number of people who have been assessed but remain without adequate, or indeed any, home supports. According to analysis from the National Doctors Training and Planning, an additional 1,660 GPs will be needed by 2028 to meet demand 21 . To meet this demand, there is a need to increase the number of GP practice teams across the state, at an estimated cost of an additional €100m annually from 2026 22 . The Integrated Care Programme for Older Persons (ICPOP), which was established in 2016, aims to implement integrated services and care pathways for older adults with complex health and social care needs 23 . The ICPOP teams are multi-disciplinary and include physiotherapists, occupational therapists, social workers, pharmacists, speech and language therapists, geriatricians, and case managers. The multi-disciplinary approach means that those with complex needs are responded to quickly in order to keep them well at home and minimise hospital admissions.
19 Irish attitudes to death, dying and bereavement 2004-2014 , J Weafer & Irish Hospice Foundation, 2014 20 Dying and Death in Ireland: What Do We Routinely Measure, How Can We Improve? , S Matthews et al., 2021 21 Demand for Medical Consultants and Specialists to 2028 and The Training Pipeline to Meet Demand , National Doctors Training & Planning, 2020 22 Policy Options to Support Ageing Well at Home , Social Justice Ireland, 2026 23 A practical guide to the local implementation of Integrated Care Programmes for Older Persons , HSE, 2017
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Experiences of Older People at End of Life 2025
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