The Sustainability of Long-Term Care in Ireland

Introduction: With Ireland's older population among the fastest-growing in Europe, a sustainable long-term care (LTC) sector that meets the needs of this growing demographic is a crucial policy objective. Recent years have seen significant changes within the LTC sector, especially since the onset of Covid-19, with a rapid shift towards private provision of home support and residential care, and an increased reliance on a small number of large providers, potentially challenging the ability of the sector to meet the needs of those who require care and support in the medium-term. Objective: This study assesses the current state of Ireland's LTC, focusing on provision, funding, and integration of care to provide an approach to inform future policies for supply, regulation, and funding management within the LTC sector. Methods: We use a mix of quantitative analysis from Ireland and qualitative evidence from research on the sustainability of LTC in Ireland and internationally. First, we construct a comprehensive, multi-component database on LTC and home support supply in Ireland for 2022. Second, we identify key themes and insights from the literature on the organisation of LTC to ensure its sustainability. Results: Our findings reveal pronounced regional inequalities in home support and residential care supply in Ireland. There is also evidence of increased reliance on the private sector in LTC provision, and a consolidation of service provisions among large care providers in particular parts of the country. Additionally, we identify the fragmented funding of the main State funding measures as a potential barrier to sustainable service delivery. Evidence from the international literature highlights the need to better incorporate person-centered funding and align services provided with the person’s specific care and support needs. Improved integration of funding across services can also facilitate care in more appropriate settings, including at home. Conclusions: The State's role in Irish LTC has evolved to focus primarily on funding and regulatory oversight. This shift implies that the willingness of the private sector to engage in care delivery, alongside geographic service distribution, emerges as critical issues for policymakers. It is imperative to explore funding models that match funding to persons’ care needs, prioritise integrated care delivery, and ensure high-quality care and support is provided to regions and populations that need it most.