This issue of Frontline comes at a time of reported over-spends by hospitals in excess of €100 million for the first quarter of 2012. Managing this over-spend is an imperative of the HSE—but at what cost?
As this issue goes to print, there is uncertainty about respite provision. Respite is seen by many families as important for the retention of their psychological wellbeing and general health. A concern for many is whether the HSE’s imperative to control the hospitals’ over-spend will lead to a blunt approach, spreading indiscriminate cost curtailment to community care and other provisions (for example, respite care). It is questionable whether people who make such decisions have a real understanding of the lived experience of caring for someone with a disability, particularly for those who have reduced incomes. It is reasonable, however, to question whether the current model of respite provision is the best fit for parents and the person with ID. If a more innovative non-centre-based provision were in place, could more families benefit? Would that long standing conundrum, those in greatest need very often get the least supports, be finally put to bed? The challenge is not to cut the respite budget, but rather to ask providers to do more through innovation, instead of placing undue reliance on a jaded model of provision
As more and more people with an intellectual disability move into living in the community, it is reasonable to question whether their needs are quantifiably factored into community care budgets. Their need to access GP services, to avail of physiotherapy, chiropody, occupational therapy, mental health services, individual counselling and supports (and other services) will have an impact on many cost centres. If their needs are not seriously factored into primary health care and access to their networks, people with intellectual disability will continue to be prisoners of indifference, even within the models of the rhetoric of inclusion.
This issue has a number of interesting articles, including one from the US by Hope Leet Dittmeier which highlights how people’s lives can be improved through community living, provided proper and appropriate supports are in place.
Healthy living and psychological wellbeing are sides of the same coin and something all of us hope to enjoy. It is about having friends, enjoying activities, making decisions, to share and to receive. It is also about celebrating in the here and now.
There is, of course, the on-going challenge to help people with intellectual disability to live meaningful lives, providing the time to listen carefully to their needs—whether they are recreational, social, work, training, health and psychological well-being. It is about people who provide support in the community knowing how to listen, and with reciprocal respect.