COVID-19: the Irish context

The Republic of Ireland has a population of just under 5 million people. The percentage of people over age 65 years is approximately 20% (CSO, 2016). Ireland has directed that all citizens over 70 years of age should “cocoon” and should not leave their homes and should minimize all non-essential contact with other members of their household (Department of Health, 2020a). Similar to many other countries, Ireland has experienced the now familiar effects of COVID-19, in that (i) it affects mostly older people and those with underlying medical conditions, (ii) there are significant clusters of the virus in nursing homes, (iii) there is a lack of testing facilities, and (iv) there has been a veritable scramble to get adequate supplies of personal protective equipment (PPE). Nursing homes have had great difficulty securing such PPEs and other necessary equipment. Maintaining staffing levels are a continuing cause of concern.

On the positive side, a significant effort has been made by government with the support of all politicians, health and social care authorities, frontline workers and the general public to combat the spread of the virus. A “lockdown” was initiated in mid-March 2020 and at the time of writing, this has been adhered to by the public. Thankfully, the health service has managed to cope with the numbers of people requiring critical medical care.

Social work with older people in Ireland: the pre-COVID-19 context of practice

Legislation and service provision for older people in Ireland have been given low priority until recent years which, it could be reasoned, is reflective of the systemic and legislative discrimination (Donnelly and O’Loughlin, Reference Donnelly, O’Loughlin, Christie, Featherstone, Quin and Walsh2015). Recently, however, there are indications that aging is beginning to be constructed in a more positive framework and older people are now almost universally perceived as a deserving group who are entitled to better quality and increased resourcing of services and support from the State (Scharf et al., Reference Scharf, Timonen, Carney and Conlon2013).

In Ireland, social workers have a key role in the care of older people. They work in general health and mental health and social care settings within the hospital, community, and residential and palliative care sectors. The largest number of such social workers are based in the acute general hospital setting. Significantly, social workers in Ireland and across Europe regularly work with people, families, and/or groups who are in crisis. They work in the gray areas of confusion, uncertainty, and doubt (Jordan, Reference Jordan2000) – nouns that can aptly fit the COVID-19 context very well.

Within the context of COVID-19 in Ireland, it should be noted that while social workers are employed in public residential care units, they are rarely employed in the nursing homes which are primarily run by the private sector. Social workers engaging with the general population of older people work with people presenting with a range of issues including mental health needs. Increasingly, social workers are likely to work with those older people who experience poverty, ill-health, depression, dementia, substance abuse, or those with unresolved traumas from previous years (Phillips and Ray, Reference Phillips and Ray2012). Issues of loss and grief are regularly to the fore in such situations. Working with the whole system including families and informal carers is also a key aspect of the work. There are also a subset of social workers working in specific psychiatric settings.

Social work in mental health services/psychiatry

The types of mental health difficulties manifest in older people in Ireland are similar to that found elsewhere in the world. Older people with mental health difficulties can present with anxiety and depression, dementia-related behaviors, and problems arising from alcohol misuse; a smaller cohort of older people can present with late-onset psychosis or schizophrenic type conditions. The social workers in the specialist mental health subset are based in community mental health teams and in acute psychiatric hospital and residential care settings. A further subset comprises social workers working on psychiatry of later life teams.

The precise mental health social work role on the older persons’ mental health teams is significantly a family-focused role. A large part of the support/intervention is in relation to family support, especially concerning persons with cognitive impairment, such as dementia. Interventions will vary depending on the underlying mental health difficulty.

What has changed?

The COVID-19 pandemic has exacerbated many issues for older people and their carers, while throwing up new difficulties, particularly an increase in mental health difficulties (Galwa et al., Reference Galwa, Raina and Lurie2020). Ageism, human rights, social justice, and ethical dilemmas form a backdrop to, for example, experiences of illness, death and dying, grief and loss, isolation, and safety concerns. Additionally, there is a reduction in formal support from service providers during these unprecedented times. For older people generally, COVID-19 has hugely challenged their opportunities to exercise self-determination in realizing their own well-being. For example, older people who are vulnerable because of a mental health problem may be further excluded from decision-making about their own care needs or plans. Given the underlying levels of ageism in society in Ireland and elsewhere, social justice was a key issue in pre COVID-19 times at both the individual and policy levels. However, such concerns have been exacerbated even further by the present extraordinary circumstances resulting from COVID-19.

Lessons from the experience – Ireland and Europe

As mentioned above, social workers work regularly with individuals and families in crisis situations, so dealing with complex situations is part of daily professional life. This has stood them in good stead in this current crisis, even though it is unprecedented. Social workers are in the frontline in Ireland and across Europe and further afield in supporting older people emotionally and practically to maintain their mental health. This pandemic gives us an opportunity to explore new ways of communicating and offering care to older people.

One of the key issues learned is the need to refocus policy toward the provision of health and social protection services that are comprehensive, integrated, accessible to, and affordable for all. From a European perspective, a greater emphasis must be given to social priorities to balance what have been the dominant economic priorities in European Union policies. This would help to protect the economic and social rights of older people generally and for those with enduring mental illness. The high incidence of and death rates from COVID-19 in nursing homes should be the catalyst for an examination of how we can meaningfully address both societal ageism and the stigma associated with mental health problems.

Responses to the pandemic have shown the similarities between problems in different countries and that we can learn much from each other. In this regard, preparations for a future pandemic must be undertaken so that there is sufficient PPE for professionals to do their jobs safely. It should also be recognized too that staff can have the same anxieties as the people they are attempting to assist. Social workers and other frontline staff must be supported and have opportunities to debrief through good self-care and organizational support strategies.

It is clear that the COVID-19 crisis has thrown up particular challenges in the care of older people with mental illness. It is important to remember that the term crisis refers to change and or opportunity, so change is an important aspect of crisis (Loughran, Reference Loughran2011). We hope therefore that as we transition to a new normal, that we take this unique opportunity to call for the setting up integrated, person-centered long-term care systems in each country (WHO, 2020) which promote human rights prioritize each person’s needs and provide the necessary resources and support to enable all older people with mental illness to age well.