Dementia is a disorder which takes a terrible toll on patients and families. In the disorder, there is a progressive loss of memory and intellectual abilities. The personality and behaviour can be affected and loved ones, by degrees, lose aspects of the person they previously knew.
In the great majority of cases, dementia can be treated at home or in nursing homes but in some the disorder may be associated with uncontrollable wandering and over-activity or even aggression or psychosis.
As people in general are living much longer, sadly the number of people suffering from dementia is increasing as the incidence increases with age.
Roscommon has one of the highest proportions of elderly people of any county in Ireland and therefore its needs for dementia care are a lot greater than most.
As I have described, the great majority of cases are treated in the community, in their homes, or in nursing homes, but a significant proportion of those with behavioural disturbances as described above, need specialist units with trained psychiatric nurses who can deal therapeutically with the over-activity, aggression or psychosis that occurs in this group.
Patients with these problems are treated in the Rosalie Unit in Castlerea, which is part of the psychiatric services. The unit is held in high regard and has dedicated nursing staff, a multidisciplinary team and a Psychiatrist of the Elderly serving its residents.
The atmosphere is bright and therapeutic and the patients receive excellent care. Going forward, there will be an increasing demand for the Rosalie Unit because of the increasing number of patients with dementia with behavioural problems.
The old age team covers an area extending from Tuam through all of Co. Roscommon and extending down as far as Athlone. It therefore will be providing care for this group of patients from a wide area comprising a population of approximately 100,000.
Any move to phase out the Rosalie Unit would, I believe, be unwise. Vision for Change, which is the guiding policy document for psychiatric services in Ireland, stipulates that there should be 30 places in such long-term residential units for dementia patients with behavioural disturbances for a population of 300,000 – that is the population of Galway/Roscommon.
At present, there is only one other unit, the CNU in Ballinasloe, with 15 beds. If the Rosalie Unit is closed, the total number of beds would be half of what is recommended for that population.
Because Roscommon has one of the highest proportions of elderly in the country, it also makes it a logical choice for location of such a unit. The new planning document for services for the elderly in Ireland recommends there should be an even higher number of beds than the 30 described above if there is a high elderly population, as we have.
Any proposal to phase out the Rosalie Unit therefore baffles me. I believe we need to think long-term. The Rosalie Unit provides sufficient beds for patients with dementia and behavioural problems.
Such patients will now be placed in nursing homes, where they will not have the expertise of psychiatrically trained staff that they need. This can result in them being placed on higher doses of medication than would be required in a more appropriate and open environment. This can decrease the quality of their lives.
At present moves are being considered to phase out the unit. Managers from nursing homes have even been brought in to select which patients they would take. I believe it would be a tragic loss to lose this invaluable facility.
This group of patients is one of the most vulnerable, largely being unable to speak for themselves or express their grief at the idea of being taken from the unit which has been their home, often for many years.
New patients who are being diagnosed with this type of dementia and who need a facility like this will have nowhere appropriate to go from now on if the facility is closed. I hope there will be a change of heart in the best interests of this vulnerable patient group.