Reilly plans fund for elderly care in the home

THE DEPARTMENT of Health is asking the Health Service Executive to establish a special fund to pay for services and facilities that would allow more older people to remain in their own homes rather than being moved to long-term residential care.

The special delivery unit in the Department of Health, established by Minister for Health James Reilly earlier this year, has written to the HSE requesting that the new fund be set up in 2012 “to provide for a range of intermediate options so that more older persons can be empowered to remain at home or to return home after convalescence”.

The department said yesterday the size of the fund had yet to be determined.

However, it said that among the measures the fund would look at would be elderly admissions units, specialised elderly care streams in hospitals, rapid access to assisted discharge packages such as home aids, home care packages, fast access to step-down rehabilitation and rapid re-entry to acute hospital services if needed.

However, money for the fund would have to come from existing HSE resources.

The department said work was underway to identify the multiple sources from which funding should be re-allocated to go into the fund.

Dr Reilly has said he is “most keen” for the development to be progressed. He said many people were currently assessed for their nursing home care while in acute hospitals where they were still ill.

“This is not appropriate. They should be assessed in an intermediate care facility while undergoing rehabilitation where a much clearer idea of their status will become apparent.”

The Minister said: “People should be allowed to stay at home for as long as possible, in their communities surrounded by their families. I don’t know of anyone who wishes to be in a long-term nursing home sooner than they need to be.”

It is understood that a recent audit of almost 1,200 common summary assessment reports on older people carried out by the HSE found that in 93 per cent of cases the patient was recommended for long-term residential care.

However, the HSE audit found that in 40 per cent of the cases it was clear the individual had not been considered for a home care package. In a further 40 per cent of cases it was not clear if the individual had been considered for a home care package.

The HSE audit also found that in 16 per cent of cases where people had been placed in long-term care they were described as having “low” dependency levels while in 29 per cent of cases the dependency level was described as “medium”.

Department sources said yesterday the “Fair Deal” or nursing home support scheme was intended to benefit persons of the highest dependency.

Since his appointment Dr Reilly has repeatedly expressed his concern that too many older persons, who did not need to be there, were being placed in long-term residential care.

He has also maintained that the State should move to give greater certainty that older persons are empowered to remain in their home for as long as they would wish to do so.

However, the proposals for the fund to keep as many older people as possible in their own homes comes at a time when large numbers of public nursing home beds are under threat of closure as a result of budget cuts, the staffing moratorium and new HIQA standards.

The Minister has suggested that smaller community nursing units with fewer than 50 places are vulnerable.

It also comes just months after the Fair Deal scheme ran into funding problems.

In a recent letter to the HSE, the chief operating officer of the new special delivery unit Tony O’Brien made reference to a meeting “to discuss a proposal to earmark a fund in 2012 from existing resources to more flexibly and appropriately address the needs of older persons in the acute hospital and community sectors”. He said the meeting agreed that the “proposal needed to be developed as speedily as possible”.