The announcement last week that the Government is to save €85 million by deferring the introduction of the 'Fair Deal' nursing home support scheme came as a blow to families crippled by the cost of caring for their loved ones, writes Caroline Madden
IF A society can be judged by how it treats its most vulnerable citizens, then the recent Government cutbacks are a sorry reflection on Ireland's priorities. Bearing the brunt of the spending cuts are elderly people in need of long-term care, and their hard-pressed families.
The announcement last week that €85 million is to be saved by deferring the introduction of the "Fair Deal" nursing home support scheme came as a blow to many families who were banking on the new system throwing them a much-needed lifeline.
Under the proposed Fair Deal scheme, anyone in need of nursing home care would pay 80 per cent of their disposable income towards the costs, and could be charged up to 15 per cent of the value of their home and assets after their death. The State would pay the balance.
The idea is that older people would no longer be forced to sell or mortgage their home during their lifetime, while their relatives would not have to subsidise care costs.
Unveiled in December 2006, the scheme was due to be introduced in January 2008 but became mired in legislative difficulties. Even if these issues are resolved this year, the new system will not be implemented until 2009, a delay advocacy groups say will impose unnecessary hardship on elderly people and their families.
"It's a big, big blow to families who had not alone anticipated it coming, but . . . had made provisions based on the Fair Deal," says Tadhg Daly of Nursing Homes Ireland (NHI), which represents the private and voluntary nursing home sector.
Even though the scheme had attracted its fair share of criticism, many families were depending on it coming in this year. "We've been getting calls for the last seven months asking when the Fair Deal is coming in," says Gerard Scully of Age Action.
"People thought they could cover the cost [of nursing home care] for a while, but that Fair Deal would backdate them and they would get the money back.
"What's happened now is that it's not going through this year - the money has been taken back, and there's no more talk about backdating it, so people have had a double-whammy."
Until now, it was understood that the provisions of the scheme would be applied retrospectively to January 1st, 2008, so people would not be financially disadvantaged by the delay in its introduction. When asked for clarification as to whether this is still the case, the Department of Health was vague in its response: "The issue of retrospection [backdating State support] will be a matter for Government when it considers the draft [Fair Deal] Bill. The Minister [for Health, Mary Harney] has said she is confident the Bill will be ready in time to be debated as soon as the Dáil resumes after the current recess."
A total of €110 million had been earmarked for Fair Deal expenditure this year, but the delay in implementing the scheme made it a sitting duck for Government cutbacks, and €85 million of this budget has now been cut.
"They saw this money lying there doing nothing, and they saw it was easy then to take it back - it's not actually cutting a programme," says Scully.
"What we would argue is that the €85 million could easily be spent on homecare packages in the community, on keeping people out of nursing homes this year."
For the time being, elderly people who do not qualify for a public nursing home bed must make do with the existing subvention system, which Daly describes as unsustainable, unfair and "quite discriminatory".
The weekly subvention stands at a maximum of €300, compared to the average weekly cost of €778 for a private nursing home room, with some Dublin residents paying as much as €1,330 a week.
One problem with the current system is that subvention payments vary greatly depending on location.
"We have cases across the country where you have two people in the same nursing home and just because they're from different parts of the country they're on different levels of State support," says Daly.
"The current system is a shambles."
The Health Service Executive (HSE) has the discretion to grant an enhanced or "top-up" subvention in certain cases.
According to Age Action, of the €110 million originally allocated to the Fair Deal scheme, some €12 million has been diverted to improving the enhanced subvention provision, but whether this will have much impact remains to be seen.
The top-up subvention scheme in Co Mayo has already been suspended this year for new applicants.
According to the western branch of the HSE, anyone currently benefiting from this scheme will continue to do so, but "resources will not permit any additional clients to this scheme at this time".
So how do people make up the shortfall between what little State support they receive and the sky-high cost of long-term care? "A lot of the time, it's from the savings of the older person," says Scully.
"If the older person had a good job and saved during their life a lot of those savings, or investments like shares, would be used to pay for the nursing home care. After that money is gone, it generally falls back on the family to pay the nursing home fee, or the [older person's] house has to be sold."
"There is no certainty as to how long one's loved one is going to remain in a nursing home, so even with the best-laid plans many families are often resorting to loans," says the NHI's Daly.
In some cases elderly people need residential care, but many would thrive at home if sufficient community care was available. "All the research has shown that older people prefer to live at home and in the community for as long as possible," says Scully.
Unfortunately, however, the lack of investment in community care means this is not always possible.
"Even though the Government has said its policy is to encourage and support people who live in the community rather than in nursing homes, it spends more money on people in the nursing homes," Scully continues. "The lack of money and investment in community care is driving people into nursing homes, which is the more expensive solution."
For families struggling to bridge the gap between a family member's income and their nursing home bill, a modicum of relief is available. Tax relief for nursing home fees paid on behalf of a relative can be claimed at the person's higher rate of tax, and can ease the financial burden.
Unfortunately, though, families will have to wait until 2009 at the earliest for a complete reprieve from the crippling cost of caring for loved ones.
Main points: the 'Fair Deal' scheme
What exactly is the "Fair Deal" scheme?
The Fair Deal scheme was designed to support older people in need of long-term nursing home care and was due to replace the existing subvention scheme, which is widely considered to be unfair and inconsistent.
A total of €110 million was allocated to the scheme for 2008.
The scheme would require all nursing home patients to contribute to their care according to their means. In some cases, part of the cost would be recouped from their estates after they die.
What's the delay?
The Fair Deal scheme was unveiled in December 2006 and was due to come into force on January 1st, 2008. However, its introduction has been delayed due to uncertainty over its legality.
As part of Government cutbacks, implementation of the scheme has now been deferred to 2009.
What will happen to the €110 million earmarked for the scheme?
€85 million will be "saved" by deferring the scheme until 2009.
€13 million is being diverted to the provision of "contract beds".
€12 million is being reallocated to improving the enhanced subvention provision for residents in private nursing homes.
Case study: the cost of care
WHEN KERRYWOMAN Paula* was told the heartbreaking news last year that both her mother (75) and father (77) needed 24-hour residential care on medical grounds, she found some solace in the fact that they were able to move to a beautiful, well-staffed private nursing home together.
This type of care doesn't come cheap though, and the monthly bill is € 3,000 per person. Both parents qualify for an enhanced monthly subvention from the Health Service Executive (HSE) of €1,877 but, even after factoring in their pensions, there is a shortfall of about €1,600 every month.
Paula and her three siblings simply don't have this kind of money at their disposal. They now find themselves in the unenviable position of owing €13,000 to the nursing home.
They were counting on the introduction of the Fair Deal scheme in January 2008, as they would no longer have had to bridge the gap between their parents' income and care costs.
Paula had calculated that they would owe €9,000 at that stage and hoped they would find some way of paying this off. But January rolled around and the scheme failed to materialise, and their debt kept mounting.
"We really had our hopes pinned on the Fair Deal coming through. We didn't panic, but we're panicking now," she says.
The siblings are now looking into getting a loan to pay off the existing debt, and they are planning on getting in touch with the HSE to see if there will be any extra relief available to alleviate the deferral of the Fair Deal scheme.
Fortunately the nursing home has been understanding so far, but unless some additional financial support is provided to Paula's family - and the many other families around the State facing the same predicament - it will become harder for them to escape the cycle of debt.
* Not her real name
