The Government's "fair deal" to finance nursing home care is mired in confusion and uncertainty, writes Carl O'Brien, Social Affairs Correspondent
IN DUBLIN'S Cherry Orchard, families of about 100 older people with Alzheimer's are being forced to care for their relatives at home due to the closure of respite beds. In Cavan, dozens of older people and their families aren't able to get extra subvention for nursing home care anymore.
Across the State, there are families who have used up their savings on fees for nursing homes, assuming a new system of Government support would be in force by now.
It was never meant to be like this. A year and a half ago, the Government announced details of its "fair deal" scheme to finance nursing home care. It was hailed as a vastly improved system which would ease the burden on families who have been forced to sell or re-mortgage homes to pay for nursing home care.
It would be a transparent system of support towards the cost of care that would be fair to all, irrespective of whether they were in public or private nursing homes. Above all, it would give certainty at a time when older people and their families are crippled by questions over the future.
But the repeated delays and rising concerns over the viability of the scheme have created even more uncertainty for patients and their relatives.
Significant legal obstacles have hindered the drafting of the legislation, which was originally due to be published last January. And as the Dáil prepares to gear down for its summer recess, there is still no indication of when the plans will come into effect.
The Department of Health says the legislation is now in its 12th draft and is being finalised by the Office of the Attorney General. It says it hopes to publish the bill "soon", although it has repeated the same statement on several occasions in recent months.
"The delays in publishing the legislation are of considerable concern to older people and their families, who are trying to make financial arrangements for their care," says Age Action's head of advocacy and communications, Eamon Timmins.
"They are also bound to cause funding problems for the HSE, especially when it comes to funding subvention for new nursing home residents and contracting public beds in private homes."
There is little doubt, however, that a new system is urgently needed. The current system of subvention for those in private nursing home care and public beds is not fair or equitable.
Maximum State subvention for nursing home care stands at about €300 a week for those lucky enough to get it. However, this falls well short of the charges being imposed.
Latest figures show that the average weekly cost of long-stay private care rose by 12 per cent last year, to €778. However, this masks huge variations in the cost of care, with residents of homes around Dublin paying up to €1,330 per week. Enhanced subvention is available in some areas, but it is on a discretionary basis and there is no transparency on who is allowed subvention and who is not.
As for public beds, the process by which people are eligible has always been murky, resulting in older people of significant financial means occupying beds which should be available for those without.
However, even as the current system worsens, many are beginning to ask whether the fair deal is really as fair as is being made out.
At the core of the issue is a long-standing Government decision to abandon its responsibility to provide free healthcare for citizens in old age.
The new scheme will erode the entitlement to State-funded long-term care in public nursing homes through the State's proposed claim to a proportion of all disposable income, as well as up to 15 per cent of the estate after death.
Groups such as the Irish Senior Citizen's Parliament point out that this appears to be a selective inheritance tax on health services for stroke and dementia, given that no other form of public healthcare currently involves a charge after death.
There is also rising concern among advocates for older people that many thousands may be caught between the gap created by the new legislation.
For example, they may not qualify under the dependency test for a bed, but cannot live independently in their own homes because of inadequate community care. In addition, the current subvention system will have ended under the new scheme, potentially leaving families stranded.
There is also a lack of clarity regarding entitlements to free care for medical card holders. For example, an older person may be forced to contribute through the fair deal scheme for services they are entitled to as a medical card holder, such as occupational therapy, GP cover, etc.
The only official comment from Minister for Health Mary Harney has been that the drafting of the legislation has proved "incredibly complex" and that she hopes that it will be published soon. However, it is questionable whether the legislation will be enacted at all this year.
Already the Department has authorised the HSE to begin spending some of the €110 million which was set aside for implementing the "fair deal" on other health spending, such as respite beds. A parliamentary question answered recently by the Minister does not rule out diverting the remainder of this money on other purposes.
The Minister for Health has at least tried to genuinely come up with an imaginative solution to a regime that is unfair and unsustainable in the long run.
But the premature decision to announce the details before legal issues were adequately ironed out, or to consult properly with groups representing older people, has dealt the scheme a massive blow before it is even published.
With nursing home beds in short supply in many parts of the State, and costs inexorably on the rise, the public - and especially nursing home residents and their hard-pressed families - deserve to know what the status of the Government's plan is, and whether it will see the light of day any time soon.
Fair deal: what is it?
Under the "fair deal", people will pay a maximum of 80 per cent of their disposable income towards their nursing home care during their lifetime, and the State will pay the balance. An extra contribution of up to 15 per cent of the value of their principal residence will be deducted from the person's estate after their death. They will not pay more than the cost of their care. For the spouse of the older person in care and certain dependants living at home, the charge will be deferred during their lifetime. All new nursing home residents will be dependency- and means-tested if they opt for the voluntary scheme.
Government officials say the changes mean people will no longer be forced to sell their home during their lifetime, while relatives of older people will not have to help pay for care costs.
However, advocacy groups say the scheme discriminates against older people as it represents a new form of payment for health services that will only target the elderly.