The HSE's Noel Mulvihill says the Ombudsman's criticism is out of date and standards in long- term care have much improved since 2005, writes JAMIE SMYTH,Social Affairs Correspondent
OMBUDSMAN EMILY O’Reilly’s criticism of the national system for providing long-term care to older people is out of date and does not take into account recent reforms, according to Noel Mulvihill, HSE assistant national director for older persons.
Mulvihill, who was appointed last October to overhaul the HSE’s delivery of services to older people, says older people get a far more consistent and higher standard of care now following a radical re-orientation of HSE services since 2005.
“Historically yes, with separate entities and 10 different health boards prior to 2005 things were done in different ways. Now we are working in a uniform and singular fashion and we have brought in mechanisms to reflect that such as the subvention system in 2007 and the Fair Deal in 2009,” he says.
Since an RTÉ investigation uncovered “systematic abuse” at the Leas Cross nursing home in 2005, Mulvihill says “huge changes” have been introduced that have re-oriented care services for the elderly.
Key changes include the introduction of an inspection regime by the Health Information and Quality Authority (Hiqa) and the development of integrated services across Ireland, he says.
Last month O’Reilly said an investigation by her office showed systems to provide long-term care for the elderly were “largely chaotic”, with people confused about rights and entitlements and subject to years of stress and crippling expense.
A draft of her report on long-term care for the elderly has been sent to the HSE prior to publication. The HSE will provide its response to the Ombudsman’s criticisms in writing later this month, says Mulvihill.
“Given the history of the [health] system there will be anomalies there. But the elderly people I deal with on a day-to-day basis are very clear on what their entitlements are and how they can access the system and use it appropriately,” he says.
Mulvihill cites the implementation of the Fair Deal – a system to provide financial support for people assessed as needing long-term nursing home care – as a major success last year.
“Rather than having multiple systems of funding for long-stay care there is now one system. So from 50 years of age you can now begin to plan what you will do in the future. You know it will cost you 80 per cent of your income and 5 per cent of your assets for a three-year period.”
He says the new system is working well after experiencing some initial teething problems.
“To date we have 13,000 applications for Fair Deal, 9,000 of them approved so far and just over 100 refusals. The average processing time is between four and six weeks,” he says.
An extra €152 million was allocated to the Fair Deal scheme in 2010 to get it off the ground. The HSE is on target to spend the full allocation. But it is not expected that the money will run out forcing older people onto waiting lists before they can access funding for nursing home care, says Mulvihill.
The HSE has adapted to meet early problems, for example, by making staff available to help patients with the 14-page Fair Deal application forms in hospitals. It has also centralised applications for the Home Loan element in the Fair Deal scheme in Tullamore to help staff deal with the complex assessment required.
The Home Loan scheme is an option for people who cannot make a 5 per cent annual charge on their assets, so instead agree for payment to be made from the proceeds of the sale of their home once they die.
So far the scheme has attracted 2,000 applications, which is lower than initially anticipated, according to Mulvihill.
Refusal rates for the Fair Deal scheme are very low, occurring only when a medical assessment considers a person can be supported in their home. However, one of the key long-term goals of the HSE is to enable more older people to be cared for in their home rather than in residential units in the future.
“Currently 4.5 per cent of the over-65 population stay in long-term care. That particular figure I would like to see reduced. Some of our European colleagues have this at 3 per cent. There will be double the number of over 65 year olds in 20 years’ time and so we need to re-orient ourselves to need less residential care. We need to expand home care and that is our challenge,” says Mulvihill.
The HSE currently provides 55,000 people with home help and 13,000 people with home care services, which offer more intensive support in homes. But there are major inconsistencies in how the service is delivered in different regions.
For example, some local areas still means test applicants while voluntary contributions are a feature in others, according to Mulvihill.
“Standards are not what I would like them to be in some parts of the country and, as a result of that, we are introducing new national standards for the home care area. These will break down what household chores and personal care should be,” says Mulvihill, who hopes to implement the new standards within the next four months.
The Department of Health must still consider the correct way to regulate the new standards and evaluate the cost of implementation, he says.
Perhaps the biggest challenge facing the HSE in delivering services to older people lies in the physical state of its residential nursing homes. Hiqa has found 60 per cent of residential units are unfit for purpose and Mulvihill estimates 75 of its 150 homes will need to be replaced within the next six years. He says public private partnerships are the answer to supplement State funding, which will not be able to fill the void.
But he insists O’Reilly’s claim that there is a move to privatise the delivery of older people’s services is not true.
“At the moment we have 600 residential units – 150 of those are public and 450 are private. I strongly advocate that we need to retain that mix. Obviously the private sector won’t go to areas where it is not commercially viable,” he says.
Another key challenge is the ongoing recruitment moratorium, which has prevented the replacement of 250 of the 4,461 nursing staff in residential units. “In some critical areas we have replaced this through agency staff and overtime but as budgets become more challenging that will be impacted on,” he says.
Mulvihill says budget estimates for 2011 are only at an early stage. “I’ll be a strong advocate for ensuring continuity of provision – we can always bring in efficiencies,” he says.