Crucial discussions will focus on the options facing the State, writes Liam Reid, Political Reporter.
When they sit down around the Cabinet table today to discuss long-term care for the elderly, there will be considerable political nervousness among some ministers.
They will be asked to consider "fundamental policy options" about how the State provides for what will be a burgeoning elderly population.
What the Government hopes to do over the coming weeks is to develop a new approach to caring for the elderly over the next 45 years.
The reforms, championed by the Tánaiste and Minister for Health, Mary Harney, have the potential to inform the public about what services they can expect when they are elderly and what money, if any, they might be asked to contribute.
One option is that some elderly people with limited current income, but holding significant amounts of equity, will be required to contribute towards residential care.
They would not be asked to sell their homes, but they might be asked to choose an equity release programme or to commit to a "deferred payment", whereby the State would be paid from their estate on their death.
The concept has not been arrived at on an ad hoc basis and is the result of research over 12 months by a team of civil servants and advisers.
Ministers have already received a detailed report from the group, which outlines in stark terms that, while care of the elderly is not a problem now, it will become one of the biggest issues facing the State unless it is tackled immediately.
Put simply, the report argues that the Exchequer cannot afford to pay the entire bill for elderly residential care. It estimates that the current cost of such care is €900 million a year, but this figure will mushroom to €6.8 billion per year by 2051.
Some of the options the Government will be examining are not controversial. The first of these is an expanded home-care service. This will not only benefit individuals. It will also benefit the State by keeping people out of costly 24-hour residential care.
The second policy option, again largely non-controversial, is for a standard needs assessment programme whereby the health services will endeavour to find the best fit for people, regardless of their means or their ability to pay.
This contrasts with the current system, whereby elderly people of limited means may not be able to find a public nursing home bed because no places are available, forcing their families to secure costly private care for them.
The system envisaged by the Government will be costly. However - and herein lies the problem - the report argues that the State might meet only 20 per cent of the envisaged €6.8 billion annual bill for care.
The suggested solution lies in untapping the value of people's homes. In this regard, the report notes that the housing stock owned by people aged 65 and over is estimated at between €70 billion and €85 billion.
Sources close to Ms Harney are at pains to point out that this will not mean people will have to sell their homes. Nobody would be denied access to services because of inability to pay.
The "deferred payment" option, which is also being considered, would enable the State to recoup a share of the costs of nursing care after an individual's death.
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