ANALYSIS: A system in which money follows patients puts care at risk when public funding runs out
EARLY IN October 2009, three weeks before the Fair Deal system of financial support for nursing homes came into operation, the Department of Health and former minister for Health Mary Harney issued a statement about the new scheme.
“Its fundamental purpose is to make long-term nursing home care accessible, affordable and anxiety-free,” it said.
Harney said it would stop young families having to remortgage their homes to pay for nursing home care for elderly parents; and, under the scheme, elderly people would no longer need to worry about not having anyone to care for them when they could no longer look after themselves. They could enter a nursing home under the Fair Deal scheme and pay no more than 80 per cent of their disposable income towards the cost of their care. The cost of care could even be deferred until after death.
The scheme was wonderful in certain ways but there was concern from the start that because the system was budget- capped by law the money provided for it would eventually run out.
This has now happened, in only the second full year of operation of the scheme. This week the Health Service Executive said the €1 billion set aside for the scheme this year will be sufficient to cater only for the 22,000-plus people already in the scheme.
Older people who need nursing home care will, therefore, now have to go on a waiting list for a bed. A person on the waiting list will get a place only if somebody already in care dies or if the person waiting has sufficient resources to pay the full cost of care themselves.
This hardly makes accessing nursing home care by the country’s elderly and frail citizens anxiety-free and affordable, which was the stated fundamental purpose of the scheme.
In last December’s budget, Harney allocated a further €6 million to Fair Deal this year, at a time when nearly €1 billion was being cut from health spending. This allocation was, as we now know, a gross underestimate of the funding required to run the scheme this year.
How could that happen? Is it that somebody in the HSE or the Department of Health got the calculations wrong? Is it like the debacle with the over-70s’ medical cards, which ended up costing €50 million more than envisaged when they were made available to all older people in 2001 without anyone knowing how many were likely to benefit?
Is it that those in charge put their heads in the sand and ploughed on with the scheme regardless of its flaws because it was something Harney insisted on being implemented? Or was the problem spotted in recent months and ignored because an election was pending and a new administration would have to pick up the pieces?
There are no clear answers to any of these questions yet but Minister for Health James Reilly manifestly will have to find more money for the scheme if hospitals are not to become jammed with older patients ready for discharge.
Reilly has been left to clear up after the detonation of what is likely to be the first of many landmines to go off during his time in the department characterised as “Angola”. What is likely to be of most concern to his team, however, is that Fair Deal was a scheme in which money followed the patient – but only until the money ran out.
Reilly wants money to follow patients in our hospitals but he has a limited budget, one that will probably shrink in coming years.
One wonders whether, when his system of money following the patient is implemented in relation to hospitals, what happened with Fair Deal will happen to them too. If it does, many more patients will end up on hospital waiting lists.