The nursing home mess

THE PRIVATISATION of the nursing home system is happening even faster than the transformation of hospital services, but has attracted little public debate. It would appear that care of the elderly is an embarrassing reality we wish to avoid. Concerns expressed to the Government about policy decisions, by groups representing older people, have been largely ignored. Now we have a situation where promised legislation and a new funding system that was to have been introduced last January may be further delayed.

There are understandable concerns about rising nursing home charges, particularly for those families that have to pay all or a portion of the cost of keeping an ageing parent in care. At the core of the issue is a long-standing government decision to abandon its responsibility to provide free health care for citizens in their old age. At first, incremental charges were imposed for public services. Then it introduced tax incentives to encourage the construction of private nursing homes. The result is that two-thirds of nursing home beds are now privately owned. But there are shortages where beds are most needed, along the east coast.

Details of a so-called "fair deal" Bill were announced by Minister for Health Mary Harney in 2006. This would involve people in long-term care paying 80 per cent of their income for nursing services and, where there was a shortfall, a maximum of 15 per cent of the value of their homes would be deducted from estates. The State would pay the balance. Significant difficulties have been experienced in drafting this legislation, however, and it is unlikely to become law before the summer recess.

As might be expected, the main body representing private nursing homes has been urging Government action and higher fees. A survey of members of Nursing Homes Ireland found that staff costs were rising rapidly. The great majority of their patients fell into medium or high dependence categories and one-third were diagnosed with dementia.

Uncertainty is impacting on the families of nursing home residents. Maximum State subvention now stands at €300 a week for those lucky enough to qualify. And while it falls far short of the charges being imposed, it does amount to about 50 per cent of the income of private nursing homes. Funding for the proposed Government scheme was made available to the Health Service Executive at the beginning of this year but because of delays, that money is now being diverted to other purposes. It is a terrible mess.

© 2008 The Irish Times

This article appears in the print edition of the Irish Times