YESTERDAY SAW THE publication of a large scale study focusing on the lived experiences of older people in Ireland’s nursing homes.
It found overwhelmingly that Ireland’s older generation wants to be more involved in the decision-making around where and how they spend their final years. The options for most, however, are limited according to those who work with, care for and represent them – and money is one of the key barriers.
Many will opt into the HSE’s Fair Deal scheme, which requires the person to hand over 80% of their income to cover a nursing home placement for the rest of their lives.
Sean Moynihan, CEO of Alone – an organisation which supports older people who remain in their own homes – commented that “in no other part of the healthcare system would a person have to contribute that much”.
You’re giving up a percentage of your housing and your pension income. You’ve paid tax, you’ve lived this long and now that you need support you’re going to have to pay for it. Some people see a pension as a social welfare payment, but if you are to get the full contributory pension of €232 per week you have to have 40 years of stamps. We have to ask ourselves: ‘What will we want for our parents? What will we want in place for ourselves?’
There has been discussion about cutting the contribution to 70% of the person’s income and while Moynihan said this would certainly be welcome, it would not make a substantial difference to residents’ finances.
“It would just give them more access to comfort money so they can buy a present for the grandchildren or so they have enough money to buy a paper, it would just allow them to do things for a bit of self-dignity.”
Moynihan said that for many older people, the option of remaining in their own homes is just not there as the basic supports are not available for them. He said the government needs to look not just at improving the nursing home experience, but at facilitating people who could live happily in their own homes with just a little help.
His organisation is also promoting the concept of ‘housing with supports’, which would involve specialised individual units supported by care staff for older people who have greater needs.
Nursing home fees
In 2012, the HSE commissioned a review of the Fair Deal scheme which was published two years ago. Since then it has been considering the various options outlined in this review and stakeholders are eagerly awaiting reforms.
The HSE told TheJournal.ie that the waiting time for the scheme is currently no greater than four weeks and this is representative of all counties. Though this has fallen significantly in recent years, the same issues remain with waiting times.
Age Action head of advocacy and communications Justin Moran said: “While people are waiting they could be in an acute hospital in which case there is a cost to the exchequer – the bed can’t be freed up because the support isn’t there. People could be at home and family could be required to get home help or family members may need to take time off work.
“That’s during the intervening period when they are trying to find a home that has a vacancy and also that they can afford. Some families are priced out of nursing homes because of additional charges.
“We have social workers who work with older people telling us, in one case a family was looking for a home in south Dublin or Wicklow and with additional charges of €85 a week they simply can’t afford it. Another client went on the public nursing home bed – and they’re quite rare – because again they can’t afford the charges,” he said.
There is a perception that once you go into a nursing home and you’ve made your contribution then you’re taken care of, but that only covers bed and board.
The most common services nursing homes charge for are social activities.
“That’s not necessarily inappropriate, but there can be very little transparency in the charges. So we had a case earlier in the year where it was €100 for social charges and that increased to €200 and it wasn’t clear why.
“We have heard examples of people charged for incontinence pads or for chiropody visits. One in particular that we’d be concerned and frustrated about is people with medical cards being charged for doctor visits because the nursing home has had a GP come in. Now that’s illegal, but we have heard of that happening.”
Ireland’s ageing population
Speaking to TheJournal.ie, Tadhg Daly, CEO of Nursing Homes Ireland, said his organisation was also concerned about the current delay in the government’s review process.
“In tandem with that we have the issue around housing, around farming assets, resident contributions. What I’m concerned about is dealing with those issues in isolation as it does a disservice to the scheme. You need to look at it in the round. Any changes in terms of amending or adjusting should be done as a totality, as a package.”
Any reform package, Daly said, needs to focus on the issue of funding to ensure there is “an appropriate number of locations and types of care facilities” into the future.
“We have an ageing population, that’s no surprise to anyone. Sometimes it’s portrayed as a tsunami or a ticking timebomb and that’s unhelpful. We should celebrate the fact that people are living longer, but by the same token, because of that we need to put structures in place. It’s not just about beds in buildings, it’s about staff, about training, about workforce.
“The age profile now is 85 plus, dependency is at maximum. People are coming to nursing homes later and that has implications for staff numbers and the cost of operation.”
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