FAMILIES OF NURSING home residents who hold medical cards and are living in private homes under the Fair Deal scheme are being billed for “incontinence wear, wound dressings, ointment and services such as speech and language therapy and physiotherapy”, a TD revealed today.
Drogheda deputy Imelda Munster has spoken out about the additional charges that families have had to pay to private nursing homes, calling it an “absolute scandal” and stating that the HSE has “turned a blind eye to the issue for years”.
Speaking in the Public Accounts Committee (PAC) and Dáil chamber today, Munster said that families in her constituency have been told to “take their parents out and put them elsewhere” when they questioned the validity of these additional charges with staff in private nursing homes.
When the issue was raised with Robert Watt, the Secretary General for the Department of Health in the PAC this morning, he said that the department does not agree with these charges, and that it is looking at setting up a system whereby families will be able to make complaints to the Health Information and Quality Authority (Hiqa) about them.
Munster, speaking at today’s committee meeting, said that this was not a good enough solution, and that it puts the onus on “the most vulnerable people in our society” to correct an issue that is a matter for the State.
Hiqa has also previously received complaints about such ancillary charges. A blind resident in a private nursing home who was being charged €2 a day for newspapers is among those who have previously complained about the Fair Deal scheme to the watchdog.
In another case a resident who just wanted to stay in their room was facing extra bills for activities such as baking, bingo and card games.
When the Irish Independent reported on these complaints back in 2017, the Department of Health was not able to say what progress was being made in tackling these issues, which are still ongoing today.
Speaking to The Journal today, Munster said that she first raised this issue with the HSE three years ago, and that she has received records of correspondence on the issue between management figures in the health service, in which it is stated that the best way to end additional charges would be for the State to alter the contract they have with private nursing homes.
“This is wrong in every sense, it is morally and ethically wrong,” Munster said of the charges.
“If the HSE can’t insert a clause into the Fair Deal scheme contracts at this stage, something should be done so new nursing homes can’t charge medical card holders for supplies and therapies that they are entitled to,” she added.
Back in 2016, Sage Advocacy, the national advocacy service for older people, raised the issue of nursing home residents incurring additional charges not covered by the fees agreed between the nursing home and National Treatment Purchase Fund (NTPF).
Sage said that it raises concerns and “major public interest questions”, that people were having to pay charges out of their own “sometimes very meagre resources”.
“There is little or no independent monitoring of how additional charges are applied.
“Residents may be charged for services and activities whether or not they want to use them, there is little no or no accessible information for individuals and families on, for example, their right to appeal or how to reduce a charge,” the service said.
It continued to state that the current charging system “is not a fair deal” for those on low incomes, especially those who only have an old age pension as an income.
“How can people in this situation be reasonably expected to pay additional charges, pay the costs of therapies and cover the costs of, for example, a specialised chair?,” Sage asked.
The Fair Deal scheme sees nursing home residents pay for a certain amount towards their care in a private nursing home.
The HSE issues the following advice to people who apply for funding under the scheme:
“If the amount you’ve been told to pay is €400 a month and the nursing home costs €1,200 a month, HSE will pay the balance of €800.
“Your payment is a fixed amount. It will be the same for any approved nursing home, no matter how much it charges.
“While you wait for funding you can choose to pay privately for care. Fair Deal funding cannot be backdated and will only be paid from the date it is approved.”
Shaun Flanagan, the Assistant National Director of the Primary Care Reimbursement Service (PCRS), wrote in a letter to HSE management officials in January of 2021 that the issue of additional charges wasn’t one for his service to “respond on”, but added that PCRS would get involved if a “programme of works emerges”.
The PCRS is a branch of the HSE which is responsible for making payments for healthcare professionals for services they provide for free or at a reduced cost to the public. It supports primary healthcare by reimbursing contractors (such as nursing homes under the Fair Deal scheme) for their services.
“Whether it is via the provision of claims data or via in the worst case assisting with any expertise we’ve developed in handling probity cases (if it emerges that a [residential care facility] charged for something a pharmacy was actually paid for by PCRS),” Flanagan further stated in his letter.
Flanagan added that if individual cases related to this issue were identified to the HSE, the HSE would investigate, and “where evidence is provided to substantiate the claim, the HSE would deduct the payment from the [residential care facility], and “reimburse the individual”.
“That is not something to be written lightly as that could involve a huge retrospective programme if this issue is substantial in size.
“For the record, prior to this email exchange, this wasn’t something which was on my radar in any form,” Flanagan further stated.
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