Nursing home location cited as factor in hospital bed retention

Elderly patients who remain in hospital beds, despite no longer requiring treatment, often do so because available nursing home spaces are considered too far from family, it has been claimed.

This week it emerged the Health Service Executive’s head of legal services, Eunice O’Raw, had said families were leaving elderly relatives in hospital to protect inheritance which might otherwise be hit by nursing home fees.

Current figures show there are eight in-patients categorised as being “non-cooperative with process”, or declining to leave hospital.

This represents just 1.7 per cent of the current 458 so called delayed discharges, a level which has itself been significantly reduced from 659 last September.

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While the number is low, hospital managers are short on options to deal with people refusing to leave.

"There are no doubt examples of families, either for financial protectionist reasons or because a nursing home bed provided is too far away in the view of the family, [who] delay in moving patients out," said Liam Doran, general secretary of the Irish Nurses' and Midwives' Organisation (INMO). "I think geography is a problem."

Staff intervention

A HSE spokesman said in such instances the individual can take an alternative care home place and later transfer to the centre of their choice.

Mr Doran said in exceptional cases, where patients refuse to leave, medical staff cannot intervene.

“It’s not open to any registered professional to ration their care to any person depending on a perceived financial plan of a family. The only consideration is to give the care to the person,” he said.

“It’s for others to address extraneous matters of financial obligations, liabilities or whatever.”

Dr John Duddy, neurologist and president of the Irish Medical Organisation (IMO) said the view set out by Ms O'Raw "seems quite extreme and doesn't take account of the reality that these are real people that doctors and nurses have to look after every day".

“The language as such is quite insulting and demeaning to human beings who have not been well.”

In some cases, Dr Duddy said, patients simply want to go home but there is no care package available to support the ongoing treatment they require.

This was also true of younger patients with severe brain or spinal injuries who end up in nursing homes.

It is quite rare for patients to refuse to leave a hospital bed, he said.

“It can be a difficult situation [when] it does arise, especially when there is such demand for beds.”

Exceptional circumstances

Last night, the HSE said the advice set out by Ms O’Raw was “not about patients who have recently completed their care but rather about rare and exceptional circumstances [where there is a refusal to leave a bed and] which arise no more than a couple of times each year”.

A solicitor with expertise in the medical area, requesting anonymity, said hospitals would be within their legal rights to remove patients although the likelihood of this happening was remote.

“The HSE has every right to ask someone to leave because they are there at will,” the solicitor said. However, this would require a court order and “that’s the last thing the HSE would want to do”.

Over 8,000 people a year enter nursing homes under the Fair Deal scheme. About 40 per cent of these come out of hospitals but that does not take into account those who go into transitional care beds.

These are located in nursing homes and taken up by patients before a permanent place is located. Their funding has been increased to provide an additional 58 spaces per week since last September.

Tadhg Daly, chief executive of Nursing Homes Ireland (NHI), said its members were not "familiar" with families keeping relatives in hospital to avoid nursing homes.

The NHI’s position is that when someone in hospital is suitable for discharge, they should return to the appropriate care setting be that a nursing home or their own home. “The ultimate thing is that we would tell people there is a need to plan in advance and have the conversation,” he said.