The much vaunted ‘Fair Deal’, introduced last October, was supposed to herald a new era in nursing home care support, but six months into its implementation, how is it faring?
THE MAIN feature of the Fair Deal, which replaces the old system of public nursing home charges and the private nursing home subvention scheme, is that while the State is continuing to fund the largest part of care costs overall, individuals are also being asked to contribute towards the cost of their long-term care. To participate in the scheme, and thereby get access to public or private nursing homes, long-term residents must contribute 80 per cent of their income, in addition to a percentage of their non-cash assets and property, which will be put towards costs such as bed and board, and nursing and personal care.
To date, 8,000-9,000 applications for the scheme have been made, although the HSE is keen to point out that because of industrial action, this is only an estimate.
The vast majority of applications are being approved, with anecdotal evidence suggesting that only about 40-50 applicants have been refused due to reasons such as long-term residential care not being deemed to be required, or because the applicant’s means was in excess of the cost of care. Some €152 million was allocated to the scheme for 2010 and, of this, it is estimated that about €23 million, or 15 per cent, was expended on the scheme in the first two months of the year.
However, the pace of processing applications is diminishing the scheme’s effectiveness. Only about half, or 4,000 applications, have been processed to date and, according to the HSE, this month it is taking between four and six weeks to process an application, with more complex applications taking six to eight weeks to process. Moreover, the processing time is on the rise – last month it was reported that applications were taking between two to four weeks to process.
Tadhg Daly, chief executive of Nursing Homes Ireland (NHI), says that in reality, some applicants have been waiting for approval since the scheme was first launched last October, pointing to “pockets of the country where determinations have been exceptionally slow”.
More severe delays are being incurred by people who are also applying for “ancillary support”, which relates to the Nursing Home Loan, a deferred loan which is secured against the person’s principal private residence. This is an option in cases where people cannot make the 5 per cent annual charge on their assets, so instead agree for the payment to be made from the proceeds of the sale of their home once they die.
To date, about one in nine applications for the scheme, or 1,100 in total, have sought this support, which can slow down the processing, as there may be issues regarding the determination of title on a property or the HSE may be awaiting consents to make a charge on a property. Also, the HSE says where properties are not registered it generally takes longer to verify the title holder as checks need to be undertaken through the Registry of Deeds.
For applicants waiting to get approval, these delays mean that it can slow down their move into a nursing home, if they are making the move for the first time, with Daly highlighting that at last count there were 1,500-1,600 free beds in nursing homes across the State. To combat this, however, the HSE has introduced a policy whereby once an applicant has been assessed as being in need of long-term care, then that person may move to a nursing home pending the outcome of their financial assessment. This is done with a guarantee of funding, subject to the applicant co-operating with the financial aspect of their application.
Delays in processing nursing home applications are also having a knock-on effect on the number of so-called “bed blockers”, a term used to describe patients who remain in hospital because an appropriate alternative facility is not available for them. Under the Fair Deal legislation, hospitals are entitled to charge older people in acute beds, to encourage them to move on to a longer-term care facility, and this provision was recently activated by Beaumont Hospital, which announced a charge of €1,365 a week for six elderly patients.
For Eamon Timmins, head of advocacy and communications at Age Action, however, the Government’s strategy of focusing on long-term care facilities, rather than community support, is problematic, and he says that the implementation of charges in Beaumont should not have been done until sufficient community services are in place.
“We do believe that community is where it’s going to need to be. Community services keep people out of nursing homes,” he says.
Timmins also points out that his organisation has received feedback from a wide spectrum of interests on the Fair Deal scheme, and is finding that there remains a lot of confusion and a lack of understanding of the system.
