AFTER MORE than a year in office, the Government has finally got around to establishing its promised review of the Fair Deal scheme for nursing homes. What is intended for the scheme remains uncertain. But greater emphasis will be placed on keeping elderly people in their own homes for as long as possible with home care and residential community packages. Enabling the elderly to live their lives as fully as possible is a commendable objective. On the basis of recent developments, however, cost cutting is likely to remain the prime objective.
Earlier this week, Minister of State for Older People Kathleen Lynch criticised the basis on which the Fair Deal system functions, making the point that any scheme based on property values is far too volatile. It provides nursing home care in return for 80 per cent of a person’s disposable income, plus 5 per cent of the value of their assets, including the family home, up to a maximum of 15 per cent. Six years ago, house values were increasing faster than nursing home costs. Not so today. There has been no suggestion, however, that these charges will be increased or replaced. Instead they will be “reviewed”. In the meantime, an additional €50 million has been made available in the hope that, unlike last year, waiting lists will not develop.
Other actions, Ms Lynch indicated, will take precedence. These will involve looking at different types of accommodation for older people and at the mechanisms used to determine whether or not an older person should be in a nursing home. In addition, she undertook to ask Minister of State for Housing Jan O’ Sullivan to meet with voluntary housing groups with a view to providing sheltered, supported and assisted living accommodation as part of a housing strategy for older people.
All of this sounds progressive. And it is. But such measures require funding and money is in extremely short supply. It has long been more cost effective to keep people in their homes or communities, rather than in nursing homes, apart altogether from quality-of-life considerations. But competition within and between different government departments and a lack of joined-up thinking has stymied this approach.
Successive governments have had an appalling record in catering for the needs of the elderly. Some years ago, the Supreme Court found State agencies had systematically charged patients for services that were free under the law. As the cost implications of an ageing population became apparent, government subsidies were provided to build private nursing homes and a new charging mechanism was introduced.
Abdication of a traditional responsibility towards a group that accounts for less than 5 per cent of the population has continued under this Government. Minister for Health James Reilly said that up to two-thirds of existing public nursing home beds may close, including all public homes catering for fewer than 50 patients. This slash-and-burn approach represents the broader picture of the State withdrawing from a traditional area of responsibility.