ELDERLY CITIZENS who, because of dementia or physical frailty, are unable to live in their own homes are likely to get a hard time when they look for State help. This group of people, amounting to less than 5 per cent of the population, has traditionally been regarded as a soft target by officialdom and, it would appear, nothing has changed. The number of public nursing home beds is going to be dramatically reduced while, at the same time, private sector care will be constrained by a funding cap.
This piles pressure on vulnerable people. The shape of things to come has been outlined by Minister for Health James Reilly. In reassuring Oireachtas members that no acute hospitals will close in the coming year, he declared that a “reconfiguring” of community nursing units was unavoidable. This meant, according to HSE chief executive Cathal McGee that up to 4,000 long-stay beds may close – two-thirds of all State accommodation – because they do not reach minimum standards. The cost of modernising these structures was put at between €600 million and €900 million, money that is not available at present.
This is a shocking development. But it comes as no surprise. When the Health Information and Quality Authority (Hiqa) was established in 2005, it was tasked with checking private, but not public, nursing homes. It was recognised that, because of the physical condition of the latter, significant investment would be required to bring them up to standard. Little or nothing was done. When the authority finally reported on public nursing homes this year, it identified “significant” issues. In response, the Government appears to have cut and run.
Care of the elderly is expensive. For years, successive governments and health officials engaged in systematic theft from residents in public nursing homes in their misguided efforts to contain costs. When the Supreme Court ruled these charges to be illegal, State involvement in the sector was systematically reduced and tax breaks were provided for alternative, private nursing home developers. To fund these new services, Mary Harney introduced the so-called Fair Deal scheme, under which 80 per cent of disposable income and 5 per cent of a resident’s assets (collected after death) would be deducted for public or private care. The scheme was oversubscribed and under-funded.
A waiting list has now developed for those seeking nursing home care under the Fair Deal scheme and the HSE is required to act as doorkeeper. A rigorous financial assessment of applicants is conducted, as well as a care needs assessment, to establish if people need or qualify for care. HSE personnel make these judgments in the context of available funding. That is wrong. In the meantime, home help is not provided to the extent that it should. The programme for government promised a review of the Fair Deal scheme. It certainly needs radical change. But there is little sign of that happening. Closing public beds represents a blunt cost-cutting exercise that will cause stress to existing patients and exacerbate administrative difficulties.