Contracts of care give power to the providers, not the residents

Many people sign contracts for nursing homes at a time of crisis, unaware of additional costs, writes Mervyn Taylor

HEDGE funds don’t beat around the bush. They only invest with the expectation of profit. So if they are interested in nursing homes, then there must be something in it for them.

In a highly-regulated sector, where many of the residents are extremely vulnerable, it can seem strange that a crisis of care for your grandparent, parent, or yourself, can be another person’s opportunity for investment. But before we reach for the lash of righteousness, we need to stop and think how we got here.

We need to ask the question asked at the Forum on Long-Term Care for Older People, organised by Sage in 2016: “Why, despite decades of policy reports and recommendations to government, is there still a systemic bias towards care in congregated settings and no formal legislative basis for support and care in the community?”

As social policy researcher Dr Michael Browne so succinctly put it recently at the Citizens’ Assembly, when he said: “No report on long-term support and care has proposed the current model.’’ Nursing home charges have to be seen in context. We cannot have it both ways; criticising public nursing homes that do not operate the same system of charging for services, for being ‘too expensive’, while criticising private nursing homes for charging for services while wanting them to be ‘cheaper’.

Long-term care, whether in the community or in a congregated setting such as a nursing home, does not come cheap. If you allow a situation to develop, whereby almost 80pc of all nursing home provision is privately run, then you cannot but end up with a situation where, to exaggerate for effect, a bed-bound atheist can be charged for activities and religious services that they do not participate in.

But, if you allow the National Treatment Purchase Fund to fund services from public and private providers in different ways, then you can only expect private providers to impose charges for some services that are provided free of charge in public facilities.

Some of the petty charges imposed by private nursing homes raise serious questions as to the motivations of those providing the service and some of the charges are many times the planned water tax charges that had so many people on the streets protesting.

Private nursing homes are, however, extremely diverse. Some are family-run and operate more as social businesses or charities than mainstream businesses. They know that money does not grow on trees but, equally, they know that money that comes from hedges means that it is the care that gets trimmed.

There is a need for greater public scrutiny of nursing home charges, but the charges are supposed to be set out in a contract of care between resident and provider and it is on these contracts that we now need to focus. Many people sign these contracts at times of crisis without access to independent advice or advocacy.

Some people have them signed for them, either because they lack capacity or because they are being quietly coerced into living in a place that they do not want to be; in effect, deprivation of liberty.

Many of the contracts are unnecessarily complex and what is most striking about them is the power of the provider and the weakness of the provided for.

It is time for Oireachtas committees to focus on this issue and it is to them that Sage will be sending its recommendations on nursing home contracts in the coming months. The experience of Sage, since it was established in September 2014, is that exploitation of vulnerable people is more likely to happen in a person’s home, than in a nursing home. Any new statutory scheme for home care will need to be thought through carefully in order to avoid some of the perverse incentives that are arising in the Nursing Home Support Scheme.

Mervyn Taylor is manager of Sage Support and Advocacy Service, which provides a seven-day information and advice service for vulnerable adults and older people: call 1850 719400 between 8am-10pm. It also provides a Rapid Response Service and where urgent support is required, a Sage representative can be available nationwide within 24 hours.