THE TRUE COST OF NURS­ING HOME CARE IN IRE­LAND

An in­ves­ti­ga­tion of over 300 nurs­ing homes re­veals ad­di­tional charges of al­most €17m. Maeve Shee­han, Wayne O’Con­nor and Mark O’Re­gan re­port

Sunday Independent (Ireland) - - Special Ivestigation -

‘Hair­dress­ing, ther­a­pies and news­pa­pers cost ex­tra’

ON a re­cent week­day morn­ing, a group of peo­ple gath­ered for a tour of The Mar­lay, a gleam­ing state-of-the-art nurs­ing home just off the M50, close to Rath­farn­ham in south Dublin. The rooms were bright and airy. The place was buzzing with ac­tiv­ity. A cou­ple of res­i­dents read the in-house news­pa­pers in the lobby. A group of ladies watched Sammy Davis Jr on TV in the sit­ting room. In another room, an ac­tiv­i­ties co­or­di­na­tor read the news­pa­per aloud to her au­di­ence. Out­side, the sun shone on a flower-filled court­yard.

This is one of the more pop­u­lar nurs­ing homes in South Dublin. There is a wait­ing list to get in. But don’t ex­pect to get in­for­ma­tion on The Mar­lay’s charges over the phone. Fam­i­lies mak­ing en­quiries about this nurs­ing home must at­tend in per­son to one of The Mar­lay’s des­ig­nated in­for­ma­tion days, or­gan­ised to keep any dis­rup­tion to res­i­dents to a min­i­mum. At the end of the tour, we are in­vited into a room, given a brochure with de­tails of the nurs­ing home’s charges, and en­cour­aged to ask ques­tions.

The nurs­ing home is paid €1,285 a week per res­i­dent by the State un­der the Fair Deal scheme. The fee in­cludes res­i­dents’ con­tri­bu­tions to­wards their cost of care. In ad­di­tion, res­i­dents must pay €50 a week for a “so­cial pro­gramme” con­sist­ing of ac­tiv­i­ties, games, out­ings, mu­sic, and arts and crafts; and €25 a week for the Mar­lay Doc­tor ser­vice, re­gard­less of whether the res­i­dent is on a med­i­cal card or not. There is also a quar­terly €12 charge for trans­port­ing sam­ples to the lab for screen­ing tests. Res­i­dents pay ex­tra for hair­dress­ing, ther­a­pies and their own per­sonal news­pa­pers. There is also a 20pc ad­min­is­tra­tion charge for each res­i­dent on top of the cost of other “bill­able” ser­vices. There was barely a quib­ble about the charges dur­ing the in­for­ma­tion morn­ing. The Health In­for­ma­tion and Qual­ity Au­thor­ity (Hiqa) has taken is­sue with as­pects of the ad­di­tional charges in its most re­cent in­spec­tion re­port on the nurs­ing home.

In­spec­tors found there was no opt out for cer­tain charges. The nurs­ing home com­mit­ted to in­tro­duc­ing an opt out.

The Mar­lay pro­vides a ser­vice that fam­i­lies are clearly happy to pay for. It is one of over 300 nurs­ing homes that fea­ture in to­day’s in­ves­ti­ga­tion into the ad­di­tional charges quoted by pri­vate and public nurs­ing homes.

Our in­ves­ti­ga­tion found that of the over 300 homes, two thirds quoted ad­di­tional charges that ranged from just €1 a day, to €325 per week in one lux­ury fa­cil­ity in Dublin. Just un­der one-third of the nurs­ing homes we con­tacted said they did not have ad­di­tional charges.

By tak­ing a ra­tio of Fair Deal res­i­dents that ap­plies across all pri­vate and vol­un­tary nurs­ing homes we were able to cal­cu­late a fig­ure of €16.9m a year in ad­di­tional in­come for pri­vate and vol­un­tary nurs­ing homes that are al­ready shar­ing in a scheme that costs the State €940m a year. That €16.9m is paid by some of the 18,000 Fair Deal res­i­dents in pri­vate and vol­un­tary nurs­ing homes, and their fam­i­lies, on top of what they have al­ready con­trib­uted through Fair Deal.

The charges are a symp­tom of deeper prob­lems with the Fair Deal sys­tem. Nurs­ing homes’ griev­ances with the scheme are ex­plained by Nurs­ing Homes Ire­land else­where in these pages.

Fair Deal was in­tended to re­lieve peo­ple of wor­ry­ing about whether they could af­ford nurs­ing home care in their old age. Older peo­ple con­trib­ute what they can af­ford. The State pays the rest.

Nurs­ing homes say they are not be­ing paid enough. And el­derly res­i­dents are be­ing hit to make up the short­fall — in the form of ser­vice charges or so­cial charges, or what­ever nurs­ing homes want to call them. How­ever, ad­vo­cacy groups, such as Sage and Age Ac­tion Ire­land, say the ad­di­tional charges have had se­ri­ous re­ver­ber­a­tions on older peo­ple and their fam­i­lies.

These groups have high­lighted sev­eral is­sues. Ac­cord­ing to Age Ac­tion, the charges are “hid­den”, to the ex­tent that res­i­dents were some­times only told about them when they were about to sign on the dot­ted line of a con­tract.

At least three agents of the State are now ex­am­in­ing the ad­di­tional charges and the con­tracts of pri­vate and vol­un­tary nurs­ing homes that con­tain them.

Doc­u­ments re­leased un­der the Free­dom of In­for­ma­tion Act show that the De­part­ment of Health set up a work­ing group to look specif­i­cally at the is­sue of ad­di­tional charges, and is ex­pected to pro­duce a pa­per on the sub­ject in Oc­to­ber.

The Of­fice of the Om­buds­man has al­ready con­cluded in a land­mark case that res­i­dents in one nurs­ing home should only have to pay for ser­vices they use — a find­ing that will have im­pli­ca­tions for other nurs­ing homes.

The Com­pe­ti­tion and Con­sumer Pro­tec­tion Au­thor­ity has con­firmed to the Sun­day In­de­pen­dent that it has launched a “project” to ex­am­ine nurs­ing home con­tracts. The pur­pose is to pro­duce guide­lines to en­sure that nurs­ing home op­er­a­tors are com­pli­ant with EU con­sumer law.

One of the great­est gaps in our knowl­edge of ad­di­tional charges quoted by nurs­ing homes is which ones are charg­ing and by how much.

Our in­ves­ti­ga­tion is by no means ex­haus­tive and we are re­liant on the in­for­ma­tion quoted to us by the homes we con­tacted.

We un­der­took this in­ves­ti­ga­tion when our at­tempts to openly ask nurs­ing homes for their charges failed.

Hav­ing reached over 300 of the coun­try’s pri­vate and vol­un­tary nurs­ing homes, our in­ves­ti­ga­tion pro­vides an im­por­tant over­view of the scale of charges be­ing quoted to prospec­tive nurs­ing home res­i­dents. This is im­por­tant not only for res­i­dents who are in nurs­ing homes, but also for pri­vate nurs­ing home op­er­a­tors them­selves.

There are two ways of look­ing at the es­ti­mated fig­ure of €16.9m col­lected in ad­di­tional charges. Fam­i­lies will look upon it as an added fi­nan­cial bur­den thrust on to el­derly res­i­dents. Pri­vate nurs­ing home op­er­a­tors will look upon it as fill­ing the gap in what the State pays them to care for our older pop­u­la­tion and what it ac­tu­ally costs them to pro­vide the ser­vice.

Nurs­ing homes in af­flu­ent ar­eas tended to quote higher ad­di­tional charges.

Lee­son Park in Dublin 6, for in­stance, was the most ex­pen­sive at €325 a week for a res­i­dent in a sin­gle room. The Sil­ver Stream group, the op­er­a­tors of Lee­son Park, said in a state­ment that it pro­vides “pre­mium” nurs­ing care in the area: “All res­i­dents join­ing the nurs­ing home agree, in ad­vance, the fee struc­ture de­pend­ing on care op­tions and ac­com­mo­da­tion re­quire­ments.

“While this nurs­ing home has com­manded a higher pre­mium since it was es­tab­lished, its level of fees has not in­creased since 2008.”

The op­er­a­tors of Kin­vara House Nurs­ing Home in Bray, which has an ad­di­tional ser­vice charge of €175 a week, said it is open about its charges and they are dis­closed in full to res­i­dents in ad­vance: “We are fully upfront about our fees. They re­flect the very high stan­dard of care and ser­vice we pro­vide. We have a high level of staff. We charge a very fair fee for the qual­ity of care and level of ser­vice we pro­vide.”

Another south Dublin oper- ator, Al­ta­dore Nurs­ing Home, where the charge is €100 per week, said charges are dis­cussed openly and trans­par­ently with prospec­tive res­i­dents. “No per­son is ever ad­mit­ted to our nurs­ing home with­out a full ex­pla­na­tion and un­der­stand­ing of what their costs and fees will be, and what is in­cluded or not in­cluded.

“All of these fees and charges are de­tailed in our Con­tract of Care which is dis­cussed with ev­ery­one when view­ing our fa­cil­ity.”

A strik­ing fea­ture of our in­ves­ti­ga­tion was the dis­par­ity not only in the scale of the charges levied — or not, as the case may be — but in the will­ing­ness of nurs­ing homes to dis­close those charges over the phone.

One of the coun­try’s big­gest nurs­ing home chains, the Brind­ley Health Care Group, told us that it does not have di­tional charges for ac­tiv­i­ties or ther­a­pies in any of its six care homes. The cost of these ac­tiv­i­ties is in­cluded in the Fair Deal price and res­i­dents pay ex­tra for other ser­vices as they need them. The Rye­vale Nurs­ing Home in Kil­dare — which re­ceived €5.4m un­der the Fair Deal scheme last year — charges its res­i­dents €1 a day for ac­tiv­i­ties.

A dis­par­ity arises in how nurs­ing homes ap­proach dis­clos­ing the is­sue of charges.

Har­vey Health­care Group pub­lishes charges for five Dublin nurs­ing homes on­line — these range from €25 to €35 a week. So do a num­ber of other smaller nurs­ing homes, such as Ard­more Care, Fin­glas.

Many nurs­ing homes are happy to share their in­for­ma­tion on charges, will­ing to post brochures, of­fer ad­vice and ex­plain in de­tail what the ex­tra charges cover.

Many also of­fered ad­vice on the ar­du­ous process of ap­ply­ing for Fair Deal. Some nurs­ing homes told us that they do not im­pose the charge if the res­i­dent can­not af­ford it. This was par­tic­u­larly so in ru­ral nurs­ing homes, but also in Dublin. The Hamil­ton Park Care Fa­cil­ity told this news­pa­per that res­i­dents are of­fered the choice of pay­ing a ser­vice charge of €50 that cov­ers ev­ery­thing, in­clud­ing taxis to hos­pi­tal, or be­ing in­voiced separately for each ser­vice.

Some nurs­ing homes re­fused to dis­close any in­for­ma­tion over the phone about charges.

Sev­eral were sus­pi­cious of our mo­tives in call­ing, sus­pect­ing that we might be re­porters. The me­dia cov­er­age of late has clearly ran­kled. Sev­eral spoke bit­terly about the pub­lic­ity given to re­cent re­ports that nurs­ing home res­i­dents were be­ing charged €20 for Mass.

Their views re­flected a sec­tor that is feel­ing un­der fire and un­der-ap­pre­ci­ated.

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