Pri­vate firms are fight­ing to cut costs — and get their voices heard

Politi­cians must lis­ten to ma­jor play­ers if they want to end the ‘mixed-up econ­omy’ in care, writes Mervyn Tay­lor

Sunday Independent (Ireland) - - Special Ivestigation -

TO para­phrase WB Yeats, change “comes drop­ping slow”. The ef­forts of the Sun­day In­de­pen­dent re­gard­ing nurs­ing home fees are hav­ing an im­pact. Agen­cies are talk­ing and Min­is­ter of State for Older Peo­ple Jim Daly seems anx­ious to bring greater fair­ness to the sys­tem. Con­tracts that we had been told were per­fectly ad­e­quate are now be­ing re­viewed.

There is talk of the Con­sumer and Com­pe­ti­tion Au­thor­ity and Hiqa hav­ing a role. Mean­while, the re­view of the statu­tory Nurs­ing Home Sup­port Scheme, the so-called Fair Deal, con­tin­ues and a con­sul­ta­tion pe­riod on the de­vel­op­ment of a statu­tory home care sys­tem will end soon.

Cer­tain things seem clear af­ter sur­vey­ing the land­scape in early au­tumn. The nurs­ing home charges is­sue is not, as some are try­ing to por­tray it, a con­sumer is­sue. It is a symp­tom in­di­cat­ing a deeper malaise.

The vast ma­jor­ity of older peo­ple want to be sup­ported to live in their own homes but de­spite the prin­ci­ples of per­son-cen­tred­ness, in­te­gra­tion and con­tin­uum of care we are now likely to have two sep­a­rate statu­tory sys­tems of care.

There is talk of the need for a ‘level play­ing field’ but that is not what the public want. They want a sys­tem that is clearly bi­ased to­ward home care and pro­vides good qual­ity sup­port and care in a con­gre­gated set­ting, such as a nurs­ing home, only when it is re­ally nec­es­sary.

What is also clear is that with­out any public de­bate, and with­out a sin­gle pol­icy rec­om­men­da­tion, nurs­ing home care has ef­fec­tively been out­sourced to the pri­vate sec­tor and public pro­vi­sion has be­come crit­i­cally low.

Back in the days, we used to talk about a ‘mixed econ­omy’. But when it comes to the pro­vi­sion of care it seems more like a ‘mixed-up econ­omy’.

The State, through the Na­tional Treat­ment Pur­chase Fund (NTPF), deals with the public and pri­vate sec­tors dif­fer­ently.

Sage sup­port and ad­vo­cacy ser­vice has con­sis­tently pointed to the role of the NTPF as cen­tral to the nurs­ing home charges is­sue.

The NTPF has to act within the terms of the rel­e­vant leg­is­la­tion, the Nurs­ing Home Sup­port Scheme Act (2009), and, in sim­ple terms, it faces the dilemma of quan­tity over qual­ity. It is the NTPF which de­ter­mines the level of fund­ing that homes get and it is the leg­is­la­tion and reg­u­la­tions which de­ter­mine what nurs­ing homes can and can­not get paid for. Es­sen­tially it is bed and board. HIQA, quite rightly, raises the is­sue of qual­ity of life and a stim­u­lat­ing en­vi­ron­ment but that needs to be paid for… and so do in­con­ti­nence pads.

That com­mer­cial com­pa­nies seek to max­imise prof­its is hardly news. That they should seek to max­imise prof­its from the care of our broth­ers, sis­ters, par­ents and grand­par­ents is surely pause for thought.

It is time for the Oireach­tas Com­mit­tee on Health to en­gage with this is­sue and, if it too is busy, why not have the new Pe­ti­tions Com­mit­tee cut its teeth on some­thing that is of vi­tal im­por­tance? Call in the NTPF, Hiqa, the De­part­ment of Health, the ma­jor com­mer­cial providers and tease out the is­sues.

They might even ask Sage which, as a sup­port ser­vice for vul­ner­a­ble adults and older peo­ple, had 46pc of its clients liv­ing in nurs­ing homes in 2016.

Equally im­por­tant, call in some of the nurs­ing home providers who don’t see them­selves as part of an ‘in­dus­try’ who of­ten aren’t mem­bers of any lobby group and who gen­uinely strug­gle to pro­vide qual­ity of care while do­ing their level best to ab­sorb as many costs as pos­si­ble. They, too, are out there and their per­spec­tive needs to be heard.

Mervyn Tay­lor is man­ager of Sage. Sage will launch a dis­cus­sion doc­u­ment on nurs­ing home con­tracts in Oc­to­ber

BAL­ANC­ING ACT: Nurs­ing home providers want to of­fer the best care pos­si­ble but they are also in busi­ness to make money

Newspapers in English

Newspapers from Ireland

© PressReader. All rights reserved.