State re­fund on wa­ter bills bet­ter spent on boost­ing care of el­derly

Im­prov­ing care home ser­vices needs fund­ing to make it hap­pen. Our el­derly de­serve noth­ing less, says Tadgh Daly

Sunday Independent (Ireland) - - Special Ivestigation - Tadhg Daly is CEO of Nurs­ing Homes Ire­land

THERE are two re­al­i­ties in Ire­land. What the State sets down as an obli­ga­tion and what it is will­ing to pay. Par­ents see this in ed­u­ca­tion, farm­ers on their land, busi­ness peo­ple see this in reg­u­la­tions, and older peo­ple see it in their care.

Care and wel­fare reg­u­la­tions, set and in­spected by the in­de­pen­dent body Hiqa, stip­u­late that nurs­ing homes must pro­vide res­i­dents with “fa­cil­i­ties for oc­cu­pa­tion and recre­ation and op­por­tu­ni­ties to par­tic­i­pate in ac­tiv­i­ties in accordance with their in­ter­ests and ca­pac­i­ties”.

This is as it should be and Nurs­ing Homes Ire­land (NHI) mem­bers pro­vide a range of goods, ser­vices and ac­tiv­i­ties that one would ex­pect for res­i­dents in what is their “home from home”.

But the State con­tract with nurs­ing homes un­der the Fair Deal scheme, set­ting out the terms of pro­vi­sion, ex­cludes the costs in­curred for such a range of goods, ser­vices and ac­tiv­i­ties.

The State’s def­i­ni­tion of what con­sti­tutes “long-term res­i­den­tial care ser­vices” un­der Fair Deal is ex­plicit and lim­ited. The Fair Deal fee en­com­passes bed and board, nurs­ing and per­sonal care, bed­ding, laun­dry, ba­sic aids and ap­pli­ances.

Fair Deal ex­plic­itly de­tails the ser­vices not cov­ered by its fees — list­ing so­cial pro­grammes, ther­a­pies, hair­dress­ing, trans­port and chi­ropody, as well as news­pa­pers and spe­cialised wheel­chairs. Pro­vi­sion of ac­tiv­i­ties and op­por­tu­ni­ties for recre­ation and ther­apy, in accordance with their in­ter­ests, ca­pac­i­ties and ded­i­cated care plan, is fun­da­men­tal to meet­ing older peo­ple’s health, liv­ing and so­cial care needs.

How­ever, for those in pri­vate and vol­un­tary nurs­ing homes, hav­ing worked hard through­out their lives and paid their taxes, it is some­thing they must pay for them­selves.

The State, in its own homes, pays for these ser­vices through the HSE, with just a frac­tion of res­i­dents charged any­thing. That is dis­crim­i­na­tory in my view.

It is right that nurs­ing homes pro­vide res­i­dents en­trusted in their care with var­ied pro­grammes of mean­ing­ful ac­tiv­i­ties and ser­vices.

How­ever, it is wrong that it should leave older peo­ple hav­ing to pay for this them­selves from the re­main­ing 20pc of their in­come af­ter the Fair Deal sup­port is con­sid­ered.

At the same time, pri­vate and vol­un­tary nurs­ing homes are tasked with pro­vid­ing care from fees that are half those payable to their HSE coun­ter­parts.

Dis­crim­i­na­tory prac­tice is be­ing over­seen by the State in care of the older per­son in the nurs­ing home sec­tor. The State is com­plicit.

Nurs­ing homes are re­quired un­der the reg­u­la­tions to pro­vide res­i­dents with a range of goods, ser­vices and ac­tiv­i­ties that are specif­i­cally ex­cluded un­der the Fair Deal. The State is de­fin­i­tive in this re­gard. In­deed, the State body that ne­go­ti­ates fees with pri­vate and vol­un­tary homes ex­am­ines each of the nurs­ing homes’ ac­counts foren­si­cally to ex­clude all these items from the fee.

Min­is­ter of State for Older Peo­ple, Jim Daly, in­formed Dail Eire­ann in July that “although the Fair Deal cov­ers core liv­ing ex­penses, res­i­dents can still in­cur some costs in a nurs­ing home, such as so­cial pro­grammes, news­pa­pers or hair­dress­ing. In recog­ni­tion of this, any­one re­ceiv­ing Fair Deal fi­nan­cial sup­port re­tains at least a fifth of their in­come”.

This news­pa­per has claimed that these costs are hid­den and I take is­sue with this. They are not hid­den and are clearly listed in each res­i­dent’s con­tract for care and is agreed on ad­mis­sion. Fees charged by nurs­ing homes will vary, based on a range of fac­tors, in­clud­ing costs in­curred and the dif­fer­ing range of goods, ser­vices and ac­tiv­i­ties pro­vided.

The res­i­dent’s con­tract, de­tail­ing charges for ser­vices, is pre­sented prior to or on their ad­mis­sion to the home.

NHI has pro­vided a Guide to Nurs­ing Home Charges for Fair Deal (NHSS) res­i­dents.

Iron­i­cally, while these charges are the sub­ject of com­ment and ex­am­i­na­tion, there is no ex­am­i­na­tion of the chasm between fees for res­i­dents in HSE-run nurs­ing homes and what is paid to res­i­dents in pri­vate and vol­un­tary ones. The higher costs of in­ef­fi­cient HSE nurs­ing homes has the di­rect ef­fect of eat­ing up large pro­por­tions of the Fair Deal bud­get.

It means there is less public money to cover all the ser­vices and items that the ma­jor­ity of res­i­dents need and end up hav­ing to pay for them­selves.

The HSE is dis­crim­i­nat­ing against res­i­dents in pri­vate and vol­un­tary homes, ev­i­denced by the fees it pays and the ac­cess to es­sen­tial ser­vices.

It has been in­de­pen­dently ver­i­fied that pri­vate nurs­ing homes are the ma­jor­ity providers of de­men­tia care.

Yet they are tasked with pro­vid­ing it for fees that are be­low those payable by the HSE to its own homes.

There is no ac­count­abil­ity be­ing ap­plied to State spend­ing in HSE nurs­ing homes and it would ap­pear the Gov­ern­ment has no idea of the true cost of pro­vid­ing the care.

The De­part­ment of Health’s promised value for money re­view on public nurs­ing homes as rec­om­mended in the Fair Deal Re­view in 2015 this has yet to get off the ground.

The Om­buds­man con­firmed in his an­nual re­port that his of­fice re­ceived just one com­plaint about nurs­ing homes charges in 2016. The com­plaint was not up­held.

There are more than 400 pri­vate and vol­un­tary nurs­ing homes un­der the Om­buds­man’s re­mit car­ing for over 23,000 res­i­dents.

The real dis­cus­sion we should be hav­ing is about the re­view of the Fair Deal scheme and the de­fi­cien­cies in its pric­ing mech­a­nism.

The sub­se­quent re­view of pric­ing that is be­ing led by the De­part­ment of Health has stip­u­lated that the ser­vices en­com­passed un­der the fee payable will re­main un­changed. The jury has al­ready ruled even though the re­view, which has been go­ing on for five years, hasn’t been com­pleted.

In re­cent years, there has been a very wel­come move away from see­ing later years as a time of de­cline — to con­sid­er­ing them to be a time of new be­gin­nings and pos­si­bil­i­ties.

The Na­tional Pos­i­tive Age­ing Strat­egy says: “En­gage­ment through ac­tiv­ity can help to main­tain qual­ity of life, pro­mote so­cial con­tact, com­bat lone­li­ness and iso­la­tion and main­tain peo­ple as ac­tive mem­bers of so­ci­ety.

“Par­tic­i­pa­tion in leisure ac­tiv­i­ties is as­so­ci­ated with a lower risk of poor men­tal and phys­i­cal health and mor­tal­ity.”

Ac­tive liv­ing for older peo­ple must be all en­com­pass­ing.

It is es­sen­tial that the 28,000 res­i­dents of our nurs­ing homes, which in­cludes 5,000 in public beds, are fully en­abled to en­gage in ac­tiv­i­ties that will bring them con­tent­ment, foster a spirit of friend­ship with their fel­lows and im­prove their men­tal and phys­i­cal well­be­ing.

How­ever, high depen­dency care that meets a per­son’s holis­tic needs comes at a cost.

Min­is­ter Daly and his pre­de­ces­sors have been clear in declar­ing that the State fees for nurs­ing care do not en­com­pass ser­vices and ac­tiv­i­ties which are es­sen­tial to sup­port­ing and pro­mot­ing a per­son’s well­be­ing.

This gap needs to be bridged in the Bud­get. The money due back from wa­ter charges might be bet­ter in­vested in ful­fill­ing the State’s obli­ga­tions to our older peo­ple as re­cently sug­gested by Daly — in­stead of giv­ing them in the­ory that which they are de­nied in prac­tice.

‘There needs to be a dis­cus­sion about the Fair Deal and its fail­ings’

‘High depen­dency care that meets a per­son’s holis­tic needs comes at a cost’

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