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

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’