Nursing homes don’t cause extra charges, they just deliver the government-designed scheme
Sort out Fair Deal or cost of care could fall back on families and hospitals, writes Tadhg Daly
THERE is much reference these days to the “people who get up early in the morning” and how they are the most deserving of resources when Budget 2018 is delivered.
But working hard and getting up early is not new and not just a phenomenon of the so-called ‘squeezed middle’.
The Sunday Independent has over the past two weeks written about private and voluntary nursing homes, the Fair Deal scheme — and charges for services that are not covered by this scheme.
The people who own, manage and work in private and voluntary nursing homes are people who get up early in the morning (and in the night and on weekends), to make sure residents have their health and social care needs met 24/7, 365 days per year.
Nursing homes provide care to people who worked very hard throughout their lives and contributed to society. These people deserve resources to meet their needs — and that is at the heart of what the Sunday Independent has been examining.
There is a perception that the Fair Deal scheme covers everything at a nursing home. Unfortunately, there are many exclusions. The State support and resources for Fair Deal are limited, and charges for services expressly excluded are a direct and foreseen consequence of this. Private and voluntary nursing homes are not causing the charges, they are just delivering the scheme within the parameters set by the State — and in effect have become messengers for communicating and implementing the State’s shortfalls in resourcing people’s health and social care needs in nursing homes.
Unlike residents in public nursing homes, those in private and voluntary nursing homes are discriminated against in terms of charges for services excluded under the scheme, and also in terms of access to primary care services. The private and voluntary nursing home providers are left with a pricing model that, in the words of the DKM report published by the Department of Health in 2015, “operates in an ad hoc manner, lacks rationale, consistency and fairness”.
The pricing model is not open to independent appeal and is run by a monopoly purchaser, the National Treatment Purchase Fund (NTPF). It specifically excludes the cost of many care needs, and discriminates on access to primary care services.
The Sunday Independent has said these costs are hidden. I take issue with this. These costs are not hidden but are clearly listed in each resident’s contract for care and agreed on admission.
What is hidden is that the State deliberately and specifically does not pay all the costs associated with people’s care, and that the HSE discriminates against nursing home residents on the basis of their address.
There have been politicians from the Department of Health willing to comment on private and voluntary nursing homes this week, demanding transparency. But their own department isn’t willing to be transparent. A review of Fair Deal and the pricing of the scheme by NTPF, has been ongoing since 2012. The last promise was that it would be published by June 1 this year. This date has come and gone.
The newly-appointed Minister for Older People Jim Daly confirmed that it is on his desk and we welcome his commitment to publish.
It is not that nursing home residents can expect great news, as a recent reply to a parliamentary question said there are “no plans to amend the services covered by the scheme” and residents of private and voluntary homes will have to keep paying for services excluded under Fair Deal. But at least when it is published, it lets a mature debate begin about the true cost of care and its long-term financing. As an organisation, Nursing Homes Ireland has long proposed a forum on these issues. To date ,the Department of Health has obstructed the formation of such a forum.
The CSO statistics published last week were welcome news: as a society, we are living longer, and this further highlights the responsibility on Government to establish such a forum to plan for the care requirements of our ageing population.
The political consensus in the Oireachtas on the reorientation of the health service from acute to community care (as laid out in the recently published Slainte care report) is welcome, too. This commitment must be acted upon.
The reality is that if the State doesn’t grapple with the issue of Fair Deal and its shortcomings, care will fall back on families, on the State in public homes and our already stretched acute hospitals.
The net cost to the Exchequer of the HSE providing these services are multiples of two to seven times the cost of private and voluntary nursing homes providing the same. If that is what happens, the people who get up early in the morning to pay taxes won’t be able to go to bed with the burdens that fall on them.