Hospitals seek to charge patients due for discharge who refuse to take up offers of long-term care

Hospitals are seeking to charge patients for bed-stays where they have been approved for long-term care but are refusing to take up the available option, Minister for Health Stephen Donnelly has said.

Mr Donnelly said he had been approached by hospitals in relation to new rules aimed at speeding up the discharge of older patients who have been approved for long-term care.

Some want to charge the full economic cost of a bed where patients approved for discharge to long-term care refuse to leave, while other patients wait on trolleys in corridors for admission to a hospital, the Minister said.

While acknowledging the challenges hospitals face, Mr Donnelly said the proposal was not under active consideration.

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On Tuesday, there were 457 patients nationally approved for discharge who remained in hospital because their pathway for leaving had not been sorted out. Of these delayed transfers of care, 160 had been approved for long-term care.

St James’s Hospital had 40 delayed transfers of care who were approved for long-term care. Figures for other hospitals included Beaumont (14), Galway (13), Tallaght (12), Waterford (11), the Mater and St Vincent’s hospital (10).

Meanwhile, 621 patients were waiting for admission to hospitals, either in the emergency department or on wards, according to the daily count by the Irish Nurses and Midwives Organisation.

Last month, the HSE issued new discharge rules under which older patients who are waiting for a nursing home will have to take the first option offered, at least temporarily. The Irish Society of Physicians in Geriatric Medicine has claimed the measure is ageist and undermines patients’ liberty.

Defending the measure, Mr Donnelly said patients would be accommodated in their choices “to the greatest extent possible”.

“We have moved to a clear rule that says if a patient is to be discharged and there’s a clinically appropriate pathway for them, and we have someone downstairs waiting on a trolley, they need to be discharged,” Mr Donnelly said.

“This is about patient safety. We will try to accommodate patients’ preferences and wishes to the greatest extent possible, but if we have an 80-year-old on a trolley downstairs in a corridor, those patients need to be discharged and the clinically appropriate pathway used.”

Mr Donnelly pointed to new French research showing that a night on a trolley in an emergency department can increase the risk of dying by almost 40 per cent for patients – from 11.1 per cent to 15.7 per cent.

The description of the measure as ageist was “a really disappointing comment to hear”, Mr Donnelly said.