Families are refusing to allow elderly relatives who are "blocking" beds in acute hospitals to be discharged, in order to avoid incurring the costs of private nursing-home care, according to senior Department of Health officials.
The officials' views are made clear in a briefing document which was prepared early last year for the department's secretary general, Michael Kelly.
It said there was a cohort of older people currently accommodated in acute hospitals who were fit for discharge but were not eligible for nursing-home subvention payments because their assets exceeded the threshold for payment of these subventions.
"Family members have been unwilling to co-operate with the area boards [health boards] in finding private nursing-home beds for their relatives as they would have to pay for the accommodation, with the result that they are left occupying acute hospital beds when they would be more appropriately accommodated in nursing homes," the document said.
"There is no incentive from the family viewpoint to co-operate with the area boards in moving their relatives to more appropriate accommodation as they have free accommodation in the acute hospital sector, thereby protecting their assets," it added.
The document was released by Minister for Health Mary Harney yesterday in the context of the current furore over why nursing-home charges were deducted from the pensions of elderly people for nearly three decades when the department was aware there were concerns over the legality of the practice.
The background paper was to have been forwarded by Mr Kelly to the Attorney General so his advice on the practice could be sought. In addition to the bed-"blocking" issue, it dealt with several other matters including existing legal advice on the nursing home charges practice and the financial implications if the charges were illegal.
Under the heading "Delayed discharges from acute hospitals" it also made it clear that some older people were being inappropriately cared for in acute hospital beds because of a lack of "sub-acute facilities" for them.
The occupation of beds by elderly people fit for discharge has been a significant factor in the continuing A&E crisis. If their beds were freed up, something which Ms Harney has promised to do, they could be occupied by patients who otherwise have to be accommodated on trolleys.