State involvement at stake in review of 'Fair Deal' scheme for nursing homes

The crisis in funding surrounding nursing home care has broadened into an ideological debate over privatisation

THE DEPARTMENT of Health is undertaking its first major review of the scheme it introduced in 2009 to fund long-term residential care of the elderly.

At stake is whether the State should continue to play a direct role in providing care, or whether it should be largely privatised if it means saving money.

The review of the Nursing Home Support Scheme, or “Fair Deal”, is likely to be complete by early next year.

While some – notably public sector employees and some older people’s advocacy groups – argue that the care of older people simply must remain within the purview of the State, others, notably private sector representative body Nursing Home Ireland (NHI), and some within the HSE and Department of Health, say public provision is just too expensive.

The review of the Fair Deal was prompted in large part by the near catastrophe last year when it ran out of money. Its inherent flaw is that it is a demand-led scheme, with a budget cap.

Anyone, regardless of whether they have health insurance, can apply to it for funding for nursing home care. Following a means and care assessment, the patient is expected to contribute 80 per cent of their disposable income to the cost of their care while the State pays for the rest. They are then free to choose a public or a private bed that meets their needs.

In May last year the annual budget was exceeded. The department had underestimated how much money would be needed and had to close to new applicants, causing huge anxiety, until further funding was found and it reopened in June last year.

The Fair Deal review’s main term of reference, according to the department, is “to examine the ongoing sustainability of the scheme”.

It will also look at the “overall cost of long-term residential care in public and private nursing homes and the effectiveness of the current methods of negotiating/ setting prices” and to look at community-based alternatives to residential care.

Private beds are cheaper – an average of €865 per week, compared with €1,245 for a public bed.

“In a challenging economic climate where cost control is an understandable priority, the increased utilisation of the private and voluntary nursing home sector presents an obvious area of potential saving for the Government,” says Tadhg Daly, chief executive of NHI.

There are about 28,500 long-term care beds, of which about 6,500 are public and 21,500 private – up from about 14,000 private beds 10 years ago.

The HSE, under pressure to claw back an overspend in the first four months of this year of €200 million, plans to close up to 898 public nursing home beds this year, on top of the 758 it closed last year.

Mr Daly says lower wage costs in the private sector account for cheaper beds. “We don’t have the premium shift rates, the overtime rates, the sick pay.” The sector, he adds, has fewer nursing staff and more care attendants and generally does not cater to high-dependency patients.