Families may be forced to pay for care

The children of elderly parents in need of long-term care may soon be forced to contribute to the cost of their care under provisions being considered by the Department of Health.

The Minister of State for Health and Children with responsibility for services for older people, Mr Ivor Callely, confirmed to The Irish Times yesterday that he was looking at reintroducing "family assessments".

"Nothing has been decided on that yet, but it is being looked at. All options are being considered. My priority is to gain maximum efficacy for the money that's in the system."

Family assessment would require the introduction of new legislation. Under such a scheme the incomes of sons and daughters would be taken into account when deciding the level of subvention paid by the State.

Currently the State will pay a means-tested subvention towards the cost of a private nursing home bed, of between €114.30 and €190.50 per week.

At the moment, the health board only takes into account the income and assets of the elderly person. Health boards do take into account the value of the elderly person's home as long as it is not occupied by anyone else.

Reintroducing the "family assessment" is likely to be controversial.

It was the most contentious aspect of the subvention scheme through the 1990s, when the regulations allowed health boards to look at "circumstances" other than the elderly person's income.

"Circumstances" in this context meant the income of sons and daughters living in Ireland who were assessed to see if they could contribute to financing the long-term care of parents.

Liability was not however explicitly spelled out in the 1990 Nursing Home Act and the Ombudsman received a high number of complaints.

According to the Department of Health-commissioned Review Of The Nursing Home Subvention Scheme, published last month, "the issue became a source of legal controversy and complaint from the beginning of the scheme".

Regulations on family assessment were amended in 1996 by the minister for health, Mr Michael Noonan, and the scheme was dropped altogether in 1999.

"There has been no debate in this country about the responsibility, or otherwise, of families to support their elderly kin in the final stages of their life," says the subvention review report.

"This was unfortunate," it continued. "Considerable savings to the Exchequer were likely to accrue."

"While it is easy to be critical of both the Department of Health and Children and health board officials for continuing with family assessment when there were so many ambiguities, the financial imperative should not be dismissed lightly," says the author of the report, Prof Eamon O'Shea of the National University of Ireland, Galway.