Cost of unwanted services making nursing care ‘unaffordable’

Age Action says some people must pay for activities they cannot take part in

Additional charges on nursing home residents are making long term residential care unaffordable for many people, Age Action has claimed.

Some nursing home residents are being charged for social activities they are physically unable to take part in while others have to pay €100 for a doctor service despite having a medical card.

Extra charges of up to €50 a month for incontinence pads are another common complaint.

Under the Government’s Nursing Home Support Scheme, otherwise known as Fair Deal, nursing home residents pay 80 per cent of their income in return for a bed in the facility of their choice.


They must also pay an annual level of 7.5 per cent on their assets, excluding the first €36,000. If they have a home they must pay 7.5 percent of its value for the first three years of care.

This pays for bed and board for residents as well as basic care needs. In 2016, 23,450 people used the scheme. Residents are supposed to have their choice of nursing homes, no matter how much they contribute to the scheme.

Age Action says the miscellaneous expenses imposed by some care homes make them unaffordable to many.

One woman told Age Action her mother has a medical card and her own doctor but still has to pay for a house doctor in her nursing home.

She must also pay for “excess” incontinence pads and said the nursing home refuse to provide an itemised bill. She is now taking legal action.

Social activities

Another woman, who pays 80 per cent of her income to the Fair Deal scheme, must pay an additional €4,474 a year in additional expenses, including €222 a month for social activities.

“In many instances residents cannot opt out of paying these charges even though they may be unable, due to their health status, to participate in social activities,” a briefing paper by Age Action says.

“It also restricts the spending power of a nursing home resident. Instead of being able to spend the money remaining to him or her on books, hobbies, clothes or gifts for family members, they must pay the nursing home for additional services they may or may not want.”

Older people who rely on the State pension often cannot afford these charges meaning their choice of nursing home is extremely limited or they have to go on a waiting list for a public nursing home bed.

A review of Fair Deal carried out by the Department of Health in 2015 found charges were being levied on residents which were presented as optional but which residents see as mandatory in practice.

The review said consideration should be given to prohibit additional charges for services which a resident does not use. However no progress has been made on this.

Nursing Homes Ireland (NHI), which represents private nursing homes, has said facilities are obliged to provide certain services to residents which are not covered by Fair Deal and that they have little choice but to pass the costs on.

“Nursing home charges are for services provided to residents for services explicitly excluded under the Nursing Home Support Scheme and agreed with all residents in the Contract for Care,” NHI chief executive Tadhg Daly said.

The Health Information and Quality Authority has examined these contracts for care and found there are good levels of compliance with regulations, he added.

Conor Gallagher

Conor Gallagher

Conor Gallagher is Crime and Security Correspondent of The Irish Times