Fighting on the home front

Elderly patients are allegedly being moved from one nursing home to another against their wishes

ELDERLY NURSING home residents and their families are being urged to contact the Ombudsman Emily O’Reilly to highlight a recent “surge” in the numbers being transferred to new accommodation against their wishes.

A few years after the Leas Cross scandal threw the spotlight on how nursing homes are run, major changes are imminent in the sector and an independent inspectorate is due to be established this year.

The Government has also promised that the so-called Fair Deal will create a level playing field in the area of costs.

But as Nursing Homes Ireland, the representative body for the private and voluntary sector, is set to celebrate its first anniversary next month, chief executive Tadgh Daly has identified the issue of unsolicited transfers of residents as a priority for his members around the country.

Age Action and the Irish Nurses’ Organisation recently highlighted the trauma suffered by residents who have to leave familiar surroundings, after public nursing homes in Bray, Carlow and Waterford were closed by the HSE for health and safety reasons.

While acknowledging the need for high standards, Age Action urged that, where possible, facilities should be refurbished rather than closed, and that friends be kept together when closure is unavoidable.

Mr Daly said that residents in private facilities were also being moved into new public units and he urged that elderly people “not be sacrificed on the altar of costs”.

The NHI chief said he had been briefed about a “significant number” of residents in contract HSE-funded beds who were being moved out of private nursing homes when beds became available in new public units.

NHI has written to the HSE urging that residents who have lived in a home for more than six months not be transferred unless they request the move. The organisation also intends to raise this issue with the Minister.

“We believe that in 99 per cent of these cases there is a waiting list for the public units, so why move people who are settled and happy where they are. It is a callous thing to do,” said Mr Daly.

He said because this situation was causing such distress for residents and their families, NHI was urging them to contact the Ombudsman about their situations.

“This has become a big issue around the country in the last few months. If people have been living in a nursing home for two or three years it is their home, it is where their friends are and it is very traumatic for them to leave familiar surroundings,” he said.

He said he believed the transfers were motivated by cost factors and that “it really is a very sad indictment of our society if we treat elderly people like this”.

He said that if the HSE was using these situations to shut down contract beds this would represent “cutbacks by stealth”.

NHI has recently estimated, based on a survey of its members, that there are now 1,800 empty beds in private nursing homes around the State. Currently there are an estimated 19,000 beds in private facilities – up 26 per cent in four years – and 9,500 in public nursing homes.

Calling on the Government to fast-track the Fair Deal legislation, Mr Daly said that many families were reluctant to access nursing homes until the new regime was introduced.

He also pointed out that nursing home beds were lying idle at a time when delayed discharges from acute hospitals was putting a huge pressure on the system. It has been estimated that almost 217,000 bed days were lost in Irish hospitals in 2008 because of delayed discharges, the majority of them accounted for by patients in the 65-plus age category who apparently had nowhere to go.

“There are places to go to but they are not being funded,” said Mr Daly who urged the Government to release funding for additional contract beds and subventions, until the Fair Deal comes into effect.

He said there was a strong sense among his members that the HSE had cut back on the amount it spends on contracting beds in private facilities, hence the delay in elderly patients being discharged from acute hospitals long after their treatment was finalised.

“It has been estimated that it can cost from €5,000 to €8,000 a week to keep someone in an acute hospital setting, so it is a false economy,” he said.

The Fair Deal, which aims to end the distinction between private and public facilities, is now expected to be introduced by the middle of this year.

Under it, residents will pay 80 per cent of their disposable income towards nursing home costs and they may be charged up to 15 per cent of the value of their home and assets after death, with the State picking up the balance of the bill.

The Government has stressed that this will take the burden off family members but critics have described it as a tax beyond the grave and have asked why older people who experience stroke or dementia should have to help fund their care while, for example, cancer or cardiac patients will not.

“One of our concerns is that it is very unclear whether services such as physiotherapy, speech therapy or chiropody will be funded or will be regarded as extras to be funded by the resident,” said Mr Daly.

He said that given the uncertainty over when the new regime would come into effect, it was very important that the Government not cut back on contract beds or the €300 a week subventions paid to some residents. He also said it was inequitable that enhanced subventions vary from region to region.

“We have situations where residents in the same home and even sharing the same room get different amounts [in enhanced subventions] because it depends on what part of the country you are from,” said Mr Daly.

The Health Information and Quality Authority (HIQA) will be responsible for the inspection and registration of all private and public nursing homes once new guidelines come into effect.

HIQA has published 32 standards and once the Minister signs off on these, the authority will recruit 50 inspectors who are expected to start work before the end of the year.

Asked about the damage done to the reputation of the sector by the Leas Cross and other scandals, Mr Daly said: “In terms of overall standards I believe that the vast majority of operators provide very good quality care. What happened happened, but we welcome the new standards.”

He pointed out that until now there had been no independent inspection of the public sector.

The HSE expressed surprise at Mr Daly’s comments and said that the number of private nursing home beds it was funding was actually increasing, particularly in the Dublin area.

In a statement, the HSE said that it was contracting over 3,000 private nursing home beds to support the early discharge of older people from acute hospitals and to prevent inappropriate admission.

“The number of beds being funded by the HSE continues to increase and most recently in January 2009 the HSE approved the purchase of an additional 245 private nursing home beds particularly in the Dublin area but also in other locations across the country,” said the statement.

“In this context therefore to suggest that there are significant numbers of elderly people being moved out of private nursing homes to save costs is simply inaccurate,” it continued.

The HSE said there were many reasons why a resident in a private nursing home “may seek or need” to be transferred and a range of issues were taken into consideration in each case.

A spokesman said that 9,000 elderly people were receiving subventions in respect of private nursing home accommodation, and 5,000 of these were receiving enhanced subventions.