Pressure on after shift in Fair Deal priorities

Stress of looking after frail relatives is often matched only by worries about how to pay for their care

For many families, the stress of looking after frail relatives is matched only by worries about how to pay for their care. With private nursing home care costing an average €1,000 a week, this option is open to only a tiny fraction of the population for any length of time. For most people, the Nursing Home Support Scheme (known as Fair Deal) is the only viable way of funding nursing home care.

Under the scheme, patients can choose a private or public facility and care is provided in return for a contribution of 80 per cent of income and 7.5 per cent of assets each year; the asset contribution increased from 5 per cent last week.

Growing pressures

The scheme has worked surprisingly well since it was introduced in 2009 but documents obtained by The Irish Times under freedom of information legislation show it is subject to growing pressures. Funding has been cut, waiting lists lengthen and decision times for the allocation of places are growing.


No wonder that Nursing Homes Ireland, which represents private operators, yesterday repeated a call for a forum on long-term residential care to thrash out the challenges facing the sector.

On any given day, about 700 hospital beds are occupied by older patients who are fit enough to be transferred to a nursing home. This number has remained high despite consternation about the extra cost involved. It was this cohort the Department of Health targeted last spring in an effort to reduce pressures on emergency departments.

At the time, there were more than 400 patients on trolleys on some days and a decision was made to make space by using Fair Deal to transfer older patients to nursing homes. HSE officials believe the decision saved lives in hospitals but it was made at the expense of those at the top of the "first come, first served" list, sometimes with disastrous consequences, the documents show.

More vulnerable

"We are already dealing with cases where people now pushed further down the waiting list have fallen etc at home, not been discovered for hours, and are arguably more vulnerable than those in an acute hospital bed," wrote department assistant secretary Geraldine Fitzpatrick.

One family wrote to Minister for Health James Reilly about their plight, saying they had been told a place would be made available for their father within four weeks. On this assurance, they paid the private fees for the interim period. "Our situation is that we can no longer afford these payments, we have over the years done more than our share, none of us are capable of carrying this burden any longer."

Secretary general Ambrose McLoughlin insisted nursing home funding be prioritised for hospital patients because the situation was at crisis point and there were serious risks to patients because beds were occupied by people fit for transfer to nursing homes. “It is extraordinary that in a crisis and emergency where patients’ lives and wellbeing are at serious risk we cannot give priority to acutely ill patients,” he said.

After the measure was implemented in mid-April, Ms Fitzpatrick pointed out that many of the nursing home places allocated under the new method went to patients who weren’t occupying emergency beds. This “fatally undermined” the argument that the measure was introduced on health and safety grounds.

An internal HSE report warned that preferential funding for hospital patients in allocating nursing home places “carries significant risk of sending out the message to community and to families that as long as you stay at home you will never access a long-term care bed”.

Paul Cullen

Paul Cullen

Paul Cullen is Health Editor of The Irish Times