More families left struggling in the battle to pay nursing home bills for the elderly


The cost of nursing home care for the elderly is soaring, creating serious financial problems for many residents and their relatives. Carl O'Brien and Kitty Holland report

Jim Quinn still recalls the gnawing worry about where he and his family would find the money to pay for his sister's nursing home bills.

Despite Phyllis's pension and the State subvention she received for her nursing home bed, there was still a wide gap when it came to footing the full weekly nursing home bill.

"She didn't have any children. I had stopped working and so had my other sister," says Mr Quinn, a 73-year-old father of three.

"The worry was always there. In the end we had to contact nephews and nieces abroad to get the money together."

Jim, and an increasing number of families with relatives in care, are quickly finding out a few home truths about the cost of long-stay care. Pensions and State subsidies were once enough to pay for nursing homes.

Now, due to the soaring cost of care, increasingly extreme measures such as selling off the family home or asking the wider family for financial support are commonplace.

"Luckily we had an extended family which stretched from Boston to Geneva who supported my sister and kept the whole thing going," says Mr Quinn. "But if you didn't have that, where would you be going?"

At the headquarters of Age Action Ireland on Lower Camden Street, Dublin, staff are fielding a rising number of callers worried about the cost burden of nursing home care.

"The situation as a whole is in turmoil because people don't know what the hell they are entitled to," says Mr Paul Murray.

"Some families are making heroic efforts to pay for a relative in care. Yet, side by side in a nursing home, there may be another person with substantial assets who isn't being asked to pay anything."

Weekly costs for private nursing homes range from between €350 and €1,000 a week, depending on the location and level of services available. If this is too costly, the law on entitlement to heavily-subsidised long-stay care provided or supported by the State is characterised by confusion.

Admission procedures are murky, rules about residents' liability to contribute to their care are often arbitrary, all of which gives rise to a disturbing lack of clarity over older people's entitlement to care.

Against this uncertain backdrop is a sector where the cost of care is soaring, and older people and their families are increasingly dogged by financial worries.

The "crisis", as support groups describe it, is now sparking a long-overdue debate on how much individuals and the State should be prepared to pay as the proportion of elderly people increases in the years ahead.

While the issue of entitlements to public beds and subvention for private beds lacks transparency, there is little doubt that those hardest hit by nursing home costs are on middle incomes. Unable to secure a public nursing home and ineligible to obtain subvention to ease the cost of private care, they are exposed to the full cost of nursing home care.

"If you're well-off it's not a major problem, and if you don't have assets, you should get a public bed," says Ms Mairead Hayes, of the Irish Senior Citizens' Parliament. "But in many ways it's those on middle incomes who are suffering most because they are under huge pressure to pay for care."

Mr Sean Collins, chairman of the Irish Nursing Homes Organisation, admits that private homes are expensive, but insists that they offer good value.

"The average cost is €570 a week, which is a colossal amount of money. But that is still much more cost-effective than the public sector." The organisation estimates that private beds cost around €30,000 and €40,000, compared to between €65,000 and €70,000 for a public bed. Public beds, however, typically offer additional services for more dependent older people.

"It's a tough business, it's seven days a week, 24 hours a day," says Mr Collins, who runs a nursing home for 32 residents in Drimoleague, Co Cork. "You're dealing with people's lives and must provide very high standards of care. Most homes would have one staff member for each resident, so there are easier ways of making money."

Given the increased cost of care, the once sacrosanct family house is now increasingly being used to finance nursing home costs.

An industry is growing up around this with an array of financial institutions offering various schemes which involve tapping into the equity of the house.

Bank of Ireland has a product which gives homeowners aged 65 or over a roll-up mortgage for up to 30 per cent of the value of their property.

Residential Reversions allow qualifying homeowners over 70 in the greater Dublin area to sell a stake in their home in return for a lump sum, a guaranteed monthly income or a combination of the two.

However, support groups advise older people availing of products of this nature to be extremely cautious and read the fine print of such agreements.

Inevitably the use of the family house for nursing care funds has implications for inheritance, but Mr Murray says older people's priorities should be paying for their own care.

"Parents are entitled to use money for their own needs. Understandably, they will want to pass on material goods, but they have already given health, education, nurturing to their children.

"They are entitled to use their goods to enhance their final years," Mr Murray says.

One inescapable conclusion, however, is that the structure of nursing homes, pension rates and the existing rate of subvention are not enough to provide for an older person's care into the future.

The Government-commissioned Mercer report into long-term care for older people concluded it was not reasonable to expect people to provide for long-term care costs by means of savings or the accumulation of assets, with the exception of housing assets.

Instead, it said an increase of 1.5 per cent in PRSI contributions was the most effective way of funding long-term care.

A report on a review of the subvention scheme, published earlier this year, concluded that the subvention was unsatisfactory, too small and, more importantly, called for a new model of funding based on home-care over nursing home care.

In a damning conclusion, it said the absence of community care was "forcing" people to opt for private nursing home care, placing even greater demand on the subvention scheme.

"We need more clarity and more uniformity in the system," says Ms Hayes, who agrees with the main conclusions of the subvention report.

"The upgrading and enhancement of community care is a priority. Older people should be facilitated in every way to live independently in their own homes and this should be a prime objective of the Department of Health and health boards."