Nursing homes charge residents for products free with medical card

Private nursing homes have blamed the HSE for them charging residents for medical products and services they would receive free of charge if living at home or in a public nursing home.

Tadhg Daly, chief executive of Nursing Homes Ireland (NHI), the organisation representing a majority of private facilities, said the HSE was responsible for the "discriminatory practice".

Mr Daly’s comments follow criticism by Sinn Féin TD Imelda Munster of the ongoing practice where residents in private nursing homes are being forced to pay for what they would receive free of charge if living at home or in a public nursing home.

Ms Munster said private nursing homes charged residents for items such as wound dressings, prescription painkillers and bedsore creams as well as for services such as physiotherapy and occupational therapy.

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It was “totally unacceptable” that private nursing homes discriminate against people in their care, she said.

In a parliamentary reply on the issue, Minister of State for Health Jim Daly said a person's eligibility for medical card services was not affected by being in a nursing home.

But he said it was very important that the taxpayer would “not end up paying for the same service twice”.

And for this reason medication and aids “that are already prescribed for individuals under an existing scheme are not included in the services” and are not covered under the Fair Deal.

Ms Munster said “this does not make sense because a person’s rights and entitlements are the same whether they are at home or in a public or private nursing home”.

She asked: “Is it the case that private nursing home contracts are given supremacy over the law of the land?”

Ms Munster added that residents or their family members were receiving “strongly worded letters” demanding payment when they were entitled to receive these items and services free of charge as medical card holders.

“When family members have complained, they have been told to go elsewhere if they don’t like the charges,” she said.

Mr Daly said, however, that nursing homes “have an open culture with regard to the receipt of concerns and complaints” and there were robust rules about dealing with them, where residents “must not be adversely affected” as a result. If an issue could not be resolved with the nursing home, the Office of the Ombudsman could investigate.

‘Top-up’ fees

Private nursing homes have been repeatedly criticised for charging “top-up” fees of €100 and more a month for social, occupational therapy programmes.

But Mr Daly of the NHI said the narrow definition of goods and services under the Fair Deal scheme and the fees paid to nursing homes “do not encompass the reality of the health and social care costs incurred to meet the day-to-day care and living requirements of persons requiring nursing home care”.

The NHI chief executive also said in a statement that numerous statutory agencies had “all highlighted the discriminatory practice operated by the HSE with regard to provision of such services for residents in private and voluntary nursing homes”.

The Public Accounts Committee held hearings last year on the Fair Deal scheme, where the State provides financial support to residents in nursing homes. In its report published last month it noted the comments of a senior HSE official that a person in a nursing home with 24-hour care is considered less of a risk than a person who might be residing alone in their home.

“As medical card services are a scarce resource, there may not be sufficient capacity to provide the services for everyone, and the assistant national director indicated that some prioritisation must take place.”

The committee noted that from a budget of about €1 billion for the Nursing Home Support Scheme, about two-thirds was expended on public nursing homes that provided one-fifth of capacity.