Changes in the funding of nursing home care announced yesterday by Minister for Health Mary Harney could become the thin end of the wedge in the provision of future services.
As the system undergoes further privatisation and costs increase, charges may also be introduced for the supply of expensive home care and community services to the elderly. It is important to have a public debate on these critical matters which go to the very heart of the modern concept of a caring society.
By re-shaping its duty of care contract with older citizens and requiring those with assets to contribute more towards public nursing home costs, the Government has rejected the option of a universal system based on higher PRSI charges or health levies. The move has been criticised by Age Action Ireland as being discriminatory and a significant departure in the way healthcare is funded.
The vast majority of people would prefer to remain at home, rather than leave their communities and enter an institution. Recent reports on nursing quality have reinforced that inclination. But there is no alternative for many individuals who may require intensive care and monitoring because of old age, a stroke or dementia. In the past, inadequate grants to make homes safer and more accessible for the elderly, along with the absence of developed community services, encouraged nursing home use. That is changing. Extra funding for home care was provided in the Budget. But community health services are still patchy and inadequate.
The changes announced involve a two-step process requiring the Health Service Executive to assess, first of all, whether an individual requires nursing home care and, secondly, how much they should pay towards that service on the basis of their assets. A ceiling will be placed on their liabilities and, for the first time, a standardised assessment system will be used in all regions for public and private nursing homes. The new system is not due to come into operation until January 2008, which should allow plenty of time for public debate and possible amendments. Discussions with the social partners, earlier this year, identified a co-payment system but left open the option of financing the scheme through social insurance or some other pre-funding mechanism.
The Minister has consistently argued that the State should not be required to subsidise the care of older people, in cases where their families and relatives would benefit significantly after their deaths. It is a reasonable case. But vulnerable people could be pressurised to dispose of their assets to avoid such liability. And it ignores the tax and insurance contributions such people made in the past. Some positive and welcome changes are proposed. Existing regulations are unfair and inequitable and should have been reformed years ago. But the Minister's primary motivation is to save money. This Government took pensioners' money illegally in nursing homes and then tried to keep it. In view of that record, there is a need for caution.