Department of Health Fair Deal Review By Annette J Dunlea
The purpose of the Scheme is to provide financial support for people assessed as needing long-term nursing home care. The scheme is founded on the core principles that long-term care should be affordable and that a person should receive the same level of State support whether they choose a public, voluntary or private nursing home. Since the 27th October 2009, the Nursing Homes Support Scheme is the means of accessing long-term nursing home care for all new entrants.Under the Nursing Homes Support Scheme, you will make a contribution towards the cost of your care and the State will pay the balance, whether the nursing home is public, private or voluntary.The HSE administers the Fair Deal Scheme within the resources available and in line with the Nursing Home Support Scheme legislation. Applicants cannot avail of State funding for a nursing home place prior to receiving approval of their Fair Deal application.As the third anniversary of the Fair Deal approaches in October it is important that the review looks at the efficiency of the application process. Department of Health guidelines refer to a turn-around time of 40 days but average times quoted by the Department have ranged from 28 days in January 2012 to 84 days in October 2011! The terms of reference are: to examine the ongoing sustainability of the scheme; the relative costs of public versus private provision; the effectiveness of current methods of negotiating prices in private and setting prices in public nursing homes; and the balance of funding between residential and community care.
Attempts to reduce the costs of the Fair Deal nursing home scheme are being hampered by long-running contracts with private nursing homes, some of which do not expire until 2016.The NTPF had adopted a policy of entering longer-term contracts with homes in 2010. More than 20 contracts currently in hand will not expire until 2016; 35 contracts will run out in late 2015; 71 contracts expire in 2014; and almost 100 will end next year.The fees negotiated with the private and voluntary nursing homes range from €650 to €1,291 per patient per week. The variation can be attributed to factors including level of care, location and whether rooms are single or shared. The most expensive homes are in Dublin, Kildare and Cork.A spokesman for the Minister for Health said recently that since the Minister indicated he wanted downward renegotiation of prices, “approximately 70” private nursing homes reduced prices. “This includes homes where the contract was up for renewal and in some cases homes where the contract has some time yet to run,” he said.There was a “rolling process of negotiation” and the was making clear to nursing home providers that “the best possible value must be achieved for the taxpayers in the context of the current economic climate”. The review needs to look at different types of accommodation for older people and at the mechanism used to determine whether or not an older person should be in a nursing home.”Where a person does not get a residential bed they should be offered home care packages, which is not currently being done.The review needs to address this so that the scheme at least meets the basic needs of residents.”Of concern the high cost of fair deal beds in the public sector, beds are 40% more expensive than the private sector!
CEO of ALONE Seán Moynihan stated, “We’re glad to hear the announcement by Minister Lynch that she intends a review of the Fair Deal Nursing Home scheme, as our experience is proving to us that the current method of operation is quite simply inefficient, and not providing the service required. We’re keen to see a speedy, thorough review, and to have positive changes implemented at the earliest possible stage. We at ALONE are particularly keen to see a greater shift towards supportive housing models in the community which maximise independence, and provide value for money. The cost of provision of nursing home care is extremely expensive, and we’d like to see some follow‐through on the Minister for Health’ repeated statements that care provision in people’ own homes is the preferred option. It is also a significantly less expensive option. ”He continued, “he vital thing is that home care packages and home help hours are fully supported by the government, and not cut. In January, it was proposed that home care hours would be reduced by an estimated 500,000 hours, which would have a significant impact on service provision. If the government is considering restructuring the Fair Deal scheme with a greater emphasis on home care, then an appropriate level of commitment must be made to the home care model.” “Our other concern,” he concluded, “s that the current Fair Deal scheme is not being implemented as planned, in terms of how applicants are being assessed. It is our experience that the current Care Needs Assessment is used mainly to decide whether or not someone should be placed in long‐term care. Where it is decided that their care needs might be better managed with a home care support package, this support is not available.
Age Action called on both Minister Lynch and Minister Reilly to address this situation as a matter of urgency, and we hope that the review of the Fair Deal Scheme will result in a resolution of this unacceptable situation, with better training for assessment staff and consistency and equal access to services for all.”Age Action welcomes the fact that the Fair Deal nursing home support scheme is being reviewed this year, but warned that the review must be broad ranging and go beyond just the financial aspects of the scheme. “We welcome the fact that the Minister for Older People, Kathleen Lynch, has questioned the feasibility of continuing with the charge on an older person’s home as part of the funding arrangement for a nursing home bed, given the small take-up among older people of that element of the scheme by older people and their families, and the administrative cost of running it,” Age Action spokesman Eamon Timmins said. The national older people’s charity also agrees with Minister’s analysis that the review needs to look at other ways of keeping people in their communities and the options of other types of accommodation, apart from nursing homes. Age Action believes the review must also examine how effective the Fair Deal has been in meeting the needs of nursing home residents who have signed up for the scheme. “Despite the considerable financial commitment made by nursing home residents and their families as part of the Fair Deal, some have found that the scheme does not cover issues such as incontinence wear, specialized wheelchairs or physiotherapy,” Mr. Timmins said. “The review needs to address this so that the scheme at least meets the basic needs of residents.” Age Action believes that that nursing home residents, their families and advocacy organizations working with them are consulted as part of the review process. Do people understand the scheme, what it covers and what to do if there is questionable charging? How many people are going to their first choice nursing home? UK research has shown that many patients actively or passively relinquished their involvement in the process of discharge planning because of the perceived expertise of others and also feelings of disempowerment linked to poor health, low mood, dependency, lack of information and the intricacies of discharge planning processes for complex needs. Are these issues relevant in Ireland and, if so, how can the Fair Deal scheme be improved?
Causes Annette Dunlea Supports
The National Council of The Blind, Ireland