A fair deal…..nursing home scheme ?

LONG-TERM nursing home residents can now apply for a new financial aid package, following the introduction of the Fair Deal nursing home support scheme yesterday. Although the scheme won’t become operational until October 27th, the new care representative appointment process has already commenced, which means that individuals looking to avail of financial aid on behalf of an applicant with reduced capacity can apply to the Circuit Court for appointment as a care representative.However, while the launch of the scheme will be welcomed by families who are under time pressure to meet the costs of care, concerns remain. Nursing homes argue that under the scheme the total costs of care aren’t being met, while patients might be hit by the fact that the amount allocated to pay for them will be capped.

The Fair Deal was due to be introduced in early 2008, but has been beset with delays. On July 1st, the Nursing Homes Support Scheme Act 2009 was signed into law, and the NTPF began negotiations with private nursing homes to agree prices on behalf of the State for the provision of long-term residential care services.

The original deadline for this process was July 30th, but nursing homes were then granted an extension of August 14th to negotiate with the NTPF.

Nursing homes were given two options – Option A, which gave a set price for single and shared rooms; and Option B, which invited those who felt the price offered in Option A did not match their expectations, to respond with their own offer and to negotiate with the NTPF.

While nursing homes bemoaned the lack of transparency in the process, and the fact that they were bound to secrecy with regards to pricing, the NTPF has now reached agreement with almost all private nursing homes, and is beginning a process of notifying the Health Service Executive of prices agreed, as required under Section 40 of the Nursing Homes Support Scheme Act.

Only seven nursing homes have yet to come to an agreement with the NTPF, and negotiations have been completed with 426 of the 433 private nursing homes that applied for the scheme. According to the NTPF, of those who have signed up, 40 per cent opted to accept rates offered by the NTPF for six months, (Option A) while 60 per cent opted to negotiate a 12-month contract (Option B).

However, while almost all nursing homes may have signed up, Tadhg Daly, chief executive of Nursing Homes Ireland (NHI), maintains that some of its members remain “unhappy’’ with the scheme, and he says it should come with a health warning because it doesn’t cover all of the nursing homes’ costs.

Under the scheme, long-term residents will contribute 80 per cent of their income, in addition to a percentage of their non-cash assets and property, which will be put towards costs such as bed and board, and nursing and personal care.

However, this website has a wide range of essential items such as social programmes, incontinence wear, opthalmic and dental services and therapies.

Geriatricians are concerned that the contracting process may not include gerontologist nursing, specialist feeding equipment, speech and language therapy etc, while the NHI is seeking a clear definition of what constitutes “goods and services” under the scheme. However,this won’t be laid before the Houses of the Oireachtas until the scheme is commenced.

What is feared is that residents may have to pay the remaining 20 per cent of their income towards the cost of services not covered under the scheme. As such, Daly says that one of the primary goals of the new deal won’t be attained. “It won’t be ‘anxiety free’ for many people,” he says.

“It won’t be a ‘Fair Deal’ for those on low incomes,” agrees Eamon Timmins, head of advocacy and communications at Age Action, questioning the ability of those qualifying for the scheme to pay. “Twenty per cent of what? If you’re drawing the State pension of €230.30 you’ll be saving a long time for a physiotherapy session.”

For its part, the Department of Health has hit back at criticisms of the scheme by indicating that local arrangements between individual providers and local HSE offices regarding the provision of incontinence wear “should continue in force for the time being”, while the issue of therapies will be addressed in the context of the forthcoming eligibility legislation.

However, with proposals for the legislation due to be brought to Government early in 2010, Daly is concerned that the eligibility limits will not be comprehensive enough and will still exclude many people. Timmins adds that these guidelines are “not satisfactory” and more clarity is needed.

The NTPF’s focus on costs has also raised some concerns, coming as it does after the mis-treatment at Leas Cross. Daly argues that the NTPF’s “one-size fits all” approach is not suitable, and that it “behoves the NTPF to behave as a responsible purchaser and to look at the care needs of an individual”.

The question has also been asked as to whether someone with gerontologist experience has been negotiating with the nursing homes, given what was learned at Leas Cross about the need for gerontologist nursing and specialist aids. Another potential issue with the Fair Deal is that it is resource capped.

“We don’t want a situation at the back-end of the year, whereby people require long-term care but there isn’t enough money in the kitty,” Daly says.

The Government allocated €55 million for implementation of the scheme in 2009, but according to the Department of Health, funding for 2010 will be a “matter for the Government in the context of the forthcoming budget”. Given the shape of the public finances, this may not be sufficient.

The Fair Deal may also be further hit by the deteriorating public finances, given An Bord Snip Nua’s report recommendation that the percentage of care costs contributed by an individual from their residence be increased from 15 per cent to a maximum of 22.5 per cent over three years, which would result in annual savings to the Government of €50 million.

“It’s hard to believe that they’re already proposing to increase this,’’ says Timmins, who adds that the 15 per cent cap is “already a very high charge for something which is essential care”.

Nursing home care that’s ‘accessible, affordable and anxiety-free’

The Fair Deal is a new way of paying for the costs of long-term residential nursing home care. The scheme’s main feature is that while the State will continue to fund the largest part of care costs overall, individuals will also be asked to contribute towards the cost of their long-term care.

The aim of the deal, which was launched by the Government in December 2006, is to make residential nursing home care “accessible, affordable and anxiety-free”.

It will replace the current system of public nursing home charges and the private nursing home subvention scheme, and will remove distinctions between public and private homes.

Although it was originally due to become effective on January 1st, 2008, legislation providing for the scheme, the Nursing Homes Support Scheme Act 2009, was passed this summer, and it is now due to be introduced on October 27th.

The process of appointing a care representative who can apply for the Fair Deal on behalf of an individual began yesterday. Nursing home residents who sign up to the deal will pay 80 per cent of their disposable income, 5 per cent of the value of their non-cash assets above €36,000 and up to 15 per cent of the value of their homes following their death, to cover the costs of their accommodation.

To qualify for the scheme, individuals must first pass a financial assessment as well as a care needs assessment.

Once the scheme comes on stream, individuals can continue with their existing arrangements or choose to transfer to the Fair Deal.

For more information see www.dohc.ie