Scheme marks the beginning of a two-tier health system

by Eamon Timmins THE publication yesterday of the Nursing Homes Support Scheme Bill 2008 marks a dramatic development in the way this country charges for essential health and nursing care services. Once it becomes law, those with dementia, paralysed by stroke or incapable due to infirmity to live independently in their own home will be cared for – but at a cost. Those deemed sick enough to be admitted to a nursing home will be charged 80% of their income during their lifetime for their care – and up to 15% of the value of their estate after their death to cover their care costs. In short, they will be viewed differently than other patients who require medical care for cancer, heart attack or any other kind of serious illness which requires acute, but not residential, care. The bill will create a new form of two-tier health system in Ireland. And with any new system come questions. A senior geriatrician posed this one to me last week: “If I assess a patient and find that they need full-time medical and nursing care, but that person refuses to sign up to the new charging arrangement whereby he would pay 80% of his income and up to 15% of the value of his estate, would the state then refuse to provide him with the care he needs?” We are anxious that any legal problems relating to this bill are sorted out before it is passed into law. It is in nobody’s interest that this legislation would face further legal challenges and delays. We accept that the cost of private nursing home care is crippling families and a solution was needed, but we do not accept the solution forwarded by the Government. Age Action is deeply concerned that, 22 months after such a significant piece of legislation was first announced by Minister Harney, carers, older people and older people’s organisations such as Age Action have not been consulted. Widespread consultation with older people is essential. If the Government is serious about caring for older people and keeping them out of nursing homes, it must now increase its investment in community care to enable as many people as possible to remain living in their own homes. Research by the Irish Association of Social Workers and Age Action in July showed that the provision of home care and home help packages was insufficient and that, in many parts of the country, these vital services were not available to older people. These supports are essential in the light of the proposed charges in the new scheme for people who remain in acute hospital beds after their acute hospitalisation treatment has ended. The reality for many of these people is that they cannot go home because there is insufficient support at home to enable them to live there independently. Others have been offered public beds up to 48km away. It is not acceptable that they should now be financially penalised by the state. We are also concerned that the draft nursing home standards, developed by the Health Information and Quality Authority, be approved as quickly as possible so that older people who will be charged under the new support scheme can be assured of quality standards.