It can be one of the hardest decisions a family will ever have to make. The decision that a parent or spouse can no longer care for themselves is never made lightly and the options - many of which can seem quite unpalatable - need to be carefully examined.
Many families start looking for help at home. The HSE provides home care packages, but criteria are strict. The packages include a range of services, including home help, nursing and therapy. On the plus side, they are not means-tested and will take into account the level of family support available, but there is no automatic right to hours.
A GP letter can often be supportive in an application for a package. Currently, the State provides 15,450 home care packages, across 10.4m hours.
Many families, if they can afford it, supplement the hours that the HSE provides with private home help from service providers like Home Instead, Senior Care or Bluebird. A case worker will visit your home, assess your needs and try to match one-on-one with the patient. Prices are graded depending on the level of care (for example 'companionship' up to full mobility needs).
However, these services do not come cheap: most have rates of between €20 and €30 an hour; more for overnight care. There is full tax relief available on the fees.
In many cases, however, a full-time nursing home is the only option. Homes can be either public or private, but all are assessed and inspected by HIQA.
With 75pc of nursing homes in the private sector, their fees can be eye-watering, climbing to €6,000 or more per month, especially in Dublin.
It's a big ask of any family, even with the full tax relief that is available. To help tackle the costs, in 2009 the Fair Deal scheme was introduced by then health minister Mary Harney.
It works a little like a pooled insurance scheme where the State pays for all the care, and the resident contributes according to their income/assets. Although not means tested (i.e. anyone can apply), there are two methods of assessment:
Medical: Based on need for long-term care for activities of daily living (washing, dressing), family/community support and possibly a physical examination.
Financial: Income and assets, including the family home. The first €36,000 of savings is excluded and if the patient's spouse is still living in the family home, only half income/assets are taken into account.
Once accepted, patients pay 80pc of their total income (e.g. pension) plus 7.5pc p.a. of their assets as a yearly contribution. The family home asset is capped at three years, i.e. 22.5pc, and can be deferred until after they/their spouse pass away, under a loan arrangement.
The patient keeps 20pc of their pension and the remainder of assets. Extra services such as hair-dressing, newspapers, incontinence wear etc., are not covered.
Tadhg Daly is CEO of Nursing Homes Ireland, which has 440 members. He says that although private nursing homes must negotiate and disclose their fees under the scheme, which are updated monthly, the same is not true of public nursing homes.
"Theirs haven't been updated since 2011. Is it €800 a week, or €2,000 a week? We simply don't know. Under Fair Deal you're never supposed to pay more than the cost of the care, but in a public nursing home, how are you supposed to know?".
Politics aside, we have an elder care time-bomb. The CSO shows that the over-80s population will rise from 128,000 in 2011 to between 470,000 and 484,000 in 2046 with more older people than children in the country. The national deficit for long-term beds, and lack of funding for them, will only increase.
The Government recently provided an additional €500m in funding - but is it enough?
1. Check the HIQA-approved nursing homes close to where you live (hiqa.ie). Price is not an indicator of quality as the home may receive subvention from other sources, but is generally based on location, as with all property. The latest inspection report is under each listing, but some may be out of date.
2. Visit potential homes and bear in mind any specific requirements your loved one has, e.g. dementia, physical disability etc. Some cater more specially for certain conditions, so it’s worth getting a recommendation.
3. Look for space, light and a good ratio of care staff. Is there space to exercise and move freely? What kind of activities take place? Are residents kept busy? Are therapists available on staff or to visit? How is health and safety handled? Ask for daily menus, and a tour of all the public areas. Most of all — did you get a good ‘feel’ about the place; after all, this is a home from home and should be warm, friendly and caring.
Helpful websites: www.nhi.ie (Nursing Homes Ireland) www.hiqa.ie (Health Insurance Quality Authority) www.hse.ie (Health Service Executive)