Friday 19 January 2018

Care concerns - nursing home costs

A new Government scheme aims to reform State supports for our public and private nursing homes to ease the financial burden facing families

Kathleen McCready, aged 78, originally from Ardara, Co Donegal, who is a resident at Belmont House Private Nursing Home, Stillorgan,
Kathleen McCready, aged 78, originally from Ardara, Co Donegal, who is a resident at Belmont House Private Nursing Home, Stillorgan, Dublin

John Cradden

NO-ONE likes to imagine themselves spending their days in the confines of a nursing home by the time they hit their 70s or 80s.

After all, we're living longer and healthier lives than our parents and grandparents thanks to medical advances and (for some) healthier diets.

The overall proportion of over-65s currently living in nursing homes is still relatively small, at about 5pc.

Furthermore, the Government wants to reduce this to 4pc by providing more community care alternatives that would enable most of us to live independently in our own homes for as long as possible.

However, long-stay nursing homes are sometimes the only option for many elderly people, particularly for those aged over 85, and those who need a high level of care.

Long-term nursing home care is very expensive. A survey commissioned by the representative body for private and voluntary nursing homes, Nursing Homes Ireland (NHI), shows that the average cost of care in a private or voluntary nursing home in 2006 was €778 a week. Weekly costs across the country ranged from as little as €485 to as much as €1,330.

Based on the average weekly price, this works out at just over €40,000 a year, but the HSE states that private nursing homes can cost about €50,000 a year.

The cost of a public nursing home bed is higher still (at around €1,700 a week according to HSE information).

But the taxpayer foots about 90pc of the bill for residents in these homes, while those in private nursing homes are forced to pay about 60pc of the costs themselves.

This is because entrants to private nursing homes are means tested and, even then, will only get a maximum subvention of €300 per week towards their care costs.

But even with the maximum subvention, many are forced to sell or mortgage their homes in order to pay for their care.

The private and voluntary nursing home sector accounts for some 65pc of all long-term nursing home places in the country, housing some 19,000 residents.

Not surprisingly, the current system of State support towards the costs of nursing home care is widely acknowledged to be inequitable, very complicated and extremely unfair.

The good news is that the Government is to significantly reform the State supports for nursing home care through a long-awaited new scheme known as the 'Fair Deal'.

This scheme was due to come into force last January, but thanks to legal delays it will not be implemented until some time in 2009.

It will be voluntary and both new and existing residents can apply to the new scheme when it is implemented.

Under the Fair Deal scheme, new entrants to nursing homes will pay a maximum of 80pc of their income every year towards the cost of their care, regardless of whether they enter a public or a private home.

If this 80pc of income does not cover the cost, the State pays the remainder. The HSE says that, in most cases, the State will be paying most of the cost of care.

But it will be entitled to recoup some of this cost through a contribution towards the cost of this care based on any assets you own, including your home.

Understanding how and when you pay this contribution is where it starts to get a bit complicated. Basically, if you have any assets worth more than €36,000, such as savings, stocks or shares, or any land or property which is not your principal residence, you must pay 5pc of the value of these assets every year for each year of your care.

If you own the house where you live, you will also have to contribute 5pc of the value of this house every year -- but only for up to three years. This means that the most you will be asked to contribute will equate to no more than 15pc of the value of your home.

So the main benefit of the new scheme is that you won't be forced to sell your home to pay for your care, or at least not until after you die.

The scheme also aims to prevent people from entering nursing homes unless they have a high level of dependency.

If you apply to the scheme, you will have to undergo an assessment to see if you require nursing home care, and both your medical and social situation will be assessed.

If you are judged to be a medium or low dependent, you will be offered homecare packages and other supports to allow you to stay at home for as long as possible.

There are still some unanswered concerns about the new scheme, however.

"The big issue is that of 'resource capping', which in effect means that if a person is assessed as requiring long-term care and no funds are available, that person cannot access care and may be placed on a waiting list," said NHI chief Tadhg Daly.

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