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Saturday 16 December 2017

Sinead Ryan: Living longer comes with a health warning about elderly care costs

Sinead Ryan

Sinead Ryan

Nobody can have been unmoved by the plight of Michael and Kathleen Devereaux, who were split up by the Fair Deal scheme after 63 years together.

Michael qualified for a room in a nursing home but his wife did not, so as he moved in, Kathleen was left in an acute hospital bed.

It was resolved only by the intervention of Health Minister Simon Harris after the 'Deputy Health Minister', none other than Joe Duffy, raised the matter on RTE's Liveline.

Michael and Kathleen are by no means alone. The Fair Deal scheme, properly known as the Nursing Homes Support Scheme, has serious drawbacks, but it's not the only state system that is bewildering for elderly people.

According to the Central Statistics Office, Irish people are enjoying longer, healthier lives. If you're over 50, you can expect to make it, on average, to 80 if you're a man and 84 if you're a woman.

One reason, of course, is that medical treatment has improved tremendously since the 1950s when you were expected to pop your clogs a couple of years after retiring.

The good news is that the number of over-65s is due to rise from today's 532,000 to 1.4 million by 2046.

Increased longevity, however, comes with a health warning about elderly care costs.

Not everyone is living longer without support, and most people want to remain in their own home as long as possible. The Government, meanwhile, seems determined to put people in residential care.

The Fair Deal scheme, which the Government supports, is in stark contrast to the Home Care Package which is insubstantial, inconsistent and depends more on geography and budgets than need.

This week I'm looking at the help available and how you can access it.

Home Care Package

HCPs are determined by a clinical needs assessment (by a health worker) and are not means-tested. What is taken into account is your age, your ability to look after yourself and any existing support you may have. Then it's down to the county budget. You have no automatic right to an HCP.

Someone living alone or just out of hospital is more likely to get help than someone who has plenty of family around.

Apply through your local health centre. A strong recommendation from your GP is always good.

Employing a Carer

You can employ a carer from any one of the many agencies such as Senior Care, Home Instead or Bluebird or privately with an ad.

They can provide services from simple companionship to 24/7 nursing care. Revenue allows full tax relief to the bill payer (not always the patient) at their marginal rate, up to an annual spend of €75,000.

Expect to pay €20 to €30 an hour for this service before tax relief.

If you have an HCP, you can still 'buy' extra hours privately, often from the same source, because much of the HCP hours are out-sourced to the same organisations.

Nursing Home Support Scheme

The Fair Deal scheme has two elements to it: a care needs assessment, which may include a physical examination and a financial needs assessment, which works out your contribution (see table for an example).

What you get: A full-time place in a nursing home of your choice (based on availability), with the cost paid by the State. With fees up to €6,000 a month, this amounts to more than €70,000 a year.

Most homes are in the private sector. What you pay: You will pay 80pc of all your income (for example, your pension) plus 7.5pc of all your assets every year. The family home "asset" stops after three years. Other assets, such as savings, shares and rental income, continue for life. There is a disregard for the first €36,000 of savings.

If you're a couple, all amounts are halved if your spouse stays in the family home. What else you pay: Incidentals such as "activity" packages, hairdressing, newspapers and some medical aids. These are not insubstantial, so ask exactly what's involved. You may have to pay for them even if you don't use them.

Carer's Allowance

Those caring full-time for someone they live with can get a benefit from the Department of Social Protection.

It is means-tested and amounts to a maximum of €247 a week if you are over 66. You cannot be working more than 15 hours a week outside of caring duties.


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