Nursing homes are very much in the news at the moment, and not for good reason. They've experienced, more than anyone else, the devastation of Covid-19.
Despite the incredible care residents receive, a nursing home is generally the last resort for families who have looked after loved ones at home for as long as possible.
Facing into the prospect, not to mention the cost, is daunting, even with the Fair Deal scheme, now entering its 11th year.
While more than 95pc of over-65s live in their communities, just 8pc are in receipt of home care, according to Age Action. It says adequate, quality, affordable care supports are a 'critical' issue which "undermines people's choice to age in place as they wish".
Home-care packages can be haphazard, reliant on monthly budgets, geography and availability, and there has been a push towards residential care.
Although monumentally more expensive, it is to some extent easier, with 70pc of places provided by the private sector.
Around 4.5pc of the population live in nursing homes, the vast majority of them through Fair Deal. That amounts to roughly 23,000 people and it costs around €1bn a year to run. The rest pay privately.
"It is time that as a society we rethink how people access the long-term care that they need so that people can make informed and confident decisions about their lives," says the charity. "The Nursing Home Support Scheme [Fair Deal] introduced a statutory right to nursing home care but as yet, there is no statutory right to home care, although it is expected to come on stream in 2021. But the experience of Covid-19 highlights the gap in the provision of services," it adds.
This week I'm looking at the different elder care options and why, despite its vast budget and welcome provisions, Fair Deal isn't the no-brainer many believe. Often it's better, economically and practically, to pay for home care for as long as possible, and in some cases, privately pay for nursing home care also.
It comes down to basic maths in the end. The sums, often being done at an emotionally charged time as families struggle with their elderly loved one, are inevitably complex, bewildering and fantastically expensive.
The only people for whom Fair Deal is truly a bargain are the Ninja pensioners; no income, no job or assets. The OAP in rented accommodation, living alone. For them, it is a boon; fully expensed, quality care in the nursing home of their choice, as long as it's needed.
For everyone else, there is a financial cost; often an overwhelming one. Research from 2019 showed the average cost of a private nursing home was €850 to €1,250 per week.
In HSE-run homes it can be as high as €2,182 due to higher fixed costs, salaries and the higher ratio of staff to patients (mainly due to public homes having more very high-dependent residents).
Nursing Homes Ireland has often quoted the disparity between the fees paid to public homes over its members' stock but for families the choice comes down to location, access and price. There are a range of options for families when it comes to care.
Home care: this can be provided under the (limited) State Home Care Package (HCP) hours provided by the HSE which can be as little as 30 minutes per day. Access is budget and location dependent, but is free to the recipient and not means tested. It is not available under the Fair Deal scheme, a criticism which is being addressed.
Private home care: agencies such as Home Instead, Bluebird, Comfort Keepers etc charge by the hour, and while expensive (anything from €20 to €40) can be bought in addition to HCP hours, providing a level of consistency for recipients as the HSE largely uses the same agencies. Full tax relief, at the marginal rate of the bill payer, is allowed against all fees. However, as with all tax reliefs, to qualify you must be a taxpayer, and many pensioners are outside the tax net. It is for this reason that an adult child often picks up the bill, and the rebate.
Private nursing homes: Although expensive, paying a nursing home privately means you get the home of your choice (although it must be privately run; HSE-run homes cannot sell private beds), and generally quick access. There is capacity in the sector; delays in transferring from acute hospitals are down to budgets, rather than availability. All fees qualify for full tax relief for the bill payer.
Fair Deal: there are two assessments, needs (medical) and contribution. Once the first is agreed, the financial contribution the resident makes is 80pc of their income plus 7.5pc of their assets (including the family home, capped after three years), including cash, second homes, shares and (outrageously) ARF pension funds, which is a double whammy as it is also billed under income. The first €37,500 is exempt.
Contributions are halved for any applicant with a spouse still living at home (eg 40pc +3.75pc). A loan scheme operates against the property charge repaid on death or sale.