New rules are needed to clamp down on families trying to dodge the Fair Deal scheme and leave their elderly relatives in hospital beds.
Their lack of engagement with the process is one of the contributing factors behind the high numbers of elderly patients staying in acute hospital when they are fit to be discharged to a nursing home, according to a new report.
The review of delayed discharges has identified a number of reasons why so-called ‘bedblockers’ are left languishing in hospital when they should be elsewhere.
The experts who wrote the report say they received a number of submissions from hospital groups and groups representing medics.
The experts said there were problems with some families choosing not to co-operate with the ‘Fair Deal’ process, known as the Nursing Home Support Scheme (NHSS).
“While the majority of patients will remain in hospital until a nursing home of their choice becomes available, the submissions suggest that some families do not co-operate with the NHSS process.
“Some may not provide the correct information, while others will refuse to send their relative to a number of nursing homes despite the patient having been accepted to the nursing home,” the report states.
A Fair Deal application not yet being submitted to the Nursing Home Support Scheme (NHSS) office was noted in 1,159 cases of delayed discharges between June 2017 and June 2018.
The report notes that "Patients and/or families may not always fully engage" in the Fair Deal process in a timely manner, which contributes to delayed discharges and bed days lost in acute hospitals.
The report calls for a strategy to be developed for hospitals to deal with families who will not engage in the process.
It is recommended that "guidance is provided to hospitals to ensure a consistent approach is adopted nationally for families who do not fully and seriously engage with the NHSS [Fair Deal] process and post-acute phase care in a timely manner".
Some families are also rejecting nursing homes that charge additional fees for certain services.
The working group recommends that hospitals be given guidance to ensure there is a consistent approach to families who do not "fully and seriously" engage with the Fair Deal process in a timely manner.
The report also notes that some families unintentionally delay the application for a Fair Deal place because of the need to source a lot of documentation in a short period of time.
It says families are making "life-changing" decisions and need time to process them.
However, Graham Knowles, chair of the University of Limerick Hospital Group and chairman of the working group behind this report, acknowledges that families face a "complex and daunting" process to get a Fair Deal application over the line.
The report also lists other reasons behind the delayed discharges. These include the lack of a joined-up approach among health providers, delays getting home-care packages, and a lack of rehab beds, particularly outside of Dublin.
The report also warned that the number of people left in hospital unnecessarily is likely to be substantially higher than the 8,125 figure recorded for 2017-2018, due to a lack of "robust" data and inconsistencies around how it is gathered nationally.
The group also suggests a public information campaign be introduced to combat the perception that people are safer in hospitals.
The longer people stay in hospital, the more vulnerable they are to infections and becoming less independent.
There is also a financial impact on the patient - and the overstretched health budget - as well as detrimental mental and emotional outcomes for the patient and their family, the report says.
The role of nursing homes in delaying people's release from hospital is also highlighted, with many refusing to take patients before noon on a Monday and after noon on a Friday. A seven-day admissions policy could help ease the backlog, it is suggested.
Homecare funding is also noted as a problem. A lack of resources and skilled carers is contributing to the backlog of patients in hospital. One hospital told the group it believed 20 patients could be discharged if the correct homecare package was provided.
A Fair Deal-type scheme for homecare is expected, but it could be 2020 before it is in place.
Older People Minister Jim Daly has said he does not believe addressing the problems with homecare in a piecemeal way is the best way to deal with it.
Complex cases and a lack of rehab beds - particularly outside of Dublin - are also noted as factors adding to the huge number of delayed discharges.
Meanwhile, resource issues and the availability of decision-makers outside of the 9am-5pm work day and on weekends are also believed to be hampering discharges in acute hospitals nationwide. There are also concerns about recruiting and retaining community carers.
The report - ordered by Mr Daly - was originally supposed to feed into this year's winter plan for the HSE. But Mr Knowles said, due to a lack of robust data, the group was unable to make measurable recommendations ahead of the crunch winter period.
A new national approach to collecting data on delayed discharges should be adopted in the short term, he added.