Thursday 19 September 2019

Homecare 'rationing' places huge cost on caring for elderly patients

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Eilish O'Regan

Eilish O'Regan

The average cost of providing six-and-a-half hours of HSE homecare support a week is just €160.

But the average price of accommodating a patient in a hospital bed, despite no longer needing medical care, is as high as €878 a night.

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The new figures showing the huge gap are striking and will leave the public wondering at the logic of HSE economics.

So why is the cash-squeezed HSE spending thousands of euro a week on the care of a hospital patient, who no longer wants to be there, when they would be looked after so much cheaply in the home to which they are desperate to get back?

When the HSE responds to the ever-growing questions about the crisis in homecare, which is not just leaving mostly older patients either confined to hospital or struggling to cope at home, it's defence is that is has a fixed budget for the service.

It has a €446m limit for homecare this year, a rise of €140m since 2015.

But it is not enough to keep pace with demand leaving more than 6,000 people on the waiting list.

Apart from the human toll of leaving people hunting for basic home support, there has been little analysis of the financial cost of failing to invest in inexpensive care.

At the same time, hospitals are already seriously in the red and the lack of beds has led to another summer of trolley gridlock with ominous signs of another winter of overflowing A&Es.

It means remarks such as that reported by Fianna Fáil leader Micheál Martin, of people in a queue for home support being told they will have to wait until someone else dies to free up hours, are part of the brutal truth about the crisis in elderly care.

It may also be time to bring back the term "bed blocker" for a hospital patient who needs step-down care but cannot leave due to lack of homecare or a nursing home place.

It is not meant in any way to be disrespectful or insulting to the patient who is at the mercy of the system.

But "bed blocker" is a more accurate description of the impact of keeping people in cramped hospitals than its "delayed discharge" replacement.

It would also better underline the predicament of other hospital patients who are waiting weeks for a nursing home bed because of delays in releasing funding in the Fair Deal scheme.

A snapshot survey by Nursing Homes Ireland this week revealed beds are idle from Cork to Donegal while patients who have been approved for Fair Deal funding must stay in hospital because of the manner in which funding is being "rationed".

The level of unmet need for home support and now nursing homecare also is causing growing distress while denying so many older people a dignified life.

On the one hand, the schemes are under-funded. On the other, the problem is leading to financial inefficiency which is affecting the running of hospitals as they are braced for another winter of congestion and patient hardship on trolleys.

Irish Independent

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