Nursing homes squeeze elderly with bundles of extra charges
Residents of private nursing homes are being charged thousands of euro for extra services, discovers Maeve Sheehan
When Jane's elderly father was admitted to a private nursing home after suffering from ill-health, her family believed they had all the costs covered.
Jane had done her research. Her father had availed of the Fair Deal scheme, which meant he would pay a contribution towards the private nursing home, and the State would pay the rest.
Shortly after he was admitted, Jane was told by the nursing home that there was an additional charge: a mandatory fee of €70 per week, invoiced to the family every month, under the guise of "physiotherapy".
Jane, who does not want to be named, pointed out that her father already had his own physiotherapist whom he continued to attend while he was in the nursing home. in Munster.
"Yet on the nursing home contract there was an additional mandatory charge, noted as physiotherapy, which amounted to €70 extra per week," she said. It wasn't the money that got to Jane. It was the lack of transparency around the extra fee.
The Fair Deal nursing home support scheme, launched in 2009, was intended to remove the financial worry and anxiety of elderly people who at that time often had to sell their home in order to move into a nursing home.
The new scheme would provide financial support to people who needed long-term nursing home care. Elderly people contribute 80pc of their income toward private nursing home costs, and up to 22.5pc of the value of their homes. The State would pay the balance and the pensioners would keep a fifth of their income for their own personal needs.
It is not quite working out like that.
Almost across the board, private nursing homes, under pressure to reach their profit margins, are imposing additional charges, often amounting to thousands of euro, on elderly residents who have already contributed their share under the Fair Deal scheme.
Elderly people have always been required to pay for the so-called luxuries such as hairdressers and newspapers. But the vast majority of private nursing homes are now charging an additional flat rate fee - often billed as a "social charge" - even if the residents are too infirm to participate in the activities.
Nursing home operators defend the charges, saying they are being squeezed by the State, claiming the fees they get under Fair Deal do not cover the cost of the care they provide, many services which are demanded by the regulator, the Health Information and Quality Authority (Hiqa).
But while the State and private nursing home operators fight it out over money, it seems that vulnerable elderly residents are bridging the gap.
The Sunday Independent contacted numerous nursing homes last week to inquire about their additional charges. Few responded, and none had information on fees and additional charges on their websites. We then inquired on behalf of an elderly parent.
We found that what nursing homes charge for "social programmes" varies from €25 to €95, covering "bundles" of services that include everything from bingo and board games, to religious services and pet therapy.
One nursing home owned by Mowlam Health Group said it did not impose any additional fees apart from services such as hairdressing and newspapers and therapies that weren't covered by the medical card. Another nursing home in the group said the additional charge was €35 per week. TLC nursing home in west Dublin charged €25 a week for "social programmes" while it was €95 a week at Ferndene in Blackrock.
There are all sorts of other potentially hefty expenses that residents can be asked to bear in a nursing home. One Dublin nursing home bills residents €20 an hour if they need a carer to accompany them to hospital. The resident will also be billed for the cost of the carer's taxi back to the nursing home. Another Dublin nursing home bills residents €23 an hour for a carer's time.
Some nursing homes bill residents a €10 surcharge for each of the three chiropody visits they are entitled to avail of for free under the GP scheme. We have seen the contract for one nursing home that charges €8 to €80 for a box of incontinence pads.
These charges are not hidden. Nursing homes are required by Hiqa to list any extra fees in contracts signed by residents. But that doesn't mean there aren't concerns.
A principle of the Fair Deal scheme is that no one should pay more than 80pc of their weekly income towards that care, leaving them with 20pc of their income for their own personal use. But the prevalence of mandatory "social charges" ranging from €25 upwards means that many can say goodbye to that 20pc.
The average income for an elderly person applying to Fair Deal is €281, out of which €224 (or 80pc of their income) goes towards their nursing home fees, leaving €57 disposable income for themselves. A not-uncommon €70-a-week mandatory additional charge for "social programmes" would leave the average nursing home resident not only broke, but in debt.
Advocacy group Age Action Ireland highlights the case of an elderly woman who is being billed a grand total of €4,464 a year for additional charges; €50 per month for incontinence wear; €222 per month for "social activities"; a €10 surcharge on each of the three chiropody visits per year she is entitled to under her medical card; and €100 per month for "doctor services" even though she is entitled to free GP care.
Justin Moran, of Age Action Ireland, said he regards the extra fees in some nursing homes as simply "extortionate".
Another "principle" of the Fair Deal Scheme is that "nobody will pay more than the actual cost of care". But it looks like this principle may also have been undermined.
One nursing home informed residents in December 2015 that they would have to pay an extra €40 a week towards their nursing home fees not because of the actual cost of their care, but because of the "financial pressures" on the company, citing inadequate Fair Deal fees and rising staff wages.
Nursing homes operators say Fair Deal is not contributing enough to cover the cost of a resident's care. The industry group, Nursing Homes Ireland, has been lobbying for years to overhaul a fee system that economists have called "ad hoc" and "irrational".
The fees with private nursing homes are negotiated with the National Treatment Purchase Fund, itself a mysterious process that operators describe as a behind-closed-doors horse-trading session that lacks any transparency or accountability.
Under its narrow terms, the State stumps up for "bed and board" and basic nursing care. It has pretty much abdicated responsibility for paying for a "quality of life", leaving that bit to private nursing homes, who must deliver it or face sanction by Hiqa. They perceive a further unfairness in the fact that HSE-operated public nursing homes get a far higher fee than their private counterparts and don't have to impose extra charges.
Hamilton Care, a nursing home in Balbriggan - one of the few nursing homes to reply to our emails - said Fair Deal fees don't take into account how much care a resident needs, plus all of the extra services Hiqa demands but the State does not pay for.
This is bad for business and for elderly residents.
"The majority of nursing homes in Dublin are cherry-picking their residents on based on their dependency level," a spokesperson said. "The reason we know this is because we take in residents that have been declined by other nursing homes."
Hamilton Care is "phasing in" a social programmes charge of €50 a week to keep its activities going; gardening, inter-nursing home quizzes, outings in two minibuses purchased by the company. . The spokesperson says she knows many residents won't be able to afford it, but she says they won't be chased for it either.
At the heart of the issue is how far taxpayers are willing to fund the ticking time bomb that is care for the elderly. Kathleen Lynch, the previous Minister of State for Health, says elderly people are not paying enough. "The notion that you would pay €260-€290 for a service costing anything up to €1,200 is unsustainable," she told the Oireachtas health committee in 2015.
Another review is under way in the Department of Health about the pricing and value for money of the Fair Deal scheme.
As ever, it is the elderly resident who is being squeezed.
The impact of these additional charges on elderly residents and their families has caused great concern amongst advocacy groups for the elderly - particularly for residents who are immobile or have dementia.
Age Action Ireland is to launch a briefing paper later this month in which it will call on the Minister for Health to require private nursing homes in the Fair Deal scheme to publish all the additional costs and charges on a website.
Sage, a support and advocacy group for the elderly, is preparing a briefing paper focusing on the contracts of care, in which these additional charges are required by law to be laid out.
Nursing home operators point out that there have been a very small number of complaints about additional nursing home charges to the Office of the Ombudsman since its remit took on private nursing homes in 2015 - seven out of 51 complaints since 2016.
The Ombudsman has made a significant ruling in one of those cases that strikes a blow for incapacitated elderly people charged for services in which they are incapable of participating. In an unpublished decision in April, Peter Tyndall found in favour of an elderly resident whose family complained when the nursing home doubled the fee for the social programme to just under €200 a month.
The resident was unable to take part in any of the activities. The Ombudsman decided the resident shouldn't have to pay the €200 if they couldn't take part in the social programme, and should pay a nominal fee instead. Furthermore, those who did pay the increase should have a say in the type of social programme they are paying for, and should "receive a breakdown of the activities" before signing up for them .
The nursing home was not identified - to protect the elderly person concerned who is still resident there. The decision may not be legally binding but it is a warning shot on behalf of elderly people caught in the middle as State and private nursing home operators go to war.