Most expensive voluntary and private nursing homes in the country revealed
Aggressive tactics, including the use of forensic accountants, were being considered to find out why the cost of nursing home care in the east of the country in particular was 30pc higher than in the rest of the country, the Irish Independent has learned.
The proposal is contained in a document from the National Treatment Purchase Fund (NTPF), which negotiates with individual nursing homes on what they can charge residents under the State-funded Fair Deal scheme.
The future of the scheme is now the responsibility of the new Older People Minister Jim Daly.
The report said the "anomaly of higher priced nursing homes in Dublin and the extended region existed prior to Fair Deal and remains a challenge to the NTPF".
"Some degree of variation in prices would be expected from county to county. However, the east in particular remains highly priced - a differential of 30pc - compared to the rest of the country," a report to the group reviewing the scheme said.
It said it was looking at "more aggressive tactics that include the use of a forensic accounting service to support the overall aim of redressing the differences in county versus city prices".
The cost of care in each nursing home does not impinge on what the elderly person in the Fair Deal scheme pays, as they are assessed on income and assets. But the higher the cost, the greater the payout from the State and the taxpayer.
A survey of costs of private and voluntary nursing homes confirms the highest prices are in the east, with some costing more than €1,300 a week and high numbers at more than €1,000. This contrasts with homes in Galway, which are mostly around €800 to €850.
The report said that due to demand for care home beds in Dublin, it was difficult to get a voluntary reduction.
In response, Tadhg Daly of Nursing Homes Ireland, which represents private nursing homes, said the price difference could be put down to the fact that the rates facilities outside of Dublin were allowed to charge were "unsustainably low".
He said he had been highlighting the unsustainable fees and fighting for many years to get the NTPF and the Department of Health "to recognise the true cost of care".
He said: "The real issue remains and there are unsustainably low fees in Dublin and in other parts of the country."
The problem of costs outside Dublin was recognised by the Department of Health-commissioned DKM report.
It pointed to "inadequate income levels to enable a return on investment in many parts of the country outside Dublin", he said.
The private nursing homes organisation said there was "no standard objective assessment basis for setting the price, related to either efficient capital and operating costs or the level of dependency of residents".
"While the NTPF does use some benchmarks, in the final analysis, the rate for each nursing home is a matter for ad hoc negotiation," it said.
"The most important factor appears to be the 'going rate' in the particular county."
The NTPF report said the higher cost of nursing homes in the east could be helped if there was a fast-tracking of more beds in areas with greater demand.
It should also be possible to repackage services for the elderly in a way that not only reduces cost, but would maintain or improve the care, it said.
The State pays around €1bn towards the cost of the Fair Deal scheme.
Most nursing home residents pay up front, which allows them to hold on to assets. Others can defray the full cost until after their death, at which point the State can claim a portion of their assets to cover the cost of their care.
Meanwhile, the working group which is reviewing the Fair Deal was told that while farmers support the scheme, they have concerns about the negative impact on farm families, in particular the viability of the farm business for the next generation.
It was clear that there were difficulties arising with the costs of care where the asset has not been transferred five years before the elderly farmer enters a nursing home, a meeting of the group was told.