Wednesday 23 January 2019

Extra fees leave nursing home residents in debt

Charges for social activities exceed what remains in pension

Health Minister Simon Harris. Photo: Steve Humphreys
Health Minister Simon Harris. Photo: Steve Humphreys
Maeve Sheehan

Maeve Sheehan

An elderly woman has been forced into debt by the controversial extra charges imposed by her nursing home for social programmes and activities.

Internal records from the Department of Health reveal that the woman paid most of her pension towards her nursing home fees under the State's Fair Deal scheme. The scale of extra charges imposed by the nursing home exceeded what was left of her pension, apparently leaving her with no income and mounting debt.

The woman's case was brought to the attention of the Minister for Health, Simon Harris, last January. Internal emails were referred to his officials who were asked to find out "what will happen" to the debt.

An internal email referred to the ministerial representation outlining a case where a NHSS [Nursing Home Support Scheme] "resident is building up a debt as the additional charges they incur are above her net income (20pc of her state pension). She has no next of kin, assets or estate. The query is regarding what will happen to these accrued debts".

The case bears out the fears of the Ombudsman, Peter Tyndall, that nursing home residents are being "impoverished" by the contentious additional charges in private nursing homes.

It also highlights the financial impact of controversial extra charges for older people surviving on the state pension, who don't have any assets, particularly those with disabilities who tend to be on lower incomes.

According to Sage, the advocacy group, social workers have reported that extra charges of up to €100 a week in South Dublin have pushed nursing homes out of reach of older citizens living in the catchment area.

In a recent letter highlighting the problem, a social worker raised the difficulties involved in finding a nursing home placement for an elderly single male service user who has a serious and enduring mental illness and little family support.

"This gentleman's Fair Deal (FD) came through relatively promptly. Finding a nursing home did not come so easily due to a recent development by which nursing homes are charging an additional fee over and above the Fair Deal subvention. The nursing homes approached informed me that this charge is in response to the HIQA requirement that a full activity programme be available for residents Monday-Friday and that FD subvention does not cover this and other costs such as incontinence wear, chiropody and other expenses.

"The result is nursing homes in my geographical area [South County Dublin] are charging between €70 and €100 per week over and above the subvention rate. This may be affordable to some families who can club together and pay the extra charge; however, in the main, our service users who require nursing home care tend to be single and without children, long-term disability allowance recipients prior to transferring to state pension; their relatives/siblings tend to be older (pensioners themselves) with family commitments of their own," the social worker wrote.

"What this means is that a cohort of our service users will be unable to access long-term care due to this extra charge/ funding deficit."

The Sunday Independent exposed the scale of fees charged by nursing homes in an investigation last year, with more than 300 facilities raising €16m per year in "extras" from elderly residents.

The Department of Health promised a working group would examine the issue. However, the group met for the first time in January of this year, according to records released under the Freedom of Information Act.

The Nursing Home Support Scheme was introduced in 2008 to help older people finance their nursing home care. Residents pay up to 80pc of their income or state pension and the Government promised that under Fair Deal, no older person would be left with less than 20pc of their income for their personal use.

But another case brought to the minister's attention highlighted the case of a severely disabled man who was left with an income of €44 a week after paying his contribution towards his nursing home costs under the Fair Deal scheme. The nursing home had introduced a €35 a week charge for social programmes, which had eroded the remainder of his allowance, leaving him with only €9 a week for his personal use. The case was brought to the minister's attention by the man's next of kin, who questioned the legality of the additional charges and requested an investigation by the HSE.

Nursing homes say they are forced to charge additional fees for social programmes and activities. The funding they receive under Fair Deal does not cover the extra activities, even though nursing homes are required by the health watchdog to provide them.

The Department of Health has also distanced itself from the issue of additional fees, saying they are a matter between the resident and the nursing home. "Any charges for additional care or other services raised by individual nursing homes are outside the remit of the Nursing Home Support Scheme," the statement said.

"As it is a private contract between the proprietor of the nursing home and the resident for the provision of additional services, the State has no liability and therefore no role in the payment of any debts that may be accrued."

The department said the Minister for older people, Jim Daly, has met with Competition and Consumer Protection Commission (CCPC) to discuss the issue. The CCPC is analysing nursing home contracts and expects to launch guidelines for providers in the summer.

Nursing Homes Ireland, which represents most of the country's private and voluntary nursing homes, has issued guidelines on additional charges to its members and has said it is committed to ensuring high levels of communication and transparency with residents and their families.

Sunday Independent

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