The true cost of nursing home care in Ireland
An investigation of over 300 nursing homes reveals additional charges of almost €17m. Maeve Sheehan, Wayne O'Connor and Mark O'Regan report
On a recent weekday morning, a group of people gathered for a tour of The Marlay, a gleaming state-of-the-art nursing home just off the M50, close to Rathfarnham in south Dublin. The rooms were bright and airy. The place was buzzing with activity. A couple of residents read the in-house newspapers in the lobby. A group of ladies watched Sammy Davis Jr on TV in the sitting room. In another room, an activities coordinator read the newspaper aloud to her audience. Outside, the sun shone on a flower-filled courtyard.
This is one of the more popular nursing homes in South Dublin. There is a waiting list to get in. But don't expect to get information on The Marlay's charges over the phone. Families making enquiries about this nursing home must attend in person to one of The Marlay's designated information days, organised to keep any disruption to residents to a minimum. At the end of the tour, we are invited into a room, given a brochure with details of the nursing home's charges, and encouraged to ask questions.
The nursing home is paid €1,285 a week per resident by the State under the Fair Deal scheme. The fee includes residents' contributions towards their cost of care. In addition, residents must pay €50 a week for a "social programme" consisting of activities, games, outings, music, and arts and crafts; and €25 a week for the Marlay Doctor service, regardless of whether the resident is on a medical card or not. There is also a quarterly €12 charge for transporting samples to the lab for screening tests. Residents pay extra for hairdressing, therapies and their own personal newspapers. There is also a 20pc administration charge for each resident on top of the cost of other "billable" services. There was barely a quibble about the charges during the information morning. The Health Information and Quality Authority (Hiqa) has taken issue with aspects of the additional charges in its most recent inspection report on the nursing home.
Inspectors found there was no opt out for certain charges. The nursing home committed to introducing an opt out.
The Marlay provides a service that families are clearly happy to pay for. It is one of over 300 nursing homes that feature in today's investigation into the additional charges quoted by private and public nursing homes.
Our investigation found that of the over 300 homes, two thirds quoted additional charges that ranged from just €1 a day, to €325 per week in one luxury facility in Dublin. Just under one-third of the nursing homes we contacted said they did not have additional charges.
By taking a ratio of Fair Deal residents that applies across all private and voluntary nursing homes we were able to calculate a figure of €16.9m a year in additional income for private and voluntary nursing homes that are already sharing in a scheme that costs the State €940m a year. That €16.9m is paid by some of the 18,000 Fair Deal residents in private and voluntary nursing homes, and their families, on top of what they have already contributed through Fair Deal.
The charges are a symptom of deeper problems with the Fair Deal system. Nursing homes' grievances with the scheme are explained by Nursing Homes Ireland elsewhere in these pages.
Fair Deal was intended to relieve people of worrying about whether they could afford nursing home care in their old age. Older people contribute what they can afford. The State pays the rest.
Nursing homes say they are not being paid enough. And elderly residents are being hit to make up the shortfall - in the form of service charges or social charges, or whatever nursing homes want to call them. However, advocacy groups, such as Sage and Age Action Ireland, say the additional charges have had serious reverberations on older people and their families.
These groups have highlighted several issues. According to Age Action, the charges are "hidden", to the extent that residents were sometimes only told about them when they were about to sign on the dotted line of a contract.
At least three agents of the State are now examining the additional charges and the contracts of private and voluntary nursing homes that contain them.
Documents released under the Freedom of Information Act show that the Department of Health set up a working group to look specifically at the issue of additional charges, and is expected to produce a paper on the subject in October.
The Office of the Ombudsman has already concluded in a landmark case that residents in one nursing home should only have to pay for services they use - a finding that will have implications for other nursing homes.
The Competition and Consumer Protection Authority has confirmed to the Sunday Independent that it has launched a "project" to examine nursing home contracts. The purpose is to produce guidelines to ensure that nursing home operators are compliant with EU consumer law.
One of the greatest gaps in our knowledge of additional charges quoted by nursing homes is which ones are charging and by how much.
Our investigation is by no means exhaustive and we are reliant on the information quoted to us by the homes we contacted.
We undertook this investigation when our attempts to openly ask nursing homes for their charges failed.
Having reached over 300 of the country's private and voluntary nursing homes, our investigation provides an important overview of the scale of charges being quoted to prospective nursing home residents. This is important not only for residents who are in nursing homes, but also for private nursing home operators themselves.
There are two ways of looking at the estimated figure of €16.9m collected in additional charges. Families will look upon it as an added financial burden thrust on to elderly residents. Private nursing home operators will look upon it as filling the gap in what the State pays them to care for our older population and what it actually costs them to provide the service.
Nursing homes in affluent areas tended to quote higher additional charges.
Leeson Park in Dublin 6, for instance, was the most expensive at €325 a week for a resident in a single room. The Silver Stream group, the operators of Leeson Park, said in a statement that it provides "premium" nursing care in the area: "All residents joining the nursing home agree, in advance, the fee structure depending on care options and accommodation requirements.
"While this nursing home has commanded a higher premium since it was established, its level of fees has not increased since 2008."
The operators of Kinvara House Nursing Home in Bray, which has an additional service charge of €175 a week, said it is open about its charges and they are disclosed in full to residents in advance: "We are fully upfront about our fees. They reflect the very high standard of care and service we provide. We have a high level of staff. We charge a very fair fee for the quality of care and level of service we provide."
Another south Dublin operator, Altadore Nursing Home, where the charge is €100 per week, said charges are discussed openly and transparently with prospective residents. "No person is ever admitted to our nursing home without a full explanation and understanding of what their costs and fees will be, and what is included or not included.
"All of these fees and charges are detailed in our Contract of Care which is discussed with everyone when viewing our facility."
A striking feature of our investigation was the disparity not only in the scale of the charges levied - or not, as the case may be - but in the willingness of nursing homes to disclose those charges over the phone.
One of the country's biggest nursing home chains, the Brindley Health Care Group, told us that it does not have ditional charges for activities or therapies in any of its six care homes. The cost of these activities is included in the Fair Deal price and residents pay extra for other services as they need them. The Ryevale Nursing Home in Kildare - which received €5.4m under the Fair Deal scheme last year - charges its residents €1 a day for activities.
Read More: Confusion on price list at Galway home
A disparity arises in how nursing homes approach disclosing the issue of charges.
Harvey Healthcare Group publishes charges for five Dublin nursing homes online - these range from €25 to €35 a week. So do a number of other smaller nursing homes, such as Ardmore Care, Finglas.
Many nursing homes are happy to share their information on charges, willing to post brochures, offer advice and explain in detail what the extra charges cover.
Many also offered advice on the arduous process of applying for Fair Deal. Some nursing homes told us that they do not impose the charge if the resident cannot afford it. This was particularly so in rural nursing homes, but also in Dublin. The Hamilton Park Care Facility told this newspaper that residents are offered the choice of paying a service charge of €50 that covers everything, including taxis to hospital, or being invoiced separately for each service.
Some nursing homes refused to disclose any information over the phone about charges.
Several were suspicious of our motives in calling, suspecting that we might be reporters. The media coverage of late has clearly rankled. Several spoke bitterly about the publicity given to recent reports that nursing home residents were being charged €20 for Mass.
Their views reflected a sector that is feeling under fire and under-appreciated.