Tuesday 25 June 2019

HSE's over-reliance on nursing homes is not just bad news for elderly it's bad for economics, too

Colette Browne

Colette Browne

The insanity that masquerades as policy in the health service was perfectly exemplified in the plight of one 92-year-old woman trapped in an acute hospital bed for almost a year at a cost of €7,000 per week because funding of €400 per week for a home-care package was unavailable.

The elderly woman was admitted to Mayo University Hospital after she broke her pelvis nearly a year ago and is now stuck there because staff have no autonomy to move funding between budgets, even when doing so would save the State a fortune.

According to the HSE, home care packages in the region have been provided "in excess of the funded levels of service" and it was now required to bring expenditure "back into equilibrium". Or, in other words, elderly people requiring modest levels of support at home can now expect to languish indefinitely in hospitals - exacerbating an already chronic trolley and waiting list crisis.

Independent Councillor Michael Kilcoyne deemed the decision "pure Leprechaun economics" and he is right, but what can be done about it? Minister of State for Mental Health and Older People, Helen McEntee, has an idea but most of you will not like it. In an interview with a newspaper yesterday she said: "There needs to be a similar model for home help as there is for the Fair Deal (nursing home) scheme".

However, the Fair Deal scheme involves elderly people paying 80pc of their income and an equity stake of 22.5pc in the family home for nursing home care. So, does the minister support the imposition of similar charges for those receiving home care packages?

A spokesman for the Department of Health told me the matter was under review and "no decisions have been made concerning the introduction of charges for home care" - but that will do little to alleviate concerns.

Meanwhile, Fianna Fáil TD Willie O'Dea has introduced a Private Member's Bill that would amend the Fair Deal scheme and compel the HSE to offer care home packages, at no cost, to those who would prefer to remain in their homes instead of entering a nursing home.

Although the Fair Deal scheme is supposed to be exclusively reserved for those who need full-time care, the high numbers of people entering nursing homes in Ireland suggests a lack of community care is forcing people to prematurely leave their homes.

Ireland has the second-highest proportion of elderly people living in nursing homes in Europe with some 4.5pc in residential care - 40pc more than the EU average. Given the average weekly cost of care in a nursing home is nearly €1,400, with home care packages costing a fraction of this amount, this over-reliance on nursing homes is not just bad for the elderly and their families, it's bad economics.

Policy decisions taken in recent years suggest this myopia is by design and not by accident. Despite the fact that there has been a 25pc increase in the population over 65 since 2008, funding for community support has decreased. In 2008, the HSE spent a combined €331m on home help and home-care packages, compared to just €320m spent last year. The number of home-help hours fell by 18.5pc, or 2.3 million hours, in the same period.

Justin Moran, of Age Action Ireland, said he was aware of one woman who was forced to enter a nursing home because a housing adaptation grant, to install a stair-lift in her home, was not available.

"Between 2004 and 2014, there was a 44.6pc increase in the numbers of people categorised as 'low dependency' in nursing homes. The fact is that there are people in nursing homes in Ireland today who could be supported in the community if services were available," he said. Ultimately, most of the funding crises affecting the health service are interconnected and related to the fact that acute services gobble up money, leaving little for community care. Bureaucrats in the HSE who prefer to spend thousands keeping an elderly woman in an acute bed, instead of making funds available for home care, are not just affecting that woman and her family. They are draining resources from other areas of the health service and limiting patients' choices.

Any plan to introduce charges for home care now would necessarily entail elderly people being forced to subsidise waste and ineptitude in the running of the health service. Currently, when private and public spending is combined, Ireland's per capita spend on the health service is the fourth-highest in the EU, but waiting lists are at record highs despite this largesse.

To date, we have had three Fine Gael health ministers who have offered little more than soundbites and spin in their attempts to resolve the escalating crisis. Current Health Minister Simon Harris's grand plan, announced last week, seems to be the reintroduction of the National Treatment Purchase Fund - which was abandoned by his predecessor, as it funnelled public money to private hospitals and did nothing to address underlying structural and capacity problems causing delayed treatment. The issue around care for the elderly is equivalent, with money being directed into hugely expensive acute hospital and nursing home care with little left over to support elderly people living independently in their community.

Instead of more tinkering around at the edges what we need to see are concrete measures to alleviate the crisis in acute hospital care which will facilitate appropriate funding of ancillary services.

Irish Independent

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