Monday 16 September 2019

Hugh O'Connell: 'Ageing population will put huge pressure on Fair Deal as scheme faces funding crisis'

Fair Deal is the State system which bridges the funding gap between an individual's contribution to their own care and the actual cost of a bed in a nursing home (stock photo)
Fair Deal is the State system which bridges the funding gap between an individual's contribution to their own care and the actual cost of a bed in a nursing home (stock photo)
Hugh O'Connell

Hugh O'Connell

The average person who accesses the Fair Deal nursing home scheme is a woman, over 80 years of age.

They have spent time in hospital receiving treatment for an acute condition while they were waiting, usually for less than four weeks, for funding to be approved for a bed in a nursing home.

As the Irish Independent has reported for many years, this is not the experience of everyone who accesses the Nursing Home Support Scheme (NHSS), more commonly known as Fair Deal.

But it is nonetheless an intriguing insight into the system - as laid bare in a social impact assessment published by the Department of Public Expenditure and Reform (DPER) this week.

Fair Deal is the State system which bridges the funding gap between an individual's contribution to their own care and the actual cost of a bed in a nursing home.

There are twice as many women as there are men using the scheme, which follows the general population trend showing men in Ireland have a lower life expectancy than women.

In fact, 66pc of the population over 85 are female.

An individual in a nursing home under Fair Deal is most likely to be aged over 80. Individuals of that age or over make up 70pc of the scheme's "clients" as the DPER analysis refers to these elderly people. Half of individuals in the nursing home scheme are over 85.

Somewhat delicately, the DPER analysis states that this average person will "exit the scheme after two to four years". Just 3.5pc of nursing home residents are there for over a decade.

In most cases "exiting the scheme" means the person has died. Their death will free up a place in the system for someone else in need - and there will be many more such people in the years ahead.

The country's ageing population means demand for Fair Deal places is soaring and will continue to do so for decades.

The analysis warns: "The population 80 years and over, who are the core NHSS clients, is forecast to rise to between 470,000 and 484,000 by 2046."

To put that in context, Fair Deal is expected to support just over 23,000 individuals this year.

The Government hopes that in future more elderly people will be cared for in their own homes, but it won't work for everyone.

The recent national risk assessment highlighted how the country's ageing population is one of the most significant risks facing the State in the coming years.

The number of people aged over 65 is projected to increase from one in eight to one in six by 2030 while the number of people aged over 85 is projected to almost double.

It painted a bleak picture of what this will mean for its pension system and health service. The implications for Fair Deal are obvious. The scheme currently costs the State just over €1bn every year and without any changes the cost is likely to sky-rocket in the future.

But the DPER analysis did find individuals accessing the scheme have more money than they did previously, most likely owing to the economic recovery of recent years.

The average value of a user's assets rose from just under €89,000 in 2014 to nearly €135,000 in 2018 - an increase of 35pc, while the average value of cash assets rose from nearly €50,000 to over €64,000 last year - an increase of 12pc.

It found that the total declared assets for people using the scheme at the end of December last year was €4bn.

Under Fair Deal, individuals in need of nursing home care make a means-assessed contribution to the cost of this by paying 80pc of assessable income and 7.5pc of the value of any assets held annually.

The State funds the difference between this contribution and the actual cost of a nursing home place.

The analysis shows that the gross weekly cost of a private or voluntary nursing home bed was €984 in 2018, of which the State covered 70pc. The cost of a public bed was €1,575, of which the State covered 82pc.

The average weekly contribution from an individual to the scheme was €301, with the average weekly cost of a nursing home bed standing at €1,280.

But already a funding crisis is facing the scheme.

The Irish Independent revealed recently the HSE failed to adequately budget for people living longer.

This, combined with a growing ageing population, will only add to the pressures on Fair Deal in years to come.

Irish Independent

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