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The Fair Deal – six months on…

Posted in Blog by saraburke on April 23, 2010

Just six months ago, the ‘Fair Deal’ scheme was introduced which changed the way nursing home care is funded and paid for. According to Minister Mary Harney, the Fair Deal would make residential care “accessible, affordable and anxiety free”. So how is it faring and has it achieved what it set out to? Up to last October, there were huge disparities in how nursing home care was paid for – if you were in a public bed all your care was paid for out of public money and you contributed 80% of your income. If you were in a private nursing home bed, some or all of the costs of your care was paid for by the State but it was a matter of pot luck as to how much of it was subvented by the State. Under Fair Deal, everybody contributes 80% of income towards care (when in care) plus if you have assets up to 5% of assets for 3 years is paid towards your care.

So what’s the difference between now and before the Fair Deal was there? On one hand it creates an even playing field no matter who you are or what type of nursing home you are in. On the other it means that everyone has to contribute towards your care including some of your assets after death. Also the budget is limited. Previously under the 1970 Health Act, every one was entitled to ‘free’ public nursing home care. The Fair Deal removes that entitlement.

There been a large uptake on the Fair Deal with about 9,000 applications of which 5,000 of these have been processed. It takes between 4 weeks and 4 months to process them.

The average cost of care is between €800 and €1000 a week. The total budget for Fair Deal is €152 million. But if you do the sums of how much the State contributes to the cost of care on average with the numbers applying the budget for 2010 is significantly short of what it allocated to it (about €80 million and that’s using very conservative estimates).

And if the money runs out, according to the HSE “a national waiting list will apply”, now this has not happened yet. But given the sums I have just mentioned it seems inevitable.

But also what’s really important is that the Fair Deal covers just bed and board and nursing care. Previously in public nursing homes other care like chiropodists, physios, OTs and speech and language were all included in the the care package. Whereas now they are additional. Technically, people with medical cards are entitled to these under primary care services but in many places these services just do not exist. While it remains a grey area for those without medical cards.

One of the key principles of the Fair Deal was that no one would be worse off and people are entitled to hang on to what they had before its introduction. So if you were in a public nursing home, your contribution remains the same and if you were being subvented  and happy with it, you can keep it. Likewise with additional supports. However if you are a new resident under the Fair Deal it is still unclear who is entitled to what support care, particularly if you are in a private nursing home without a medical card.

One of the main rationales for the Fair Deal was to get people out of hospital who were in need of nursing home care. Yet the figures available show no impact yet. Although its hard tell as HSE can’t gather information at the moment due to continued work to rule by unions.

There were more delayed discharges in December (783) after the Fair Deal was introduced than in September (742). And it seems there is a particular problem with under 65 year olds who are in hospital in need of nursing home care getting stuck there because the costs of their care is more expensive than what is being paid for under the Fair Deal. So generally care is paid at a rate between €500 and up to €2000 depending on level of dependency, however some people would need care costing far in excess of this.

I have spoken to nursing homes who estimate care for some of these people would cost between €2-4000 but no nursing home will take them under Fair Deal as the pay is capped at the rate agreed between the nursing home and NTPF. I am aware of cases where people are stuck in hospital as their care costs are considered too high.  And it is very unclear what happens these cases.

So in effect its Fair Deal or No Deal. It seems that in these cases there are no options for these people – these would be people with extreme brain injury who cannot live in other assisted living places, also people with early dementia and young people with degenerative conditions that require high levels of nursing such as MS.

THere seems some confusion about this group as I saw an internal HSE memo dated 16 April saying under 65 were no longer to be dealt with under Fair Deal but have been reassured by HSE and DoH that this decision has been reversed…. But clearly the Fair Deal is not working for this population. Especially the 120 under 65 year olds currently stuck in hospital not due to shortage of places but due to high cost of their care in any other setting.

ANy feedback or thoughts on the Fair Deal most welcome..

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