No surprise that ‘Fair Deal’ has run out of money

Posted in Blog by saraburke on May 20, 2011

Just 20 months old, the nursing home support scheme (named the Fair Deal) has run out of money, so what will happen older people in need of nursing home care and why are we only hearing about this now? Fianna Fail broke this story on Wednesday afternoon.  According to a spokesperson for Minister Reilly he only became aware of this funding crisis in the last week. But this was a train coming down the tracks since the scheme came into existence in October 2009.

Many people, like the highly thought of geriatrician Des O’Neill, advocacy groups working with older people and I, made this point since the scheme was announced. If you have a limited budget and infinite demand or need then inevitably you are going to run in to trouble and out of money – do the sums – there are approximately 30,000 nursing homes beds with an average cost of €50,000 a year – this adds up to 1.5 billion but the budget is less than €1.01 billion…

But this has not just come out of nowhere, the HSE flagged it in their January and February 2011 HSE PR report. It is unclear from the ministerial briefings released under FOI how much the Minister was aware of this as most of the relevant section is blacked out.

It is not surprising that there is a shortage of money for the scheme, given the declining health budget for this and all other aspects of the health services. When asked for an explanation as to why this is happening now and how it was not foreseen, Minister Reilly and HSE are saying there is a rapid increase in demand for Fair Deal places and the escalating costs of care.

However, no one currently in nursing home care need to worry – nothing will change for them – but for those who are applying it is a problem. The HSE say people should continue to apply, they will be processed but not cleared unless vacancies arise.

The most recent figures show 22,930 people at end of April were covered by Fair Deal – which according to the HSE means its budget is at its ceiling of €1.01 billion. Figures for  March show 900 new applicants, yet only 330 leaving system that means there’s a shortfall of 570. These figures also show a significant increase between December and March with 660 new applicants in December and 900 in March.

As well as the official explanation of increased demand and costs, other factors influencing this funding crisis are the ageing population, our inadequate primary and community care services and according to official sources ‘the scheme is a victim of its own success’. Speaking on 19 May 2011, Minister Reilly said ‘demand outstripped expectation’ however all predictions of population need for residential care would show that as the current system is structured and operates demand will inevitably outstrip supply.

So what happens now? Minister Reilly says he busy banging heads together, that he wants to understand why this situation has occurred but really he has few options and none of them are good. These include: a supplementary budget, although there is no money for a supplementary budget; taking money from elsewhere which is difficult as everywhere is short of money; or else starting a waiting list which in effect is the rationing of residential care for those in need of it.

As the situation stands, people will only get places as existing places are freed up. This will mean more older people will be kept in hospital (often referred to as bed blockers as they don’t need to be there).  This in turn will cause even greater delays in Emergency Departments and even more cancellations of planned surgery and treatment for public patients. This is close to the worst possible news Reilly could get nine weeks into office.

In the long term, this funding crisis highlights the need for a debate about who gets and who pays for what services. Given that the government is committed to universal coverage, its hard to see how this can be delivered in the current environment. Possible solutions lie in better access to home care services, those who can afford to pay more through taxes or co-payments, and or having fewer people in residential care. In Ireland the average length of stay in residential care is four years on average, in the USA it is one year – the best is probably somewhere in between but none of these solutions come quickly or without cost. This is perhaps the first landmine for the new health minister in the department known to be like Angola.

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