Waiting for others to die – the only way to get a nursing home bed
HSE figures released today (1 September) reveal that 1,100 older people who are medically in need of a nursing home place and have been through a rigorous financial assessment are languishing on a waiting list for that bed. When the Nursing Home Support Scheme (the so-called Fair Deal) was launched less than two years ago it was heralded as “accessible, affordable and anxiety free”. Obviously it is proving to be none of these (it is not accessible for those on the waiting list, it is not affordable for the State as it as run out of money and it is not anxiety free for the older people and their families who wait for a nursing home bed) so what does the Fair Deal waiting list mean for those on it and why is there a waiting list? In August, the radio airwaves were busy with people ringing in about relatives who had been approved for the scheme but who couldn’t move into the bed, even if its available, because the money is not there fund it.
In reality, this means older people are inappropriately waiting for that bed at home or in a hospital bed. A situation that has been brought to my attention is a woman in her 80’s who fell at home five months ago. She was brought to one of the city’s main Emergency Departments and eventually got a bed, where she took quite a while to recover. But now she has been in hospital for over two months even though she does not clinically need to be there. This woman and her family say she’s getting excellent nursing care in the hospital. The woman has settled in quite well there, her husband and family visit her daily, but she’s on a busy ward, a ward where people are dying or being returned to after serious surgery and it’s just not the appropriate place for her to be.
The family went through the nursing home support scheme application process, were approved, have found a suitable place in a nursing home near her family, have persuaded her to go and now that they’ve got a place and she’s ready to go, she can’t get in… Meanwhile people in the same hospital’s Emergency Department can’t get a bed..
The nursing home support scheme was paused in May when it ran out of money, it was unpaused in June by the Minister and yet it’s grinding to a halt by the end of August. So what’s going on?
The Nursing Home Support Scheme has run out of money less than two years in operation, this was always inevitable with the scheme’s faulty design of a limited budget and yet there is unlimited need. We have a growing, ageing, sicker population, with poor community services, where demand for residential places exceed supply. The bottom line is that it was badly designed and it is just not sufficiently funded
The waiting list of 1,100 older people is made up of two sets of people; those in hospitals beds (offensively known as bed blockers, officially known as delayed discharges) and those in the community. According to the HSE there are 800 delayed discharges, so about 300 others are waiting for their nursing home bed in their own homes. And the HSE said that they are being approved for funding purely on a chronological basis. Basically to get a place at the moment, someone has to move out of one, so those waiting are waiting for others to die.
The 1st September uncoincidently also witnessed unprecedented seasonal highs for the numbers waiting on trolleys in Emergency Departments. According to INO figures, now the official ones, measured at 8am each day, there were 389 waiting on trolleys, an exceptionally high figure for this time of year. The hospitals with the worst situations were
- 48 people on trolleys in Galway
- 21 in Wexford
- 35 Beaumont
- 31 in Vincent’s
- 27 in Beaumont
- 24 in the Mater .
And there is a direct relationship between the waiting list for the Nursing Home Support Scheme, 800 delayed discharges and trolley queues in Emergency Departments.
The scheme as controversially suspended in May when it ran out of money, so what has happened since May to people applying for the nursing home scheme? A new more cumbersome administrative process is in place, operating through 18 offices around the country (why not four or 32 matching the regions or local health offices, I don’t know). The application process takes much longer before people could reasonable expect to be processed in six weeks, now its double that.
Also the system has been playing catch up, since it was unpaused, 1,750 have been approved for funding and are in now nursing homes.
An additional €15 million has been made available, although €30 million was promised. And the numbers in nursing homes under various schemes has remained static. In May 2011, there were 22,277. On 1 September the figure given was 22,300, not much of an increase given the growing demand of an ageing population and a waiting list of 1,100.
Also, it just does not make sense to have 800 people in hospital beds which cost between five and ten times the amount it costs to keep someone in a nursing home bed when the health budget is under more pressure than ever before. And even though the HSE hospital and community budget has been merged, but there is still a different pot of money for nursing home care – so there is still no incentive in the system for moving someone out of a hospital bed that costs €5000 a week into in a nursing home bed that costs €1000. That’s a real problem and given that the nursing home support scheme is an example money follows the patients, it’s not proving a great example.
Minister Reilly has invested a lot of political capital in this scheme, but he was unavailable for comment on it. In response to questions put in on the extensive waiting list the Department of Health said that “any delays will be resolved in the final quarter in 2011”.
This is a very ambitious statement given the increasing queues to get in to nursing homes, the growing, ageing population, with more people looking for more services.
The new much heralded Special Delivery Unit in the Department of Health under the stewardship of Martin Connor is meant to get up and running next week. The back log of people trying to get into hospital and nursing homes combined with an ever declining HSE budget, less staff and closure of hospital beds, wards and services mean that the Minister’s commitment to rid Emergency Departments of trolleys and reduce waiting lists for elective treatment means James Reilly and his special delivery unit have a very challenging winter ahead…