A five-month wait for a nursing home bed is no Fair Deal

Analysis from Irish Independent on 7 November 2014.

Yesterday Minister for Health Leo Varadkar declared his dissatisfaction with the fact that there are over 2,000 older people waiting 15 weeks for nursing home care. And now that the fourfold increase in the numbers of older people waiting for nursing home beds has hit the public radar, Minister Varadkar and Minister for Older People Kathleen Lynch have a “plan”.

‘Fair Deal’ – the Nursing Home Support Scheme – was heralded on its launch in 2009 by the then minister, Mary Harney, as “accessible, affordable and anxiety-free”. Yet just five years later, it has hit the wall – a wall that was completely inevitable from its flawed inception.

The Fair Deal’s budget was capped and last year it had its budget cut, despite the fact that we have the fastest-growing ageing population in Europe. It is extraordinary that it was not set up with a budget linked to easily predictable population need.

Most older people remain in the community in the winter years of their life. But some, often the oldest and the frailest, need nursing home care. Over the last year, the numbers assessed as needing a nursing home bed rose from 523 to 2,182 and the waiting time increased from four to 15 weeks. This is an incredible growth over just one year – and the waiting time cited does not include the average four-week application process.

There is nothing “accessible, affordable and anxiety-free” about this scheme for those 2,182 older people waiting over five months for a bed.

Having a short stay in a good community nursing unit and or good home care enables most older people to live where they usually want to – at home, even after a hospital stay. The longer an older patient is left inappropriately in a hospital bed or at home without adequate supports, the more likely they will end up needing nursing home care or as an emergency admission to hospital.

Yet the nursing home budget was insufficient from the start and there were 2.3 million fewer home help hours last year when compared to 2008.

Minister Varadkar earmarked €25m in Budget 2015 to tackle ‘delayed discharges’ – people who are left in hospital beds when they don’t need to be there, simply because the appropriate care does not exist for them at home or in a nursing home.

The HSE keeps good data on those stuck in hospital beds, which show some stark trends. Over half of all delayed discharges in October were in Dublin and over three quarters of them were waiting for a nursing home bed.

It is not just much better for these people not to be in hospital beds, it is much cheaper and it also frees up hospital beds required for emergency admissions and planned hospital treatment. Tackling delayed discharges is a good place to start.

At the moment, nursing home places are “freed up” when someone leaves a nursing home, usually in a coffin. There is some extra money for a few additional places towards year-end, but not nearly enough to meet demand. Securing a nursing home bed for the 2,100 plus older people who have been thoroughly assessed as needing this care would cost about €90m. The Nursing Home Support Scheme is being reviewed and its long overdue publication is expected in the new year.

Last year’s service plan allocated an extra €5m to social care packages specifically to get delayed discharges out of hospitals. Under this scheme, 325 people got transitional care and 245 people got special home-care packages. This was a positive move, but just a drop in the ocean – many more of these packages are needed.

There are no details available of the ministers’ “plan”, but it is most likely a common-sense combination of better hospital-release planning through links with primary and community services, more home-care packages and step-down, short-term, community nursing home beds, as well as more money for long-term nursing home places.

Just like the high numbers of people left on trolleys in emergency departments, the chronically high numbers of delayed discharges left in hospital beds – and the high numbers of older people left without the nursing home care – are all symptomatic of a system with insufficient resources to meet need.

And each of these are sure to be a very good indicator of huge amounts of sick and older people in the community who need help, but who are lucky enough not to end up in hospital or a nursing home, yet.

Even with seven years of austerity, it is simply unacceptable that hundreds of people are unnecessarily in hospital beds and thousands of older people are waiting over five months for a nursing home place.

It does not make economic sense, and for those people who do not have time on their side it is inhumane. Making sure these people get the care they need, very soon, would make a big difference to their lives and their families.

Delivering on it would a good test of Varadkar’s mettle in his first year as health minister.

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