Q&A on the Fair Deal
From the Irish Independent on 13 February 2015
What is the Fair Deal?
It is the Nursing Home Support Scheme (NHSS) which funds residential nursing home care for older people. It is administered by the HSE. Latest figures show there were 22,618 people funded under this scheme in November 2014. People can choose public, private or voluntary nursing homes under the NHSS.
Why is it in the news?
Because HSE chief Tony O’Brien described it as the ‘Achilles heel’ of the health services at yesterday’s routine Oireachtas Health Committee meeting. Mr O’Brien predicted that unless extra funding is found, the waiting list for the scheme will grow to 2,200 people by the end of the year and waiting time will reach 20 weeks.
So what’s the problem?
The problem is that people who need residential nursing home care are often nearing the end of their life. They should not have to wait five months for essential care that they are assessed to require. The big problem right now is that more people need a residential place than are currently funded under the Nursing Home Support Scheme.
Why are there insufficient funds for the Nursing Home Support Scheme?
The NHSS, established in 2009, was set up as a budget-capped scheme. Given that there are increasing numbers of older people as our population grows and ages, having a limited budget meant it was always inevitable that it would run out of money. An extra €3m was allocated to deal with the high numbers of long waiters in November and December 2014 as part of the HSE’s Winter Pressures Plan. This resulted in an extra 300 NHSS bed approvals on top of the routine 700 places which are allocated each month.
How does one get on the scheme?
Anyone can apply through their local health office. In order to get accepted on the scheme, one first goes through a Care Needs Assessment which assess if one actually needs long-term nursing home care. If one is deemed in need of care, there is a Financial Assessment which determines one’s contribution to the cost of care and the corresponding level of State financial assistance.
People generally contribute 80pc of their income towards the cost of their care and 7.5pc of the value of any assets every year. Where assets include land and property, the contribution based on these assets can be deferred until after your death under a Nursing Home Loan. Only when one has gone through these stages is one deemed eligible for the scheme and then the time begins on the nursing home waiting list.
What is the solution?
Speaking at the Dáil committee yesterday, minister Kathleen Lynch said the ‘Fair Deal scheme should be demand-led’. This would mean that money would be allocated to the NHSS to meet the actual need and not be budget capped. This requires extra funding.
Will this happen?
The NHSS was meant to be reviewed in 2012. Three years on we are still awaiting this review to be published. It seems inevitable that it will recommend funding on the basis of need as well as many more home and community supports for older people.