Government’s lack of courage fails us all, but more importantly, our oldest and frailest citizens
Column from Irish Independent on 21 July 2015 on long-awaited, watered government review of the Nursing Home Support Scheme.
On February 12, Minister of State for Primary and Social Care Kathleen Lynch starkly told the Oireachtas Health Committee that the Nursing Home Support Scheme was “unsustainable in its present form… we have to take a serious look at the additional funding that will be needed”.
She continued: “Some of the funding will have to come from the public purse, but equally we have to look at other sources of income. “I am not going to pre-empt what is in the review, but if it does not deal with the funding element, it will have done a very poor job.”
Yesterday’s publication of the Review of the Nursing Home Support Scheme is proof that they have done a very poor job.
In a statement issued to coincide with the long-awaited review, the same minister said: “The review shows an overwhelmingly positive picture of the scheme… The review looks at the future financing of the scheme… The Government is not contemplating any fundamental change to eligibility for the scheme or the rates of contribution asked of participants.”
In other words, the Government will not increase the cost of nursing homecare for citizens in the run up to a general election.
On numerous occasions, Ms Lynch has stated that people will also have to contribute to the cost of publicly provided homecare (which is currently provided without cost) in a similar way to the Nursing Home Scheme.
Speaking at the same health committee in February, she said: “There are other elements and I hope it will allow people in the community access to Fair Deal while still being able to remain in their own home.”
There is no such mention of that now. The closest this anodyne report comes to saying this is recommending a review of “the absence of contribution towards the costs of publicly funded community-based care”.
The Nursing Home Support Scheme Review published yesterday is the most enormous political kicking the can down the road imaginable.
What was put in the public domain is a watered-down obfuscation of any real attempt to deal with financing long-term care.
Not only does this review not bite the bullet on how to finance long-term care, but it beautifully kicks to touch with the 71 recommendations by setting up a working group “to oversee implementation of these recommendations”.
In classic government speak, the report identifies “a number of administrative improvements” that can be made. But on any controversial issue, the review delays dealing with them by recommending another review.
As well as reviewing homecare, it suggests the Department of Health should carry out a value-for-money review of public nursing homes and the NTPF review of the current system of pricing private nursing homes in 18 months’ time.
The Nursing Home Support Scheme was introduced in 2009 as a new way funding nursing-home care. The review was promised after three years.
Nearly six years on, the Government review fails to assess whether the scheme current nursing-home scheme is sustainable – even though the minister is clearly on the record saying that it is not.
Not only that, but its recommendations for future funding (in the absence of charging individuals more, which Kathleen Lynch said previously was inevitable), means the money must come from taxes, but this government won’t raise taxes.
The report purposively underestimates the amount needed for the scheme for 2016 at €10m, when it is well known that at least €25m is needed each year for the system just to stand still and meet demographic demands.
The review validly makes the point that just 5pc of older people end up in residential care, yet nursing home care takes up 60pc of the funding for all services for older people.
It recommends increasing the amount and types of home and community care. But again, it conveniently underestimates these costs and fails to make a call as to where the additional funding should come from.
Meeting the care needs of older people in the community and in nursing homes is a major challenge facing government and society. But it is not the demographic time bomb often portrayed. Most older people experience relatively good health and they and their families look after themselves until the end of their lives.
Ireland has a younger population than most of our OECD counterparts, which gives us time to plan and get right this most important care policy.
There is some interesting detail in this report, but it fails spectacularly to outline the financial and societal challenges on how best to meet the care needs of older people now and in the future.
The current nursing home scheme is unsustainable but the Government will not admit that because it is too close to election time. What is detailed in the report as sufficient to fund the scheme in the near- and long-term is a vast under-estimate. The absence of detail on how to improve and fund care at home and in the community is notable solely for its absence.
Once again, the Government’s lack of courage is failing us all – but more importantly, it is failing our oldest citizens.