Nursing Homes Support Scheme in disarray

A badly designed Nursing Homes Support Scheme means that 1,100 older people are now waiting for nursing home places. By Sara Burke.

HSE figures released last Thursday (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 Homes 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 has 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 take up their nursing home place, even if it was available, because the money is not there to fund it.

This means older people are inappropriately waiting for a nursing home place at home or in a hospital bed. One case that has been brought to my attention is that of a woman in her 80s 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 is getting excellent nursing care in the hospital. The woman has settled in quite well, and her husband and family visit her daily, but she is on a busy ward; a ward where people are dying or being returned 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 Homes Support Scheme was paused in May when it ran out of money, was started again in June by the Minister for Health James Reilly, and yet it’s grinding to a halt again by the end of August. So what’s going on?

Basically, the scheme has run out of money less than two years into its operation. This was always inevitable given its faulty design. It has a limited budget and there is unlimited need. We have a growing, ageing, and sicker population, with poor community services, and demand for residential places exceeds supply. 

The waiting list of 1,100 older people is made up of two groups: those in hospital 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. The HSE has said that they are being approved for funding on a purely chronological basis. Essentially, for a place to come free at the moment, someone has to move out of one - so those waiting are waiting for others to die.

There is a direct relationship between the waiting list for the scheme and trolley queues in Emergency Departments

1 September 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:

• Galway - 48
• Beaumont - 35
• Vincent’s - 31
• Beaumont - 27
• Mater - 24
• Wexford - 21

There is a direct relationship between the waiting list for the Nursing Homes Support Scheme, the 800 delayed discharges and trolley queues in Emergency Departments.

After the controversial suspension of the scheme in May, when it ran out of money, a new and more cumbersome administrative process was put in place, operating through 18 offices around the country. Before the new process was brought in people could reasonably expect that their applications would be processed within six weeks; now the wait-time is double that.

An additional €15 million in funding has been made available for the scheme, 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.

It simply does not make sense to have 800 people in hospital beds that cost between five and ten times what 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 budgets have been merged, 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.

Minister for Health James Reilly has invested a lot of political capital in this scheme, but he was unavailable for comment on it. In response to questions about 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 aim given the increasing queues to get in to nursing homes, and our growing, ageing population, with more and more people looking for more services.

The new and much heralded Special Delivery Unit in the Department of Health under the stewardship of Martin Connor is due to get up and running this week. The backlog of people trying to get into hospitals and nursing homes, combined with an ever declining HSE budget, fewer staff and the closure of hospital beds, wards and services, mean that Minister Reilly and his special delivery unit have a very challenging winter ahead.

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Image top: FatMandy.