Briefing notes issued to Health Minister Leo Varadkar show a number of significant challenges for the Nursing Home Support Scheme and long-term residential care in the future.  Niamh Cahill reports in the Irish Medical News.

Several commentators have voiced concerns about the future of long-term residential care in Ireland in the last year. The Department of Health was, heretofore, never among this cacophony.

But briefing notes issued to Health Minister Leo Varadkar on his appointment state that waiting times for the release of funding under the Nursing Home Support Scheme (NHSS) are to rise from seven to eight weeks to between 14 and 16 weeks by the end of the year.

As of June 19, 1,390 people were on the Scheme’s placement list waiting on funding, with an average waiting time of 10 weeks and huge knock on-effects on delayed discharges in hospitals.

The notes outline what stakeholders and reports have been saying for some time, that demographics suggest an increased demand for long-term residential care in the future.

Despite this growing demand, the budget for the Scheme was reduced in 2014 by 35 million to 939 million, with 23 million being transferred to community services.

Indeed, Government has stated that its priority for 2014 is the development of an integrated care model for older people’s services, with a focus on home and community care.

The briefing notes state that this plan will: “Provide a greater range of options to avoid admission to acute hospitals, support early discharges, and where appropriate rehabilitate and re-able patients after periods of particular difficulty.”

The budget for home help services in 2014 is 185 million and 130 million for home care packages, which excludes the extra 23 million investment.

The figures clearly show that the cost of community and home care is drastically cheaper than the cost of residential care – costs that the current Government, where health cuts are still being sought, are seeking to avoid.

But there is credence to the argument that older people wish to stay at home for longer, a view Government is adamant to highlight and support.

Yet, as the number of older people continues to rise, it is inevitable that more people will need residential care in the future, particularly those who have complex care needs and comorbidities.

By 2046, more than 20 per cent of the Irish population will be aged 65 or over, compared to 11 per cent in 2011.

The briefing notes from the Department show that the rate of growth of the over 65s Irish population is almost double that for the entire EU.

The over 65s cohort is expected to rise by 20,000 per annum over the next three years, growing to between 850,000 and 860,000 by 2021 compared to 535,000 in 2011.

“The over 80s population is set to rise even more dramatically. By 2021, the population over the age of 65 is expected to increase by close to 40 per cent, representing an additional 200,000 people,” according to the briefing notes.

“In monetary terms, it is estimated that these demographic pressures equate to an additional funding requirement of the order of 200 million per annum over the coming years.”

The briefing notes show that a minimum of 7,600 residential care beds will be required between now and 2021.

To maintain a 20 per cent presence in the market, public beds will have to grow by 1,500 by 2021, the notes add.

A review of the Scheme is currently underway. The review was due to commence in 2012 and be completed by early 2013 but after this target failed to be met it was then expected to be completed by the end of 2013 or early 2014. It is now anticipated that the review will be completed sometime this year.

“The outcome of the review will inform consideration of the appropriateness of a Nursing Homes Support Scheme type approach for the disability and mental health sectors,” a spokesperson told IMN back in March.

The review is examining a number of factors including the sustainability of the scheme and the cost of long-term residential care in public and private nursing homes in the short (2016) and medium (2023) term.

It will also look at the current methods of setting prices for nursing home care and at considerations to extending the scheme to community based services and other sectors, such as disability and mental health, as well as making recommendations for the future operation and management of the scheme.

While the review has yet to be published, it would appear that any solutions proposed by Government to growing financial demands on the sector will involve ensuring older people stay at home for as long as possible.

But achieving this aim is not without difficulty, as improvements in other parts of the health service, in terms of timely access to outpatient and hospital services, will need to be facilitated.

During the first four months of 2014, around 3.3 million home help hours were provided and over 12,600 people were in receipt of home care packages.

The demand on these services is huge and families of loved ones regularly call for more home care, due to cuts to the services in recent years.

The 23 million injected into community services is to be welcomed, but it is clear more is needed.

Some 10 million of the funding will be used to target intensive home care packages for 250 people annually.

Another 10 million will address so-called funding shortfalls, according to the Department, in the provision of public short stay beds and help to maintain provision at 1,860 beds.

A further 3 million will be used to commission 25 intermediate/transitional care beds for 650 people and 20 beds for 130 people.

Yet, according to the briefing notes, there have been no developments in utilising the 3 million to provide these beds to date.

Other older people initiatives, such as the single assessment tool project, to direct resources to those with the greatest need, are progressing, albeit at a slow rate.

Unhappy with Government policy, Mr Tadhg Daly, CEO of Nursing Homes Ireland (NHI), believes that waiting times for the Scheme are unacceptable.

“Older people who have been assessed by the HSE as requiring nursing home care are already waiting three months,” he stated.

“It is leading to deterioration in older persons physical and psychological health. Such delays have very significant consequences for the wider health service, with the HSE already reporting an upward trend in numbers delayed discharge and 78 per cent of such persons awaiting nursing home care.

“There is an opportunity to seriously address the present crisis in older person care in the coming weeks on Budget Day. Budget 2015 can deliver reassurance to older people by ensuring Fair Deal in the year ahead is appropriately resourced to ensure they can access nursing home care in a timely manner. This must be a priority and must be grasped.”

As demands for more cuts within health leading up to next month’s Budget continue, it appears there is little room for investment in the residential care sector.

There is also the financial problem of ensuring that public residential care homes meet HIQA building standards by 2015.

Current investment plans will not be enough to ensure all homes meet the standards by this deadline, it is understood.

Mr Tony O’Brien, HSE Director General, recently stated that the HSE must save before it can invest.

This may be true, but for how much longer can the health service fail to invest without a crisis developing in older persons’ care?