To what extent are hospitals being used as a dumping ground by families for financial reasons?
This is the uncomfortable question raised in internal Health Service Executive correspondence over the issue of "bed blocking" in Irish hospitals.
Documents seen by The Irish Times reveal high-level concerns within the HSE over the occupancy of beds by patients who have been declared fit but refuse to leave, or whose families refuse to allow them to leave.
In some cases, according to HSE head of legal services Eunice O’Raw, this is because the family wants to inherit the patient’s assets rather than have them used to fund a nursing home place through the Fair Deal scheme. In other cases, farming families keep family members in hospital in order to avoid financial penalties that would otherwise be due because the patient is not managing the farm, she says.
Appalling as these scenarios sound, they probably account for just a fraction of the cases involving well patients who are still occupying hospital beds. True bed blockers – a term frowned upon by medical professionals – are few in number, even if some have been in place for years.
On any one day, there are hundreds of so-called “delayed discharges” in the system, and they are one of the main causes of the perennial “trolley crisis” in emergency departments. Treated patients have to leave in order to make room for incoming, urgent cases; delays in this process inevitably give rise to a backlog.
Affecting documentary
A very different facet of the debate was to be seen in Monday night's affecting documentary, We Need to Talk About Dad, which was made by television presenter Brendan Courtney and is about caring for his father Frank after he had a stroke. It highlighted the lack of options available in caring for older people, the difficulties in navigating Fair Deal and the delays that arise in the system.
As the programme showed, many delayed discharges are marooned in hospital because of a lack of viable options for home care or step-down care, or simply because the process of successfully applying for a nursing home place is taking longer than it should. They may even be stuck in hospital because the consultant who needs to sign them out is not available at the weekend.
It is hard in such circumstances to blame a family for not agreeing to the discharge of their loved one until all the pieces of the care jigsaw are in place.
With an extra 25,000 people turning 65 each year, these issues are becoming ever more pressing. The Fair Deal scheme has worked reasonably well since it was set up in 2009 in providing a measure of stability, given the financial pressures of providing care as we collectively live longer.
It is a blunt instrument, however. The Government’s announcement this week of a consultation process on a new statutory home care scheme is long overdue.
