The Nursing Home Support Scheme, commonly known as Fair Deal, has generally been considered a success since it was introduced in 2008. By footing the cost of a nursing home stay in return for a contribution by the resident based on income and assets, the scheme has provided much-needed certainty for older people contemplating the move from the family home into residential accommodation. It covers both private and public nursing homes, so applicants can choose where they want to stay.
Even before the current cost-of-living crisis, the scheme was experiencing stresses. Private operators, who account for about 80 per cent of nursing home beds in the State, have grown increasingly restive about the rates paid by the State for the upkeep of Fair Deal residents, especially when compared to the sums the HSE allocates to support its own homes. It has become routine for private operators to levy additional “top-up” charges on Fair Deal residents to make up for the claimed shortfall in funding.
Before the Covid pandemic, two official reports found public nursing homes were paid over 60 per cent more per resident per week than private nursing homes. Factors behind the differential included better pay and conditions for staff in public nursing homes and the higher cost of running older State-own buildings as nursing homes. While it is often claimed that public nursing homes have more higher-dependency residents, one of the reports found little difference in the levels of dependency between public and private homes.
Recent inflationary pressures have exacerbated these problems. As with other sectors, nursing home providers have received State help with the cost of energy, but they have also been affected by rising food, staffing and medical costs.
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More than 20 private or voluntary nursing homes have closed in the past 18 months, in many cases due to financial pressures, according to Nursing Homes Ireland. As reported by The Irish Times last week, a Cork nursing home, Beaumont Residential Care, has told its residents it is pulling out of Fair Deal from the end of this month. The home will remain open but only for private residents. Providers are now warning of a “tidal wave” of nursing home operators following suit by withdrawing from Fair Deal.
The consequences of such a trend would be disastrous. Ignoring the problem will not make it go away. Any further restriction of the supply of nursing home places will inevitably result in even greater overcrowding in hospitals. After almost 15 years in existence, the Fair Deal scheme is due a proper review. It should include an examination of the claims of underfunding made by private providers, and make recommendations to rectify funding imbalances if these are shown to exist.