Category Archives: Aging

Aging, Nursing Homes

Will the nursing home sector face a crisis?

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A significant deadline is facing the Nursing Home sector in Ireland and one that is a big concern. That deadline is for nursing homes to fully comply with the 2009 Health Information and Quality Authority (HIQA) standard for physical environments. That is section 25 in the National Quality Standards for Residential Care Settings for Older People in Ireland. In that document, dated 17th February 2009, it mentions that existing facilities must comply within six years of the implementation of the standards. It is unclear if the deadline is therefore 17th February 2015 or end of July 2015 as another HIQA document mentions (The Regulator Notice on Premises & Physical Environment RN001/2013).

In any case, the requirements specify many criteria, including:

  • Bedrooms having minimum of 9.3 m2 usable floor space (excluding en-suite facilities) in all single rooms.
  • Shared bedrooms to provide a minimum 7.4m2 per resident, with no more than two residents per room except for high dependency rooms where a maximum of six applies.
  • One wash hand basin per bedroom (minimum of one wash hand basin per two residents, or one per 3 for the high dependency rooms).
  • One assisted bath or shower per 11 residents, located in close proximity to bedrooms.

It has been claimed in a recent paper by CBRE that the nursing home sector will need a significant investment of capital in order to comply with these new regulations. Failure to do so could result in a significant number of nursing home closures, thereby leading to a critical lack of nursing home beds.

While raising the standards of the physical environment in nursing homes is laudable, and seems like a reasonable goal for HIQA to have, it does have costs. Someone has to pay for it. This will lead to an increase in nursing home fees. If nursing homes are being closed down, that in itself will put upward pressure on fees. Couple that with fee increases to cover the cost of investment to comply with the increased standards and the total could become unbearable. What will people do who are already struggling to meet fees currently?

Nursing Home Ireland in its submission to the Oireachtas Joint Committee on Health and Children in November 2013 also mentions a deadline of July 2015 and that the HSE has indicated that an investment by the State of €1.7 billion is required for the nursing homes in the public sector alone in order to achieve full compliance and to retain its share of 20% of the overall nursing home sector. Will the state make this investment and achieve compliance in time? Nursing Home Ireland is concerned that the public sector nursing homes will negotiate extenstions with HIQA. It does not want a situation where public and private nursing homes are treated differently.

Do you think that public and private nursing homes should be treated differently in respect of enforcing the national standards?

Do you think that HIQA should stand its ground and stick to the 2015 deadline, even if nursing homes have to close because they don’t have the space or the investment capital required to give extra floor space and extra bathing facilities to the residents? Is Ireland wealthy enough to pay for this increase in physical environment standards across the board?

Aging, Nursing Homes

Elderly nursing home residents hit with extra fees of €720 per year

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A new controversy has started concerning the deflecting of fees for “extras” from the HSE to family members. These “extras” include services such as physiotherapy, chiropody, transport to hospital when needed, and toiletries.

In a letter to 30 residents of the Caryfort Nursing Home in Glenageary, Co. Dublin, the home said that it was advised by the National Treatment Purchase Fund to charge each resident up to €720 per year for such extras. It said that health service officials suggested that this be done to cover reductions in the amount of money which it receives as part of the Fair Deal scheme.

So, the Fair Deal scheme will pay out less, and the elderly have to pay more:  €720 more per year. This will be a big blow to the most vulnerable in our society, and to their families. These extras are necessary for the care of the elderly. They are not “optional extras”.

The Irish Patients Association (IPA) have said that the increased use of extra charges is an indication of the impact of health service cuts and that the “sneaky tax” is likely to be repeated across the country.

Stephen McMahon, the IPA Chairman pointed to cuts in Fair Deal payments to private nursing homes ranging from €1 to €75 per week as highlighted in a review of 50 private nursing homes in the Dublin-Wicklow region. Depending on the facility, some residents are facing increases of up to €3,600 a year in charges as the nursing homes turn to the residents to make up the shortfall. McMahon sees this as another sneaky stealth tax, introduced by the back door, without the backing of the Dáil.

For more see Irish Examiner article.

Aging, Nursing Homes

Shortage of Nursing Home Capacity Predicted

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In a report commissioned by Nursing Homes Ireland, BDO chartered accountants find that demand for nursing home beds is now exceeding supply in parts of the country, and the shortage is widening rapidly.

Putting numbers on it, 100 additional nursing homes will be needed over the next seven years to cater from an additional 8,000 people approximately.

The number of people aged 85 and over is rising significantly and one in five of these needs long-term residential care.

This will present tough challenges on the country. If nursing home care capacity is not increased, the consequence is that hospital beds will be occupied instead, with a knock on effect on surgical waiting lists and the health system generally. For individuals and their families the questions of “what to do” and “where to go” will be asked, but may not be adequately answered.

The report points out that the cost of providing care in an acute hospital is up to eight times that of providing care in a nursing home.

Nursing Home Ireland Chief Executive Tadhg Daly is calling for urgent investment in this area.

For further reading:

Article in the Irish Examiner on Wednesday 12th February 2014

Nursing Homes Ireland article on the subject. 11th February 2014

The full BDO report: Health’s Ageing Crisis: Time for Action

 

 

Aging, Care in the Home

Reduction in Housing Adaptation Grant for Older People and People with a Disability

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Families needing to redesign, remodel or make alterations to their houses to accomodate the the needs of the elderly or those family members with a disability will now find it harder to get access to this grant and in many cases the value of the grant will be reduced.

Such alterations may include widening doorways to facilitate wheelchair access, converting downstairs rooms to bedrooms or adding a downstairs bathrooms due to the inability or difficulty to use a the stairs.

The changes to the scheme came into force on 1st January 2014 without any prior announcement, and the main changes are:

  • Changes to the income bands to qualify. The earnings over which no grant will be paid has been reduced from €65,000 to €60,000.
  • For older people, the maximum grant has been reduced from €10,500 to €8,000.
  • Also, for older people the age for eligibility has been raised from 60 to 66 years.
  • The income of all adults in the household is now included in the income assessment.
  • Proof of compliance with the local property tax is now required.

More details can be found on the Department of the Environment, Community and Local Government website page: Adjustments to the Housing Adaptation Grant Schemes for Older People and People with a Disability.

These changes have been criticised by Age Action , saying that it will hit the most vulnerable older people and those on lowest incomes the hardest. The introduction of the changes only came to light because a document for local authority officials was leaked to the media.

The cuts and reductions in this grant raises concerns that elderly people and those with a disability will find it more difficult to remain living in their own homes.

According to Age Action spokesperson Eamon Timmons: “While the intention of the review was to make the schemes more focused and targeted at those most in need, the impact is that changes to Housing Aid for Older People scheme mean that funds will be spread more thinly, with the poorest of older people now receiving a reduced maximum grant while also being expected for the first time to pay for a percentage of the work.”

Have you or members of your family been impacted by this change?

Aging, Care in the Home, Nursing Homes

Aging and Institutional Care from an Elderly Perspective

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Aging, by definition, takes time. If it happened in an instant we would all get a dreadful shock. If we went to bed one night looking like a 21 year old, and awoke the next morning and saw an 80 year old looking back at us in the bathroom mirror. Having just written that, it just struck me that that experience can actually happen to some 21 year olds after a bad night out, but they usually recover from it. The aging process is slow and gentle, so slow and gentle that we don’t notice it on a daily basis. We see the changes if we look back at photographs of ourselves taken several years ago. Do we like the change that has happened to us over those years? Maybe not, but there is not at lot we can do about it, and so long as we can keep on living an active life and doing the things we have been doing, we can accept it and life can be good.

From middle to older age, there is a difference between our actual age (as per our birth cert) and the age that we believe, think, act and feel like. If we can act and feel like we are 20 to 30 years younger than we are – then that’s a good thing. Feeling “old” is usually a complaint.
Act your age - not!

If we accept this, then it is important not to overlook the fact that this 20 to 30 year perception difference does not disappear once an elderly person needs care.

In a recent Sunday Miscellany radio broadcast at about 24 minutes and 24 seconds into the program, the writer Brian Leyden has a wonderful piece on aging. In it, he talks about a friend of his who is in her 90s and still living in her own home in rural Ireland. Her blood boils at this discrepency between what she considers her rightful age to be and her actual age. She does not want to “give in” to being old at all. She was not happy when her doctor’s medical report on her failing eyesight meant the loss of her driving licence. This loss of freedom to sit into her car and drive off at a whim to wherever she wanted to go was deeply felt.

As care givers, we are all too consumed with trying to do what we believe is best for the person we care for that we don’t think about their perspective as to how they want to live, and the age they perceive themselves to be and want to live at. This is a challenge.

Brian mentions that his friend’s energies are focused on:

  • Living in her own home, on her own terms
  • Staying out of hospital
  • Avoiding being caught up in the “care for the elderly”

The last point can be readily recognised by many relatives as they hit this resistance on the part of their elderly relatives, to receiving “extra care”. Nobody likes to accept the fact that they need someone else to help them do things that they have always done for themselves.

An important point in Brian’s piece is the perception that institutional care is not for the person’s own good, but to keep the family happy. The institution keeps the person “safe”, sheltered and fed. Brian’s friend does not want to be “wrapped in cotton wool” and be deprived of living. We are invited to question the way in which institutions deliver care. Are they “robbing the elderly of choice, purpose and even conversation”? Brian says that “having things to do, gives people something to talk about”. So if our care delivery keeps the person so “safe” that they have nothing to do, then they will just sit in silence. And isn’t that too often the experience in nursing homes?

We are reminded that “what keeps a person engaged in life is the knowledge that there are things that won’t get done unless they do it themselves. This is what gets us out of bed in the morning. This is what drives us on. Knowing that we are responsible for keeping ourselves warm, fed, the bills paid, and our social rounds going”

This is a real challenge for care givers, especially nursing homes as they are businesses which need to be efficient and that leads to processes and standardisation, treating their clients in the same way. It is easier and more efficient to “wrap them all up in cotton wool” and keep them “safe”, than to deal with each as an individual, and encouraging, facilitating and challenging each in his/her own way to his/her own limits, to do more, to make choices, to have purpose.

Dare a nursing home leave some task undone which the client could do for him/herself? Or would the home stand accused (by family or inspectors) of poor standards and lack of care?

How much independence are we happy for the person to keep? Do we take it all away so that we can rest easy that they are “safe”, or do we give them as much as they are able for, accepting that there are consequences, and sometimes mishaps, sometimes severe or even fatal?

Brian tells us that from his friend’s perspective, “Being responsible for whatever happens is not the price to be paid for her independence, it is the reward“.

Aging, Nursing Homes

HSE Plans cuts to Nursing Home Fair Deal Scheme in 2014

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The recently announced HSE Service Plan 2014 proposes, among other changes and cuts, to move €23 million from the Nursing Home Support Scheme (NHSS) “A Fair Deal” to Home Care Packages and other community support services. This could be seen as a move to encourage elderly people to stay in their own homes, however, according to Nursing Homes Ireland, it will mean around 939 less elderly people will get financial support towards a nursing home place. According to chief executive Tadhg Daly, the demand for nursing home care is growing. At the end of September 1,268 people were waiting for support under the Fair Deal scheme.

What will this mean for the elderly people who are too ill or otherwise not capable enough, even with home help and carers, to remain at home? How will such people and their families cope when they know that what is needed is around-the-clock care to get up, wash, use the bathroom, etc.

According to the Service Plan, this initiative will provide approximately 190 intensive home care packages at a time, benefiting approximately 250 people in a full year.

More about this in the press:

Are you or someone you care for currently on a waiting list for the Fair Deal nursing home scheme? Do you want to share your experience, and your view on how this funding shift will affect you? Please leave a comment.