July 2012: HCCI makes submission to the

Government Review of the Nursing Homes

Support Scheme, Fair Deal

Home and Community Care Ireland welcomes the Department of Health's call for submissions to the Review of the Nursing Homes Support Scheme, Fair Deal.

With regard to the Terms of Reference outlined in the call, the HCCI feels that it is important to look at the whole area of long term care rather than just the reconfiguration of the Fair Deal Scheme (FDS) specifically. Accordingly, the HCCI addressed the review of the Fair Deal Scheme in the wider context of the current model of care for the elderly and the need to look at other ways of keeping people in their communities, apart from nursing homes, in line with the following considerations:

(i) Offering options to patients: HCCI would propose the compulsory assessment of all applicants for the FDS for a home care package as well. Whilst there would undoubtedly be an administrative cost associated with this, the long-term potential savings available if even a small percentage of nursing home residents were able to remain in their home for longer are significant. More important than the cost element is that international research is clear that from a health and well-being perspective, people prefer to stay in their home if it is an option.

(ii) Personalisation: Giving the power of choice back to the patient regarding their healthcare, and their lives in general, leads to a greater sense of empowerment on the part of the patient, and means better care that is tailored for each individual circumstance. It includes:

1) Tailoring support to individual needs;
2) Ensuring patients have access to information, support and advocacy to help them make well-informed decisions about their healthcare provision; and
3) Highlighting the importance of early intervention, prevention and rehabilitation to ensure patients are supported early on and in a manner that is appropriate to them.

(iii) The effective use of scarce resources: Presently there is a total of about €350m allocated for home care and a further €900m for the FDS. The HCCI would call for the merging of these two funds with funds being allocated in accordance with the results of care plan assessments and also patient preferences. It is our opinion that any fixed allocation to one option automatically creates a bias that may not be in accordance with best use of funds or with patient preferences.

Instead of fixed separate funding for residential care and home care, patients and healthcare professionals need to be made aware of the full range of options open to them with flexible funding being channelled to the options being selected.

(iv) Developing community care: A central aim of the Minister for Health James Reilly and the HSE is to move care back into the community. Developing primary care teams is an essential part of any community-care based health service model. HCCI feel that by encouraging more people to be cared for at home rather than in residential settings, this will provide an important boost to the setting up and successful functioning of these primary care teams. A full copy of the submission can be obtained by contacting the HCCI office.