Provision of long-stay care in the context of greater health service reform

The Ombudsman is of the view that there should be a greater emphasis on allowing persons to remain at home for as long as possible.   Home Help hours, Care Assistant hours, Home Care Grants and other supports should be viable alternatives to entering long-term care.  These services should be available nationally under a transparent, objective and equitable process that is highly responsive to emerging needs. Indeed where possible, there should be greater planning for the needs of vulnerable older people living in the community, thus limiting sudden and reactionary admissions to Hospitals and Nursing Homes when a situation deteriorates. There is also a need to develop further rehabilitation services at in-patient, day patient and community level, once again using a national, equitable and needs based model.   According to a recent report, it is likely that 80% of people assessed for long-stay care had not been considered for or offered home care alternatives (“Still no way out for discharged delayed”, Irish Times, 26 June 2012).  

The NHSS does not appear to be appropriate for an intermediate service facilitating patients to step-down to care in their own home.  (Any such step-down provision is provided outside the terms of the Scheme and consists of short-term programmes on the initiative of the Minister of the day, for example the Transitional Care Initiative which is currently being funded from money diverted from the NHSS and the National Treatment Purchase Fund.   The Ombudsman is aware of one case where an applicant was refused assistance under the Scheme as it was his wish to return home – which he did after a short stay in a nursing home.  However, his family was refused financial assistance under the Scheme for this very reason leaving them to pay the full amount of nursing home fees for the stay.)  As the Scheme currently operates, there would appear to be little incentive for a patient to aim towards returning to their own home.

Emily O’Reilly
Ombudsman
16 July 2012