In Ireland, 70 new pensioners are added every day and that comes at a high cost

Most of us will live at least 20 years of retirement in good health. So, with all the whining and whining we do about ‘the government’ and ‘the HSE’, the truth is that we’re in pretty good health.

Now for the bad news: all of this comes with an economic warning.

We are adding 70 new retirees to Ireland Inc every day and many will require more care for multiple co-morbidities in their later years. This is at the expense of current taxpayers. And there isn’t enough of that.

Although we take a multidisciplinary approach to elder care, you have not missed the headlines about nursing home closures, the so-called “delayed discharges” due to a lack of home care support or low beds.

We also cannot ignore the huge costs of community support and home care. Fair Deal, the 12-year-old care home scheme, receives over €1 billion in taxpayer support each year and supports around 23,000 people in residential care (see below).

A similar amount is being spent on home care packages for 56,429 people — feeble at best and dependent on postcode.

The sector has been largely privatized, with global investment firms owning 40 percent of our nursing home beds (4,618 in 60 homes are owned by just three such companies), meaning it’s profitable for now.

Fees paid to households under the Fair Deal remain well below those paid to HSE-owned households and further closures are inevitable in a cost of living and heating crisis.

Staff is hard to find, pay is poor and the regulatory burden is justifiably high. This means just over 6,000 older people are on home care waiting lists, unable to stay at home or needing more hours, but are either ineligible for residential care or in a bureaucratic jumble about it.

For those of us watching, or in the sandwich generation caring for children and parents, the future of nursing, for all its medical advances, may not hold an attractive future.

One of the blockages is that the vast majority of people – albeit with care support – want to stay in their own homes for as long as possible, Fair Deal appropriating some of the income and wealth to self-finance this can only be used for full-time care .

For many families, this is the last step rather than the first.

Mary Butler is Junior Minister in the Department of Health with special responsibility for older people. She is keen to introduce better home care, facilitated by a co-funding model. But so have previous ministers.

It has received funding from the 2021 budget for pilot programs to be implemented under Sláintecare and four are underway in Galway, Cork and Dublin for 592 assessments.

The Ministry of Health emphasizes that this is not a “fair home business”, but a comprehensive support system that includes health workers, day care, meals on wheels and better home care.

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rental income

A recent and welcome change in how Fair Deal contributions are calculated means that the amount of rental income from a person’s home that they can keep while in a care home has been increased.

This has long been an anomaly in the system, where selling the vacant home removed it from the 22.5 per cent cap on care expenses, but renting it out resulted in total income being assessed at 80 per cent.

Now up to 60 percent can be retained by the resident. Ironically, this move was not taken to help owners, but to open up some of the estimated 6,000 such vacant homes to the rental market.

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Accompanying care

Some companies have entered this market as intermediaries of two issues: providing home care for the elderly and providing a living space for the caregiver.

TheHomeShare.ie and ElderHomeShare.ie are two such providers, but both emphasize that the caregiver is not medical assistance. Rather, they are companions who perform light duties, company, and entertainment in exchange for shelter.

For families who want the comfort of having their loved one monitored and kept company, this can work very well.

Crucially it costs around €250 a month and not the exorbitant care packages not provided by the HSE which can amount to thousands each week.

The fairness of fair deal

There are two requirements before a Fair Deal is agreed: a medical needs assessment (by a GP or consultant) to show that the patient requires full-time care in an institutional setting, and a financial assessment to calculate how much they will contribute to the costs will contribute to such a supply.

With some care homes charging around €1,500 per week (€78,000 per year), this is an important decision.

Fair Deal works by charging residents 7.5 percent of the value of their assets (such as the family home, business, or other property) plus 80 percent of their annual income (such as pensions, rental income, or stock dividends). They can defer capital contribution under a loan agreement until after their death, and in either case, the family home levy is capped at a maximum of 22.5 percent after three years.

You never pay more than the cost of care. However, it is not a “pooled” arrangement where everyone pays something for the benefit of all – like insurance. Each person’s contribution is individual and relates solely to their means. You can choose the home you want, depending on the availability of the beds, regardless of the cost.

The alternative is to pay privately. If this is the case there is no financial assessment, no contribution from the HSE and the payer can claim a tax credit of up to 40 per cent on the contribution. Whilst there are agencies that can help with the application and calculation, the HSE has an excellent downloadable brochure (hse.ie, Care Home Support Scheme) that explains everything simply.