The new system of funding nursing-home care for older people represents a tax on disability and dementia and discriminates against the elderly, a leading specialist in geriatric medicine has said.
Addressing the annual meeting of the Irish Medical Organisation, Dr Shaun O'Keeffe, consultant in geriatric medicine at Merlin Park University Hospital in Galway, questioned why an older person who has no option but to enter long-term care because of illness, should have an additional charge levied on their estate after death.
"We do not try and retrieve the cost of cardiac stents or oncology drugs after patients die, so why are we penalising older people who become ill," he said.
Describing "A Fair Deal", the new system of subvention for nursing home care introduced by Minister for Health Mary Harney, as neither fair nor transparent, Dr O'Keeffe said he was also concerned at the unplanned expansion of the private residential care sector in the Republic.
Decrying the demise of small owner-managed nursing homes, the specialist said research had shown that corporate-owned nursing homes employed fewer nurses and had higher rates of regulatory violations.
Dr O'Keeffe told doctors he was concerned at the lack of national guidelines on the use of physical and chemical restraints on older people living in nursing homes.
He described research he had carried out in the west of Ireland which found that half of long-stay patients had been prescribed anti-psychotic drugs inappropriately as a chemical restraint. "Is it likely there are other Leas Cross [nursing homes] out there?" he asked in reference to the report into deaths at the north Dublin nursing home.
Dr Iain Carpenter, a consultant geriatrician from Kent, listed some of the key issues he said had emerged from the Leas Cross review.
Among these was the need for ongoing staff training and the need to match staff numbers and skill mix to the care needs of residents.
A founding member of interRAI, an international group that has developed an assessment system aimed at improving the quality of residential care, he said implementing the system here would help monitor the quality and outcome of the care of older people at both local and national level.
Dr Brian Meade, a board member of the Health Information and Quality Authority (HIQA), which is now responsible for the inspection of nursing homes, said a 35-member expert group was formulating inspection and best practice standards for the sector.
"They will be ready for public con- sultation by the end of June and should be in place by the end of 2007," Dr Meade said.