The intricacies of the Fair Deal nursing home scheme and the lack of a statutory equivalent for older people who wish to be supported by the State to stay at home was illustrated this week. The challenges facing Frank Courtney, seen in his son Brendan's emotionally-charged documentary on RTÉ, revealed the confusing complexity of the process and a paucity of options for older people with a disability.
A legal entitlement to homecare help is needed to replace the piecemeal system currently operated by the Health Service Executive. At present, patients being discharged from hospital after a stroke or a diagnosis of cancer must apply, with the guidance of hospital staff, to their local HSE office for a recommended number of home help hours.
The application may or may not be approved; often it will be for less hours than required; and in any event there is a substantial delay in many parts of the country between approval and a homecare agency being able to supply a home help to work the approved hours.
For someone who is terminally ill, and who wishes to die at home, these systemic delays are a significant source of stress. For others, the more ready availability of an approved nursing home place forces a reluctant loss of autonomy.
Minister of State for Mental Health and Older People Helen McEntee has announced a consultation process with a view to establishing a new statutory home care scheme. Her time scale, however, is disappointing; a three-year wait before a fully fledged scheme becomes operational seems excessive. While the legislative details of a homecare scheme to match the nursing home subvention need to be comprehensively thought through, the issue must be dealt with in a shorter timeframe.
Research shows that three quarters of older people wish to remain living at home with assistance. Not to have a robust statutory scheme, with an equal cost base as the nursing home option, to facilitate the wishes of older people in the Republic is unacceptable.