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Ireland: state pays maximum of £124 a week to the cost of a nursing home bed

BMJ 2002; 324 doi: https://doi.org/10.1136/bmj.324.7353.1543/a (Published 29 June 2002) Cite this as: BMJ 2002;324:1543
  1. Muiris Houston
  1. Dublin

    In the Republic of Ireland, the proportion of people aged 65 or over is set to increase from the current level of 11% to 24% by 2050. This growth will be particularly rapid after 2025, a direct result of the high birth rate in the 1960s and '70s.

    Long term care for elderly people who are incapacitated is provided in several different ways.

    If a 74 year old woman had a stroke, for example, and required nursing home care, several options are available. She could be placed in the long stay ward of a geriatric hospital, in a welfare home, or in a district (cottage) hospital. Maintenance charges are payable. The maximum weekly rate is the patient's weekly income less an amount determined by the health board (a body similar to England's former health authorities). If the person has a spouse living at home, these charges are based on not more than 40% of their combined income. The current statutory old age pension in the republic is €124 (£80; $120) a week.

    Alternatively, a bed in a private nursing home may be sought. The health boards may pay a subvention towards the cost of a nursing home if the person is sufficiently dependent on nursing home care and unable to pay part of the maintenance cost. The current maximum subvention is €190.50 a week.

    In assessing means for this subvention, all sources of income, including wages, pensions, rental income, investments, and savings are included. A value of 5% of the principal residence of the person is assessed as annual income, although this may be discounted if it is occupied by a spouse or other dependent. Before 1998 the means of children were considered, but the regulations were then amended to exclude this contentious clause.

    No system of personal insurance for nursing home care exists in the republic. To meet the short term needs of those who cannot pay, the health boards use “contract beds” in private nursing homes. They pay the full price for the use of the bed, which is usually used as a measure to move a patient from an acute hospital bed when treatment is complete but the patient is unable to return home.

    There is still a tradition of the extended family providing care for elderly people. This burden falls almost exclusively on women. According to Professor Davis Coakley, professor of geriatric medicine at Trinity College Dublin, nine out of 10 women in a caring role give on average 50 hours a week to the task. A means tested carers allowance of less than €100 a week is available but is reduced in proportion to other income.

    No state provision exists for long term nursing care in the home.

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