Funding Long-Term Care in Ireland Professor Eamon OShea NUI Galway - - PowerPoint PPT Presentation

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Funding Long-Term Care in Ireland Professor Eamon OShea NUI Galway - - PowerPoint PPT Presentation

Dec 17, 2023 142 likes •339 views

Funding Long-Term Care in Ireland Professor Eamon OShea NUI Galway Care of Older People Year Spending on As % of all HSE Per Capita over Care of Older Gross Non- 65 People Capital m 2009 1,738 12.4 3,514 2010 1,683

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SLIDE 1

Funding Long-Term Care in Ireland

Professor Eamon O’Shea NUI Galway

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SLIDE 2

Care of Older People

Year Spending on Care of Older People €m As % of all HSE Gross Non- Capital Per Capita over 65 € 2009 1,738 12.4 3,514 2010 1,683 12.4 3,299 2011 1,433 11.0 2,720 2012 1,365 10.4 2,509 2013 1,366 10.5 2,429 2014 1,468 11.1 2,528 2015 1,569 11.3 2,612

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SLIDE 3

Home Care Market 2014

HSE NforP Private

Home Help Home Care Packages Private Customer s

€142 €53 €33 €54 €175m €107m €63m €43

HSE

€20 €195m €130m €20m €345m

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SLIDE 4

Ageing Reforms

  • Care of the Aged Report 1968
  • Years Ahead Report 1988 – community
  • rientation
  • Health (Nursing Homes) Act 1990
  • Nursing Homes Support Scheme (Fair

Deal) 2009

  • National Dementia Strategy 2014
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SLIDE 5

Fair Deal

  • People generally contribute 80 per cent of

their pension towards cost of care

  • 7.5 per cent annual contribution from the

asset value of the family home - charged for three years.

  • Cost €948 million in 2015 for 22,000

people

  • Reviewed in 2015 - sustainability concerns
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SLIDE 6

Advantages of Fair Deal

  • Certainty
  • Statute-based
  • Transparent
  • Choice
  • Market stability
  • Equity within older people cohort

(compared to previous arrangements)

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SLIDE 7

Criticisms of Fair Deal

  • Cost sharing
  • Means-testing
  • Bureaucracy
  • Residential bias
  • Farm assets
  • Inequity – relative to other age

cohorts, illnesses and diseases

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SLIDE 8

Home Care

  • Fair Deal confined to residential care
  • No statutory basis for home care
  • Uncertainty of community-based funding
  • Significant un-met need in the community
  • Reliance on family care
  • Supply-driven model
  • Personalised care only developing
  • Social model is weak
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SLIDE 9

What Do Older People Want?

  • Good information
  • Choice
  • Individualisation of care
  • Integrated care
  • Family involvement
  • Opportunity to live well at home
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SLIDE 10

Principles for Funding Long-Stay Care

  • Care requirements should determine

funding - individualisation

  • Funding bias towards home care

solutions - different funding bundles

  • Access to public resources on the

basis of need

  • Common measure of dependency –

Single Assessment Tool

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SLIDE 11

Financing Options

  • Family
  • Market
  • Private insurance
  • General taxation
  • Social insurance
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SLIDE 12

Family

  • Families provide bulk of care in Ireland
  • Contribute close to 50% of total cost of

dementia care – around 1 billion euro

  • Family responsibility – freely chosen or

compulsory?

  • Mutuality
  • Longitudinal issues
  • Support structures
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SLIDE 13

Private Markets

  • Development of private home care market
  • Private expenditure on home care services

and supports is increasing

  • Autonomy and choice – preference

revelation – likely to increase

  • Equity - voice and exit issues
  • Public-private mix – is there optimal mix?
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SLIDE 14

Private Insurance

  • Moral hazard
  • Adverse selection
  • Affordability
  • Appropriate products – biased to

residential care

  • Cost sharing levels unacceptably high
  • Information deficiencies
  • Consumer myopia
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SLIDE 15

General Taxation

  • Structures already exist for collection and

administration of funds

  • Broadness of tax base; maximum risk

pooling

  • Democratically accountable
  • Universality
  • Problem of accessing money - competing

priorities

  • Taxation has not delivered for home care
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SLIDE 16

Social Insurance

  • Visibility of long-term care
  • Transparency and accountability
  • Risk pooling-albeit narrower than tax base
  • Life-time contribution – solidarity and

reciprocity

  • Competitiveness issues
  • Contribution may be too high for political

system to bear

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SLIDE 17

Co-Payments

  • Cost-sharing
  • Supplements taxation and social

insurance system – keeps taxes and social insurance payments lower

  • Incentives and nudges
  • Impact on demand and use of services
  • Universality – citizenship
  • Means testing - costs and benefits
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SLIDE 18

Conclusion

  • Spending 3 times more on residential care than

home care

  • Family carers remain central of the care system
  • Need individualised home care solutions, more

choice, including better/different housing

  • Community-based care requires additional and

statutory-based funding

  • Social insurance should be re-examined as

potential funding model for long-stay care in Ireland