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Part 3 of the 'Who will look after me when I get old' series. My guest is Sinead Ryan, a journalist focusing on consumer and personal finance matters. We look at the range of care options for older people in Ireland. This includes nursing home care, the 'Fair Deal' Scheme and home care options.
This is a link to the HSE information booklet on the Fair Deal Scheme (officially known as the Nursing Home Support Scheme) - https://www2.hse.ie/file-library/fair-deal/nursing-homes-support-scheme-information-booklet.pdf
Sinead is a columnist with the Irish Independent and has a weekly radio programme called 'The Home Show' on Newstalk every Saturday morning. Please see her website for more information - http://sineadryan.com/
Episode Transcript:
Margaret O Connor 0:09
Welcome to season two of the Are Kids For Me podcast. I will continue to speak to people in a range of different circumstances about their personal and professional experience of answering this question. Thank you so much for your positive feedback on season one, and I really hope you find these episodes useful.
My guest today is Sinead Ryan. Sinead is a print and broadcast journalist focusing on consumer and personal finance matters. She's a columnist with the Irish Independent and has a weekly radio program called the Home Show on Newstalk every Saturday morning. Carrying on with the series of episodes focusing on who will look after us when we get older, we discuss the range and cost of care options available in Ireland, focusing on nursing homes and home care. So hi, Sinead, thanks a million for joining me today. I really appreciate you taking the time.
Sinead Ryan 1:04
Thanks Margaret, nice to be here.
Margaret O Connor 1:07
Perfect. So we are continuing on our series of very adulty questions of who's going to look after us when we get older. And we're going to have a look at kind of the care, care option side and the costs of that in Ireland. So where would be a good place to start with that you think?
Sinead Ryan 1:26
Well I suppose talking about the demographics that we have in Ireland, and we're lucky that we are a first world country and we've one of the longest life expectancies really in the world. So anybody born today can, you know, be fairly confident of celebrating their 90th or even 100th birthday. So that's really what we're looking at. And there's far more older people than there has ever been alive in Ireland at the moment. And that's due to education, medical advances, better nutrition, we all look after ourselves a little bit more. And, of course, that comes with consequences. And one of those is the whole area of elder care, and the cost of elder care and what has been done to try and prepare and plan for that. So at the moment, I suppose it's safe to say that nobody wants to end up in a nursing home, that's not something that we would probably choose for ourselves. But it does become inevitable for a small cohort of people. Now, around 5% or 6% of the population live in a nursing home. So it's not huge. But it does translate to over 30,000 older people. And therefore, plans I suppose have to be made around that and arrangements put in place and very often, then it falls to the family to do that, and decide whether to keep maybe an aging relative at home as far as you can, before entering nursing home. About 50% of admissions, Margaret, to nursing homes come from acute hospitals. So something has happened that person, it could be a fall, it could be an illness. And then the other 50% are really I suppose, from the family setting the family home, and usually only after a very arduous time of really trying to do everything we can for our loved ones in terms of home help and care, and it just it gets to the stage where residential care is probably the best option.
Margaret O Connor 3:38
Okay, well, that's really interesting. I hadn't thought about it in that level of detail. So it's really good to know. Okay, so yeah, so it tends to be.. is it more you know in those situations.. so it might be quite a sudden thing, you know, it might be something that is made in maybe not the most planned way for this kind of an emergency or if other plans have stopped working.
Sinead Ryan 4:02
Yes, that's very often the case. And for a lot of families, this can be the very first time they have considered this or they are in this system of residential care. And it can be a shock, because it obviously comes at a time when somebody is very ill, you're trying to do your best, you're maybe holding down your own job and your own life and, you know, it can be something that is thrust upon you. And in other cases, of course, it can come after a very, very long period of time of slow decline. And you know, that you're trying to manage across that. So yes, a lot of times it can be sudden, but a lot of the times it's just the inevitable final stage, I suppose, of a process.
Margaret O Connor 4:49
Ok..And I suppose I know. ..I know the the the terms of this phrase of the fair deal, I know has been around for a while in Ireland. I have no idea what it means but it's it seemed to be the big thing there for while. Is that still in place?
Sinead Ryan 5:03
It is still in place. In fact, it's 10 years old now. It was brought in by Mary Harney when she was health minister. And I think it was a very good idea. Because what went before Fair Deal, was that nursing home residency was really based on whether you could afford it or not. And the vast majority of people could not afford it, and still wouldn't be able to afford. So to have a scheme in place, which is a bit like a pooled insurance scheme. So that everybody pays what they can afford, and the state picks up the rest of the cost. So it is actually a very equitable, fair system, nobody gets better care because of the amount of money they have. And I think we probably all want a situation, especially for our most vulnerable people that your care is, is not dependent on how much money you or maybe your children have in order to fund it.
Margaret O Connor 6:05
Okay, and Okay, and that's still in place, it's still operating..
Sinead Ryan 6:09
It is still in place. In fact, about 80% of people currently in residential nursing home care, are there under the Fair Deal scheme. So you don't have to take it up. But most people do take it up. The average cost of a nursing home is around 1500 euros a week. So that's an enormous cost for people to bear. And it's certainly for the case where maybe you've only got maybe singleton's, somebody may be trying to support mom or dad in this home, and they've no siblings themselves, that can be terribly expensive. And indeed, for families, even where they divvy out the cost, it can become like a second or third mortgage.
Margaret O Connor 6:54
Ok wow, that is very substantial. Okay. Okay. Um, and is there something else then, is there something to do with the house as part of the Fair Deal or am I wrong?
Sinead Ryan 7:04
So the way Fair Deal works is that the government supports it. So it's a statutory body that supports fair deal. And it works on the basis that we can work out how much somebody ought to contribute to Fair Deal. And so that's a very kind of clear set of sums. But it might be that the government doesn't get some of that money back for years and years, because of course, the one question that people can't answer is, how long will I need to pay for this care. So the way fair deal is structured is that a portion of the individual's assets and income is taken from the time they entered nursing home under Fair Deal, until they pass away. And those sums are very simple. They're certainly not cheap, but they're simple. And essentially, it is 80% of your income is taken to pay for Fair Deal, and seven and a half percent of your assets every single year. So the longer you're in the nursing home, clearly, the more expensive it gets, but you don't have to pay the asset bill up front. So let me give you an example. The people I suppose for whom Fair Deal is a complete no brainer, it's an absolute go for it are what I call ninjas, no income, no job or assets. Right (laughter)..So if you have, if you have people who are, you know, it probably what we would call on the old age pension, right? Kind of that image of kind of the little old lady hooded against the bar heater you know, she doesn't own her own house, she really is surviving on the state, welfare system and all that. Now, for somebody like that fair deal, it's extra ordinarily beneficial, because suddenly they're going to get top quality care in the nursing home of their choice. So there's not you're not kind of divvied out into the poor ones, and the rich ones and the public ones, the private ones, there's no, no, no, that doesn't exist at all. You get the nursing home of your choice, your family's choice, and 80% of your pension will be taken off you to contribute to that nursing home. Now, on the basis that, the weekly pension is about 240 euros. That means the state is trumping up well over 1000 a week to keep you there. So you know it's a it's a super deal if you want to look at it from that aspect. Now, at the other end of the scale, you might have somebody who's quite well off or maybe they have a large house, maybe they have a second home, they might have a business. They're earning quite a lot in retirement because they were wealthy enough and in a position to make provision for themselves. Now in their case, they also get 80% of their income taken and seven and a half percent every single year off their assets. The family are sent a bill for that. Now that could mean that potentially they end up paying far more than the cost of a nursing home. But there is a clause in the act that covers Fair Deal that says you will never pay individually more than the cost of your care. But it does mean that wealthier families have the option not to enter Fair Deal.
Margaret O Connor
Okay right. Yeah so you do need to work out...
Sinead Ryan
Yeah, you do have to do some sums, I've done them over the years, I've kind of thrown a load of numbers at this to try and find what is the tipping point. And it's not entirely clear, because obviously, lots of circumstances have to be taken into account. But essentially, if you earn more than 25,000 a year in retirement, or you have property valued over about 600,000, you really should sit down and do your sums and try and work out whether you want to be in it or not, because remember, any private nursing home fees that you pay and 20% of people in nursing homes are there privately, they're paying the full fees, you get full tax relief on those. So 40% of the bill is reduced as a result of the fees that you pay, because the government is very, very generous with the tax relief on this particular thing. So there is quite a sum to do, there are people out there who can help you do it, it is pretty back of the envelope with a decent calculator will do it for you. But it is certainly worth considering. So I would say to people in the first instance, don't assume that Fair Deal is the only gig in town and don't feel that you have to avail of it.
Margaret O Connor 11:34
Ah ok, that's really useful information. Okay. And can I ask, this might be completely wrong. But just because we were talking about wills, with Karen's a solicitor in another episode, does that interfere..so if you're leaving property to someone, and then just the fair Deal interrupt that?
Sinead Ryan 11:53
Well, it won't even interfere with the with the will, but it will interfere with your inheritance. So what you'll find is that when Fair Deal sets itself up, so when you enter the scheme, there's quite a bit of paperwork involved with this. And your next of kin or, or your spouse, generally speaking, will be deciding this on your behalf. So you enter into a contract with the government effectively, that says, look, I'm agreeing to having my mother's pension deducted by 80% percent a week, you know, that comes straight from social welfare in a lot of cases so that's just whipped away. But for people who have private pensions, of course, a lot of them do, they have to agree that a portion of that is going to be taken every week or every month. And then at the end of the year, they'll get a bill, which represents seven and a half percent of all the assets that they own. So that means you have to get your property valued before you enter Fair Deal, you have to get your property valued. Any second properties you have, any rental income, remember, it's going to be taken as well 80% of that, if you've got assets, such as a business, the assets that will be valued and taken as well. So it's really not for the faint hearted. And there is a derogation going through the Dail at the moment regard farming families because it had been quite unfair, that the farm was effectively being cut up to pay the Fair Deal bill. And I suppose we don't really want that happening. Certainly farming families don't want that happening. So they were getting a kind of a stay on the on the farm assets. But that hasn't yet, that hasn't yet come into play. So there are quite a lot of sums, quite large numbers to crunch. But for the for the majority of people going into Fair Deal make sense. But it does mean that the children who are left behind who might have been inheriting the family home, or other assets and property will now definitely get less as a result. But again, because you don't know how how long your loved one is going to need that care. It could be one year, it could be six years, it could be 12 years.
Margaret O Connor 14:03
Yeah, yeah. So okay, you're not paying it at the time it's coming..
Sinead Ryan 14:07
You can pay it at the time, lots of families do but the bill comes in at the end of the year, if you have a house worth.. I don't know say let me do the sum for you, say half a million euros, right. So you're going to be presented with a bill each year for 37,500 euros. Now you can decide to pay that bill. Okay. So you might take it out of savings or or some other thing. Or you can defer it for a number of years and then when the house is sold, yes, or the person passes away, then the entire bill becomes payable. Now there is a cap on the family home assets. So I said that was seven half percent taken of the assets every year, that is true, and but for the family home that stops after year three. So in fact the maximum that can be taken off the family home is 22 and a half percent of its value.
Margaret O Connor 15:01
Ok..I'm surprised it sounds like it's been really well thought through (laughter) there is quite a lot of detail..
Sinead Ryan 15:07
It has and it hasn't, it's because I mean, the taxpayer supports the Fair Deal scheme to the tune of a billion euros every single year, because there aren't enough coming off in assets to prop the scheme up of itself. So the government is under severe pressure, when it comes to funding Fair Deal. And it is going to have to make some decisions in the years to come whether to increase again, it's done it before, the percentage that is due, or whether to try and fund it in some other ways. So so it's, it's not really doing what it says on the tin, but that doesn't stop anybody entering it or being allowed to enter.
Margaret O Connor 15:46
Okay, okay. And is it something and if if like, is a person allowed do it for themselves? Can you process and make that decision for yourself if you're able to do it?
Sinead Ryan 15:56
Yes, of course you can but there are two tests that you need to satisfy. And the first is the medical need test. So you can't decide in the whole your health, look, I'd love to see out my days in a nursing home and get my three square meals a day and do a bit of bingo, but I don't really need it right (laughter). So to enter Fair Deal, you have to be unable to stay at home. Okay. And now, it's an interesting thing, because one of the criteria that the HSE looks at when it's assessing the medical need is what family supports you have at home to help you stay there. So if you have a whole bunch of children who can all divvy in and come and stay overnight with mom or dad or cook meals or whatever, well, that's fine. And that that might delay your your ability to go into Fair Deal. But for singleton's, for families, you know, maybe only with an only child, or family living far away, you will kind of bump up the list as a result but in fact it's not like the hospital. There's very, very little waiting time on Fair Deal. Generally, in normal times now outside COVID, from application to entry, you're looking at a matter of weeks. There's plenty of space out there, put it that way. So nursing homes, I know, we feel oh, they're jammed and that. That's not true. Okay, the one down the road from you might be, but that doesn't mean that another one will be available.
Margaret O Connor 17:20
Okay, okay. Interesting. Yeah. So again, I suppose people if they're if they're not planning to have children of their own, that's a factor to be aware of that, that that is taken into account.
Sinead Ryan 17:31
Yeah, I think there's a little bit of unfairness in this. Because certainly, you know, anecdotally, I suppose it is the case that child free people can very often end up with the parental burden in later life. In other words, you know, we've heard about the sandwich generation of women and men, but mainly women in their maybe 40s and 50s, dealing with their own children and caring for elderly parents. Well, of course, consequently, if you don't have children yourself, you can often be the one who can who's there to mind mammy, or daddy, you know, like you're not doing anything, you have loads of time, off you go (laughter) and, and be so you know, childfree people can find themselves inadvertently classed in the role of carer which they may not have planned for and may not want indeed, and that can that can sometimes add to that complicated mix.
Margaret O Connor 18:25
Okay, but from the HSE point of view, if you're there, you're counted as..
Sinead Ryan 18:30
You're counted as support indeed, and that also is true, even if you don't take Fair Deal up. One of the other options are home care hours, that the HSE give for people to come into the home. And one of the key criteria there whether you, you get that or not, because those hours are not means tested. And they are not part of the fair deal scheme. They're free, which I think is a shame. But there you go. And one of the key criteria is who can come in and look after you if we don't send somebody. So you could qualify for fewer hours because you have your daughter or son living around the corner.
Margaret O Connor 19:13
Okay. Right. Yeah. And okay, so that is that is another option, though. So again, there needs to be some medical need or some physical needs that you need somebody to come in and do...
Sinead Ryan 19:28
Yeah, now, the home care packages are not... Well, it's it uneven in its application, because it depends on geography, and it depends on budgets. Fair Deal does not. So the home care package is different. You'll hear some people in some countries or parts of our country saying it's terrible. It's awful. I'm only getting an hour a week for my mother. Other people will say, oh no, I have somebody coming in for 15 hours a week. It's great. But that's not something that you can determine and it's a great shame. They are talking about putting it through fair deal. But it is very difficult to do, it will require legislation and an extensive budget in order to, to prepare for it and plan for it and claim on it. And it is the truth that most elderly people availing of home care packages ultimately end up in residential care anyway. And so it is an uneven system but the people that are going into do the care are generally fantastic, top quality.. the government outsources a lot of this to private companies. And you'll have heard the ads with them Home Instead, Senior Care and Bluebird Care and all those. So you can buy extra hours from them. So the HSE saying, well, we're only giving you five hours a week, you can buy private hours, and it's usually the same carer and it works terribly well. That's expensive. You'd normally be paying 20 to 50 euros an hour for that care, although you do get tax relief on it.
Margaret O Connor 20:58
All right. Okay. So that's another option . I wanted to ask actually, sorry, this is just something.. I'm not sure if we really have them here. The kind of supported accommodation, or is there something that's kind of in between, you know, that you might be in, you might be in your own kind of accommodation unit. It's not a full on nursing home, but there's kind of care available...
Sinead Ryan 21:18
Sheltered sheltered care. And there is some of it. And actually, there was a fantastic scheme down in Limerick. And that sold out nearly immediately when it was launched. And it did terribly well. And that was one in Galway in Barna. So these are little kind of maybe bungalows, or townhouses, but they would have medical care on site, nursing usually, or Meals on Wheels or that kind of thing.. companion care, hugely popular people love it, they're just simply isn't enough of it. And I suppose part of the reason is that there is such pressure on ordinary housing at the moment for, you know, between first time buyers and students and all that, that this doesn't get a look in, and it is in enormous shame. Other countries do this incredibly well, in Britain, Germany, Austria, you know, you'll find housing communities made up of retired older people, and many of them living individual lives to one extent or another, but there's care on hand to do it, and it's just a shame. We just don't have more of it.
Margaret O Connor 22:22
Yeah, it does sound lovely. Yeah. I know somebody, a guest I interviewed before, her.. her grandmother, who is now..she must be 96 or 97, I might be wrong on that. But is living in one of those in the UK. And it sounds wonderful. It sounds really nice.
Sinead Ryan 22:37
Yeah. And people do want to live at home longer if they can. But you know, they really do. And if we could support that, and help them to do it, it would be such a better place to be. But there just seems to be this push both at when we're babies, and when we're elderly into residential care as as the model rather than how about we support people to stay in their own homes, or in the homes of their of their sons and daughters.. As long as it's practically possible. And most families do do that, but they're doing it without maybe without the added assistance that they could do with.
Margaret O Connor 23:14
Ok..So I suppose for people maybe who are listening to this, and they're, they're imagining or are planning for their futures and they're, you know, they're not planning to have children of their own as part of that image? Like, is it possible..I don't know. Is it possible to kind of plan specifically for ..obviously, it'll depend on your health, more than anything else but is was advice I guess you'd give them for for for planning for later life?
Sinead Ryan 23:41
Yes, indeed, there are. There are several kinds of pieces of guidance. And the first is financial. I mean, the more you can plan for your own financial future. Now, we're straying into the area of pensions, but that's kind of a big bailiwick for me anyway, if you can, if you can prepare for your own financial future, you're going to be far better off than being reliant on the state. That's the first thing, right. And people who don't have children have the added benefit of having more money generally, because they haven't spent it all their kids. And as a result, being able to put that by from as early in life as is possible gives you the best possible outcome in later life, that's the first thing. The second thing is legally. And if you don't have children yourself, and the time comes, for somebody to be making decisions on your behalf, it's very important that the right person rather than a court, chooses that. So you can affect what's called an enduring power of attorney. And I would absolutely encourage people to do this. And this document sets out somebody that you trust and that you wish to be making decisions with your money for you when you are no longer in a capacity to do that. And that just doesn't mean, when you're very elderly although we hope it well. It could mean at any other stage, for instance, if you had a very serious accident, or you found yourself, maybe in hospital or without capacity to make decisions. So I think that's very, very important. And indeed, for for singleton's who themselves, don't maybe have siblings to encourage their parents to allow them make that enduring power of attorney, it's done with the person rather than by the person with the solicitor. And it is a very powerful document. So it's done with great care. And with good advice, but actually, it then means that you're not going to end up with kind of distant relatives either not caring or deciding for you or then being made a ward of court and having having a court committee having to make those decisions.
Margaret O Connor 25:54
Absolutely. Okay, yeah. So planning ahead, I suppose planning ahead to hope that you have as much choice as possible, and kind of thinking through what you'd like, what you definitely wouldn't like, in different circumstances and trying to be in the best financial position to follow that through really?
Sinead Ryan 26:14
Yes,
Margaret O Connor 26:15
Yeah. Which makes sense (laughter) when you say it but it takes a bit of planning.
Sinead Ryan 26:22
Yeah, no and it is important. I know, none of us want to think of that until we get much older. Lots people don't think about wills and inheritance, pension, and all that kind of stuff. But actually, you know, we none of us know what's going to happen, especially the year we've just had, and it is good to have plans in place. Because, you know, without them then somebody that maybe you don't know, and has never met you gets to make those decisions. And really, I think probably most of us would not want that to happen.
Margaret O Connor 26:54
Absolutely, yeah, no, absolutely. And I know I mentioned that to you about Karen the solicitor, was really saying that to try and maintain kind of as much choice and control as you can in, you know, potentially different and difficult situations. So, yeah, planning ahead, I guess is the best way for them so. Brilliant, that's really useful information. So I suppose having an idea of the cost involved, and the options involved or the options available. I know, I suppose things change over time. But that is that's the general landscape we have in Ireland at the moment.
Sinead Ryan 27:28
Now I'll just, I'll just direct people then for more information on Fair Deal if they're interested in it by telling you that we've been talking about Fair Deal all this time but that's not actually about the scheme is called. It's just what we call it (laughter). The proper name for it is the Nursing Home Support Scheme. So there is an excellent booklet provided by the HSE online, but you're going to have to Google HSE Nursing Homes Supports Scheme to get it. And when you do, they will have a full booklet, it's very interesting. And it covers all the whys and wherefores, and how it works and all that kind of thing. And people then drop that down, have a look and decide then whether or not it's something that they want to think about for themselves or for their loved ones and how it all works
Margaret O Connor 28:14
No, that's brilliant. I'll see if I can put a link in for that. That's that's really great. And thanks, Sinead. That's really, really interesting. And as I said lots, lots of food for thought, and but really useful information. Is there anything else you'd add? Or do you think is enough?
Sinead Ryan 28:29
Well, I think I the only other thing I'd say is that there is this.. I suppose it's the way because of the way our health system works, that people think there is this public private divide and one is better than the other. I would honestly say when it comes to nursing homes, that's kind of flipped on its head, there are private nursing homes, and there are public nursing homes. But you cannot say one is better than the other. Now there are good and bad private nursing homes and good and bad public nursing homes. But in fact, there's no you know, they're all monitored by HIQA. And generally, most people agree the care is very good. However, when it comes to Fair Deal, Fair Deal patients can go can go into public nursing homes, or the private nursing homes that have Fair Deal and most of them do. However, a private patient cannot go to a public nursing home. So if you're paying for your own elder care, you are then limited to the private nursing homes and the beds that they have available. And usually you'll find that's where the delay is if there is one.
Margaret O Connor 29:32
Ah ok..Yeah, no, that's that's really useful information. It's very hard. I'm laughing because I'm trying to imagine how hard it is to figure that out if you haven't a clue of the systems..
Sinead Ryan 29:43
Yeah, you could fall forty nursing homes and be wondering why aren't they talking to me? Because the first question you'll be asked is are you coming here on Fair Deal? You know just there's a handful of nursing homes, private nursing homes that don't want anything to do with Fair Deal and that's fine. They don't have to take patients in under it but where they do..you know, before you go looking at nursing homes, that's the first question, will you take a private patient? And or do you have Fair Deal beds? And once you establish that, then you can go picking and choosing and viewing and looking at asking your questions and all that kind of thing.
Margaret O Connor 30:18
Okay, okay. Yeah, no, it's so brilliant to have the languages like, I always think every little thing has its own little world. And if you don't know that first question, or the language around it, it can be very confusing.
Sinead Ryan 30:29
And you and you can get kind of because everybody's doing this sometimes in a rush. And it's not something you've known about before, and you can't really research and you can kind of be caught unawares, by some of that, you know, and what's covered and not covered. I mean, Fair Deal generally covers the contribution that you make, it covers your bed, board, and medical care. What it does not cover and again, it depends on the nursing home, are things like the arts and crafts, the music, the bingo and hairdressing newspapers, you know, so very often the family can find themselves with two bills, one for Fair Deal and then one or all the supplementary stuff with the nursing home and that that's kind of a, you know, a little bit of a frustration for some people.
Margaret O Connor 31:14
Okay, okay. Yeah, again, really important to know. Okay. Fantastic. Look, that's really brilliant Sinead, I really appreciate it..it's really useful to fill in that part of the jigsaw, along with everything else. So I really appreciate you taking the time to talk to me today.
Sinead Ryan 31:34
Great. You're more than welcome, Margaret. And we do talk about this every so often on the radio programme 'Home Show' on Newstalk, which is on Saturday mornings at nine. And of course, I cover it regularly in the Irish Independent every Saturday as well.
Margaret O Connor 31:46
Fantastic, brilliant. Yeah, so people can definitely follow up there if they want to find out anything more specific. That's brilliant. Brilliant. Thanks Sinead.
Sinead Ryan 31:54
All right, no problem.
Margaret O Connor 32:02
Thanks very much to my guests for taking part and to you for listening. I would love to hear your feedback and any suggestions for other topics you would like to see covered in this series. I would also love to build a community of like minded people, so please follow the Are Kids For Me pages on Facebook and Instagram if you want to find out more on this topic. I look forward to hearing from you and watch out for the next episode coming soon
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