Another elder care support set to be restricted as number of transitional care beds capped

A second service for the elderly has been restricted following a decision by the HSE to cap the number of transitional care beds (TCBs) it funds for patients waiting for a place in a nursing home or convalescent home.

Officials in the HSE have warned that this will add to bottlenecks in acute hospitals.

The cap was set in mid-June when the National Transitional Care Office wrote to community health organisations instructing that there would be “a set number of weekly TCB approvals” going forward, and that once the allocation is reached, patients should be put on a waiting list.

“This will continue to be adjusted on a monthly basis for the remainder of the year and allocations will be made based on review of expenditure on a monthly basis,” according to correspondence seen by the Irish Examiner. Last month, this newspaper reported that the HSE had introduced restrictions in its home support services, to run until November, as part of a budget-balancing exercise.

This latest restriction was greeted with dismay by other HSE officials. In the Cork/Kerry region, one warned it would “create significant bottlenecks in some sites and impact on convalescence take-up whilst awaiting home support delivery”.

Moreover, it will “result in additional delays to discharge and ED waits every morning, as currently, the HSE does not have the bed capacity in the acute or HSE community to manage the volume of patients requiring care”.

Delayed discharges stood at more than 470 as of the end of December, with 16,623 bed days lost as a result. The National Transitional Care Office (NTCO) replied saying it is “aware that the capping of TCBs is going to have an impact on hospitals right across the country”.

“Unfortunately there is no choice if we are going to reach a breakeven position at year-end and ensure the funding lasts the year,” said the NTCO.

Another highly-placed official within the South/Southwest hospital group wrote in an email on June 20 that the TCB cap is “just another example of the funding limits being applied by the community to support their breakeven plan”.

“Last week, the Acutes were notified of a limit on care packages such as home help hours” the official wrote.

Today it is a limit on transitional care beds. This seriously impacts flow in our hospitals and a resultant increase in delayed discharges which we are currently experiencing. Another example of pressure on the Acute System.

The HSE’s National Transitional Care Scheme assists acute hospitals discharge patients from hospital who are medically fit, but require nursing home care or convalescence care, up to a maximum of four weeks.

The HSE said the number of applications for the scheme “has increased” and that it “increases and decreases” the volume of approvals on a weekly basis” to enable it “to manage demand and capacity across the whole year”.

The HSE said there are eight people on the waiting list for TCB funding (less than two weeks into the cap) who have applied for the Nursing Home Support Scheme and that “and approval for those patients is in progress”.

They said there is “currently no waiting list for patients awaiting approval for convalescence care”. Approximately 1,000 people are being supported in transitional care, according to the most recent HSE figures, while the number of people in acute hospitals approved for transitional care stands at more than 10,000.

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