Compulsory insurance may fund home care

Compulsory long-term insurance, means-tested co-payments, and funding through taxation are among the options put forward in a new report that will inform debate around the future funding of formal statutory home care.

However, in European countries where these models exist, the need to contain costs due to demand has led to rises in co-payments and a tightening of eligibility criteria, making formal home care more difficult to access.

The report, Approaches to the Regulation and Financing of Home Care Services in Four European Countries, looked at Germany, the Netherlands, Scotland and Sweden.

Formal home care in Germany and the Netherlands is funded by compulsory long-term insurance and means-tested co-payments. Taxes fund home care in Scotland and Sweden, with small co-payments for all services in Sweden and payment for household tasks by those who can afford to in Scotland.

However, the report warns that the cost of these schemes is on the rise in all four countries.

• Germany has increased co-payments to 30% of the total formal home care costs, as well as hiking long-term insurance premia for childless couples.
• Netherlands has waiting lists and has reduced its needs-based service allocation by tightening access criteria.
• Scotland has asked citizens who can afford it to pay for home help.
• Sweden has tightened eligibility criteria.

The report, conducted by the Health Research Board on the Government’s behalf, says the national governments in each of the four countries have “overall control of the vision of home care”. However, Ireland adopts a “laissez-faire” approach, with “a weak government role and no vision for home care regulations”.

The models scrutinised offer a basket of services which include personal care and help with household tasks.

Nursing care is included in Germany, the Netherlands and Scotland. In Scotland, the recipient must pay for housekeeping tasks if they earn over £16,000 (€18,800). Sweden’s basket includes emotional and social support. All four countries have an element of user choice “with services typically offered in kind or via personal cash budgets, direct payment, or voucher systems”.

The report said there are “three typical ways in which home care users contribute to their public formal home care services — free of charge, means-tested co-payments, or fixed co-payments”.

Yesterday, Helen McEntee, junior minister for older people, said no decision has been made on a funding model. Asked on RTÉ radio if it would be similar to the Nursing Home Support Scheme/Fair Deal where participants pay up to 22.5% of the value of their home, she said: “I don’t know if that would be an option because people are still living in their home.”

A public consultation process is due to commence at the end of May which Ms McEntee expects to take six to eight weeks, but she was unable to say how long it will take before a scheme is actually devised.