Bang goes your inheritance

luckat

http://www.irishtimes.com/newspaper/ireland/2008/1010/1223560351386.html?via=mr

Nursing home Bill changes method of fee payment

OLIVIA KELLY

THE LONG-AWAITED legislation for a new system of nursing home funding, which allows older people and their familes to pay nursing home fees from their estates after they die, has been published by the Department of Health.

The "fair deal" scheme had been due to come into effect last January but was delayed because of legal difficulties surrounding applications for people who no longer had the mental capacity to look after their own affairs.

Although this legal problem has been resolved, Minister for Health Mary Harney indicated yesterday that the Nursing Homes Support Scheme Bill would be unlikely to proceed through the Dáil this year. The scheme is not now expected to come into force until the middle of next year.

Under the scheme, people moving into a nursing home will pay a maximum of 80 per cent of their income towards the cost of their care, based on a Health Service Executive (HSE) assessment of their assets.

<snip>

nesf

This is an interesting bit:

Fears that family businesses, including farms, would be broken up after the resident's death have been allayed by a provision excluding assets transferred more than five years before entry into the nursing home from assessment.

So if people have their affairs in order before getting towards the age where nursing home care is going to be needed they can minimise the impact on their estate. Also by having a good pension in place, nursing home fees might be completely covered and for people without a good pension, or much in their estate, it's still capped at 80% and 15% respectively so the worst off aren't going to have to fork over all of their estate for care (that and it can't be taken while a partner or a dependent child is there).


At the moment, the fees for private nursing homes completely rule them out for people who don't have liquid assets (i.e. cash, or their children don't have cash). For a person on their own this can be gotten around by selling their home or similar to raise the cost of it but in situations where you've a couple where one needs nursing home care and the other doesn't then this simply isn't an option and the new scheme would make it possible for them to get into private nursing home care without needing to do something drastic like selling the home with someone still living in it or placing a large financial burden on the kids to pay.

stovelid

LOL at bang goes your inheritance.

The temerity of the old fogeys using their own assets to pay for a retirement home instead of sorting out the kids with a gaff.

Mr.Micro

The cost is 700 euro plus per week, probably more in some places to stay in a nursing home. Where do they get off charging so much and they are not fun places. An hotel would be cheaper and a lot better, and more fun. Well the pressure then is for the relatives to look after granny,grandad or uncle Bob and not dump him or her in a home, so that the greedy HSE does not get the cash to waste that's my advice.

luckat

Stovelid, let me tell you how this is going to work: the old folks are going to help their kids get a gaff when they're (the parents) in their 50s.

Then when they're in their 70s or 80s or 90s, and need care, who do you think makes those arrangements? Those same kids.

So now they're going to be faced with a choice: one of us give up her (yup) career and mind the aged parents full-time, and hang on to the inheritance, or sign them in to somewhere that they can have full-time nursing care, and lose all but 20% of that inheritance, while the health boards (who themselves means-test the oldies) grab the rest.

Guess who's going to be the resentful, angry person ending up exhausted and drained, minding old people?

In the case of people with Alzheimer's, this is particularly severe - they really need full-time care in a safe, locked place, with a multiplicity of carers. But this 'fair deal' will mean that's just what a lot of people won't get.

nesf

Mr.Micro wrote: »

An hotel would be cheaper and a lot better, and more fun.

The hotel wouldn't have medical services attached though so the comparison isn't valid.

luckat

Hotel wouldn't have a secure environment either, if people had Alzheimer's-caused or Parkinson's-caused dementia.

But it's beside the point. This is going to be a choice between a state grab of old people's property, or middle-aged people giving incompetent care to the old so as to hang on to an inheritance.

Thoie

nesf wrote: »

The hotel wouldn't have medical services attached though so the comparison isn't valid.

The medical services attached to the majority of nursing homes that I've been in contact with aren't much better than you'd find in a hotel to be honest. And I'm talking about "good" nursing homes here.

From my experience of 3 nursing homes (which I appreciate isn't a huge sample).

There are no doctors attached. In case of medical emergency, a local GP is called, or an ambulance.

The majority of staff are not trained nurses, but similar to the housekeeping staff in a hotel. This is not a dig at the general staff - all I have dealt with are pleasant and do their best, but for the most part their jobs involve cooking and cleaning. Some are trained to assist in duties such as helping someone put on a cardigan, or helping someone stand up from a chair. They are not equipped to cater for people who are incapacitated and need help washing/dressing/getting in and out of bed.

There is usually one trained nurse on duty. Maybe two. These nurses are supposed to be responsible for the health of your elderly loved ones. In reality they hand out medicines, and not much else. AFAIK they are supposed to do "rounds" and check on all guests at frequent intervals, but this simply doesn't happen.

Nursing homes, despite their name, are really not for nursing. Any resident with an illness beyond a common cold cannot remain resident, and will be sent to hospital. Nursing homes do not have the facilities for meals in bed, for example.

I'm not sure what the answer is. At some point in the future one, or both of my parents may need help that I am unable to provide. I will happily forego "my" inheritance (the money and home that my parents have worked long and hard to procure for themselves) if I can see them well looked after in a way that I can't provide. However I hope by then there is a viable alternative to nursing homes as they exist at the moment.

luckat

You're quite right, Thoie - it's not "your" inheritance; but I can see people doing everything to avoid the scenario where a combination of the State and its privatised pals takes 80% of people's property in exchange for the very "care" you describe.

luckat

Christopher Hitchens' definition of a 'banana republic' in the current Vanity Fair -

http://www.vanityfair.com/politics/features/2008/10/hitchens200810

- is intended for America, but suits Ireland just fine: "this apt summary of a collusion between the overweening state and certain favored monopolistic concerns, whereby the profits can be privatized and the debts conveniently socialized".

nesf

Thoie wrote: »

The medical services attached to the majority of nursing homes that I've been in contact with aren't much better than you'd find in a hotel to be honest. And I'm talking about "good" nursing homes here.

From my experience of 3 nursing homes (which I appreciate isn't a huge sample).

There are no doctors attached. In case of medical emergency, a local GP is called, or an ambulance.

The majority of staff are not trained nurses, but similar to the housekeeping staff in a hotel. This is not a dig at the general staff - all I have dealt with are pleasant and do their best, but for the most part their jobs involve cooking and cleaning. Some are trained to assist in duties such as helping someone put on a cardigan, or helping someone stand up from a chair. They are not equipped to cater for people who are incapacitated and need help washing/dressing/getting in and out of bed.

There is usually one trained nurse on duty. Maybe two. These nurses are supposed to be responsible for the health of your elderly loved ones. In reality they hand out medicines, and not much else. AFAIK they are supposed to do "rounds" and check on all guests at frequent intervals, but this simply doesn't happen.

Nursing homes, despite their name, are really not for nursing. Any resident with an illness beyond a common cold cannot remain resident, and will be sent to hospital. Nursing homes do not have the facilities for meals in bed, for example.

I'm not sure what the answer is. At some point in the future one, or both of my parents may need help that I am unable to provide. I will happily forego "my" inheritance (the money and home that my parents have worked long and hard to procure for themselves) if I can see them well looked after in a way that I can't provide. However I hope by then there is a viable alternative to nursing homes as they exist at the moment.

I'd have the opposite anecdotal evidence but an even smaller sample (I've only had enough contact with 1 nursing home to be able to discuss it in detail). There is a GP attached and the medical service is better than what you describe (though I don't at all doubt that it's like that where you've seen).

My point was that simply drawing the comparison with a hotel is misleading, as is pointing out that they're much cheaper than a private hospital bed (usually), in both cases they are quite different things (i.e. zero medical staff in the first and an abundance in the second) not that nursing homes are centres of medical excellence or anything. Many from what I've heard are adequate at best but that's just hearsay and I can't back it up.

luckat

'Having your affairs in order' is all very well, but I can see people who discover that they have an illness that may kill them in a couple of years - or the beginnings of dementia, say - committing suicide to avoid their children losing anything they may have gathered in their lifetime.

I love the bit that says businesses and farms shouldn't be broken up - typical PD thinking. It's fine to take everything if someone is an ordinary working person, but God forbid that a *profitable enterprise* should be broken up.

is_that_so

luckat wrote: »

'Having your affairs in order' is all very well, but I can see people who discover that they have an illness that may kill them in a couple of years - or the beginnings of dementia, say - committing suicide to avoid their children losing anything they may have gathered in their lifetime.

I love the bit that says businesses and farms shouldn't be broken up - typical PD thinking. It's fine to take everything if someone is an ordinary working person, but God forbid that a *profitable enterprise* should be broken up.

Bit of misrepresentation at work here or ignorance of some self-evident truths, methinks. A farm or business that ends up being broken up may not be viable in its smaller version and thus reduced in value, at which point everyone loses out.

Also not sure where the basis of these suicides are coming from beyond an obvious distaste for the system in question. Any evidence for this beyond speculation?

As a system it makes sense and care does need to be paid for. Personally would happily sacrifice my "inheritance" to offer the security of quality care to my loved ones in their final years.

nesf

luckat wrote: »

I love the bit that says businesses and farms shouldn't be broken up - typical PD thinking. It's fine to take everything if someone is an ordinary working person, but God forbid that a *profitable enterprise* should be broken up.

You can't just break up farms and businesses a lot of the time. Farms below a certain size just aren't worth running and it's even more relevant for businesses when they're small to medium businesses. It's not typical PD thinking, it's common sense. Enforced business break up would screw over the small business person, which are by and large "ordinary working people".

luckat

OK, let me give you a scenario.

I give you Helena, a 70-year-old widow living on a small pension. She doesn't have a farm or a business. Helena's only wealth is her house, which is worth €600,000.

Helena's son, Jack, has just returned from the US with his famly. He went there to make his fortune, but that didn't happen.

Helena must now think about her future and take a gamble. If she does nothing, and five years from now she gets a stroke, say, or cancer, or a heart attack, Jack will have nothing. Everything will go to pay for the nursing home.

So she signs over her home to Jack. Now she's effectively a pauper. Jack owns her home, and she has no rights over it. If he dies himself, his wife will own it.

stovelid

luckat wrote: »

OK, let me give you a scenario.

I give you Helena, a 70-year-old widow living on a small pension. She doesn't have a farm or a business. Helena's only wealth is her house, which is worth €600,000.

Helena's son, Jack, has just returned from the US with his famly. He went there to make his fortune, but that didn't happen.

Helena must now think about her future and take a gamble. If she does nothing, and five years from now she gets a stroke, say, or cancer, or a heart attack, Jack will have nothing. Everything will go to pay for the nursing home.

So she signs over her home to Jack. Now she's effectively a pauper. Jack owns her home, and she has no rights over it. If he dies himself, his wife will own it.

Let me give you a scenario.

Stovelid would like the state to make adequate provisions for the elderly. Even if it meant higher taxes. The state doesn't. Stovelid wets himself laughing at the thought that they ever would.

Stovelid's mother owns her house. Stovelid hasn't made his fortune but he's doing well enough.

Stovelid's mother needs care. She decides to use her home to pay for said care.

Stovelid therefore gets no inheritance. Stovelid couldn't care less as Stovelid wants his mother to get any care that she needs and would give up ten times his inheritance to have his mother around for an extra year.

Mr.Micro

nesf wrote: »

The hotel wouldn't have medical services attached though so the comparison isn't valid.

There are no medical services in a residential home for your information and my point is valid. Its the GP who is called if a resident becomes ill or if a transfer to hospital is necessary. Most of the personnel working in a residential home are not medically qualified. Get your facts straight.

plodder

Hello. Just came across this discussion by chance.

An acquaintance told me an anecdote a while ago that had me gob-smacked. This person related the story of how his mother was in hospital but no longer needed to be, and the HSE contacted the family to try and get them to arrange a nursing home. This person, had been "tipped off" as to how the HSE works in this situation. The communication (ie letters and phone calls) are initially cordial and business-like but if progress is not being made, they turn up the heat and pressure etc. almost to the point of the threatening to turn the old lady out on the street.

But, the acquaintance had been forewarned, and stood his ground. Eventually, the HSE relented, and with a degree of pride, this person told me that the HSE found a place for his mother, and paid for it.

I was so gob-smacked, I wasn't able to tell him what I thought, of this.

What kind of people would play a game of chicken with the HSE, using their own mother !!!!

nesf

Mr.Micro wrote: »

Most of the personnel working in a residential home are not medically qualified. Get your facts straight.

But there are some who are medically qualified which is my point. Other than there being a bed in both and some meals provided the two are quite different entities in function etc.

Mr.Micro

nesf wrote: »

But there are some who are medically qualified which is my point. Other than there being a bed in both and some meals provided the two are quite different entities in function etc.

There may be some or one who is medical by that I mean nursing, not qualified to treat or prescribe in fact. Rudimentary or basic at best I do believe as any medical treatment will still be by GP or a hospital. An hotel would still be cheaper than 700 Euro plus for the most basic care and small meals. Since subvention is going to be abolished and the state will make a claim on the property of the resident, the cost of the care has to be addressed.

Thoie

Mr.Micro wrote: »

There may be some or one who is medical by that I mean nursing, not qualified to treat or prescribe in fact. Rudimentary or basic at best I do believe as any medical treatment will still be by GP or a hospital. An hotel would still be cheaper than 700 Euro plus for the most basic care and small meals. Since subvention is going to be abolished and the state will make a claim on the property of the resident, the cost of the care has to be addressed.

If you read back over my post and nesf's response, you will see that he has already answered that. I have a similar experience to you, that the only medical staff may be a nurse, and that a local GP is called when needed. Nesf has the experience of a nursing home that had a full time GP attached.

In many cases a hotel may be as good as a nursing home. In nesf's experience, this obviously isn't the case. Thought would have to be given to the type of hotel though. A hotel mostly populated by business men, or local lads coming in to watch the match isn't going to provide the same experience of company to an elderly guest.

nesf

Thoie wrote: »

Nesf has the experience of a nursing home that had a full time GP attached.

To clarify, not a full time one, he's attached on a part time basis making regular weekly check-ups on residents who require monitoring or for whom medical intervention is in the balance (deciding whether or not they could go under an anaesthetic etc). Basically he deals with the stuff that the nurses can't but that doesn't warrant the person being transferred to hospital. It's better than a random GP coming in though because for long term cases it's the same doctor looking after them which is of value both medically and of stability for the patient (which for older people can be very important). By "attached" I meant that it's a particular doctor that handles things and that there is no extra cost for this, it's included in the price rather than it being a case where a GP has to be called in and paid for as if the person was staying in a private home or hotel.

CiaranC

luckat wrote: »

OK, let me give you a scenario.

I give you Helena, a 70-year-old widow living on a small pension. She doesn't have a farm or a business. Helena's only wealth is her house, which is worth €600,000.

Helena's son, Jack, has just returned from the US with his famly. He went there to make his fortune, but that didn't happen.

Helena must now think about her future and take a gamble. If she does nothing, and five years from now she gets a stroke, say, or cancer, or a heart attack, Jack will have nothing. Everything will go to pay for the nursing home.

So she signs over her home to Jack. Now she's effectively a pauper. Jack owns her home, and she has no rights over it. If he dies himself, his wife will own it.

Whats your point?

My own parents only have a home, Id fully expect them to use their own wealth to provide for themselves when they are old. Why would they be expected to hand it over to me for nothing?

Mr.Micro

CiaranC wrote: »

Whats your point?

My own parents only have a home, Id fully expect them to use their own wealth to provide for themselves when they are old. Why would they be expected to hand it over to me for nothing?

I think that the general idea and correct one, if possible, is that the family look after their ageing parents in the home of the parents. Parents bring up their children, so they in turn should be ideally cared for by their offspring. Not always possible I know, as the parent(s) may need 24 hour help,or have dementia, alzheimers disease whatever. At least the new leglislation may give rise to families collectively taking on their moral responsibilities to the elderly instead of relying on the state as it will now cost a good or all of their inheritance.

nesf

Mr.Micro wrote: »

At least the new leglislation may give rise to families collectively taking on their moral responsibilities to the elderly instead of relying on the state as it will now cost a good or all of their inheritance.

Eh, the scheme is that the person pays 80 percent of their weekly income towards the cost of their care (if they're in a home this isn't that big a deal) and then if there's excess the Government covers it and recovers up to 15% from the sale of the person's home (depending on the size of the excess) where the sale of the house can be deferred until after the death of a spouse, cohabiting partner or dependent child or relative so people won't get turfed out of their homes to pay for it.

So in no way can it cost all of the inheritance, at most the house of the person is sold and the family gets to keep 85% of the proceeds with the State taking the other 15%. Any excess cost beyond 15% of the price of the house will be covered by the State.

At worst the scheme forces the sale of the family home but this could be kept within the family with the proceeds split between the kids and the child who wants to stay in the house getting out a mortgage on it (which, depending on how many other kids there are, could be quiet small).

Mr.Micro

No matter which way you look at it the proposed scheme will change the perspective and if the costs are not met the Government will have a claim on any property. It may not be long once this legislation is introduced then it may be amended as the road ahead will be that families pay much more for the care of their relatives via selling the relatives property or the Government be paid a bigger percentage once the relative is deceased. The take for the care of the relative will only increase as the 15% for now is just the start, thats a prediction IMO and the state will fund care less and less.

nesf

Mr.Micro wrote: »

No matter which way you look at it the proposed scheme will change the perspective and if the costs are not met the Government will have a claim on any property. It may not be long once this legislation is introduced then it may be amended as the road ahead will be that families pay much more for the care of their relatives via selling the relatives property or the Government be paid a bigger percentage once the relative is deceased. The take for the care of the relative will only increase as the 15% for now is just the start, thats a prediction IMO and the state will fund care less and less.

Sure but discussing the current proposed legislation, it doesn't seem overly harsh on people. You've in this a choice, we can pay it through taxes, have our children pay for it out of their income or pay it out of our own pocket posthumously from our estate. With the prospect of a greying population in the future without a large base of young workers to fund such projects with their tax, this option seems fair enough to me. The 15% cap prevents poorer people's estates from disappearing completely to pay for their care while larger estates would (by their 15%) cover more or perhaps all of the cost of their care.

The Muppet

As I understand it the HSE will reclaim money spent by taking 5% per annum of the estate to maximum of 15% . The money will only be reclaimed after the person in the nursing home dies. I only heard a little about the scheme but what I did hear sounded fair to me.

Mr.Micro

nesf wrote: »

Sure but discussing the current proposed legislation, it doesn't seem overly harsh on people. You've in this a choice, we can pay it through taxes, have our children pay for it out of their income or pay it out of our own pocket posthumously from our estate. With the prospect of a greying population in the future without a large base of young workers to fund such projects with their tax, this option seems fair enough to me. The 15% cap prevents poorer people's estates from disappearing completely to pay for their care while larger estates would (by their 15%) cover more or perhaps all of the cost of their care.

Of course, I am not completely against the proposed legislation but I have my doubts that the take will remain at a maximum of 15%. Ireland is going down the route ( has already in many areas in reality) of private health care and insurance. Care of the elderly will be the same in future. It appears to cost more and more to look after an elderly person, as I have said already 700-900 euro per week. That is exploitation and outrageous. At the very least it may focus families where possible to take on their moral responsiblity and look after elderly relatives inheritance or not.

NewDubliner

It' been missed in the post-budget analysis so far that the government will restrict tax relief on medical expenses to the standard rate of tax.

In a sitiuation where a family pays to keep a relative in a nursing home, the tax relief (covering up to 41% of the cost) will now be halved.

BrianD3

80% of pension + up to 15% of primary residence + up to 100% of other assets.

Hardly "bang goes your inheritance"

As opposed to the situation at the moment where those who don't qualify for subvention may end up paying
-100% of pension
-Sell primary residence to fund care
-Use other assets to pay for care
-If you live long enough and the funds run out only then will you be taken into a public nursing home (or a private nursing home with HSE contracted beds)

There are lots of people out there who have been crying out for this fair deal scheme to be introduced. Eg people who own their house and are paying for their care out of pension+savings but savings were running out and it was getting to the point where the house would need to be sold.

But those who have already "jumped" and sold their house could be feeling aggrieved as while the state can only take up to 15% of a primary residence, it can take up to 100% of other assets. Therefore if you sold your house and have x amount of cash sitting in the bankfrom the proceeds from what i can tell all of that is potentially payable.