Preamble [skip if tl;dr]
I've had occasion to question the relentless spread of three-letter acronyms TLAs in biochemistry and astrophysics. There probably aren't enough TLAs ( 26 * 26 * 26 = ~17500) to go round especially if you have no expectations for the utility of ZXZ and QFQ. ZQZ is of course <slaps forehead> the IATA code for Zhangjiakou Ningyuan Airport. Haven't heard of Zhangjiakou? For shame! it is home to more people than the Republic of Ireland. I've been caught out <duh!> woeful ignorant about the basic political geography of China before. Anyway, when we run out of TLAs we can gear up to the half million FLIGs - four letter initial groups. No fun unless these acronyms are self-referential. I mention this because a couple of new health related FLIGs have been in the news this week - HIQA and NTPF. Not really news I guess because I've slagged the Health Information and Quality Authority (HIQA) (Irish: An t-Údarás um Fhaisnéis agus Cáilíocht Sláinte would that be UFACS?) in the past for taking a year to report on the cause of a single iatrogenic death. I compared that with the Penney Report which laid out the causes of the 1957 Windscale nuclear meltdown on the Prime Minister's desk 16 days after the adverse event. The other FLIG is NTPF National Treatment Purchase Fund.
There is a new report from Age Action, the charity and advocacy group for older people, about the 'extras' which are added to the bill in nursing homes across the country. My view of the nursing home business tends towards that of predatory publishers in science. How difficult can it be, an entrepreneur will say - you charge each occupied bed in excess of €1000/week; pay the cleaners, orderlies, receptionists and cooks at the minimum wage = €350/week and the degree-qualified staff a little more. On dit que you need 2.4 carers per caree which suggests a 'profit' of €160 per person per week = €8,000/yr . . . say 50 beds = €400,000 gross. If you're running the thing as a business, then you'll have an accountant looking for ways to pare down the overheads in any way that doesn't involve sacking the accountant. €1,000/wk is for bed, board and laundry. Possibly a lot of laundry because the old tend to be a bit leaky. That is rather to the point because apparently some elders are being charged extra for incontinence pads whereas you might expect that to go with the territory.
A few years ago, the Government implemented a Fair Deal scheme which was a first attempt at getting a balance between the state being responsible for the care of the elderly and infirm and people being responsible for themselves and their aged parents. The realpolitik of it says that The State has a vested interest in having people die shortly after their 65th birthday while the family may well see further utility in the retired. We're off to England later this month to have a week's qual-time with the grandchildren, for example. The Fair Deal scheme says that, if you have assets, you are expected to contribute 80% of your income and 7.5% of your assets each year towards the cost of your nursing home. If your assets are property you can take out a Nursing Home Loan and pay the 7.5% after your death. The scheme is obviously not for the super-rich who can afford to pay whatever private nursing homes charge. The compassionate purpose of FD is that an old citizen in need of care should not have their choice curtailled because they are poor - we don't want the bring back the Workhouse.
The extras more generally include such things as social events, newspapers, GP visits, chiropody and can run to €100/wk - even when you don't avail of them. As a commentator on the wireless pointed out there is a difference between choosing not to go to Friday bingo because you're feeling crook or you're quarrelling with That Sadie Murphy and not going because you're blind. The problem is that Fair Deal is a contract with the government for a minimum service and that (ignore my simplistic accounting above) is a tad above break-even; the extras are what allows the proprietor to send his kids to fee-paying schools. The logistics require that some bundling of the costs is allowed otherwise you'll have people claiming they only ate half their peas and asking for a discount. It's probably kinder and more inclusive if you don't have any extras at all. By legislation or compassion we need to decide what needs to be provided to achieve a certain minimum QALY <woot another FLIG!> [prev] for everyone involved. That must be more than bed, food and laundry or we'll have a shameful Romanian orphanage scenario. CareChoice in Dungarvan Co Waterford has drinks and pig's feet every Friday afternoon: which is clearly good for morale. They found in the Relief of Belsen that lipstick and respect were better than food for survivorship. The thing about a nursing home is that it is Home but one from which you often cannot escape. In a just society everyone should expect to be cared for with respect, compassion and competence in their declining years but they shouldn't also expect to be able to leave a farm of land to their children.
And we'll leave aside the disconnect between it being unethical to allow your dog or sheep to 'suffer' and unethical also to off your aged and respected grandfather under any circumstances. I could also make an argument that inheritance perpetuates, even exaggerates, inequality of opportunity and what's left when you die should be shared more widely than your immediate descendants. You have, after all, been supported in your declining years by your postman, your neighbours, the corner-shop and the HSE. Few people leave a bequest to Pat the Post.