On Monday night Ireland’s system of caring for the elderly was dealt a devastating blow. It came not from an inquiry or a professional report about quality and standards, or even from a television investigation with hidden cameras showing outrageous abuse. No, it came wrapped in the velvet glove of a heartwarming story about a loving family’s search for the proper care for their father.
This makes the Courtney family sound like the Waltons, but they were both highly impressive and reassuringly human. There was nothing unusual about them except that their mother, Nuala, is extraordinarily beautiful and that the eldest son, Brendan, is a television presenter and fashion stylist and designer and is on our screens a lot this winter, advertising a furniture retailer.
An email from the HSE’s chief legal adviser was released yesterday under the Freedom of Information Act. In it she told officials that some families delay moving their elderly relatives from hospitals to avoid taxes or to hold off signing up to the state’s Fair Deal scheme, by which a proportion of the cost of nursing home care is paid for by a person’s estate after their death.
Monday night’s programme, We Need To Talk About Dad, told the story of the dedicated and loving relatives of a sick person — and in the Irish health service there is no position more abject than that of the loving relative.
The programme centred on how the Courtneys’ father, Frank, had a stroke, his second. This put the family in the twilight zone of a care crisis that they had never anticipated and which, perhaps less understandably, the health system showed no sign of having anticipated either.
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It left everyone saying surreal and deeply sad things. “The first stroke was easy,” is how Deboragh, one of Frank’s daughters, put it.
“Homecare should be the reality. We’ve just got to afford it before it’s too late,” Brendan said.
His family didn’t want Frank put into a nursing home on the ground that he was “too young”, which was a comment in itself on our expectations for longevity and continuing health.
“Look at me, camera, I’m knackered,” Frank, who is in his seventies, said before talking about his pain and frustration.
He wanted to go home. His family wanted him home. “Your husband should be at home with you,” Nuala said simply.
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The only problem was that the health service was not able to help Mr Courtney get home; it was set up to move him to a nursing home. And it was on that simple conflict that We Need To Talk About Dad turned. And turned and turned.
Each of the Courtneys’ limited options was explored. At one point Brendan snapped. “I’m sick of talking about this,” he said.
The crux of the matter is the state’s Fair Deal scheme can only be used for institutional care. It does not allow people to be looked after by professional carers in their home even though, as Brendan pointed out, the price of both options is similar. Whether you are in a nursing home or being professionally cared for in your own home it comes in at about €2,000 a week.
Surely the saddest scene in the programme — and there was some stiff competition — was when a very nice, humane manager tried to explain the Fair Deal system to Brendan and his sister Suzanne only to fail, as she frankly explained, because she didn’t entirely understand it herself. This programme showed that Fair Deal is so cumbersome and complex that no one can fully understand it.
Even Brendan, with a degree in accounting and a calculator and a very good pair of glasses could not make sense of it. Suzanne, who told us that she also works with figures, couldn’t either. Which valuation of the family home would be taken as final, Suzanne asked — the valuation now, or at the point of sale? Presumably the house would be sold years hence, when both the Courtney parents had passed on.
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Well, the manager said, she didn’t know.
“If the calculation isn’t complete we can’t make the decision,” Suzanne said.
She was very calm and civil about it. She seemed to be shocked more on a professional basis than anything else.
We Need To Talk About Dad ended with the Courtneys planning to adapt the family home, but since the programme was made Frank has gone to live somewhere unspecified, where Brendan said he is very comfortable. The government has promised to start a new consultation process on long-term care to include a possible new system of home care.
By sharing their experience on We Need To Talk About Dad the Courtney family has performed a real public service. Frank was particularly happy about the warm public reaction, much of which has come from people who have had the same experience. The Courtneys will probably get a People of the Year award. The rest of us can only wonder how many television programmes it’s going to take to reform the rest of our health service.