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Health Service Executive Dublin Mid-Leinster - Public Respite Bed

Year Concluded: 2007

Complaint Details:

I received a complaint from the son of an elderly woman who had been admitted to Tullamore General Hospital (part of the Dublin Midlands Hospitals Group), through the Casualty Department, suffering from a chest infection. The woman, who lived in County Offaly, had previously suffered a stroke and had Parkinson's Disease, was normally cared for at home by her family. Her Consultant recommended that she avail of a period of convalescent prior to her returning home.

When the family sought to have their mother placed in the Birr Community Nursing Unit for two weeks convalescent care, they were refused by the Admissions and Discharges Committee. This Committee manages admissions and discharges to the Unit, and has responsibility for assessing all clients for residential care provided by the Health Service Executive (HSE). The Committee had considered the views of the multidisciplinary team, including those of the physiotherapist and occupational therapist, and recommended that the woman be discharged home with the support of the Community Rehabilitation Team.

The family was unhappy with this decision, and complained to my Office that they were forced to obtain convalescent care for their mother in a private nursing home, even though she was a medical card holder, and there were two public respite beds available at that time. They were also concerned that there was no appeals mechanism in place to deal with their complaint, and they felt that they had no voice in relation to the provision of care for their mother.

As a consequence of my examination of this complaint, I contacted the HSE and suggested it consider:

• adopting a more flexible approach with regard to the occupancy of the respite beds in Birr, given the demand for these beds at any given time, and the difficulties in obtaining private nursing home accommodation for patients who may require respite care following discharge from the general hospital;
• giving relatives or family members an option to attend during the multidisciplinary assessments of patients;
• giving applicants for respite or rehabilitation care an invitation to submit their request in writing for consideration by the Admissions and Discharges Committee so that the main carers can have a formal input into the multidisciplinary assessment system;
• conveying the Committee's decision either orally or in writing to the applicant with an outline as to how that decision was reached;
• establishing an appeals mechanism so that applicants who are refused can appeal this decision to a person who has not been involved in the original decision-making process - this would create a more transparent system.

In its response, the HSE acknowledged that public respite beds were available in Birr at the time the woman sought convalescence, and it agreed to refund the complainant the costs incurred for private nursing care, (€462), not covered by nursing home subvention. It also recognised the importance of having a family member present during the assessment of an elderly patient, and stated that while this might not always be possible at the time of certain assessments, consultation would take place regularly either by phone or in person with family members or relatives. The HSE also recognised the benefits of encouraging family members to put in writing the underlying reasons for requesting respite or convalescence care, which could then be put before the Admissions and Discharges Committee for consideration. It also accepted that decisions made by the Committee should be conveyed to the family outlining the basis for the decision reached. Finally, the HSE agreed that an appeals structure should be put in place which would allow applicants whose request had been refused, an opportunity to have their application examined by a person not involved in the original process.

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