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Chapter 1: Introduction and Background
home care. Under this scheme, the older person makes a contribution towards the
cost of their care and the state pays the balance. This applies whether the nursing
home is public or private. In summary, the older person will contribute 80% of
assessable income (their assets, e.g. pensions and property) and 5% of the value of
any assets in excess of the asset disregard per annum in care. The asset disregard is
the amount of assets that is totally excluded from the means assessment. The asset
disregard is €36,000 for an individual or €72,000 for a couple. The older person can
avail of a deferred contribution that will apply only to each year of care and will be
charged on a pro rata basis for any period of care of less than one year. The principal
residence will only be included in the financial assessment for the first three years of
the time in care. This is known as the 15% or three-year cap, and means that after
three years of care the older person will not be liable for any further deferred
contribution based on the principal residence. In the case of a couple, this means that
the deferred contribution based on the principal residence will be capped at 7.5%
where one partner remains in the home while the other enters long-stay residential
care. If there is a partner or certain dependants living in the residence, the charge
may be further deferred for their lifetime.
While choice of residence is now possible, many researchers have found that the
quality of life experienced in these residential care homes is not satisfactory. One of
the issues identified that impacts upon residents’ quality of life is the lack of resident
autonomy (Cook, 2010; Murphy, 2007; Murphy et al., 2007; Brown, McWilliam and
Ward-Griffin, 2006; Edwards, Staniszewska and Crichton, 2004; Randers and
Mattiasson, 2004; Tester et al., 2004; Edwards et al., 2003; Barkay and Tabak, 2002;
Lothian and Philip, 2001; McCormack, 2001;Ball et al., 2000; Davies, Ellis and
Laker, 2000; Edwards and Staniszewska, 2000; Kane and Kane, 2000). Rodgers and
Neville (2007) argue that a major problem in enabling personal autonomy in
residential care facilities is that of communal interests, whereby organisational needs
are privileged over the rights of individuals. They add that while institutional
routines maximise efficient use of staff time and provide care efficiently and
economically, they are highly likely to interfere with the autonomy of those cared
for. Cook (2010) adds that these routines affect residents’ identity and autonomy. To
date no research has been undertaken in Ireland that specifically explores the
phenomenon of resident autonomy. Further research is now required, which will