Hostname: page-component-cd9895bd7-dk4vv Total loading time: 0 Render date: 2024-12-27T06:50:24.475Z Has data issue: false hasContentIssue false
  • English
  • Français

Ireland's long-stay charge refunds: mental capacity and dilemmas in a psychiatric institution

Published online by Cambridge University Press:  13 June 2014

Annette Kavanagh ,
Stephen Browne ,
Richard Horgan ,
Derek O'Sullivan ,
Noel Sheppard  and
Michael Kirby
Annette Kavanagh*
Affiliation:
Department of Psychiatry, Waterford Regional Hospital, Waterford, Ireland
Stephen Browne
Affiliation:
Department of Psychiatry, Waterford Regional Hospital, Waterford, Ireland
Richard Horgan
Affiliation:
Department of Psychiatry, Waterford Regional Hospital, Waterford, Ireland
Derek O'Sullivan
Affiliation:
Department of Psychiatry, Waterford Regional Hospital, Waterford, Ireland
Noel Sheppard
Affiliation:
Department of Psychiatry, Waterford Regional Hospital, Waterford, Ireland
Michael Kirby
Affiliation:
Department of Psychiatry, Waterford Regional Hospital, Waterford, Ireland
*
Correspondence E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective: All patients who resided in state provided long-stay care in Ireland were required to pay the state for that care until 2006. In 2001 the Irish Ombudsman and Information Commissioner had highlighted the issue of the entitlement of people with medical cards to provision of free long-stay care. The Health Repayment scheme was subsequently set up in 2006 to facilitate the repayment of long-stay charges wrongly paid by patients. Issues of mental capacity arise particularly in the context of long-stay psychiatric patients applying for repayment of long-stay charges. Our aim was to devise a test suitable to assess the capacity of an individual to make an application for refund charges.

Method: There was no specific test in existence to assess the capacity of an individual to make an application for refund of charges. A suitable test was devised based on the available literature which assessed whether the person understands the ‘nature and effects’ of making a refund application. Fifty-eight long-stay patients were deemed to be entitled to apply for a refund.

Results: Staff identified 47 (80%) patients as possibly lacking the capacity to make an application. Of these, 14 patients (29.8%) were found to have capacity to make an application (mean age 58.5 years) with 33 (70.2%) found to lack capacity (mean age 73 years). Of those with capacity 50% had a diagnosis of schizophrenia/schizoaffective disorder. None had cognitive impairment of degenerative origin. Of those who lacked capacity 45.5% had a diagnosis of dementia. All of the patients with dementia who were assessed were found to lack capacity whereas 59% of those with a diagnosis of schizophrenia/schizoaffective disorder lacked capacity.

Conclusion: A substantial number of long-stay psychiatric patients may lack the capacity to make particular decisions. In this study the group who lacked capacity were an elderly group with dementia common. This process raised a dilemma about how a patient without capacity to make a refund application can then manage the money claimed on their behalf and whether guardianship safeguards are necessary.

Keywords

Mental capacityRefundLong-staySchizophreniaDementiaMedical cardCharges
Type
Brief Reports
Information
Irish Journal of Psychological Medicine , Volume 25 , Issue 3 , September 2008 , pp. 100 - 103
Copyright
Copyright © Cambridge University Press 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Presentation to the Joint Committee on Health and Children 21 June 2001. ‘Nursing Home Subventions, an Investigation by the Ombudsman regarding payment of Nursing Home Subventions by Health Boards’. Office of the Ombudsman.Google Scholar
2. Health (Charges for inpatient services) Regulations 1976Google Scholar
3. Health Repayment Scheme (www.repay.ie)Google Scholar
4. Health (Repayment Scheme) Act 2006 (www.oireachtas.ie/documents/bills28/acts/2006/A1706.pdf)Google Scholar
5.Nursing home refund scheme grievances. Irish Medical News 2008; Feb 18.Google Scholar
6. English V. Assessment of Mental Capacity: Guidance for Doctors and Lawyers 2004.Google Scholar
7.UK Law Commission: Law Commission Report 231, Mental Incapacity, HMSO 28 February 1995Google Scholar
8. Section 4(4). Health (Repayment Scheme) Act 2006Google Scholar
9.Raymont, V. Not in perfect mind – the complexity of clinical capacity assessment. Psychiatric Bull 2002; 26: 201–204CrossRefGoogle Scholar
10.Okai, D, Owen, G, McGuire, H, Singh, S, Churchill, R, Hotopf, M. (2007) Mental Capacity in psychiatric patients. Br J Psychiatry 2007; 191: 291–297.CrossRefGoogle ScholarPubMed
11.Folstein, MF, Folstein, SE, McHugh, PR. ‘Mini-mental state’. A practical method for grading the cognitive state of patients for the clinician. J Psychiatric Res 1975; 12(3): 189–98.CrossRefGoogle Scholar
12.Warner, J. Participation in dementia research: rates and correlates of capacity to give informed consent. J Med Ethics 2008; 34: 167–170.CrossRefGoogle ScholarPubMed
13.Marson, D, Harrell, L: Executive dysfunction and loss of capacity to consent to medical treatment in patients with Alzheimer's disease. Sem Neuropsychiatry 1999; 4: 41–49.Google ScholarPubMed
14.Scott, YH, Kim, MD, Caine, ED. Utility and Limits of the Mini Mental State Examination in Evaluating Consent capacity in Alzheimer's Disease. Psychiatr Serv 2002; 53:1322–1324.Google Scholar
15.O'Neill, AM. Wards of Court in Ireland (First Law 2004).Google Scholar
16. Law Reform Commission Report (LRC 83-2006). Vulnerable Adults and the Law.Google Scholar