Skip to main content Accessibility help
×
Home
Hostname: page-component-544b6db54f-vq995 Total loading time: 0.195 Render date: 2021-10-23T18:31:47.262Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "metricsAbstractViews": false, "figures": true, "newCiteModal": false, "newCitedByModal": true, "newEcommerce": true, "newUsageEvents": true }

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*
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: annettekavanagh@doctors.org.uk

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.

Type
Brief Reports
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
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: 201204CrossRefGoogle 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: 291297.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: 167170.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: 4149.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; 53:13221324.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
1
Cited by

Send article to Kindle

To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

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

Send article to Dropbox

To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

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

Send article to Google Drive

To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

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

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *