If the Government were to provide subsidies for premium nursing homes, anything provided by the state would be considered a right by the people and invariably lead to more being demanded at the expense of taxpayers ("Shelved: Plans for different model of nursing home"; Monday and "Room to test models of care"; Tuesday).
The issue raises three questions:
First, what costs should be the responsibility of nursing home residents?
Second, what subsidising mechanisms should be used for people who cannot afford to pay for nursing-home care?
Third, what mechanisms are in place to ensure that people have the adequate income to pay for their own nursing-home care?
The approach to answering these questions will result in the creation of different experiences.
For example, people who can afford to stay in premium nursing homes should pay the full cost of their nursing-home care.
To do so, families of the elderly must be prepared to change their spending habits by putting aside some money to pay for such luxuries; they cannot rely on the state for subsidies.
Those who do not have sufficient income to pay for premium nursing services should choose standard homes, and the state should offer them subsidies to enable poorer citizens to pay for such care.
Public funding of the healthcare component of nursing-home care should be based on the principles of shared risk, which must recognise nursing homes as not accommodations of choice, but as a source of necessary healthcare support for many older adults with chronic illnesses and disabilities.
Should differences in nursing-home accommodation costs be tolerated in a needs-based healthcare system?
Subsidising premium nursing homes would induce other no-frills nursing homes to upgrade their facilities to enjoy the subsidies, which may lead to uncontrolled competition and fewer beds to cater for lower-income patients.