The Irish Nursing Homes Organisation (INHO) says the State is facing an extra €1 billion in repayments on top of yesterday's Government announcement after receiving legal advice which suggests patients in private nursing homes were also illegally charged.
While the Government is planning to repay at least 22,000 residents in State-run institutions who were illegally charged for care, the INHO says an extra 15,000 older people with medical cards in private nursing homes were also unfairly charged.
Government sources, however, say legal advice from the Attorney General's office suggests the State is on "reasonably solid ground" in deciding not to repay people in private nursing homes.
Many patients in private nursing homes were in receipt of State subsidies, known as nursing home subvention, which contributed to the overall cost of care. Patients' incomes and pensions were used to make up the balance of the nursing home charges.
The legal advice commissioned by the INHO, seen by The Irish Times, says these patients were entitled to services free of charge if they received "in-patient" services.
Patients resident in private nursing homes who paid the full cost themselves are not affected, however, as they were not subject to "unlawful" deductions.
The INHO's claims come as an 80-year-old woman begins a High Court action regarding the State's liability to meet the costs of private nursing home care. A successful action could have implications for thousands of other patients.
INHO chief executive Paul Costello claimed yesterday that, based on average weekly nursing home charges of €500 since 2001 - when the medical card scheme was extended to the over-70s - the State is facing a further bill of €1 billion or more.
He said it was only a matter of time before there were successful legal claims which could leave the State open to another major payout.
The Ombudsman Emily O'Reilly has expressed concern about deductions relating to patients in private institutions. In a statement issued earlier this year, she said the controversy regarding public patients "does not deal with the issue of those medical card holders who could not be provided with a bed in a public institution, due to a shortage of such beds, and who were directed by the health boards towards private care, without in any way acknowledging their own responsibilities in the area".
The subvention scheme was also the subject of a highly critical report by the Ombudsman's office in January 2001, which criticised the means-testing system as creating severe financial hardship for patients and their families.
The Ombudsman also criticised the fact that many had no choice but to go to private homes because there were insufficient facilities in the public institutions.
