Funding for long-term care: Problems with capacity assessment of the hospitalized older patient

European governments are examining novel ways to manage scarce resources, not least with respect to funding of long-term care. However, such mechanisms must not sacrifice good clinical practice on the altar of political expediency. The Nursing Homes Support Scheme Act (the "Fair Deal") has radically restructured funding for long-term care in Ireland. The majority of patients entering long-term care do so from the acute hospital setting. The Fair Deal provisions are complex, involving financial assessment and disposal of property and assets before and after death. Many patients requiring long-term care lack the capacity to make complex financial decisions. This paper examines some of the issues surrounding capacity assessment in the acute hospital setting. (C) 2010 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved.