The intense debate about business of operating care homes is a major interest both in tackling the Covid-19 crisis and also on a longer term basis for the social and economic implications of their future survival.
What formerly were called residential homes or nursing homes have become, during the current crisis, the focus for extensive sympathetic scrutiny.
The immediate care needs of elderly residents have belatedly been recognised as part of the crisis in health care.
Unusual and unexpected crises have provoked ad hoc helpful efforts mainly from the professional services available to the health service.
The immediate crisis in the care homes was foreseeable.
A health crisis affecting the elderly would predictably find its way towards arrangements which brought together in one place many older people.
The crisis in care homes immediately created a demand for more extensive services than were readily available.
That is now an accepted need. However, the crisis in care homes should also serve to emphasise two overlapping continuing problems.
These stem from the institutional arrangements which mean that care homes are organisationally NOT part of the health service.
They are providers of social service. Admittedly the distinction can be borderline but organisationally, financially and politically there are differences.
As many families are already painfully aware, whereas the (acute) health services are free at the time of need, continuing care, away from a hospital setting is not universally available.
It is subject to charges for the cost of care which, to a modest degree, are offset through a means tested arrangement.
The fees charged for a place in a care home take the arrangements one step further away from a universal standard service.
Care homes are usually not owned or managed by Government.
They are private, or sometimes charitable, organisations. Most care homes must pay their way and fees charged are, to many lower income families, a heavy charge on a wider family.
The financing of places in care Homes has been, and remains, a critical factor.
The fees charged by care Homes are set by their owners.
There is little dispute that, even to operate on a break-even or modest profit margin, weekly or monthly charges will seem formidable to average income households. These fees affect families in slightly different ways.
Where an older person accepts a place in a care home, if that person has personal funds above a modest level, then they (or their family) are expected to pay the full fees charged by the care home.
Where the older person only has personal funds falling below the means test limit, then social services funds will contribute partially to the cost of the fees but often not enough to meet the total.
Family and relatives find it necessary to 'top-up' the payment.
This system, long acknowledged as a weakness in meeting the financial costs of Care Home provision, means that many families face continuing 'top-up' payments that seriously impact other household budgets.
This dilemma does not suggest that care home owners are making excessive profits.
Many owners argue that providing the minimum expected standards can be difficult.
Some units have been closed as owners find more attractive uses for funds tied up in these properties.
The harsh reality is that treating continuing care for the elderly as being outside the health service means that the system has continuing financial weaknesses which many UK governments have acknowledged but have failed to get a political consensus on answers because of the concerns about how a more adequate system might be funded.
Two features stand out. First, the cost (after any means test) for a residential place can be prohibitive for people of even average incomes.
Second, for people with only modest savings, the Government supplementary payment for a care home resident is badly out of line with the cost of providing a residential place.
Asking for payment 'top-up' from poorer households is onerous and unwelcome.
If the NI Executive has some scope for discretionary budget spending, an allocation to reduce these socially unwelcome features would be money well spent.