Ms Siobhán McArdle:

I thank the Chairman and members for the invitation to attend the meeting to discuss housing for older people, including the fair deal scheme. I am joined by my colleague Ms Larthwell, principal officer from the social care and mental health division in the Department.

Ireland’s demographics are changing. Welcome improvements in health outcomes and extended life expectancy have changed our expectations for how older people should live within their communities. For the most part, older citizens clearly indicate their preference to live in their own homes and communities for as long as possible. The programme for Government 2020 commits to creating an age-friendly Ireland, while Sláintecare aims to provide the right care in the right place and at the right time.

The Department of Health aims to support the will and preference of older people to live and age well in their own communities. The provision of enhanced integrated health services in the community, with a focus on prevention and early intervention of chronic disease conditions, aims to support older people to live well at home and to reduce the likelihood of hospital admission. Through the HSE national service plan for 2022, the Department of Health has invested approximately €670 million in home support provision and reform and a further €195 million to enable the continued delivery of the enhanced community care programme across all community healthcare organisations.

The Department of Health and the HSE, partnered by Age Friendly Ireland and ALONE, also provide complementary support co-ordination models to link older people with services such as befriending and signposting to local community groups. As highlighted by the health and housing joint policy statement, Housing Options for Our Ageing Population, these initiatives play an important role in connecting older people to their communities, reducing the poor outcomes associated with social isolation and helping people to quickly and easily access services they need.

Although the direction for Government policy is to support individuals to remain in their homes, long-term residential care will continue to be necessary for some older people in order to meet their healthcare needs. The nursing homes support scheme, NHSS, also known as the fair deal scheme, is the State’s means-based system of financial support for people who are not in a position to pay privately for their long-term residential care. Its aim is to ensure that when residential care is necessary, it is accessible, affordable and regulated to provide a high quality of professional care. Although we expect there will be an increased diversion from residential care as community supports improve, population ageing will continue to drive a high demand for residential care.

To avail of the NHSS, older people must have their care needs assessed to determine that they require full-time residential care. Residents contribute to the cost of their care at a basic rate of 80% of their income and 7.5% per annumof the value of their assets, with the State making up the balance of the cost.

The nursing homes support scheme is worth €1.4 billion. The core tenet of the scheme, and the reason that it is called the fair deal, is that those who have more pay more and those who have less pay less.

At this time of housing crisis, the Department is acutely aware that access to housing is one of the key social determinants of health. Providing people with a home of their own enables them to access a range of community supports, including, where required, health services in their community.

Some older people who avail of the NHSS leave their homes vacant while accessing care. While there are many reasons for this, it is probable that the standard financial assessment rules have acted as a disincentive to some who would otherwise have chosen to sell or rent out their home. This must now be balanced against the national priority to maximise the use of the existing housing stock, including the homes of those who are in care. To address this, in line with departmental policy commitments, the Nursing Homes Support Scheme (Amendment) Act 2021 removed a disincentive to selling a home left vacant by changing the way in which those sale proceeds were assessed.

The Department of Health, in collaboration with our colleagues in the Department of Housing, Local Government and Heritage, is now developing a further amendment to reduce a disincentive for participants in the scheme to rent out their home. As committed in Housing for All, it is important to ensure that this incentive is developed "in a way that is targeted, equitable, evidence-based and provides appropriate safeguards for vulnerable older people". The proposed amendment will reduce the rate of assessment on rental income from the home to 40% rather than the previous 80%. The Department and stakeholders have highlighted concerns about the unintended consequences of this measure. Many of these impacts are expected to be mitigated by the partial nature of the exemption and will be monitored through a review. This review will also provide for an ability to amend the rate of assessment further, should it prove necessary and appropriate.

In conclusion, it is a key objective of the Government and the Department of Health to ensure, where possible, that older people can live and age well in their own homes and communities. The Department is also committed to supporting equitable and affordable access to safe, high-quality long-term residential care for older people when and where required. Now, by rebalancing the incentives created by the fair deal scheme, the Department is also delivering actions to increase the number of potential properties available in the State thus further supporting access to housing for all.