Seán Power (Kildare South, Fianna Fail)

I move: "That the Bill be now read a Second Time."

I am pleased to have the opportunity to introduce the legislation. Government policy on older people has long since been to support them to live in dignity and independence in their own homes and communities for as long as possible and to support appropriate long-term care where this is no longer possible. It was for this reason that the nursing homes subvention scheme was introduced in 1993. The aim of this scheme is to provide financial assistance to older people towards the cost of maintenance in a private nursing home. The Bill is designed to ensure the existing subvention scheme for private nursing home care is grounded in primary legislation and it will also help the Health Service Executive to implement the scheme on a standardised basis across the country.

I will outline the major developments the Government is pursuing to improve services for older people before getting into the detail of the Bill. It has been the policy of successive Governments to endeavour to help older people maintain themselves in the community while, at the same time, providing for appropriate residential care, where living in the community is no longer possible. The policy of this Government in the development and delivery of services for older people is to maintain them in dignity and independence at home for as long as possible, in accordance with their wishes.

The focus on services for older people has increased over the past 18 months, particularly in the area of long-term care, whether residential or community-based. Additional funding for services for older people and palliative care amounting to €150 million was allocated by the Government in the 2006 budget — an additional €110 million for 2006 and an additional €40 million for 2007. This is the largest ever annual increase in funding for older people and palliative care and clearly demonstrates the Government's commitment to improving the quality of service provided to our older citizens. Approximately two thirds of this money was allocated to community support for older people. This is in line with the focus on keeping people in their own homes in independence and dignity, with proper health and social support systems in place in the form of, among other supports, home care packages, increased home help hours and increased day and respite care places. A full year cost of €55 million was allocated to home care packages, €30 million of which is for 2006. An additional 2,000 packages are to be delivered by the end of 2006, with the majority being implemented in the second half of this year. The latest HSE figures indicate 1,366 packages in place, 249 of which have been commenced since 1 January 2006. The delivery of the 249 packages means that the executive has met its targets for the first quarter.

Not every older person can, or wishes to, remain in his or her own home. Of the budget investment, €20 million has been allocated to the further development of the subvention scheme in 2006. This is a full year cost aimed at standardising means tests and bringing greater consistency to the different levels of enhanced subvention support throughout the country. A sum of €8 million of the budget package was also provided to cover the cost of 250 extra nursing home beds, which the HSE has sourced from private nursing homes. The HSE is in the process of sourcing 250 extra beds from private nursing homes to accommodate older people requiring such care.

The nursing homes subvention scheme was introduced in 1993 following the Health (Nursing Homes) Act 1990 and the subsequent Nursing Homes (Subvention) Regulations 1993 which were made under the Act. The purpose of the subvention scheme is to provide financial assistance to older people towards the cost of maintenance in a private nursing home. The scheme does not cover, nor was it ever intended to cover, the full cost of private nursing home care. The 1993 regulations provide that a subvention can be paid to an applicant qualifying on both dependency and means grounds. Dependency is assessed according to an applicant's ability to carry out the tasks of daily living, such as washing and dressing. There are three levels of dependency set out in the regulations, maximum, high and medium, which are referred to in the Bill ascategories I, II and III.

The maximum rate of subvention that may be payable to a person is determined in the first instance by their level of dependency, and the current maximum rates of subvention, as set out in the regulations, are €114.30 per week for a person of medium dependency, €152.40 per week for a person of high dependency and €190.50 per week for a person at the maximum rate of dependency. Once a person's rate of dependency has been determined, the HSE carries out a financial assessment of the applicant which takes into account the value of the applicant's income and assets, subject to certain exclusions outlined in the regulations. The appropriate level of subvention to be paid is then determined, based on the level of dependency and the outcome of the financial assessment of the applicant. This may result in the payment of the maximum level, a reduced level of subvention or no subvention at all, as appropriate to the determined dependency level. Where a person is married or cohabiting, the means assessment is based on half of the combined means of the couple. In certain cases, the Health Service Executive has the discretion to pay an enhanced rate of subvention over and above the rates outlined, such as where personal funds are exhausted. This discretion regarding individual cases is a matter for the HSE.

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