Tim O'Malley (Limerick East, Progressive Democrats)

I am taking the matter on behalf of my colleague, the Minister for Health and Children.

The charging for long-stay care under the Health (Amendment) Act 2005 is being implemented by way of the Health (Charges for In-Patient Services) Regulations 2005. These regulations were signed on 14 June 2005 and reinstated charges for inpatient services and provided for the levying of a charge in respect of the maintenance of persons in receipt of in-patient services. The regulations were prepared following extensive consultation with the HSE and others. Section 53 of the Health Act 1970, as amended by the Health (Amendment) Act 2005, provides, inter alia, for the levying of a charge where services have been provided for a period of not less than 30 days or for periods aggregating not less than 30 days within the previous 12 months.

The regulations, in keeping with section 53 of the Health Act 1970, as amended, have provided for two different classes of persons on whom charges can be levied. Class 1 refers to people in receipt of inpatient services on premises where nursing care is provided on a 24-hour basis on those premises. In this case, a weekly charge can be levied of €120, or the weekly income of that person less €35 or 80% of the weekly income of that person, whichever is the least. Class 2 refers to people in receipt of inpatient services on premises where nursing care is not provided on a 24-hour basis on those premises. In this situation, a weekly charge can be levied of €90, or the weekly income of that person less €55 or 60% of the weekly income of that person, whichever is the least. In this regard, charging of patients in long-term care commenced on 14 July 2005, which was after the expiration of 30 days after the regulations were signed. These regulations provide for the maximum charge to be levied on either class of person. The actual charge will vary from person to person depending on individual circumstances and under the legislation, the Health Service Executive can waive or reduce the charges to avoid undue financial hardship.

Following the enactment of the Health (Amendment) Act 2005 and the Health (Charges for In-Patient Services) Regulations 2005, the HSE established an expert group to deal with this complex area and to develop a set of national guidelines to deal with the provisions of the legislation. This expert group developed a comprehensive set of guidelines in line with best practice, having considered legal opinion and its implications in relation to complex cases.

Legal opinion received by the HSE advised that the legislation and the regulations apply to all persons who are provided with inpatient services either by the HSE or by an agency or service provider on behalf of the HSE where those persons are residing in a long stay institution or those persons with an intellectual, physical or mental disability are residing on community type residences where nursing or medical care is provided.

When drafting the guidelines, the expert group considered section 4(b)(4) of the Health (Amendment) Act 2005 which provides that the HSE may reduce or waive a charge imposed on a person if it is of the opinion that having regard to the financial circumstances of that person it is necessary to do so in order to avoid undue hardship for that person.

This was particularly relevant in the case of community hostels where the residents live largely independent lifestyles, assisted by appropriate supports, with the objective of realising their maximum potential to integrate with the local community.

In light of the above and in consideration of the additional expenses incurred as a result of this independent lifestyle, the criteria for assessment for residents in community hostels include an allowance up to a maximum of €90 per week towards socialisation and care plan expenses. This allowance relates to the additional expenses incurred as a result of greater independence and integration into the community.

When calculating the charge, the HSE also makes an allowance up to a maximum of €60 per week, for any contribution that the resident makes to the weekly running costs of the community hostel. In addition to these allowances, there are also other allowances listed in the national guidelines which can be factored into the assessment for a charge, if applicable. These include dependent child, life assurance, medical insurance, rent or mortgage allowances, loans or repayments, maintenance payments, travel costs, rehabilitative employment allowance and other outgoings.

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