Paudge Connolly (Cavan-Monaghan, Independent)

I thank the Ceann Comhairle for selecting this issue for debate. I look forward to some answers from the Minister of State in regard to the nursing home subvention scheme. It is my understanding that changes to legislation should improve the lot of citizens, most especially in matters relating to the welfare of the elderly. The recent changes to the legislation on nursing home subventions, however, have been particularly hurtful for elderly people.

The situation prior to 1 January 2007 was that subvention was paid at a rate of €190 per week. Patients then contributed some €180 per week from their pensions, retaining €40, or €42 if they were over 80 years old. This gave a total of €370, with an additional enhanced subvention being met by the HSE to give a total of €650, which met the average cost of a bed in the Cavan-Monaghan area. Since 1 January, however, the nursing home subvention was increased to €300. Patients must still contribute €180 from their pension, giving an amount of €480, and the shortfall of €170 must be met by the patients or their families.

I understand the information I have supplied is correct. The first casualty in this new situation will be the few euro in pocket money that is left to patients every week. This will effectively be stolen by the HSE as the extra charge is imposed on patients and their families. The average cost of a bed in the Cavan-Monaghan area is anywhere between €650 and €800 per week but the HSE has set a minimal rate of €540. I cannot understand this. Many of the staff who must deliver these subvention programmes are unhappy.

It is unfortunate that the contract is between the patient and the nursing home and that the HSE has stepped out of the way. I have spoken to nursing home owners who say their prices will increase, if they have not already done so, because of the rising cost of oil, gas and electricity and as a result of rising staff wages. I heard of one nursing home with some 50 beds where the wages bill alone will increase by €100,000 per annum. In such circumstances, it is inevitable that the cost of beds will increase.

Another difficulty relates to the processing of subvention payments in general hospitals. Time is often wasted in trying to identify whether a patient is entitled to subvention, during which time a bed continues to be occupied in the hospital. When a patient is in hospital his or her charges are met by that hospital but it is a different situation when the patient enters a nursing home, where a different budget is in operation. There is constant internal wrangling about who pays for what. It is little wonder we have difficulties in Beaumont Hospital, for instance, given that one in six beds there are occupied by patients who are already fit for discharge. Many such patients remain there for three months or more at a high cost to the community.

Attempts to deal with this problem between August 2005 and December 2006 focused on five discharge initiatives. These initiatives helped to free up beds in Beaumont Hospital but people with elderly relatives realise quickly that if there is one discharge initiative followed by four others, it is most likely there will be further such initiatives.

Discharge initiatives are favourable to patients. It pays them to stay in the hospital bed because there is no means testing of discharge initiative patients. They are asked only to contribute €120 per week from their pension on an ongoing basis. This is not the way forward. We must ensure there are more nursing home beds in the community. Another difficulty is that some nursing homes are charging more than €1,200 per week for a bed. It is not the best use of health service resources to subsidise such a luxurious level of accommodation.

It is vital that more geriatricians are appointed in the health service. In County Meath, for example, there is not one geriatrician available to patients. This has knock-on effects. It is unacceptable that patients should have to wait up to 18 months for geriatrician appointments and occupational therapy assessments.

Hospice cover is also required for patients at weekends. Such patients receive excellent care from Monday to Friday but those families who wish to look after their relatives at home are isolated at weekends.

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