Máire Hoctor (Tipperary North, Fianna Fail)

I propose to take Questions Nos. 14, 33, 53, 71 and 87 together.

The Bill providing for the new nursing home support scheme, A Fair Deal, is currently being finalised by the Office of the Attorney General and will be published when it has been approved by Government.

Details of the fair deal were announced in December 2006 to facilitate full consultation with the social partners and other stakeholders. The legislation is complex and requires careful drafting to ensure the interests of older people requiring residential care are fully protected. In the course of progressing the legislation, the Department has received legal advice on a number of matters, some of which are the subject of consideration in the context of finalising the Bill. The issues are legal rather than constitutional in nature. However, it would not be appropriate to comment further until the Bill has been brought before the Government for approval.

The fair deal is designed to remove from real financial hardship individuals and their families who under the current system of nursing home subvention must sell or remortgage their homes to pay for nursing home care. There will be one transparent system of support towards the cost of care that will be fair to all irrespective of whether they are in public or private nursing homes. The basic commitments of the new scheme are that individuals will be asked to contribute, based on income and assets; the HSE will meet the balance of cost in homes approved for the purpose; individuals will not have to sell or mortgage their homes; individuals will not have to borrow to fund costs; individuals will not experience unaffordable costs and an individual's family will not have to find money for his or her care.

The new scheme encompasses five key steps. The first of these steps is a care needs assessment carried out by a multidisciplinary team of HSE health care professionals. A person assessed as requiring residential care can apply to the HSE for a means assessment to calculate his or her contribution to care. Under the scheme, people requiring long-term residential care will contribute 80% of their assessable income, for example, their pension(s), whether for public or private nursing home care. Depending on the amount of a person's assessable income, there may also be a contribution of up to 5% of a person's assets. The State will meet the full balance of cost thereafter in public or private nursing homes.

Payment of the contribution based on assets can be made at the time when care is received or may be deferred until settlement of a person's estate. This deferred contribution will be based on the actual number of weeks spent in residential care, the cost of care and, consequently, may be less than 5% per annum. No one will pay more than the cost of their care. In addition, where the deferred contribution applies to the principal private residence, it will be capped at a maximum of 15%, or 7.5% in the case of one spouse in long-term residential care while the other remains in the home. This means that after three years in care a person will not be liable for any further deferred charge on the principal residence. It also means that as much as 85% of the value of the principal residence may be maintained for the beneficiaries of the person's estate. This is not something that can be guaranteed at the moment.

Where a spouse or certain dependants are living in the principal residence, the contribution may be further deferred until after the death of that spouse or dependant or until such time as a person previously qualifying as a dependant ceases to qualify as such. Finally, individuals can choose care in any approved private or public nursing home subject to availability and an ability to meet their particular needs. If an individual opts for a private nursing home, he or she will make a co-payment to the nursing home and the State will meet the balance of the cost to provide the service. If the individual opts for a public nursing home, the State will collect the co-payment and provide the service.

An additional €110 million has been provided for the introduction of the new scheme in 2008 and the development of long-term residential care services. I confirm to the Deputy that the HSE has not been instructed by Government or my colleague, the Minister for Health and Children, Deputy Mary Harney, to divert into other areas of health spending the €110 million allocated in budget 2008 for implementation of the fair deal scheme. However, it should be noted that the provision of 200 additional contract nursing home beds by the HSE was approved by the Minister for Health and Children in January of this year. The cost of the additional beds is to be met from within the HSE's total financial allocation in respect of long-term residential care services for older people.

Current standards for nursing homes are set out in the Care and Welfare Regulations 1993. The HSE inspects private nursing homes on the basis of these standards but public homes are not inspected. The Health Act 2007 provides for the registration and inspection of all nursing homes, public, private and voluntary. Future inspections will be carried out by the Office of the Chief Inspector of Social Services which is part of the Health Information and Quality Authority. The existing inspection and registration systems for residential services will be replaced by a strengthened and expanded system. Deputies will be aware that the board of HIQA submitted draft standards for approval by the Minister for Health and Children, as required under section 10(2) of the Health Act 2007. These draft standards are currently under consideration by the Department. The standards and regulations required to underpin them will be subject to a regulatory impact assessment, RIA, before finalisation. It is hoped work on the RIA and the regulations will commence later this year. In the meantime, the Health Service Executive continues to carry out inspections of private nursing homes under the Care and Welfare Regulations 1993.

Additional information not given on the floor of the House.

This is the first full year of operation of HIQA and the organisation is still in the process of recruiting staff and building up its operational capacity. It has been allocated a budget of €16.8 million in 2008 to meet the estimated costs of its planned work programme, including the phased commencement of nursing home inspections by the Office of the Chief Inspector of Social Services.

Under the fair deal, the National Treatment Purchase Fund, NTPF, will negotiate prices for long-term care with private nursing home owners on behalf of the State. While private nursing homes will also have to be registered to be approved for the purposes of the scheme, HIQA will not have to carry out inspections on all nursing homes prior to the introduction of the scheme.

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