Kathleen Lynch (Cork North Central, Labour)

I thank the Deputies for raising this issue. I agree with both of them that this is a very worrying time, not just for elderly people but for their families and those who support them.

This issue relates to the nursing homes support scheme, the fair deal, which is a system of financial support for individuals in public, voluntary and approved private nursing homes. The scheme is available to anyone assessed as needing long-term nursing home care, including dementia-specific nursing home care. The scheme involves a fundamental change in the way in which long-term nursing home care is funded. The new scheme supports the individuals in need of long-term nursing home care, not the facilities providing the care. This means that money follows the patients, regardless of whether they choose public, private or voluntary nursing homes. It ensures that these facilities are not being funded for empty beds. Almost 21,000 applications for the scheme have been received since its commencement, with nearly 3.000 applications received in the first quarter of 2011. Over 16,000 of these have been processed to completion.

It is important for people who are already in care to be assured that there is no threat to them. Old people are vulnerable enough and it is easy to worry them.

The legislation underpinning the scheme enshrines the principles of a resource cap, patient choice and funding following the patient. In this regard the total long-term residential care budget in 2010 was €979 million. The budget for long-term residential care in 2011 is €1.011 billion. This is effectively funding for the nursing homes support scheme, albeit that transitional arrangements, for example subvention, contract beds and saver cases in public nursing homes, must also be facilitated from within the subhead. The Nursing Homes Support Scheme Act 2009 defines "long-term residential care services" as maintenance, health and personal care services. The services which fall within the scope of long-term residential care include nursing and personal care appropriate to the level of care needs of the person; basic aids and appliances necessary to assist a person with the activities of daily living; bed and board; and laundry service.

The cost for each public nursing home has been determined using the definition of "long-term residential care services" underpinned by an agreed set of cost components which has been laid before the Houses of the Oireachtas. The scheme does not cover therapies because a person's eligibility for other schemes, such as the medical card scheme or the drugs payment scheme, is unaffected by the nursing homes support scheme. In other words, a person can continue to receive goods and services in accordance with the terms of these other schemes regardless of whether they are in a private nursing home or elsewhere. In determining the services covered by the nursing homes support scheme, it was considered very important that the care recipient and the taxpayer would be protected and would not end up paying for the same services twice. For this reason, goods and services that are already prescribed for individuals under an existing scheme are not included in the services covered by the new nursing homes support scheme because this would effectively involve paying twice for the same items or service.

As the Deputy is aware, the Minister for Health and Children has recently been made aware of a serious shortfall in the budget for this year. The budget is coming under pressure from, among other things, increases in overall costs and increases in net demand for long-term care. Furthermore the HSE has advised that the long-term residential care subhead is also funding services other than those covered by the nursing homes support scheme.

I should point out that we understand these other services, which include therapies and medications, are being provided to people in nursing homes. The Minister is currently seeking to ensure that only agreed costs are met from the long term residential care budget. The Minister has sought further information about the level of funding provided for, and the costs drivers impacting on the fair deal budget. The main priority at this stage is to establish what steps might be taken to allow more people to benefit from the scheme. In the meantime, applications for financial support under the scheme will continue to be accepted and processed. However decisions to grant approval will be subject to the availability of funding. A full examination of the funding situation is underway, conducted jointly by the Department of Health and Children and the HSE. The commitment in the programme for Government to review the fair deal scheme will be undertaken separately.

I find it rich to listen, not to Deputy Ó Caoláin, but to a Deputy who was a Minister of State when the Government allowed the Minister for Health and Children to distance herself so far from the Department that it was not merely at arm's length but out of her control. What we are looking at here must have been seen by the previous Government before it went out of office.

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