Róisín Shortall (Dublin North West, Labour)

I thank Deputy Kelleher for raising this issue. The nursing homes support scheme will have been three years in operation in October and is on schedule to be reviewed this year. The scheme was introduced in 2009 with the commitment to review its operation after three years. The reason for allowing this period to elapse is to ensure that trends and statistics will be available to inform the work. The review is now on schedule for this year and is in the course of preparation. Among other issues, the review will examine the ongoing sustainability of the scheme; the relative cost of public versus private provision; the effectiveness of current methods of negotiating price in private, and setting price in public, nursing homes; and the balance of funding between residential and community care. As the Deputy can see, the review is wide-ranging. The views of relevant stakeholders will be considered as part of the review. Planning and terms of reference for the review are being finalised at present.

The nursing homes support scheme provides financial support to people who have been assessed as requiring long-term nursing home care. Applicants to the scheme undergo a financial assessment to determine how much they will contribute towards the cost of their care each week, and what portion of the cost the HSE will meet. The scheme is resource capped. In this regard, the total gross long-term residential care budget in the current year is €994.7 million. This is effectively funding for the nursing homes support scheme, albeit that transitional arrangements - that is, subvention, contract beds and people who were in public nursing homes prior to the introduction of the scheme - must be also facilitated from within the subhead.

Additional funding of €55 million was originally allocated to the scheme for 2012. However, the Minister for Health subsequently decided to transfer €13 million of the €55 million for a pilot scheme of increased and targeted community care interventions in 2012. The decision on the transfer of funding was taken following analysis of a report into the care needs assessment process which determines whether a person requires long-term residential care. The report was based on an audit of 1,200 persons in long-term residential care. It found, among other things, that while in 93% of the cases long-term residential care was recommended, in 40% of the cases the individuals were not considered for interventions such as home care packages. In a further 40% of the cases it is not clear if they were considered for such packages.

This report will now also form part of our consideration for the wider review now being planned. The special delivery unit is working with the HSE to ensure intermediate facilities and options are available to older persons with the overall objective of ensuring that as many people as possible are empowered to remain in their homes for as long as possible in line with their wishes and Government policy.

It is therefore a wide-ranging review but that is not to take from the success of the scheme itself. If we find that significant numbers of people are in long-term nursing home when they would prefer to be at home in supported housing with home help, we need to move in that direction. Given the way the system currently operates, it incentivises the residential aspect of care rather than the community setting, which is most people's first choice.

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