Marcella Corcoran Kennedy (Offaly, Fine Gael) | Oireachtas source

I move amendment No. 1:

To delete all words after "Dáil Éireann" and substitute the following:"recognises that:

— the Nursing Homes Support Scheme (NHSS) provides financial support towards the cost of long-term residential care services in nursing homes. It is an important scheme, ensuring that long-term nursing home care is accessible to everyone assessed as needing it, regardless of their age;

— with a budget of €940 million in 2017, the NHSS will support just over 23,600 people by the end of the year;

— the time applicants spend on the placement list for funding has not exceeded four weeks since early 2015 and we must ensure that any changes to the NHSS do not impact on this;

— under the NHSS, an applicant contributes up to 80 per cent of their assessable income and a maximum of 7.5 per cent of the value of any assets per annum. The State then pays the balance of the cost of care. Notably, the first €36,000 of an individual’s assets, or €72,000 in the case of a couple, is not counted at all in the financial assessment;

— the NHSS has a number of important safeguards built into it. Among these safeguards is the provision that nobody will pay more than the actual cost of care. Furthermore, where an applicant’s assets include land and property held in the State, the contribution based on such assets may be deferred and collected from their estate. This is the optional loan element of the NHSS, the purpose of which is to ensure that a person does not have to sell their home during their lifetime to pay for long-term nursing home care. A nursing home resident can apply for this deferral at any stage; and

— an applicant’s principal private residence will only be included in the financial assessment for the first three years of their time in care. This is known as the ‘three year cap’;

further recognises that:

— when the NHSS commenced in 2009, a commitment was made that the scheme would be reviewed. The report of the review was published in July 2015. Arising out of that review, a number of recommendations called for more detailed consideration of key issues, including the treatment of business and farm assets for the purposes of the financial assessment element of the NHSS;

— the Programme for a Partnership Government has also committed to reviewing the NHSS to remove any discrimination against small businesses and family farms;

— an interdepartmental/agency working group has been established to oversee the implementation of many of the recommendations contained in the review of the NHSS;

— considerable policy work has been taking place in the Department of Health in relation to examining potential solutions to the issues raised. Proposals for changes to the NHSS are being developed, with the specific intention of addressing and alleviating the concerns of the farming community when it comes to the uncertainty that many farming and business families feel in relation to the annual contribution to the NHSS and the potential impact of this on the sustainability of the farm or business;

— the NHSS is underpinned by primary legislation, and as such any changes made to the scheme will require amendment to this legislation. The issues currently being examined are legally complex, and all aspects of the NHSS need to be taken into consideration. The equitable treatment of people under the NHSS must be borne in mind and we must be cognisant of the constitutionality of any proposed changes in terms of equality of treatment;

— it is essential that any amendments made to the NHSS do not in any way negatively impact on its future financial sustainability. The NHSS is a vital piece of the wider healthcare system, and we must be cognisant of the fact that any negative impact on the scheme would have wider detrimental implications for the health service;

— the important position and contribution of the farming community in Irish society is recognised and valued. The importance of maintaining the farm as a productive asset to be passed down within the family unit is acknowledged;

— the important position and contribution of the business community, particularly small family-run businesses, in Irish society is recognised and valued. The importance of maintaining a business as a productive asset to be passed down within the family unit is also acknowledged;

— the concerns that farming and business families have in relation to the NHSS, particularly regarding the uncertainty of future liabilities based on the farm or business value in cases of family members working the farm or business is acknowledged;

— the NHSS already contains provisions in relation to the treatment of income generating assets such as farms; and

— in particular, the three year cap applies to a person’s farm or relevant business under certain circumstances as follows:

— the person has suffered a sudden illness or disability which causes them to need long-term nursing home care;

— the person or their partner was actively engaged in the daily management of the farm up until the time of the sudden illness or disability; and

— a family successor certifies that he or she will continue the management of the farm; and

calls on the Government to:

— bring forward the proposed changes in relation to this issue in the context of Budget 2018;

— honour the commitment in the Programme for a Partnership Government to remove discrimination against small businesses and family farms; and — publish the necessary primary legislation required to bring effect to these proposed changes to the NHSS without undue delay following the completion of the examination of this issue and decisions in the context of Budget 2018."

I thank the Deputies for the opportunity to speak about the fair deal scheme and the issue of family farms and small businesses and how they are treated under the existing legislation. As outlined in A Programme for a Partnership Government, we are fully committed to introducing changes as soon as practicable to remove discrimination against small business and family farms under the fair deal nursing home scheme. This is something my colleague, the Minister of State, Deputy McEntee, is committed to delivering and I assure the House that work is well under way on this issue.

The Government’s priority is to ensure our older population is looked after, supported and protected. We are living longer than ever before, and, thankfully, the signs are that this trend will continue. This is something to be celebrated and embraced, however, we must also be cognisant of the fact that our ageing population brings about challenges across a wide range of areas, not the least of which is long-term care. We know that most of our older people want to remain in their own homes and communities for as long as they are able, and it is certainly Government policy to support this and something about which we feel strongly. It is a fact, however, that there will always be a cohort of people who require access to quality long-term residential care. We must ensure that this is provided, especially when people are at such a vulnerable stage in their lives. Access to suitable long-term care must be available to people if they require it. To ensure this, we must protect the successful operation of the fair deal scheme, and ensure that it continues to afford that access in a sustainable way.

The nursing homes support scheme, NHSS, or the fair deal scheme as it is commonly known, is a system of financial support for those assessed as needing long-term nursing home care. Participants contribute to the cost of their care according to their means while the State, through the Health Service Executive, pays the balance of the cost. The scheme aims to ensure that long-term nursing home care is accessible and affordable for everyone and that people are cared for in the most appropriate settings. Anyone who is assessed as requiring long-term residential care can avail of the scheme, regardless of age, as long as the person's care needs can be appropriately met in a nursing home that participates in the scheme.

With a budget of €940 million in 2017, the scheme will support just over 23,600 people by the end of this year. In order to manage the available funds within budget throughout the year, a national placement list is operated by the HSE, whereby funding approvals issue to applicants in chronological order. This ensures equity nationally. The budget for the scheme and its successful operation will ensure that the time applicants spend on the placement list for funding should not exceed four weeks. In fact, waiting times for funding have not exceeded four weeks since early 2015, and we must ensure that any future changes to the scheme do not undo this success. This is in the interests of all our older people. The fair deal scheme covers the cost of the standard components of long-term residential care, which are nursing and personal care appropriate to the level of care needs of the person, bed and board, basic aids and appliances necessary to assist a person with the activities of everyday living and laundry service.

A financial assessment is carried out by the HSE to determine how much applicants can contribute to the cost of their care. Applicants will contribute up to 80% of their assessable income and a maximum of 7.5% of the value of any assets per annum. The State will then pay the balance of the cost of care. A person’s level of contribution is unaffected by their choice of nursing home, be it a public, private or voluntary nursing home. It is important to note that an applicant's principal private residence will only be included in the financial assessment for the first three years of their time in care. This is known as the three year cap.

The scheme ensures that nobody will pay more than the actual cost of care and contains a number of important safeguards. Where an applicant's assets include land and property held in the State, the contribution based on such assets may be deferred and collected from the estate. This is the optional loan clement of the scheme, the purpose of which is to ensure that people do not have to sell their home during their lifetime to pay for long-term nursing home care. A nursing home resident can apply for this deferral at any stage.

Other important safeguards are also included in the scheme. The first €36,000 of an individual’s assets, or €72,000 in the case of a couple, is not counted at all in the financial assessment. An applicant will keep a personal allowance of 20% of his or her income or 20% of the maximum rate of the State non-contributory pension, whichever is greater. This is in recognition of the fact that, although the NHSS covers core living expenses, residents can still incur some costs in a nursing home, such as social programmes, newspapers or hairdressing. If an applicant has a spouse or partner remaining at home, he or she will be left with 50% of the couple's income or the maximum rate of the State non-contributory pension, whichever is greater. If both members of a couple enter nursing home care, they each retain at least 20% of their income, or 20% of the maximum rate of the State non-contributory pension, whichever is greater.

Certain items of expenditure, called allowable deductions, can be taken into account for the financial assessment, including health expenses, payments required by law, rent payments and borrowings in respect of a person's principal private residence. A person's eligibility for other schemes, such as the medical card scheme or the drug payment scheme, is unaffected by participation in the nursing homes support scheme or residence in a nursing home.

I will now look in detail at the treatment of small businesses and family farms under the fair deal nursing home scheme. On Second and Committee Stages of the Nursing Homes Support Scheme Bill, concerns were raised about the treatment of farms, in particular the potential impact of the annual charge on the sustainability of family farms and businesses, and specifically in circumstances where care may be required for a long period of time. It is Government policy to encourage orderly succession arrangements for farms, and this is also endorsed by farming organisations and, I am sure, most public representatives in the House. Revenue has a number of schemes in place designed to protect the value of a transferred family farm, such as tax relief schemes relating to capital gains tax, capital acquisitions tax, stamp duty, capital allowances, stock reliefs, income tax exemptions for land leasing and income tax exemptions for profits from woodland.

In most cases, early succession arrangements in families should ensure that farm assets are transferred well in advance of five years before nursing home care is required, meaning that a levy on the farm asset is, in fact, avoided entirely. The rate of people planning succession in an early manner is still not as good as it should be, and again I take this opportunity to encourage everyone, particularly farmers, to commence, in a timely way, their succession planning. Taking all of this into account, and in acknowledgment that unexpected health events can occur which prevent early succession arrangements, a farm or relevant business can also qualify for the three year cap.

This applies where the person has suffered a sudden illness or disability which causes him or her to need care services; the person or his or her partner was actively engaged in the daily management of the farm up until the time of his or her sudden illness or disability; and a family successor certifies that he or she will continue the management of the farm.

Concerns have been raised about the treatment of family farms and small businesses under the fair deal scheme. As outlined in A Programme for a Partnership Government, we are fully committed to introducing changes as soon as practicable to remove discrimination against small businesses and family farms. My colleague, the Minister of State, Deputy Helen McEntee, is committed to delivering on this commitment. I assure Members that work is well under way on the issue.

When the nursing home support scheme commenced in 2009, a commitment was made that it would be reviewed. The report on the review was published in July 2015. Arising from the review, a number of recommendations called for more detailed consideration of key issues, including the treatment of small family business and farm assets for the purposes of the financial assessment element of the scheme. In advance of the review, submissions were sought from groups or bodies which wished to make a contribution. The Irish Farmers Association and others made submissions in that context. The submissions were taken into account when the report on the review was being prepared. An interdepartmental agency working group, chaired by the Department of Health and including representatives from the Department of the Taoiseach, the Department of Public Expenditure and Reform, the HSE and the Revenue Commissioners, has been established and is overseeing the implementation of many of the recommendations contained in the review. The recommendations include improvements to the administration of the scheme; a review of how prices for private and voluntary nursing homes are set by the National Treatment Purchase Fund; a value for money and policy review of the cost differentials in public and private or voluntary residential facilities.

As I said, the treatment of family farms and small businesses is an important matter for consideration by the Department and work on the matter is nearing completion. In fact, as outlined in our amendment, we will bring forward the proposed changes related to this issue in the context of budget 2018 and will honour the commitment in A Programme for a Partnership Government to remove the discrimination against small businesses and family farms. It is important to note that the nursing home support scheme is underpinned by primary legislation and changes made to the scheme will require an amendment to that legislation. The issues being examined are legally complex and all aspects of the scheme must be taken into consideration. Earlier I mentioned the equitable treatment of people under the scheme. We must be cognisant of the constitutionality of proposed changes in terms of equality of treatment and ensure the proposals we bring forward will be legally robust. We are committed to the review of the treatment of family farms. The Minister of State, Deputy Helen McEntee, and I appreciate the concerns of farm and business families about the scheme, particularly the uncertainty of future liabilities based on the farm value in the case of family members working the farm, an uncertainty brought about by not having a cap on these liabilities. These considerations are being taken on board. I again confirm that we will bring forward the proposed changes in the context of budget 2018 and that we will honour the commitment in A Programme for a Partnership Government to remove the discrimination against small businesses and family farms.

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