Thursday, 10 February 2005
Nursing Home Subventions.
Question 6: To ask the Tánaiste and Minister for Health and Children if she has plans to change the criteria for supplementary subvention as provided by health boards to bring it more into line with current nursing home costs; and if she will make a statement on the matter. [4215/05]
Question 20: To ask the Tánaiste and Minister for Health and Children if she has plans to increase the maximum rate of supplementary subvention that is awarded to patients going into nursing homes; and if she will make a statement on the matter. [4216/05]
I propose to take QuestionsNos. 6, 20 and 90 together.
As the Deputy will be aware, responsibility for the administration of the Nursing Home (Subvention) Regulations 1993 rests with the Health Service Executive. There are currently three rates of subvention payable under the regulations, that is, €114.30, €152.40 and €190.50 for the three levels of dependency which are medium, high and maximum.
Under Article 10.6 of the Nursing Homes (Subvention) Regulations 1993, the executive may pay more than the maximum rate of subvention in a case, for example, where personal funds are exhausted. The application of these provisions in an individual case is a matter for the executive in the context of meeting increasing demands for subvention subject to the provisions of the Health Act 2004. The average rate of subvention paid by the executive generally exceeds the current approved maximum rate of subvention.
The nursing home subvention scheme is being reviewed by my Department and I do not intend to increase rates of subvention pending the outcome of the review.
Will the Minister of State confirm that no consideration has been given to existing patients under the Tánaiste's ten point plan outlined in respect of the accident and emergency crisis? Will he also agree that the average cost of nursing homes has doubled in the past four years? Will he agree that the current rate of subvention payments he outlined are derisory for the patients involved? Does he consider it acceptable that patients have to practically beg the health service to get an enhanced subvention? Will he agree that these patients are at the mercy of CEOs in the health service? How does he feel about the fact that 60%, or the majority, of nursing home patients pay between €400 and €500 per week to nursing homes?
Will the Minister of State clarify his remark to the effect that when patients no longer have any more means the health service can give higher rates? I am dealing with two cases where patients sold their family homes a few years ago. They wrote to the health service advising that their funds are now exhausted. In these cases it is not the position that these patients have their family homes; they have sold them. They have been given little or no assistance by the health service involved. Their position is not in agreement with what the Minister of State said. Will he comment on those important questions?
We provided €5 million when the subvention scheme was introduced in 1993. Last year we spent over €114 million on it and this year it is expected that we will spend approximately €120 million on the scheme.
When the scheme was introduced it was never intended that it would cover the full costs of nursing home care; it was intended to provide some assistance. I accept what the Deputy said about the amount of assistance being provided, that the top-up payments families must pay are increasing and that puts pressure on a number of families.
We are reviewing the scheme. The Department of Social and Family Affairs is also involved in this. We had a meeting on this matter earlier this week and it is being treated as a priority. We have appointed a group of senior officials to oversee this work and bring proposals to Government in mid-2005.
The Minister of State said nothing about the patients who have gone broke and have no funding. These supplementary payments have not increased since 2001, even though I pointed out all the other developments that have happened since that time. We have been waiting for a policy on the long-term care of the elderly for four years. Under the circumstances and with what is happening in acute hospitals and in the community, we must move faster to resolve these problems and not let them reach crisis point.
If the Deputy knows of individual cases of particular hardship, he can provide us with the details and we will examine them. The funding of long-term care is a problem and we are treating it as a priority. We hope to introduce proposals on it later this year.
I also know of cases where people have been pauperised. They are dependent on the enhanced subvention and find that the cost of nursing home care is increasing to the point where they can no longer pay the bill. Will the Minister of State look at the number of discretionary payments being made over and above the limits? I suspect the numbers are very small. I am in contest with the East Coast Area Health Board about a case and it has been a less than edifying experience.
People suffering from Alzheimer's disease require high maintenance care in the late stages of the condition and the cost of nursing home care can be extremely high, far greater than the enhanced subvention. Will provision be made for people who have those high costs?
There was recognition in the legislation that people living in long-term community welfare homes are entitled to retain a small portion of their pension. There is no such protection for people in a private nursing homes and often they must give up all of their pension, leaving them with no money. These people might not have relatives who can provide them with the small amount of money they need for ongoing expenses or their partners may be on the old age pension and barely able to look after themselves. Will that be examined when the policy is being developed?
Currently, more than 7,000 people are in receipt of a subvention. The subvention scheme is under review and, under the Nursing Homes Subvention Regulations 1993, the executive may pay more than the maximum rate of subvention in a case where there is severe difficulty. It is not our intention to cause hardship and, where it exists, we would like to intervene and assist.
The Minister of State talks about hardship but the reality is that with a 12-year waiting list to get into a public nursing home in greater Dublin, many children find they have no alternative but to put their parents into a private nursing home. Does the Minister of State accept that an elderly person on a pension of €160 a week with a supplement of €80 a week cannot meet the balance, even with an enhanced subvention? Will the Minister of State make this a priority? We have been talking about reviews for a long time, particularly in greater Dublin where prices are exorbitant. We must deal with this by the middle of the year.
It gives some indication. This year we will spend €120 million. The scheme is not perfect and changes should be made. I regularly meet the difficulties raised by Deputies today. That is why we are reviewing the scheme — to introduce greater equity. The Mercer report examined the funding of long-term care and, following a meeting earlier this month, we appointed a number of senior officials to oversee this work. They will bring forward proposals to Government in the middle of this year. We realise the seriousness of the issue and we intend to act on it.
It depends on the family home. If I saw someone living in a property worth €1 million, I would not have any difficulty in that person paying for his or her care. It would be different for someone living in a small cottage with no means. They are different situations and it is hard for me to answer a question put in such general terms.
I am aware of a case of an elderly lady who lived in a small terraced house, a former council home, valued at €150,000, which is not a lot of money in today's terms. Her family live in other parts of the country and outside the country and that home was where they came when they visited. The mother, who was in a nursing home, could not get a subvention and her children had to sell the home and dispose of their mother's effects while she was still alive. For them the trauma was like dealing with their mother's death before she had died. From their coming home until the time of her funeral, there was nowhere to wake her or gather to share their memories of her. Is the Minister of State open to a more caring and humane approach in such cases?
Just as Opposition Deputies hear of these problems in their clinics, Government Deputies are told the same stories. We realise that such situations are extremely sensitive and must be dealt with in a sensitive manner. When assessing a person's means at present, if a property is valued at over €75,000, it is taken into consideration. That is a very small amount and very few properties would be excluded. We are aware the scheme needs to be changed. That is why it is being reviewed and we will show a caring approach in making the necessary changes to the scheme.