Thursday, 13 October 2005
Nursing Home Subventions.
I am grateful for the opportunity to raise this important issue. The HSE western area has decided to abolish the payment of enhanced subvention for nursing home residents due to funding shortfalls. This is an unacceptable cutback. Although 117 people in Mayo in receipt of enhanced subvention will continue to receive it, anyone else without independent means requiring a nursing home place will no longer be able to afford it. In the case of a rock bottom nursing home tab of €450 per week a funding shortfall of €100 per week will exist.
Cutbacks of some 100 beds have been made in Mayo in recent years. As the State is unable to provide sufficient public residential beds, older people will occupy even more acute hospital beds for longer periods because there is nowhere else for them to go. This will worsen the trolley chaos that already exists. The entire subvention scheme is unacceptable and is in disarray.
Nationally there is disparity between amounts payable for a nursing home place. For enhanced subvention the maximum amounts payable, after subvention and pension payments, range from €680 or more in the east of Ireland to €30 in the mid-west. This range across the country is unacceptable, especially in respect of the new HSE set-up where so much uniformity had been promised. Older people need some certainty on the funding available so that plans can be made. If nursing home places are needed there must be certainty on availability of places.
I urge the Minister for Health and Children, Deputy Mary Harney, to address the chaos that exists by providing the necessary funding to the HSE to restore enhanced subvention payments. The HSE does not receive a designated budget to make these payments. In recent years services had to be cut back in order to make these payments. Our older people deserve better than to be subjected to this additional trauma.
Enhanced subvention exists for people who have nothing else. Means testing has proved that these people have nothing, no money except the pension, no land, no property and no relatives with money. If relatives exist they do not have money and the old people are totally impoverished. These people are at the mercy of the State and it is letting them down and I regard this as another cutback. In the HSE western area the maximum subvention is €220 per week and once a pension is added to this there remains a funding shortfall of €100. Enhanced subvention is a necessary top-up for those people. Otherwise, where can they go? They will end up occupying a hospital bed. If the State does not pay this top-up for them, they will be unable to afford a nursing home place and will continue to occupy that hospital bed, thereby unwittingly depriving someone with an acute condition of that bed. A person will be on a trolley downstairs in a hospital because the bed upstairs is occupied by an older person who would prefer to be in a nursing home.
I thank Deputy Cowley for raising this matter on the Adjournment. On behalf of the Tánaiste and Minister for Health and Children, Deputy Harney, I wish to outline to the House the current position regarding enhanced subvention in the western area.
Deputy Cowley and all Members of the House will be aware that the nursing home subvention may be paid towards the cost of private nursing home care where a person is unable to meet the cost or where he or she has been assessed as needing nursing home care by the Health Service Executive and where the person has satisfied a means test. The amount of subvention will depend on the degree of nursing home care required, that is, medium, high, maximum, and the amount of the person's assets including property, stocks and shares, savings etc. The rates of subvention payable are as follows: for medium dependency there is a payment of €114.30 per week; for high dependency the payment is €152.40 per week; and the amount for maximum dependency is €190.50.
The nursing home subvention scheme was introduced to assist with the cost of private nursing home charges and was not intended to cover the entire cost of nursing home care. However, I am very aware that the gap between the rates of subvention being paid and nursing home costs has widened considerably in recent years.
The Health Service Executive may, in accordance with article 22.4 of the Nursing Home (Subvention)(Amendment) Regulations 1996, pay more than the maximum rate of subvention relative to an individual's level of dependency, for example, in cases where personal funds are exhausted. The application of these provisions, however, is a matter for the HSE in the context of meeting increasing demands for subventions.
The average rate of subvention paid by the HSE generally exceeds the current approved basic rates mentioned above. Spending on the nursing home subvention scheme has increased from €5 million in 1993, when it was introduced, to a figure in the region of €140 million this year.
When a person applies for a subvention it is subject to a means test and a person's assets are taken into account, but the test currently being used is very much in need of a change. If person's house is valued at more than €95,000, it would rule him or her out but one would have to travel a good distance before one would find a house worth less than that. When one considers that the average price of a second-hand house in Dublin is close to €400,000, it gives some indication of the necessity to change the guidelines. We will be announcing changes in that regard in the near future.
The Department has been informed by the HSE that the position in the western area is that every person in receipt of nursing home subvention and enhanced nursing home subvention is being paid and will continue to be paid. There is a heavy demand for enhanced nursing home subvention. Each individual application for enhanced nursing home subvention will be reviewed by the local health office manager in each county in the HSE western area and each case will be considered individually. Also, as part of the 2006 Estimates process, proposals have been put forward by the HSE for additional funding for the western area.
A working group chaired by the Department of the Taoiseach and comprising senior officials from the Departments of Finance, Health and Children and Social and Family Affairs has been established. The objective of this group is to identify the policy options for a financially sustainable system of long-term care, taking account of the Mercer report, the views of the consultation that was undertaken on that report and the review of the nursing home subvention scheme by Professor Eamon O'Shea. This group is expected to report to the Tánaiste and to the Minister for Social and Family Affairs in the very near future.