Tuesday, 22 November 2005
Nursing Home Subventions.
I am calling for the Minister for Health and Children to amend the nursing home subvention scheme under sections 22 and 23 of the Nursing Homes (Subvention) Regulations 1993 and to increase the subvention in view of the large number of families forced to avail of private nursing homes for elderly parents due to a lack of public nursing home places.
Owing to the shortage of beds in community hospitals, elderly people who need full-time care and attention must accept beds in private nursing homes. Elderly people are compelled to accept this situation without reference to means, although I am aware of the health liaison officer who organises admission to private nursing homes for people who are fit to be discharged from general hospitals.
In the Cork-Kerry area, 489 people are waiting for enhanced subvention. One can imagine their plight. Their families cannot afford to pay the nursing home fees while other elderly people in the community hospital benefit from free care. We accept that in our community hospitals, but there are private nursing homes in almost every parish and no extra beds have been placed in the community hospitals. People are forced to accept beds in private facilities that are not being paid for by the State. The Ombudsman has stated that if elderly people are entitled to medical care in a hospital, they are entitled to free care. Elderly people should have that long-stay care.
On the Nursing Homes (Subvention) Regulations 1993, the circumstances that are assessed for the purpose of these regulations includes the capacity of a son or daughter aged 21 or over residing in the jurisdiction. The 1993 regulations include assessing the ability of a person in respect of whom subvention is being sought to carry out tasks of daily living on the basis of his or her degree of mobility, ability to dress unaided, ability to feed unaided, ability to communicate, extent of orientation, level of co-operation, ability to bathe unaided and quality of memory and degree of continence. That is outrageous in this day and age when such a major percentage of the population is elderly and requires long-stay care in private nursing homes because there are no extra public beds. I call for the amendment of the Nursing Homes (Subvention) Regulations 1993.
I will take the Adjournment on behalf of my colleague, the Tánaiste and Minister for Health and Children, Deputy Harney. I thank the Deputy for raising the question as it provides me with an opportunity to outline to this House the current situation with the nursing home subvention scheme.
A nursing home subvention may be paid towards the cost of private nursing home care where a person is unable to meet the cost, 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 granted will depend on the degree of nursing home care required — medium, high or maximum — and the amount of the person's assets, including property, stocks and shares and savings. The rates of subvention payable are for medium dependency €114.30 per week, high dependency €152.40 per week and maximum dependency €190.50 per week.
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. Under article 22.3 of the Nursing Homes (Subvention) Regulations 1993, the HSE may enter into an arrangement with a registered private nursing home to provide inpatient services under section 52 of the Health Act 1970. In making an arrangement with a private nursing home under article 22.3, the HSE may pay more than the maximum rate of subvention, as mentioned already, relative to an individual's level of dependency, for example in cases where personal funds are exhausted in accordance with article 22.4 of the Nursing Homes (Subvention) (Amendment) Regulations 1996.
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 in 2005. The Department is working on changes to the regulations to, inter alia, update the assessment thresholds that are used when determining a person's eligibility for subvention to more appropriate up-to-date levels.
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 following the publication of the Mercer report entitled Study to Examine the Future Financing of Long-Term Care in Ireland. 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. The report of the group will be submitted to Government shortly.