Joe Callanan (Galway East, Fianna Fail)
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I thank the Minister of State for attending the Dáil to hear my call for extra funding for nursing home subvention in the western area, especially County Galway, where the level of enhanced subvention has been reduced. I will quote the difference in levels of subvention paid in the different areas. These figures were received from the association of nursing homes and include the full amount of basic and enhanced subvention. The rates are as follows. Those in the eastern area get €680, the southern area, €557 and the north-eastern area, €432, while the rate for the western area is €299 to €310. Clearly, the rates paid in the eastern area are more than double those paid in the west. I accept there may be a small difference in charges, but nothing like this.

Currently, there is a particular problem with the Galway area, where the enhanced subvention is capped at €85, giving a total rate of €275, leaving a major shortfall to be filled by relatives, even after taking old age pension into account. The annual budget for subvention in Galway last year was €9 million, but due to great demand, €11 million was spent. The HSE has now instructed the people involved that they must revert back to the figure of €9 million this year, so there must be a cutback. I call on the Minister of State to provide the money or to tell the HSE to provide the money for the increased enhanced subvention, especially in the Galway area, and to try to make the differences more appropriate so that payments in the eastern area are equivalent to those in the western area.

The criteria for improved enhanced subvention are also being curtailed. If a patient is on a waiting list for a public bed for which he or she is eligible, is offered a public bed and refuses, enhanced subvention payment ceases after a 28-day period. Where a patient's personal moneys have been depleted over the years while in a nursing home, enhanced subvention priority up to a maximum of €85 per week may be granted. This is subject to review. A patient must be resident in a nursing home for a maximum of six months to be in receipt of subvention prior to making an application for enhanced subvention. Exceptional cases will be reviewed by the general manager. This makes matters very difficult for patients in the western area. Nursing home charges have increased substantially in the past few years, but the biggest problem is that the basic subvention of €190 has not increased since the 1990s. This must be reviewed and a higher rate paid.

I thank the Minister of State for introducing the home care packages. I always believed home-based subvention should be brought in, but the home care packages are no doubt as close as the Minister of State can get to this. It means people can be treated in their own homes. I also felt the choice should be there. It is important that people can stay in their own homes and be treated there for as long as possible. I have nothing against nursing homes but if a survey were carried out, I believe most people would like to remain in their own homes for as long as possible. A time may come when that is not possible, but the home care packages are very welcome. I hope the scheme will be expanded to include more moneys in the future. I thank the Minister of State and ask him to review the situation, especially in Galway, and have the subvention rates increased to an acceptable level.

Tim O'Malley (Limerick East, Progressive Democrats)
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I am taking this matter on behalf of my colleague, the Tánaiste and Minister for Health and Children, Deputy Harney. I thank Deputy Callanan for raising the question as it provides me with an opportunity to outline to this House the current situation with regard to 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 and 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, that is medium, high, maximum, and the amount of the person's assets, including property, stocks and shares, savings and so on. The rates of subvention payable are as follows: 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 in the region of €140 million in 2005. Additional funding for services for older people and palliative care amounting to €150 million was allocated in the 2006 budget. This is the largest ever increase in funding for services for older people and demonstrates the Government's continued commitment to older people and putting them at the centre of health policy now and in the future.

The investment package is primarily focused on caring for people at home, in accordance with their expressed wishes. This is in line with international trends and reflects the growing independence of older people who want to stay living in their own communities. However, for those requiring residential care, the Government has allocated an additional €20 million towards the nursing home subvention scheme for 2006 to provide for extra subvention payments and address the variations in payments in different areas, as alluded to by Deputy Callanan.

The Department of Health and Children is working on primary legislation to expand the policies and principles of the subvention scheme to facilitate implementation of the scheme by the HSE throughout the country and it is intended to bring this legislation before the Oireachtas in the near future.

The thresholds contained in the Nursing Homes (Subvention) Regulations 1993 regarding an applicant's assets and the value of an applicant's primary residence were increased by regulation on 14 December 2005 to bring them into line with today's values.

A working group chaired by the Department of the Taoiseach and comprising senior officials of the Departments of Finance, Health and Children and Social and Family Affairs was established following publication of the Mercer report, Study to examine the future financing of long-term care. The objective of this group was 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 undertaken on that report and the review of the nursing home subvention scheme by Professor Eamon O'Shea. The report of the group has been submitted to Government and is being considered.