Pat Breen (Clare, Fine Gael)
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Nursing home subvention levels are payable by the HSE. The subvention is means-tested and there are considerable problems associated with the means by which applicants are measured. The most substantive issue, however, is the subvention amount. Prevailing market conditions among private nursing homes makes the means-testing and the subvention amounts meaningless.

I have received many complaints about this. In Ennis, I have one instance where an individual is paying €1,500 a month to a nursing home. Despite the resident being on the top level of subvention — €400 of this is for a special bed — he must pay an enormous sum to make up the deficit. For a person on a modest salary, paying €1,100 a month for a relative in a nursing home is the equivalent to paying a sizeable mortgage.

I have examined nursing home charges in County Clare. With the exception of public nursing homes, the amounts charged bear no relation to the subvention amounts paid. Six private nursing homes in County Clare charge between €560 and €657 a week for a private room. The cheapest rate I could find in the private sector was €540 a week for a twin room. In contrast the amounts payable by the HSE for subvention are €114, €152.40 and €190.50 a week, according to the level of dependency of the patient. Nursing home charges, therefore, amount to between three and four and a half times the subvention rate, without the luxury of a private room. If the modest old age pension of less than €200 a week is applied, there is still a considerable shortfall which very often has to be met by hard-pressed relatives struggling with their own financial problems. If one is paying the more expensive nursing home charges being levied in the cities, such as in the Minister of State's area of Dublin, the gap widens even more.

The Government's continuing failure to tackle the accident and emergency crisis has led to some people opting to stay at home to die rather than face the drudgery of the health service, as highlighted in last week's "Prime Time Investigates" programme. Furthermore, due to the costs of private nursing home care and the State's failure to provide more realistic subvention levels, people are being forced to stay at home in more problematic conditions. Hardship cases cannot be taken on directly by the State because of the lack of sufficient numbers of public nursing home beds. Only applicants with nursing home needs can make it through the assessment criteria even though they must often wait a year or more before a place comes up. Those who are particularly vulnerable are bachelors and spinsters with no near relatives. Even if they have assets such as land or a home, for one reason or another they often cannot realise them. These people end their days in poverty. They may not be in ill health but cannot cook for themselves or carry out some basic tasks and they fall through the State safety net. This year is the 90th anniversary of the 1916 Rising and it is astonishing that elderly people are still treated in such a shabby manner. It is appalling that those who built the State should have to end their days in such conditions.

I was amazed to learn that despite the huge rises in nursing home care costs, the Minister has not deemed it necessary to increase the subvention levels or to relax the means testing criteria in recent years. The Minister should also look at the discretionary hardship payments from the HSE. In County Clare, it is €65 per week. This is not just discretionary it is subject to budgetary constraint and varies from region to region. Why is it not standardised and separate from budgetary conditions?

I implore the Minister to look at this area, which is of great concern to the people of County Clare and other areas, and to increase subvention levels or authorise the HSE to provide finance to allow for the relaxation of the means test and standardisation of the discretionary hardship payment. The money should be spent where it is needed, not on wasteful projects such as electronic voting.

Brian Lenihan Jnr (Dublin West, Fianna Fail)
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I will take the Adjournment on behalf of my colleague, the Tánaiste and Minister for Health and Children. I thank the Deputy 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, medium, high or maximum, and the amount of the person's assets, including property, stocks and shares, savings, etc. The rates of subvention payable are: 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 Home (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.

Spending on the nursing home subvention scheme has increased from €5 million in 1993, when it was introduced, to €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 palliative care services 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 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. The Department of Health and Children is also currently 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 this legislation is currently proceeding through the Oireachtas.

The thresholds contained in the Nursing Homes (Subvention) Regulations 1993 for 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 from the Departments of Finance, Health and Children and Social and Family Affairs was established following on from the publication of the Mercer report entitled, Study to Examine the Future Financing of Long-Term Care in Ireland. 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 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 has been submitted to Government, where it is being considered.