Catherine Murphy (Kildare North, Independent)
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I attended a meeting in St. Raphael's in Celbridge on Sunday. St. Raphael's is run by the St. John of God Brothers and the meeting was called to explain the new HSE long-stay charges. While the Health Act 2005 provided for charges, the context was the illegal charging of elderly people in nursing homes. I looked at the speech made by Minister of State, Deputy Seán Power, at the time and it focused heavily on the elderly. Indeed, the explanatory memorandum states that such weekly rate shall not exceed 80% of the maximum of the weekly rate of old age non-contributory pension within the meaning of the Social Welfare Acts.

We heard on Sunday of two categories of charges. Where a nurse is employed on a 24-hour basis, the charge is €120, and where the nurse is rostered for less than 24 hours the charge is €90. While I am focusing on St. Raphael's which cares for those with an intellectual disability, the charges also apply to those in community residences with a physical disability.

Many of those in the €90 category are occupied during the day with jobs in a sheltered environment on the campus. Some are in receipt of a social welfare payment of €168.50 per week but they will now be allowed to keep only €55. Many of these residents enjoy a trip to the cinema, bowling or selecting and buying their own clothes. This has a direct impact on them because €55 will not be enough.

A further category of people attached to St. Raphael's are in capital assisted houses with a house parent. This programme is paid for by the Department of the Environment, Heritage and Local Government, while the house parent is paid for by the HSE. They live within the surrounding community. This group will not have anything deducted from their welfare payment — an equity issue. Some of those who live in St. Raphael's are on the housing waiting list and aspire to living in a house within the community. That option, however, is not available to them. Not only are their housing aspirations not being met, but they are having their independence curtailed.

A young man described to me how he takes his brother out each weekend. Their parents are dead and he has very limited means himself, so he is concerned that he not will be able to continue to do this. He is also concerned about how his brother's needs will be met in terms of clothing, shoes and incidentals. The mother of a girl who requires 24-hour care talked to me about the extra costs of replacing clothes because her daughter has behavioural problems. Many of those who were at the meeting on Sunday were elderly and, while the scheme allows for exceptional needs, many do not wish to ask for such help.

It is not at all clear if the annual allocation to St. Raphael's will be cut by the amount collected; indeed, the administration will be an additional burden. One man on Sunday expressed the view that the net result may be that administration will wipe out the earnings from the charges.

St. Raphael's, unlike private nursing homes, relies to a great extent on fund-raising by the parents and friends of the institution. On Sunday as the relatives of residents were arriving to hear about the new charges, tickets were being sold for another fund-raiser to keep the show on the road. Without this support the State would have to fully fund other services and it is short-sighted that the same people are being hit twice. The expert group had the opinion of three different barristers and came to the conclusion that unless the law was changed the charges would have to be imposed. This is a particularly vulnerable group in society, who are in effect paying the price for illegal charging of those in nursing homes.

Not everyone is born with an equal chance in life. Some people, through accident or illness, lose part or all of their independence. These charges are mean. They go nowhere near covering the cost of the care provided, but that is not the point. I ask that a commitment be given to reconsider this issue with a view to introducing legislation to right a wrong.

Tim O'Malley (Limerick East, Progressive Democrats)
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I am taking the matter on behalf of my colleague, the Minister for Health and Children.

The charging for long-stay care under the Health (Amendment) Act 2005 is being implemented by way of the Health (Charges for In-Patient Services) Regulations 2005. These regulations were signed on 14 June 2005 and reinstated charges for inpatient services and provided for the levying of a charge in respect of the maintenance of persons in receipt of in-patient services. The regulations were prepared following extensive consultation with the HSE and others. Section 53 of the Health Act 1970, as amended by the Health (Amendment) Act 2005, provides, inter alia, for the levying of a charge where services have been provided for a period of not less than 30 days or for periods aggregating not less than 30 days within the previous 12 months.

The regulations, in keeping with section 53 of the Health Act 1970, as amended, have provided for two different classes of persons on whom charges can be levied. Class 1 refers to people in receipt of inpatient services on premises where nursing care is provided on a 24-hour basis on those premises. In this case, a weekly charge can be levied of €120, or the weekly income of that person less €35 or 80% of the weekly income of that person, whichever is the least. Class 2 refers to people in receipt of inpatient services on premises where nursing care is not provided on a 24-hour basis on those premises. In this situation, a weekly charge can be levied of €90, or the weekly income of that person less €55 or 60% of the weekly income of that person, whichever is the least. In this regard, charging of patients in long-term care commenced on 14 July 2005, which was after the expiration of 30 days after the regulations were signed. These regulations provide for the maximum charge to be levied on either class of person. The actual charge will vary from person to person depending on individual circumstances and under the legislation, the Health Service Executive can waive or reduce the charges to avoid undue financial hardship.

Following the enactment of the Health (Amendment) Act 2005 and the Health (Charges for In-Patient Services) Regulations 2005, the HSE established an expert group to deal with this complex area and to develop a set of national guidelines to deal with the provisions of the legislation. This expert group developed a comprehensive set of guidelines in line with best practice, having considered legal opinion and its implications in relation to complex cases.

Legal opinion received by the HSE advised that the legislation and the regulations apply to all persons who are provided with inpatient services either by the HSE or by an agency or service provider on behalf of the HSE where those persons are residing in a long stay institution or those persons with an intellectual, physical or mental disability are residing on community type residences where nursing or medical care is provided.

When drafting the guidelines, the expert group considered section 4(b)(4) of the Health (Amendment) Act 2005 which provides that the HSE may reduce or waive a charge imposed on a person if it is of the opinion that having regard to the financial circumstances of that person it is necessary to do so in order to avoid undue hardship for that person.

This was particularly relevant in the case of community hostels where the residents live largely independent lifestyles, assisted by appropriate supports, with the objective of realising their maximum potential to integrate with the local community.

In light of the above and in consideration of the additional expenses incurred as a result of this independent lifestyle, the criteria for assessment for residents in community hostels include an allowance up to a maximum of €90 per week towards socialisation and care plan expenses. This allowance relates to the additional expenses incurred as a result of greater independence and integration into the community.

When calculating the charge, the HSE also makes an allowance up to a maximum of €60 per week, for any contribution that the resident makes to the weekly running costs of the community hostel. In addition to these allowances, there are also other allowances listed in the national guidelines which can be factored into the assessment for a charge, if applicable. These include dependent child, life assurance, medical insurance, rent or mortgage allowances, loans or repayments, maintenance payments, travel costs, rehabilitative employment allowance and other outgoings.