Paudge Connolly (Cavan-Monaghan, Independent)
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I thank the Ceann Comhairle for selecting this issue for debate. I look forward to some answers from the Minister of State in regard to the nursing home subvention scheme. It is my understanding that changes to legislation should improve the lot of citizens, most especially in matters relating to the welfare of the elderly. The recent changes to the legislation on nursing home subventions, however, have been particularly hurtful for elderly people.

The situation prior to 1 January 2007 was that subvention was paid at a rate of €190 per week. Patients then contributed some €180 per week from their pensions, retaining €40, or €42 if they were over 80 years old. This gave a total of €370, with an additional enhanced subvention being met by the HSE to give a total of €650, which met the average cost of a bed in the Cavan-Monaghan area. Since 1 January, however, the nursing home subvention was increased to €300. Patients must still contribute €180 from their pension, giving an amount of €480, and the shortfall of €170 must be met by the patients or their families.

I understand the information I have supplied is correct. The first casualty in this new situation will be the few euro in pocket money that is left to patients every week. This will effectively be stolen by the HSE as the extra charge is imposed on patients and their families. The average cost of a bed in the Cavan-Monaghan area is anywhere between €650 and €800 per week but the HSE has set a minimal rate of €540. I cannot understand this. Many of the staff who must deliver these subvention programmes are unhappy.

It is unfortunate that the contract is between the patient and the nursing home and that the HSE has stepped out of the way. I have spoken to nursing home owners who say their prices will increase, if they have not already done so, because of the rising cost of oil, gas and electricity and as a result of rising staff wages. I heard of one nursing home with some 50 beds where the wages bill alone will increase by €100,000 per annum. In such circumstances, it is inevitable that the cost of beds will increase.

Another difficulty relates to the processing of subvention payments in general hospitals. Time is often wasted in trying to identify whether a patient is entitled to subvention, during which time a bed continues to be occupied in the hospital. When a patient is in hospital his or her charges are met by that hospital but it is a different situation when the patient enters a nursing home, where a different budget is in operation. There is constant internal wrangling about who pays for what. It is little wonder we have difficulties in Beaumont Hospital, for instance, given that one in six beds there are occupied by patients who are already fit for discharge. Many such patients remain there for three months or more at a high cost to the community.

Attempts to deal with this problem between August 2005 and December 2006 focused on five discharge initiatives. These initiatives helped to free up beds in Beaumont Hospital but people with elderly relatives realise quickly that if there is one discharge initiative followed by four others, it is most likely there will be further such initiatives.

Discharge initiatives are favourable to patients. It pays them to stay in the hospital bed because there is no means testing of discharge initiative patients. They are asked only to contribute €120 per week from their pension on an ongoing basis. This is not the way forward. We must ensure there are more nursing home beds in the community. Another difficulty is that some nursing homes are charging more than €1,200 per week for a bed. It is not the best use of health service resources to subsidise such a luxurious level of accommodation.

It is vital that more geriatricians are appointed in the health service. In County Meath, for example, there is not one geriatrician available to patients. This has knock-on effects. It is unacceptable that patients should have to wait up to 18 months for geriatrician appointments and occupational therapy assessments.

Hospice cover is also required for patients at weekends. Such patients receive excellent care from Monday to Friday but those families who wish to look after their relatives at home are isolated at weekends.

Brian Lenihan Jnr (Dublin West, Fianna Fail)
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I will take this matter on behalf of the 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 the House the improvements made to the nursing home subvention scheme. The scheme was introduced in 1993 to assist with the cost of private nursing home fees. A subvention may be paid where a person has been assessed as needing nursing home care by the Health Service Executive and where he or she has satisfied a means test.

Since 1 January 2007, there are no longer three separate rates of subvention. Persons who apply may receive any amount up to a maximum of €300 per week. Additional funding of €55 million was provided for this purpose in budget 2007. The change in the rate means that as many as 1,800 people not previously eligible for subvention may now qualify for a payment. In addition, the HSE has finalised national guidelines for the standardised implementation of the nursing home subvention scheme. These were circulated on 29 January 2007 to all subvention officers working in local health offices.

Nothing in the guidelines shall operate in a way that is inconsistent with the proposed new scheme for 2008, A Fair Deal. Furthermore, nothing shall worsen an applicant's overall position in 2007 by comparison with 2006. Under the guidelines, the assessment of means will now be carried out using a national standard financial assessment method. This should address past complaints about inconsistency in the administration of the scheme and the amounts of subvention paid from place to place.

The guidelines detail a number of improvements to the subvention scheme, all of which are consistent with the proposed new scheme, A Fair Deal. First, the means assessment process will ensure that a remaining spouse or partner is not left with less than the current maximum rate of the non-contributory State pension. A further improvement is that the HSE will cease imputing income from the principal private residence where it has already been imputed for three or more years. This is again consistent with the new scheme. In addition, the HSE will not automatically exclude individuals from applying for subvention, and consequently from the means assessment process, on the basis of the property or asset thresholds. Everyone will be eligible to undertake the means assessment process.

In addition to the increased rate of basic subvention, additional funding of €30 million has been made available in 2007 for enhanced subvention. This is a supplementary subvention that may be paid by the HSE to a person in or entering private long-term care. The amount of enhanced subvention paid is at the discretion of the HSE and varies according to the cost of care and the circumstances of the applicant. The additional enhanced subvention will be used to develop a consistency between the payment of subvention during 2007 and the new nursing home support scheme for 2008, and to work towards equalisation of the level of support paid to people in different areas, taking local prices and a person's means into account.

The HSE guidelines provide that it is not necessary to qualify for a basic subvention payment in order to apply for an enhanced subvention payment. However, an applicant for enhanced subvention will be subject to the means assessment. In light of the above improvements, the HSE is reassessing all those already in receipt of a nursing home subvention. I advise people in private nursing homes who do not currently receive a subvention payment to apply to the HSE for an assessment.