Kathleen Lynch (Cork North Central, Labour)
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Question 49: To ask the Minister for Health and Children if it is still proposed to introduce the fair deal for nursing home care on 1 January 2008; her views on whether there is time for appropriate consultation on the detail of the scheme in that timeframe; and if she will make a statement on the matter. [29968/07]

Phil Hogan (Carlow-Kilkenny, Fine Gael)
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Question 52: To ask the Minister for Health and Children if her proposed fair deal for nursing home care will be introduced as planned on 1 January 2008; and if she will make a statement on the matter. [29992/07]

Máire Hoctor (Tipperary North, Fianna Fail)
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I propose to take Questions Nos. 49 and 52 together.

The legislation for the new nursing home support scheme, a fair deal, is being drafted. The intention is to publish the Bill as soon as possible and to have it in place by 1 January 2008.

The Minister originally announced her proposals for the new nursing home support scheme in December 2006. Information leaflets, a guide to the fair deal and a frequently asked questions document have all been available to the public since. In addition to dealing with queries and representations from interest groups, public representatives and members of the public, the Department also met a number of interested parties, including the social partners, the IFA and the Irish Senior Citizens Parliament.

Jan O'Sullivan (Limerick East, Labour)
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I met representatives of nursing home owners and various senior citizens groups which are all concerned about the timeframe involved. I wish to ask a few questions in respect of their concerns. The first relates to the standards that will be drawn up by HIQA will not, as I understand it, be available when the legislation is introduced and will only be produced later. Is it not strange that the fair deal will come into play before the standards relating to it appear?

My second question relates to whether senior citizens will have a choice of nursing homes. I understand the National Treatment Purchase Fund will be given the role of deciding on and allocating nursing homes to individuals. I would be concerned about this because a facility might be located a long distance from a person's home or a person might not wish to be sent to a particular home. It may eventually be the case that large nursing homes will take in many people because it will probably be cheaper to proceed in that way. The people to whom we are referring will live in these homes.

My third question involves family homes and the percentage of the value of a family home that will be taken subsequent to the death of the person who owns it. There are serious concerns with regard to this aspect of the matter. How will a spouse or another member of a family who remains in the family home and might be on social welfare payments or a low income pay this percentage? There are many questions relating to this matter and I do not believe there will be adequate time for consultation before 1 January.

Máire Hoctor (Tipperary North, Fianna Fail)
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I also met nursing home owners in recent times and I am aware of their concerns. The NTPF is still in the preparatory stages of finalising the forthcoming legislation. We propose to introduce the legislation as soon as possible and expect the advertisement relating to nursing homes to be placed in the near future. I understand people's concerns in that regard. Applications to provide nursing care will be approved in time. Nursing home owners will be obliged to meet a certain standard, of which they will be notified in due course.

As regards the fair deal and people's homes, people remaining and living in their own homes while their loved ones are being cared for should not be concerned. It will only be when a loved one dies that the question of the percentage will become pertinent.

Jan O'Sullivan (Limerick East, Labour)
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What will happen in the case of a person still living in a house after his or her loved one dies?

Mary Harney (Dublin Mid West, Progressive Democrats)
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It only becomes relevant when the house passes on. In other words, following the death of the loved one being cared for in a nursing home. The Deputy will be happy to hear that people will not be put out of their houses.

Jan O'Sullivan (Limerick East, Labour)
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What would be the position of an unmarried 40 year old daughter living in her parents' house where both parents had died? Would she be allowed to remain until she was 90? Am I correct in understanding that no money would be drawn against the value of the house?

Mary Harney (Dublin Mid West, Progressive Democrats)
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Only if she were the carer.

Máire Hoctor (Tipperary North, Fianna Fail)
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She would be allowed to remain only if she were the carer of the person or persons originally admitted to the nursing home.

Jan O'Sullivan (Limerick East, Labour)
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If it were her family home, surely she would be entitled to live there and not be obliged to try to raise a mortgage in order to pay the State. It seems extraordinary——

Mary Harney (Dublin Mid West, Progressive Democrats)
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At present, people in this situation are obliged to sell their houses. People are not obliged to opt for this scheme, it is voluntary in nature.

James Reilly (Dublin North, Fine Gael)
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We are all aware that there is going to be a major problem with regard to the funding of nursing homes. My difficulty with what I have seen so far of the Bill is that it refers to drawing down other resources before the family home is touched. How will this apply in the case of small businesses and farms? Will people be obliged to sell their businesses and use up all their assets before their family home comes into play? What will happen, for example, in the case of a young man who is running a shop with his mother and who decides to take over the business and invest money in it?

I cannot understand how the Minister or the House can envisage a situation, particularly in the aftermath of Leas Cross, in which we will seek further funding from people in respect of their care in their old age without first ensuring the standards of care in the relevant institutions will be set in stone. People entering nursing homes and their loved ones must be able to rest assured that they will be looked after in the best possible way. How will the NTPF set fees if it does not know what standards are reached? I wish to declare to the House that I have a 25% interest in a nursing home. The points which concern me are care of the elderly and the standards that will be applied.

Age Action Ireland is extremely concerned. The elderly is the first group to have this eligibility approach foisted upon them. Hundreds of thousands of euro are spent on cancer and cardiology patients but they are not asked to sell their homes. This issue requires a great deal of further discussion and elaboration. It works for some small groups of people but it certainly does not work for many others. I hope we have the time to discuss this matter and tease it out.

Máire Hoctor (Tipperary North, Fianna Fail)
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As Deputy Reilly has a quarter share in a nursing home he is aware of the fact that inspections take place in private nursing homes at least twice a year. We already achieve a standard. If a house is already transferred it is not an issue with regard to the payment of nursing care. We anticipate the HIQA standards will be ready by June next year.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Will the Minister of State clarify what is the role of HIQA with regard to private nursing home facilities? Will she assure the House that HIQA has a role in ensuring full inspection and accountability of all State funded places, be they in public or private nursing homes, for senior citizens and other residents of such facilities? The Government is committed to extending the remit of the social services inspectorate to include residential care for older people. What progress has been made with this proposition?

Máire Hoctor (Tipperary North, Fianna Fail)
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The Health Act 2007 provides for the establishment of the Health Information and Quality Authority, which will provide the standards of nursing care in public and private nursing homes. Private nursing homes are already subject to inspection. It is expected that HIQA standards will be in place next year at which point they will be rolled out.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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The Government is committed to extending the remit of the social services inspectorate. Will the Minister of State indicate whether it will include residential care for older people and what progress, if any, has been made on this?

Máire Hoctor (Tipperary North, Fianna Fail)
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It will happen next year and will include residential nursing homes.

Jan O'Sullivan (Limerick East, Labour)
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Highly reputable nursing home owners who wish to care for their patients are extremely concerned that if the standards are not in place when the fair deal starts they may not have patients sent to them by the National Treatment Purchase Fund because they may not be the cheapest. They may have more nurses employed per patient and better standards in other ways than those who see it purely as a business. This is the most significant concern but not the only one with regard to the system being established before the standards are in place. I am concerned that the nursing home with the cheapest price is what the National Treatment Purchase Fund will choose. In the absence of standards, the cheapest price may not mean a good nursing home for patients.

Máire Hoctor (Tipperary North, Fianna Fail)
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I agree that the cheapest price may not mean the best standard. We will rely on the NTPF to ensure that in the tendering process the best standard is assessed on an individual basis for each nursing home which enters into the contract.

Jan O'Sullivan (Limerick East, Labour)
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We need real assurance on this matter. I am extremely concerned about it.

James Reilly (Dublin North, Fine Gael)
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In conjunction with this, I hope we have similar investment in community initiatives to keep people at home. Nobody likes to go into a nursing home because it means a loss of independence. The HSE has been inspecting nursing homes for some time. However, we have not been reassured by what is happening. The HSE inspecting its own homes is not proper.

Máire Hoctor (Tipperary North, Fianna Fail)
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This is why HIQA was established as an independent inspection body to investigate public and private nursing homes. Deputy Reilly will appreciate that we know people live longer and in a healthier state if they remain at home for as long as possible. The Government has an excellent record of achievement in this. This year, we had the successful introduction of home care packages throughout the country whereby nurses, physiotherapists and occupational therapists attend to a person in his or her own home. We intend to continue and increase this in the coming year.