Dáil debates

Thursday, 9 October 2014

Topical Issue Debate

Nursing Homes Support Scheme Administration

3:35 pm

Photo of Barry CowenBarry Cowen (Laois-Offaly, Fianna Fail)
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This year there has been an alarming escalation in the number of people waiting for long-term care under the fair deal scheme, in addition to an increase in the length of time people must wait. Last month, 2,000 people were on the waiting list. Since July the time spent on the waiting list has increased from three months to four months. The waiting list in July increased from 1,465 to 2,007 people.

The situation has resulted in a dire situation for older people and their families. The delays caused by the HSE while waiting for approval are costing people thousands of euro. The cost is up to €1,000 a week in some cases. People are entitled to access care under the fair deal scheme but they find themselves trapped on the waiting list and forced to remain in hospital. That has an obvious impact on hospitals in general, especially acute hospital beds, and there are associated costs to the State. The other impact is on nursing homes and their ability to trade and provide a service.

Once the scheme was provided to people, negotiation with nursing home owners was possible which allowed the scheme to be backdated, but that is no longer the case. The cost associated with the delays are to the detriment of the applicants and their families. Many of them simply cannot afford the situation. Families cannot take advantage of an offer of a place within a nursing home close to them which might suit their needs and requirements as they cannot afford it. If and when approval becomes available, three to four months later, there is no guarantee that the service within the facility to which they applied will still be available.

It would be cheaper and more cost-effective for the State to address the deficiency of administrative staff. I was told that €23 million was diverted from the scheme to the community care package. The situation of many of the people who made representations to me on the matter has deteriorated to such an extent that the time provided to them has been cut. When they apply for home help for an hour a day, they are provided with only half an hour a day. I do not see where the extra money that was taken away from the fair deal scheme is being provided.

I urge the Minister to speak to his counterpart in the Department of the Environment, Community and Local Government, Deputy Kelly, about the schemes to assist the elderly and the disabled, for example, the home adaptation scheme which carries out necessary repairs to meet the needs of people within their homes to avoid them being a burden on the State. Funding has dried up to such an extent in County Offaly that I am acting for 70 people who have been told by the local authority that, due to the lack of availability of funding, it cannot address the needs of those applicants. In many cases people were told that it would be a further three to five years before the applications could be processed. The average cost per applicant is approximately €20,000. The cost to the State of not providing the funding amounts to approximately €18 million. The figure is based on €1,000 a week for five years to provide care in a nursing home setting, which the Government is forced to do in the absence of being unable to maintain people in their own home by virtue of the lack of funding which might have adapted their home to their needs. The provision of €1.4 million could alleviate the problem which would allow an overall saving of approximately €16.5 million.

I urge the Minister to make an effort to converse with his ministerial counterpart with a view to addressing the deficiency with a once-off payment which might meet the demand and reduce the burden on the fair deal scheme. I corresponded with the Department and those responsible for improving the situation, but to date, unfortunately, that has been to no avail. Has the Minister made any inroads in terms of his forthcoming budget or on impressing on the sector the need to be more efficient and to address the deficiencies? The scheme was devised to assist people. People should be allowed to be accountable in some shape or form for the service they receive. That is not the case to any great extent currently.

Photo of Leo VaradkarLeo Varadkar (Minister, Department of Transport, Tourism and Sport; Dublin West, Fine Gael)
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I thank Deputy Cowen for raising this important issue. The nursing homes support scheme, a fair deal, is a system of financial support for individuals who require long-term nursing home care. Anyone who is ordinarily resident in the State and who may need nursing home care, regardless of age, can apply for the scheme.

The total budget for long-term residential care in 2014 is €939 million. It should be pointed out that a number of people covered by funding arrangements which preceded the scheme are also funded from this provision. The HSE releases funding weekly to balance activity across the full course of each year. The HSE operates a national placement list to match the funding available at any given time to demand. All applicants who are approved for funding are put on the placement list in order of their approval date. Funding issues to applicants in a strict order to ensure equity nationally. The current waiting time on the placement list is 15 weeks, with 2,114 people on the list awaiting release of funding.

In the first seven months of 2014, a total of 3,553 new clients were funded under the scheme. The length of time an applicant remains on the placement list depends on the number of approved applicants awaiting funding for the scheme at any given time and the number of applicants receiving payment under the scheme. This means the duration of time on the placement list can fluctuate.

While I would prefer if we had no need for waiting lists of this kind, significant funding pressures exist in the health service generally, and the nursing homes support scheme must operate within the funding available to it and manage that in the most effective way possible. I must emphasise that while residential care is an important part of the supports in place for older people, Government policy is to enable as many older people as possible to remain in their homes and communities for as long as possible. Towards that end, funding for community services has been augmented by transferring €23 million from the provision for residential care to enhance new and more intensive home supports for those with higher or more complex needs, as Deputy Cowen acknowledged.

The review of the nursing homes support scheme, which is under way, will consider the sustainability of the scheme itself, and will also consider the way in which we balance residential and community supports. The needs of older people are, and will remain, a very high priority for the Government. The resources that are available will continue to be applied to provide the best possible mix of supports and services in a way that most effectively matches the needs and preferences of older people themselves, with a particular focus on enabling people to live as independently as possible for as long as possible.

Photo of Barry CowenBarry Cowen (Laois-Offaly, Fianna Fail)
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I thank the Minister for his response but he has merely restated what I said about the current situation. It is another example of what the Minister might agree was a flawed health budget this year. The question is how the Minister will address the issue I outlined, among others.

It is easy to acknowledge the current deficiency and inefficiency that exists. The Minister said it is the Government’s prerogative to allow people to remain in their home for as long as possible. That is most laudable and I support it wholeheartedly. If the Minister meant what he said and if he wants it to carry any weight and show he can be different from the Ministers who have preceded him, he will acknowledge what I said. For example, 70 people are waiting to have their homes adapted in order for them to stay at home and live longer in their homes. The cost of that is approximately €1.5 million. The Minister is standing idly by while the Department of the Environment, Community and Local Government allows a local authority to inform such people they will have to wait three years to five years before their applications can even be fully assessed. The Minister must then carry the can. If they were to apply for the fair deal scheme, the Minister would be obliged to pay €18.5 million to provide care. We all know the majority of the applicants would be in the cemetery before the five years is up. Those are the facts of the matter. That is the bottom line. No amount of glossing over figures and saying the sum of €23 million was diverted here, there or elsewhere will cover up what is happening. The change has not made an impact because the money has not followed the patient, as per the mantra of the Minister’s predecessor.

Will the Minister address this in a real and meaningful way, looking at basic, obvious, black and white issues? If so, we can work together to alleviate difficulties in this and other areas.

3:45 pm

Photo of Leo VaradkarLeo Varadkar (Minister, Department of Transport, Tourism and Sport; Dublin West, Fine Gael)
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The situation is far from satisfactory and I will not pretend otherwise. There are roughly 700 delayed discharges in acute hospitals at the moment. Most of these are elderly patients who have been discharged by a consultant and are ready either to go home or to go to a nursing home but cannot do so. More than half the 700 delayed discharges are in Dublin city.

There will always be delayed discharges for various reasons, but if we could lower the number from 700 to 350, it would have a significant impact. It would free beds to lower the number of people on trolleys and reduce surgical waiting lists. This issue is one of the ten priorities I have outlined for my Ministry. It is under discussion at the moment in the context of putting together a budget for 2015 and a service plan thereafter. We need additional resources for social care, because it is very underdeveloped in this country relative to Northern Ireland and England, and we need them for the nursing home support scheme.

I have not had specific engagement with the Minister for the Environment, Community and Local Government, Deputy Alan Kelly, on the issue of housing adaptation but I will speak to him and ask my officials to examine Deputy Cowen's figures to see if they stack up. The Deputy will be aware from his constituency work that not everyone who seeks housing adaptation would otherwise be in a hospital or nursing home. Many live in the house in any case. To do what the Deputy suggests would require a distinction between those who can live in a house without adaptation and those who would otherwise be in a hospital or nursing home. There may be common sense in what the Deputy says so my officials will examine the figures.

The Dáil adjourned at 3.55 p.m. until 2.20 p.m. on Tuesday, 14 October 2014.