Mary Butler (Waterford, Fianna Fail)
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I congratulate the Minister of State with responsibility for mental health and older people, Deputy Jim Daly, on his appointment. As chairperson of the all-party working group on dementia, I look forward to working with him on the issue of older people.

Thankfully, people are now living longer and most of us will live independently for the rest of our lives. Less than 5% of elderly people require care late in life and every effort should be made to facilitate this. Under the nursing home support scheme introduced in 2009, often referred to as the fair deal scheme, the State offers financial support to people whose care needs indicate they require long-term residential care. The scheme covers the cost of the standard components of long-term residential care, namely, nursing and personal care appropriate to the level of care needs of the person; bed and board; basic aids and appliances necessary to assist a person with the activities of everyday living; and laundry service.

Age Action Ireland, which does fantastic work to protect elderly people, has uncovered disturbing cases that some nursing homes are ripping off the elderly. Last week, it published a new briefing paper on nursing home charges which states that older people and their families are being prevented from choosing nursing homes under the fair deal scheme because of additional charges. One of the key principles of the fair deal scheme is that older people have choice and no one is prevented from choosing the nursing home he or she prefers for reasons of income. However, steadily increasing charges imposed by nursing homes are pricing older people and their families out of the market because the extra charges are a step too far for some families. When someone is completely dependent on the State pension, as many people are, he or she is left with only €50 per week after making the contribution levied under the fair deal scheme. Obviously, he or she will not be able to afford an additional charge of up to €200 per month imposed by some nursing homes for social activities.

While nursing homes are permitted to charge additional fees to fair deal residents for certain services, some of these services may be required to be provided by the Health Information and Quality Authority. Age Action Ireland has uncovered abuses in charges to the elderly for services such as social activities, incontinence wear and therapies. Residents, some of whom are of limited means, face charges ranging from €15 to €100 per week. As a result, they have only limited funds to buy clothes or gifts for grandchildren, which can cause them distress.

Openness, transparency and accountability are key for every service provider and we all have a reasonable expectation to be made aware of the cost of any service we buy or employ. It is not too much to expect that fees charged by nursing homes should be publicly available online and easy to understand and that patients should be informed of extra costs they may incur prior to taking up residency. In this regard, I welcome the response from Nursing Homes Ireland, which has made clear that nursing homes must be transparent in pricing and long-term care. The organisation also provides all members with a template contract for care. I look forward to the Minister of State's comments on the issue.

Jim Daly (Cork South West, Fine Gael)
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I appreciate the opportunity to speak on the important issue raised by Deputy Butler, which has been reported in the media and is a source of considerable concern for the individuals affected and their families.

The nursing homes support scheme, otherwise known as the fair deal scheme, provides financial support towards the cost of long-term residential care services in nursing homes and ensures that long-term nursing home care is accessible to everyone assessed as needing it. Participants contribute to the cost of their care according to their means, while the State pays the balance of the cost. The scheme covers the cost of the standard components of long-term residential care, namely, nursing and personal care, bed and board, basic aids and appliances and laundry service. A person's eligibility for other schemes, such as the medical card scheme or drugs payment scheme, is unaffected by participation in the nursing homes support scheme or residence in a nursing home.

In determining the services covered by the nursing homes support scheme, it was considered very important that the care recipient and taxpayer would be protected and would not end up paying for the same services twice. For this reason, medications and aids that are already prescribed for individuals under an existing scheme are not included in the services covered by the nursing homes support scheme as this would involve effectively paying twice for the same service.

Although the nursing homes support scheme covers core living expenses, residents can still incur some costs in a nursing home, such as social programmes, newspapers or hairdressing. In recognition of this, anyone in receipt of financial support under the nursing homes support scheme retains at least 20% of his or her income. The minimum amount that is retained is the equivalent of 20% of the non-contributory State pension. An operator should not seek payment from residents for items which are covered by the nursing homes support scheme, the medical card or any other existing scheme.

Part 7 of the Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) Regulations 2013 stipulates that the registered provider of the nursing home must agree a contract in writing with each resident on his or her admission to the nursing home. This contract must include details of the services to be provided to the resident and the fees to be charged. Residents should never be charged fees which are not set out in the contract. The Department of Health and the Health Service Executive are not parties to such contracts, which are concluded between each resident and the private or voluntary nursing home.

Registered providers of nursing home care are obliged to provide an accessible and effective complaints procedure. Concerns about additional charges should in the first instance be taken up with the nursing home provider. I would encourage anyone with concerns to raise them with the nursing home through this complaints procedure. The Office of the Ombudsman can examine complaints about the actions of a range of public bodies and, from 24 August 2015, complaints relating to the administrative actions of private nursing homes. The Office of the Ombudsman normally only deals with a complaint once the individual has gone through the complaints procedure of the private nursing home concerned.

Age Action's paper, which highlights this issue, is welcome and I assure the Deputy that we are committed to ensuring members of the older population are protected and get the care they need and deserve, particularly at this vulnerable stage in their lives. An interdepartmental agency working group has been established to progress some of the recommendations contained in the review of the nursing homes support scheme, which was published in 2015. I have requested that the working group further examine the matter the Deputy has raised, namely, additional charges, and report to me on same. I have also met Age Action and Nursing Homes Ireland in the past week to discuss the issue of additional charges. It was a productive meeting.

To improve the transparency of these additional charges, I have outlined that a schedule of charges should be provided to potential residents on inquiry as opposed to at the point of admission to a nursing home. Nursing Homes Ireland undertook to advise its members to do so and has reissued its template contract for care to all members. Furthermore, next week I will meet the National Treatment Purchase Fund, NTPF, and HIQA to discuss this issue further and determine their positions on it. The Department of Health will continue to engage with relevant bodies and monitor the issue.

It is important that older people are protected and have all the information they need to make an informed decision, especially as many older people who are entering long-term residential care are at a vulnerable stage in the lives.

Mary Butler (Waterford, Fianna Fail)
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I thank the Minister of State for his answer and I welcome his request for a schedule of charges to be provided to potential residents on inquiry rather than at the point of admission. This important element is the crux of the matter.

As spokesperson for older people, I have visited many nursing homes in Waterford city and county and have been impressed by the services offered. However, the core of the issue is the fact the subvention provided by the Government is on average €200 more for public nursing homes than it is for private nursing homes, which may be contributing to the additional costs some residents are incurring.

I was surprised by a recent answer to a parliamentary question that each private nursing home had to negotiate and agree a price for long-term residential care services with the NTPF. It varies from nursing home to nursing home. When the Minister of State meets the NTPF next week, he might suggest that the prices be more standardised.

I was also surprised to learn that a private nursing home had received a subvention of €910 when a public nursing home in the same area had received a subvention of €1,100. Surely one would expect the same level of care in each nursing home and, it would be fair to say, that the costs of subvention would be similar. I appreciate and understand that the subvention would be more in respect of a patient with additional complex needs, but that was not the case in the instance in question. I am delighted to hear that the Minister of State has been working with the steering committee that was established to oversee the review of the pricing system for private long-term residential care facilities. I await that report.

The Minister of State might not have heard me say it, but I am the chair of the Oireachtas all-party group on dementia. We are meeting him in the morning with Senator Kelleher. I look forward to working with the Minister of State.

Jim Daly (Cork South West, Fine Gael)
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I appreciate a spotlight being put on any issue affecting older people, who are my area of responsibility. As the Deputy will be aware, I have only been in the job for three weeks and this issue has arisen straight away. There is an onus on us as a Government and a society to protect vulnerable people and ensure older people are not being taken advantage of in nursing homes. From my perspective on what is happening, the jury will be out until I get the full picture. That is why I am looking forward to my meetings, including a further one with Nursing Homes Ireland this week, the NTPF and-----

Mary Butler (Waterford, Fianna Fail)
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Age Action.

Jim Daly (Cork South West, Fine Gael)
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-----HIQA. We must ensure that we do not compromise any of the activities undertaken in nursing homes. I want there to be more activities undertaken. It is not right that older people should just sit in a chair with their heads to one side for the entire day or lie in bed without being moved. They should get entertainment, stimulation and so on. We must ensure and encourage a comprehensive range of activities for older people. I do not want anything in this debate to take from that. We are adding years to life, but we also want to add a good quality of life to the years people are spending in nursing homes.

As Age Action is stressing, the key to this is consistency and transparency. The Deputy referred to both when discussing the online publication of charges. I would have no difficulty with the charges being covered by the State or anyone else. We can examine any method, but activities should continue and be charged for - if they are charged for at all - in an open, transparent and consistent way. If that is done, I will be satisfied that our elderly people are being looked after.

I welcome the attention that the Deputy is bringing to this very important subject.