Pauline Tully (Cavan-Monaghan, Sinn Fein)
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I wish to raise the issue of boarding out regulations which comes under SI 225 of 1993. As the date suggests, these regulations first came into operation in 1993. They allow for individuals or families to take care of elderly people in their own home. This is suitable for an older person who is not able to live independently or with family members of their own, or does not want to live alone.

Boarding out is not suitable for the care of people who need high levels of medical support but it can reduce social isolation. It makes use of family homes rather than expensive residential facilities. It saves the State money while also fostering independence and well-being. The regulations have not been updated since 1993. A review was conducted ten to 12 years ago but very little change was made to the scheme.

Providers are contracted by the HSE to provide care for up to six elderly people in their own home. The CHO decides on the amount to be paid to the provider each week. Each resident also pays an amount of money to the provider which is decided by the HSE. Providers are asking that the regulations, which have been in place for 28 years and which have not been updated in over 12 years, be reviewed; that the weekly contribution from the HSE be increased and standardised across CHO areas; that the amount paid by the older person be standardised; that the number of residents allowed per house be increased; and that income tax concessions be updated. This care model is much more economical than the nursing home model. Older residents can stay in the community and live much more independent lives. This supported housing option for the elderly is strongly supported by Alone, the charitable organisation for older people.

Currently, the amount paid by the HSE towards the care of residents varies from €110 in one CHO area to €165 in another. Residents are asked to pay a fee which can vary from €140 in one CHO area to €180 in another. Problems arise when residents from different CHO areas are living in the same house and are paying different amounts from their pension. Providers are also receiving different amounts for each person in their care, again depending on which CHO area they come from. The amount the HSE pays for each resident and the amount residents pay towards their care should be standardised across all CHO areas in the interests of fairness. The amount contributed by the HSE must also be increased. It has not increased in more than 12 years and the cost of living has risen immensely in that time and in the last year in particular, the cost of food has risen considerably. I ask that the maximum number of residents permitted under the scheme be increased from six to nine. The taxation system needs to be amended to enable host families to avail of tax exemptions similar to those available under the rent a room scheme or the foster care legislation. Similar schemes exist in the UK. A submission could be made to the Revenue Commissioners to enable host families to avail of the tax exemptions currently available under the rent a room scheme.

I first contacted the Minister for Health, Deputy Donnelly, on this issue last September and he advised me to speak to the Minister of State with responsibility for older people, Deputy Butler, which I did. I emailed details to her and have pursued this issue regularly. I put the proposals I have just outlined to officials in the Department of Health for assessment but I have not heard back from them. If the officials need more information or want to talk to people involved in this, that can be arranged. I sincerely hope this statutory instrument can be examined and updated.

Frank Feighan (Sligo-Leitrim, Fine Gael)
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I thank Deputy Tully for raising the boarding out scheme, in which she is very interested. The Government is committed to supporting people to live in dignity and independence in their own homes and communities for as long as possible. Where this is not feasible, the health service supports access to quality, long-term residential care where this is appropriate. We will continue to develop and improve health services in all regions of the country to meet this objective and to ensure quality and patient safety.

The 1993 regulations provide a framework for the operation of a boarding out scheme. These regulations include specific conditions relating to maintenance, care and welfare of an older person in a private house. The intention of the scheme was to provide social and personal care to older people who did not want, or were unable, to live on their own but wanted to remain in their local community. Under the regulations, the HSE must be satisfied that the house is suitable and the householder is fit to look after the person accessing the scheme. The householder must provide suitable and sufficient care, nutritious and various food and adequately attend to the needs of the person. The householder must also respect the privacy of the individual. Not more than six people can be boarded out in one house.

The regulations also set out standards regarding the suitability of accommodation, cleanliness, safety and other related matters. The regulations provide that the HSE may pay to the householder an amount not exceeding half the weekly rate of the non-contributory State pension in respect of each person accessing the scheme. In addition, the person being boarded out must pay to the householder an amount which is agreed between the HSE, the householder and the individual boarder. It was not intended that the scheme would provide medical or nursing care beyond the levels normally provided in a person's own home. Those availing of the scheme require a level of social care which is delivered by people who are funded to provide this service through the scheme, together with contributions from the older person.

The boarding out scheme has diminished over time and is now only available in a limited number of areas across the country. According to the HSE, there are 17 boarding out facilities across three of the CHOs. In 2017, the HSE completed a review of the scheme which concluded that an expansion was warranted. The last year has been very challenging for the health service in terms of responding to the current pandemic. This has highlighted the continuing importance of supporting people, including our older population, to access the right care in the right place at the right time. The boarding out scheme facilitates older people to remain in their communities where they might otherwise be accommodated in residential care. It can also help to reduce social isolation. While the use of the boarding out scheme by the HSE has traditionally been small, there is value in exploring it further. I am pleased to advise the House that the Minister of State, Deputy Butler, has asked officials in the Department to consider this model of care and the relevant regulations in the context of our overall commitment to enhancing opportunities for older people to stay in their homes and communities for longer.

Pauline Tully (Cavan-Monaghan, Sinn Fein)
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I welcome the fact that the Minister of State, Deputy Butler, has asked officials to give this model of care more consideration to determine if an expansion of the scheme is warranted. That is good news. However, the issues I have outlined need to be addressed for those who are currently providing care under the scheme. Providers of boarding out facilities are currently working for less than the minimum wage. They are doing an immensely important job in helping our older generation to continue living in the community and ensuring they have the independence to do the things they wish to do. Providers, as well as providing a bed and meals, often bring people for appointments, collect their prescriptions and some are even cutting hair at the moment.

The HSE does not promote this form of care. I looked at the HSE website under "Services for Older People" but it is not mentioned or if it is, it is well hidden. Nursing homes are on the website but I could not find any reference to boarding out facilities. Alone supports this model of care, as referenced in its report, Housing Choices for Older People in Ireland - Time for Action, published in 2018. Alone believes a demand for up to 750 places could be met if the provision of this service was replicated across all CHO areas. Obviously, regulation and monitoring would be required and tax exemptions would be needed for providers to make this scheme more attractive. At the time of the report's publication, there were only 51 people boarded out but many people do not know this facility exists.

The average cost annually to the State for boarding out facilities ranges from €8,000 to €9,000 per person per year, while nursing home care costs approximately €50,000. These are approximate figures and there will be differences from region to region but the savings to the State could be in the region of €30,000 per person. I wonder why this option is not being promoted more. I appreciate that it will not suit everybody but there are many for whom it would be ideal. Many older people living at home without proper supports often end up in nursing homes because their health fails due to their inability to care for themselves. If this option was available, it would avoid that outcome. While boarding out will not suit everyone, it should be an option that more people can consider.

Frank Feighan (Sligo-Leitrim, Fine Gael)
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Again, I thank the Deputy for raising this issue. Our overriding objective is to support older people to live in dignity and independence in their own homes and communities for as long as possible. The Government is committed to the continued enhancement of health and social care services delivery at both individual and community level. Under the Sláintecare model, we are looking at a significant shift in our model of care towards one that is focused on prevention and early intervention, a model in which care will predominantly be provided at the lowest level of complexity in our local communities.

It is important that we look at the boarding out scheme in this context, ensuring that it aligns with broad reform, such as the development of a statutory scheme for the financing and regulation of home support services. In addition, a reformed model of service delivery will be introduced to ensure the provision of home support in a transparent, equitable manner based on standard assessment of care needs.

A review was carried out 28 years ago and this review, which was carried out three years ago, may need a further review. I thank Deputy Tully for her concern and consideration.