Batt O'Keeffe (Cork South Central, Fianna Fail)

I am pleased to have this opportunity to deal with this matter on behalf of my colleague, the Minister for Health and Children, Deputy Harney. I thank the Senator for raising the matter as it provides me with an opportunity to outline to the House the current position with regard to the nursing home subvention scheme.

A nursing home subvention may be paid towards the cost of private nursing home care, where a person is unable to meet the cost and where he or she has been assessed as needing nursing home care by the Health Service Executive and where the person has also satisfied a means test. The amount of subvention granted will depend on the degree of nursing home care required, that is, medium, high or maximum level, and it will take into account the amount of the person's assets, including property, stocks and shares, savings, etc. The rates of subvention payable are as follows: in the case of medium dependency, the rate is €114.30 per week; in the case of high dependency, the rate is €152.40 per week; and in the case of maximum dependency, the rate is €190.50 per week.

The nursing home subvention scheme was introduced to assist with the cost of private nursing home charges and was never intended to cover the entire cost of nursing home care. Under article 22.3 of the Nursing Home (Subvention) Regulations 1993, the HSE may enter into an arrangement with a registered private nursing home to provide inpatient services under section 52 of the Health Act 1970. In making such an arrangement the HSE may pay more than the maximum rate of subvention, relative to an individual's level of dependency, in cases where, for example, personal funds are exhausted, in accordance with article 22.4 of the Nursing Home (Subvention) (Amendment) Regulations 1996. The application of these provisions, however, is a matter for the HSE in the context of meeting increasing demands for subventions. The average rate of subvention paid by the HSE generally exceeds the current approved basic rates mentioned above.

Spending on the nursing home subvention scheme has increased from €5 million in 1993, when it was introduced, to a figure in the region of €140 million in 2005. The Government allocated an additional €20 million towards the nursing home subvention scheme for 2006 to provide for extra subvention payments and to address the variations in payments in different areas, as alluded to by the Senator.

The projected expenditure on nursing home subvention, which includes enhanced subvention for the HSE western region in 2006, is €48,591,000. The HSE western region provides subvention and enhanced subvention on an individual needs basis in line with current legislation, namely, the Nursing Home Act 1990, and regulations, that is, the Nursing Home (Subvention) Regulations 1993. Applications for enhanced subvention are dealt with on a case by case basis in each local health area. The supports paid by the HSE vary from person to person and region to region, depending, for example, on nursing home fees.

The Health (Nursing Homes) (Amendment) Bill 2006 is designed to ensure that the existing subvention scheme for private nursing home care is grounded in primary legislation and to help the HSE to implement the scheme on a standardised basis across the country. In addition, national guidelines on nursing home subvention are currently being developed by the HSE to ensure an even and equitable application of the scheme nationally.

The future of residential care funding was discussed by the social partners as part of the Towards 2016 negotiations. The ten-year framework social partnership agreement 2006-16 states that there should be appropriate and equitable levels of co-payment by care recipients based on a national standardised financial assessment. In addition, the agreement also states that the level of State support for residential care should be indifferent as to whether that care is in a public or private facility. The Department is currently drawing up proposals as agreed with the social partners in Towards 2016.