Máire Hoctor (Tipperary North, Fianna Fail)

I thank the Cathaoirleach and Senators for giving me this opportunity to make a statement on the nursing homes support scheme and on the standards for residential care settings for older people. The Government is committed to ensuring access to quality nursing home care for all who need it. Two key initiatives in this area are the new nursing homes support scheme, which will address issues of access and affordability, and the standards for residential care settings for older people, which will address the issue of quality.

The Minister for Health and Children and I published the Nursing Homes Support Scheme Bill 2008 on 9 October. The scheme is designed to remove real financial hardship from many individuals and their families who, under the current system of nursing home subvention, have to sell or remortgage homes to pay for the cost of nursing home care. Under the new scheme, there will be one transparent system of support towards the cost of care that will be fair to all, irrespective of whether they are in public or private nursing homes.

The basic commitments of the new scheme are that individuals will contribute towards their cost of care based on their income and assets, and the HSE will meet the balance of cost in nursing homes approved for the purpose. Individuals will not have to sell or mortgage their houses to pay for their care. They will not have to borrow to fund the care costs. They will not experience unaffordable care costs, nor will their families have to find money for their care. The scheme will equalise the level of State support available to individuals, regardless of whether they are in public or private nursing homes. This will meet one of the objectives of Towards 2016, which is that State support should be indifferent to whether a person is in public or private care. This is not the case at the moment.

The State currently pays approximately 90% of the cost for people in public nursing homes. In contrast, the State only meets about 40% of the estimated average cost of care in a private nursing home, while some people receive no support. The result is that many people in private nursing homes have to sell or mortgage their homes to meet their care costs. There are five key components to the new scheme, namely, the care needs assessment, the means assessment, the calculation of the individual's contribution to their care, the selection of the nursing home and the calculation of the level of State support.

The first step is the care needs assessment. A person, a family member or a guardian can apply to the HSE for an assessment of care needs. The needs assessment will be carried out by appropriate health care professionals using a common care needs assessment process. If a person is assessed as needing long-term residential care, he or she can apply for financial support. This will involve undergoing a means assessment, the purpose of which is to establish how much the applicant can contribute to the cost of his or her care. The means assessment will take into account a person's income and assets. In the case of a couple, the means are assessed as 50% of the couple's combined income and assets. The assessment will not take into account the income of other relatives such as the applicant's children. The scheme includes safeguards to ensure that a person's spouse or partner who remains at home retains at least the non-contributory State pension and that the person has a sufficient personal allowance.

Individuals will contribute 80% of their assessable income and 5% of the value of any assets in excess of the asset disregard per annum. The asset disregard will be €36,000 for an individual or €72,000 for a couple. The asset disregard provided for in the current subvention scheme stands at €11,000 so this represents a very significant improvement. If a person's assets include land and property based in the State, the 5% contribution based on such assets can be deferred. In effect, the HSE will advance a loan for that portion of the contribution. A charging order will be registered against the property enabling the money to be recouped from the person's estate when it is settled. That is known as ancillary State support.

In the case of the principal residence only, the deferred contribution will be capped at15%. This means that after three years of care, a person will not be liable for any further deferred contribution based on his or her main residence. If a spouse or certain dependents are living in the residence, the contribution will be further deferred during their lifetime. The dependants that qualify for a further deferral are known as connected persons. To qualify as a connected person, a person must be either a child under 21 years of age of the person who received care, a relative in receipt of certain specified social welfare payments or whose total income is not more than the maximum rate of contributory State pension or a relative who is the owner of a building to which the family home is attached. In addition, the connected person must have been living in the family home for at least three years before the original request to defer contributions was made and must not have an interest in any other property. A person can also opt to pay the contribution at the time of receiving care if he or she so wishes.

Once a person's contribution has been calculated, he or she will be supplied with a list of public and private nursing homes. The private nursing homes will have been approved for the scheme. As part of the approval, the price charged for care will have been agreed with the National Treatment Purchase Fund. A person can choose care in any of the nursing homes on the list, subject to a place being available and the suitability of the home to cater for his or her needs. If a person selects a public nursing home, he or she will pay a contribution to the HSE and the State will pay the balance. If a person selects a private nursing home, he or she will pay his or her contribution to the nursing home provider and the State will pay the balance.

Since the fair deal was originally announced, a new feature is the inclusion of a provision whereby a person may apply to the Circuit Court for an order appointing him or her as a care representative of a particular person. The appointment of a care representative is only necessary where a person does not have full legal capacity and wishes to apply for ancillary State support. However, a person appointed as a care representative may assist with any matter relating to the scheme.

A care representative must act in the person's best interest at all times and shall keep accounts of his or her actions. The following people may apply to be appointed as a care representative, a person's spouse or partner, a parent or child of the person, a brother or sister of the person, a niece, nephew, aunt or uncle of the person and a registered medical or other such health practitioner, other than the proprietor of a nursing home. A care representative will not need to be appointed if a person is already a ward of court or if a sufficient registered enduring power of attorney is in place. The inclusion of this protection is vital for older people, some of whom are among the most vulnerable members of our society.

While on the theme of protection, I would now like to turn to the second focus of my statement today, which concerns the standards for residential care settings for older people. We are all aware that the first choice for older people is to remain living at home for as long as possible with the support of their families and community support services where necessary. This is the essence of Government policy. However, when this is no longer possible, it is important that older people should have access to the best possible residential care available.

A fundamental principle of the health service reform programme is to put the users of health and personal social services at the centre of those services. We need to ensure the protection of residents, to safeguard and promote their health, welfare and quality of life, and to ensure that there is a focus on the well-being, dignity and autonomy of older people. We must also ensure that our older people receive appropriate levels of care in surroundings which are of a high standard. To ensure quality we must have evidence-based standards. Standards must acknowledge the unique and complex needs of the individual at the centre of care. They must recognise the additional specific knowledge, skills and facilities needed in order for service providers to deliver a person-centred and comprehensive service that promotes health, well-being and quality of life. They must set service providers the goal of providing a setting in which older people can experience a good quality of life.

The present standards for nursing homes are set out in the 1993 care and welfare regulations and the Health Service Executive inspects private nursing homes on the basis of these standards. Under the Health Act 2007, the existing inspection and registration systems for residential services will be replaced by a strengthened and expanded system. The Act strengthens and modernises the registration and de-registration process. Statutory responsibility will be given to the chief inspector of social services for inspecting and registering children's residential centres, residential centres for people with disabilities and residential centres for older people, including private nursing homes. The chief inspector will inspect centres against the regulations governing these centres and standards set by HIQA.

Last year we published draft national standards for residential care settings for older people. The standards were developed by a working group chaired by the Department of Health and Children and included the Health Service Executive, the Social Service Inspectorate and the Irish Health Services Accreditation Board.

As the Health Act 2007 provides that the enhanced inspection function will be taken over by the Health Information and Quality Authority, known as HIQA, the draft standards were formally referred to HIQA for consultation and finalisation. The authority established a wide-ranging working group to finalise the draft standards and I acknowledge the significant contribution made by that group.

Earlier this year, the HIQA board submitted its final draft national quality standards for residential care settings for older people to my colleague, the Minister for Health and Children, Deputy Harney, for her approval, as required under the Health Act 2007. There are 32 standards under the following seven groupings: rights, protection, health and social needs, quality of life, staffing, the care environment, governance and management. The standards apply to all homes, both public and private. They require the preparation of individual care plans for all residents, specify ideal training for staff, and emphasise good communications with patients and relatives.

As Minister of State with responsibility for older people, I have had the opportunity to visit many such facilities across the country. The standard of care being provided at present is, by and large, of a high quality. However, there is a consensus with which I think we can all agree — we must continue to ensure consistently high standards of care across the public, private and voluntary sectors. This is the core of what these standards are about. They are designed to encourage continual improvement. Their significance lies in the framework they create for nursing home care across the country, and for the provision of sufficient care to maintain the well-being of those cared for with regard to the nature and extent of their dependency. They are consistent with the Government's policies, principles and legislation.

Regulations will be introduced to underpin the standards and at the moment the Department of Health and Children is in the process of carrying out a regulatory impact analysis on them. As part of this process, we commissioned an independent consultancy to carry out a cost benefit analysis on the financial impact the standards will have in long-term residential settings. Furthermore, in October, my colleague, the Minister, Deputy Harney, and I, co-hosted a public consultation session in Dublin Castle on the standards in the context of the regulatory impact analysis. The purpose of that event was to provide key stakeholders an opportunity to feed into and inform the RIA before finalisation and to discuss the standards, their criteria and the proposed regulations in advance of their introduction.

Participants included representatives from voluntary and advocacy groups. Service providers were represented by Nursing Homes Ireland, a representative organisation for the private and voluntary nursing homes sector, and the Health Service Executive together with several private nursing home owners and several participants from the voluntary sector. Dr. Tracey Cooper, the chief executive of HIQA, was also in attendance together with a number of representatives from the medical professional organisations.

This consultation formed a vital role in hearing from key stakeholders and will feed in to the final analyses. It is expected that the RIA will be completed in the early part of November and that both the approved standards and regulations will be in place in 2009.

I thank Senators once again for inviting me to address the House. I look forward to hearing their comments both on the nursing homes support scheme and on the standards for residential care settings for older people.