Jim Daly (Cork South West, Fine Gael) | Oireachtas source

Fáiltím roimh an deis labhairt leis an Seanad ar an ábhar tábhachtach seo. I am grateful for the opportunity to contribute to the debate on the nursing homes support scheme, more commonly known as the fair deal scheme. The Government's priority is ensuring that our older population is looked after, supported and protected. We are living longer lives than at any other time and, thankfully, it appears that this trend will continue into the future. This is to be celebrated and embraced but we cannot ignore the challenges our ageing population brings with it, not least that of long-term care. Most of our older people signal their desire to remain in their own homes and communities for as long as they are able. It is Government policy to support this and it is something we feel strongly about. However, there will always be a cohort who require access to quality long-term residential care. This is why the fair deal scheme is such an important element of the range of services available for older people. The scheme is a system of financial support for those assessed as needing long-term nursing home care. Participants contribute to the cost of their care according to their means while the State pays the balance of the cost.The scheme aims to ensure that long-term nursing home care is accessible and affordable for everyone and that people are cared for in the most appropriate settings. With a budget of €940 million in 2017, the scheme supports 23,600 people. The Government target is that people will wait no longer than four weeks for approval for the scheme. I am able to report that target has not been breached this year.

The fair deal scheme covers the cost of the standard components of long-term residential care which are nursing and personal care, bed and board, basic aids and appliances necessary to assist with the activities of everyday living and laundry services. A financial assessment is carried out by the HSE to determine how much an applicant can contribute to the cost of his or her care. An applicant will contribute up to 80% of their accessible income and a maximum of 7.5% of the value of any assets per annum. The State will then pay the balance of the cost of care. It is important to note an applicant's principal private residence will only be included in the financial assessment for the first three years. This is known as the three-year cap. The first €36,000 of an individual's assets, or €72,000 in the case of a couple, is not counted at all in the financial assessment. A person's eligibility for other schemes, such as the medical card scheme or the drugs payment scheme, is unaffected by participation in the nursing home support scheme. Nobody will pay more than the actual cost of care.

Although the nursing home support scheme covers core living expenses, residents can still incur some costs in a nursing home. In recognition of this, anyone in receipt of financial support under the scheme retains at least 20% of his or her income or 20% of the maximum rate of the State pension, whichever is greater. An operator should not seek payment from residents for items which are covered by the scheme, the medical card or any other existing scheme. Registered providers of nursing home care must agree a contract in writing with each resident on his or her admission to the nursing home, which includes details of the services to be provided and the fees to be charged. Residents should never be charged fees that are not set out in the contract. Registered providers of nursing home care are also 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 encourage anyone with concerns to raise them with the nursing home through this complaints procedure. The Office of the Ombudsman can also examine complaints relating to the administrative actions of private nursing homes once the individual has already gone through the complaints procedure of the private nursing home concerned.

I have met Nursing Homes Ireland, NHI, on a number of occasions to discuss the issue of additional charges in an effort to ensure more consistency and transparency on the part of nursing homes in dealing with additional charges. I have asked that nursing homes advise prospective residents of these charges at inquiry stage rather than on admission. I also requested an updated contract for care template to be used by all nursing homes. Nursing Homes Ireland has already undertaken work on this with regard to its members. I have also met Age Action, the National Treatment Purchase Fund, NTPF, the Health Information and Quality Authority, HIQA, and the Ombudsman on the topic. It is important that older people are protected and have all the information they need to make an informed decision.

A review of the nursing home support scheme was published in July 2015. An interdepartmental agency working group chaired by the Department of Health has been established to oversee the implementation of many of the recommendations contained in the review of 2015. These include improvements to the administration of the scheme, a review of how prices for private and voluntary nursing homes are set by the NTPF and a value for money and policy review of the cost differentials in public and private voluntary residential facilities which will commence in 2017.

Significant progress has been made on the implementation of the administrative reforms to the scheme. Separately, the NTPF is progressing work on its review in conjunction with my Department and the Department of Public Expenditure and Reform. I have also asked the interdepartmental group to consider the matter of additional charges in nursing homes and to examine the options that might be available.

Turning to the matter of farms and small businesses, concerns have been raised about the treatment of farms and in particular the potential impact of the annual contribution on the sustainability of family farms and businesses and specifically in circumstances where care may be required for a long period. On this front, I have had ongoing negotiations with the IFA. As recently as last week, I advised it of my intention to apply the cap that applies to private residential properties to farm assets and small business assets. It is an ambition of Government and Government policy to encourage orderly succession arrangements for farms. It is also endorsed by farming organisations. In most cases, early succession arrangements in families should ensure farm assets are transferred well in advance of five years before nursing home care is required, meaning a levy on the farm asset is avoided entirely.

As outlined in A Programme for a Partnership Government, we are fully committed to introducing changes as soon as practicable to remove any discrimination against small businesses and family farms. It is important to note the scheme is underpinned by primary legislation and that, as such, any changes made to the scheme will require amendment to this legislation. My Department is liaising with the Office of the Attorney General regarding the potential changes to the fair deal legislation which will address the concerns raised.The issues currently being examined are legally complex and all aspects of the scheme need to be taken into consideration.

I mentioned at the outset that it is Government policy to promote care in the community for older people so they can continue to live in their own homes for as long as possible. The only statutory scheme in place at present to support older people is the fair deal scheme. However, the Government is committed to establishing a new, separate statutory home care scheme, along with a system of regulation for home care services. The Department of Health is currently engaged in a detailed process to progress this. The statutory scheme for home care will introduce clear rules in regard to the services for which individuals are eligible and in regard to how decisions are made on allocating services. For that reason, developing a new statutory scheme will be an important step in ensuring that the system operates in a consistent and fair manner for all those who need home care services. It will also help to improve access to the home care services that people need in an affordable and sustainable way. The system of regulation for home care will help to ensure that the public can be confident the services provided are of a high standard.

The Minister, Deputy Harris, and I launched a public consultation on home care which opened on 6 July and closed yesterday. A report on the findings of the consultation will be published in the coming months. While these are important steps in the process, a significant amount of additional preparation needs to be carried out before final decisions are taken on the form of the home care scheme and system of regulation. This is required if the reforms are to be successful, affordable and sustainable. Every effort will be made to progress this matter as quickly as possible.