Mark Daly (Fianna Fail)
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I welcome the Minister of State, Deputy Rabbitte.

Paul Daly (Fianna Fail)
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I also welcome the Minister of State. I thank her for taking the time to come in and deal with this issue. For the record, the question is to ask the Minister of State whether the rate of pay for those who use their homes for the HSE boarding out scheme for elderly people under the boarding out regulations of 1993 could be increased in light of the increasing cost of living and associated costs of running this type of accommodation. It is pretty self-explanatory from the conversation we have on a daily basis in every sector of society with the increased cost of living.

I ask this question this morning specifically on behalf of Lisa and John Corroon in Ballinagore, who have a boarding out home that facilitates six residents. Their residence is somewhat rural and would be five miles from the nearest town. The cost of ferrying their residents to chiropody, physiotherapy and medical and dental appointments has, with the increase in diesel alone, not to mention those relating to food, heating the residence, etc., gone through the roof. This is something of which we are all very much aware.

The regulations were reviewed in 1993. While they have been reviewed since, there has been no change to them. The Corroons rate of pay from the HSE went nine years ago from €90 per week to €110 and then three quarters of the pension. They are getting somewhere in the region of €270 to €280 per person per week. That is one night in an average hotel with breakfast and none of the facilities they are covering. They are unable to survive and continue. That is evident by the fact that very limited numbers of people have availed of the boarding out scheme in recent years. The numbers have dropped off. These people take the maximum six residents, but some very quick and simple sums will tell the Minister of State that the saving by having those six people in this environment as opposed to in a nursing home is approximately one eighth of the cost, depending on what calculations one does. We are looking at a difference of somewhere between €8,000 to €9,000 to €50,000-odd per annum. When you go to look this up, and when I was doing my research this morning, you find there is either very limited or very little information on the HSE website. It is as if it is a secret. It is almost as if it is not wanted because one must go trawling and scratching way below the surface to even find out the basic information. It is as if it is not being promoted or literally not wanted.

Another issue I encountered when I was doing my research is the fact that different community healthcare organisations, CHOs, have different policies and different payment rates. This can cause a major issue for people who are on the borderline and maybe have residents who fall under the jurisdiction of two different CHOs. They will actually be on different rates in the one residence or house.

The kernel of the issue and the key question is that there would be a review of the payment structure. As I said, there is a saving to the State. The fact that it is a smaller facility with a maximum of six residents is very beneficial for our elderly people to be in those kinds of environments. The people who approached me in the case I am using as an example are just one example of this kind of well-run, tight ship. Their residents remain Covid-free. That has been the acid test in all such environments over the last couple of years. They are doing their very best. As I said, they actually kept Covid-19 out of their residence. That is how tight a ship they run. For less than €300 per week, however, they are finding it very hard to survive. They are not making any money out of this; some of their own money is actually going in to keep the show on the road. The matter needs to be reviewed. I hope the Minister of State can look on my request favourably.

Anne Rabbitte (Galway East, Fianna Fail)
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I am taking this Commencement matter on behalf of the Minister of State, Deputy Butler, who sends her apologies for not being here this morning. I would like to thank the Senator for raising this issue, which is a key priority for the Minister of State, Deputy Butler, and for the Government. It will allow more people to engage in services that will allow them to remain independent and to live in their own homes with dignity and independence 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 both quality and patient safety.

The 1993 regulation provided a framework for the operation of a boarding out scheme. The regulation included specific conditions relating to maintenance, care and welfare of an older person in a private home. The intention of the scheme was to provide social and personal care to older people who did not want to or who were not able to live on their own but who wanted to remain living in their community. The phrase that is important here is “local community”.

Under the regulations, the HSE must be satisfied that the house is suitable and that the householder is fit to look after the person who is being boarded out. The householder must provide suitable and sufficient care, nutritious and varied food and adequate attendance, having regard to the needs of the person. The householder must also respect the privacy of the person who is being boarded out. Not more than six people can be boarded out in one house. The regulation also sets out standards as to the suitability of the accommodation, including cleanliness, safety and other related matters. I am reading all this into the record because perhaps not too many people know about this. I genuinely believe that this, until I read it before the House morning, was one of the best kept secrets. I personally also thank the Senator for raising this issue.

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 which is payable at the time in respect of each person being boarded out. In addition, the person who is being boarded out must pay to the householder an amount which is agreed between the HSE, the householder and the person who is being boarded out.

The boarding out scheme has diminished over time. It is now only available in a limited number of areas across the country. At present, it is understood that there are only 17 boarding-out facilities across three community healthcare organisations. The HSE completed a review of the scheme in 2017, which concluded that an expansion of the scheme was warranted. While the use of the boarding out scheme by the HSE has traditionally been small, there is value in exploring it further. I would go so far as to say that this relevant not just for older persons, but that we could also look at within the area of disability.

The pandemic has highlighted the continuing importance of the need to support older people living in our community who wish to remain in their communities where they may otherwise be accommodated in residential care. I am pleased to advise the House that my colleague, the Minister of State with responsibility for mental health and older persons, Deputy Butler, has requested that officials in the Department consider this model of care and the regulation for the scheme, as well as the rate of pay and implications of the raising costs associated with running these accommodations in the context of our overall commitment to enhancing opportunities for older people to stay in their homes and in their communities for longer.

What the Minister of State, Deputy Butler, has committed to doing is very welcome. I thank the Senator for raising this issue.

Paul Daly (Fianna Fail)
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I thank the Minister of State. I appreciate that she is here on behalf of the Minister of State, Deputy Butler. I welcome in her statement the commitment by the Minister of State, Deputy Butler, to review this. However, my specific question was about pay rates, which should be addressed sooner rather than later. The regulations were introduced in 1993. In her statement, the Minister of State, Deputy Rabbitte, said that is now being recommended that we would look at enhancing this model. The numbers are dropping off. She mentioned that there are only 17 registered care homes at the moment. Why is this so? It is because people are not able to financially to maintain them.

In theory, we might be saying that this is a brilliant model that we would love to expand but if we are not rewarding the people who are providing these fantastic facilities, there will be more and more dropping off. If the pricing model alone is not dealt with immediately, the next time we are back before the House having this conversation, I can guarantee the Minister of State that the figure of 17 that she quoted will have decreased and not increased, irrespective of how the Department or the HSE may value the model or think that it needs expanding.

Anne Rabbitte (Galway East, Fianna Fail)
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I thank the Senator again. It is important to say the Government is committed to trying to establish schemes which are focused on prevention and early intervention in respect of appropriate care settings. The point that the Senator has just made is fair. The cost of this scheme is one eighth of the cost of going into a nursing home. It is also keeping people in their community. What the Senator described to me is a family network. However, at the end of the day, costs are rising. I will discuss it further with the Minister of State, Deputy Butler. There is also the fact that within the gift of the HSE locally we do not need to stand behind legislation. There is a word called “discretion”. If there is a need to support that particular house or any of the 17 houses, it should be looked at in the light that we look at all other providers in the areas of disability and older persons. We treat all equally.

Paul Daly (Fianna Fail)
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The HSE is on record as saying that this needs to be done through legislation.

Anne Rabbitte (Galway East, Fianna Fail)
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Okay.