Richard Bruton (Dublin North Central, Fine Gael)
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Question 308: To ask the Minister for Health and Children the thresholds which will apply in 2007 under the nursing home subvention in respect of the savings necessary to disqualify an applicant and the savings which will be disregarded, the value of subvention for different categories of care dependency and the value of enhanced subvention, the income ceiling above which means will reduced the allowed subvention, the value of house property which will disqualify an applicant inside and outside of Dublin; and the extent to which these have been changed from prevailing levels in Estimates 2007. [39694/06]

Seán Power (Kildare South, Fianna Fail)
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As the Deputy may be aware, the Health (Nursing Homes) Act 1990 and the Nursing Homes Regulations 1993 provide for the payment of subvention for private nursing home care for applicants who qualify on both medical and means grounds. General rules for the assessment of means in respect of an application for nursing home subvention are set out in the Second Schedule of the Nursing Homes Regulations 1993, as amended by the Nursing Homes (Subvention) (Amendment) Regulations 2005.

There are currently three rates of subvention payable, i.e. €114.30, €152.40 and €190.50 for the three levels of dependency which are medium, high and maximum and these rates apply in all parts of the country.

Under the current Regulations, when considering an application for subvention, the Health Service Executive carries out a means test which takes into account the means (including assets) of the applicant and his or her spouse/cohabiting partner, where appropriate. The means test involves looking at the applicant's income for the previous twelve months. Income from all sources is taken into account and is assessed net of PRSI, income tax and the health contribution and the income of a married or cohabiting person is half the total income of the couple. In assessing an applicant's assets the first €11,000 of such assets is disregarded. The HSE may refuse to pay a subvention if an applicant has assets exceeding €36,000 (excluding their principal residence). The HSE may impute an income of 5% of the estimated market value of the principal residence of an applicant for subvention, regardless of market value, unless the residence is occupied by a spouse or son or daughter aged less than twenty one years or in full time education or in receipt of certain social welfare pensions/allowances, and generally does so unless there are exceptional circumstances. The Regulations provide that the HSE may refuse to pay a subvention if the value of the applicant's principal residence is in excess of €500,000 (where the residence is located in the Dublin area) or €300,000 (where the residence is located outside the Dublin area) and the applicant has an income of at least €9,000 per annum.

The HSE has discretion to pay more than the maximum rate of subvention relative to an individual's level of dependency in a case, for example, where personal funds are exhausted. The application of these provisions in an individual case is a matter for the HSE in the context of meeting increasing demands for subvention, subject to the provisions of the Health Act, 2004. The average rate of subvention paid by the HSE generally exceeds the current approved basic rates. The supports paid by the HSE vary from person to person and region to region, depending on nursing home fees for example.

Additional funding of €20 million was provided for the administration of the Nursing Home Subvention Scheme in 2006 bringing the total available budget to €160 million. The additional €20 million is to support more basic nursing home subventions and reduce waiting lists for enhanced subventions: it is also to bring more consistency to subventions support throughout the country.

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. It was prepared on a "no policy change" basis. In addition, national guidelines on nursing home subvention are currently being developed by the HSE to ensure an even and equitable application of the regulations nationally.

The Government is currently considering new policy on Long Term Care and several principles underlying this were agreed with the social partners in "Towards 2016". These principles include, for example, that there should be one standardised national needs assessment for older people needing care. The use of community and home-based care should be maximised. Sheltered housing options will be encouraged. Where residential care is required, it should be quality care and there should be appropriate and equitable levels of co-payment by care recipients based on a national standardised financial assessment. The level of support for residential care should be indifferent as to whether that care is in a public or private facility. The financial model to support any new arrangements must also be financially sustainable.

The Department is currently drawing up proposals for the Government's consideration based on the principles in "Towards 2016".