Written answers

Wednesday, 1 April 2009

Department of Health and Children

Health Services

9:00 pm

Photo of Joe CostelloJoe Costello (Dublin Central, Labour)
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Question 118: To ask the Minister for Health and Children the procedure that pertains when a patient requires to be moved from a hospital directly into residential care; the consent required; the assessment of assets and savings undertaken; the situation that pertains to the family home; if she has produced leaflets for patients and relatives detailing different cases that might arise; and if she will make a statement on the matter. [13847/09]

Photo of Máire HoctorMáire Hoctor (Tipperary North, Fianna Fail)
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: I would firstly like to address the portion of the Deputy's question relating to procedures for entering residential care and the issue of consent. The HSE is placing a major focus on improving processes and pathways for patients admitted to acute in-patient settings through the implementation of the Code of Practice for Integrated Discharge Planning. The Code was launched nationally in December and a rigorous process of implementation has begun with the establishment of Joint Implementation Groups in each area working across primary and secondary care services.

In addition, the Deputy will be aware that my colleague the Minister for Health and Children recently approved the national standards for all residential care settings for older people under section 10(2) of the Health Act, 2007. It is intended to have the relevant parts of the 2007 Act commenced on 1 July, 2009 to allow the Chief Inspector of Social Services inspect all centres against the regulations governing these centres together with the standards set by HIQA.

Amongst other things, the standards govern the procedure for moving to long-term residential care. In particular, Standard 10 addresses the assessment requirements by providing that "Each resident has his/her needs assessed prior to moving into the residential care setting, a full assessment upon admission, and subsequently as required to reflect changes in need and circumstances during his/her period in residence". Standard 3 addresses the issue of consent within the residential care setting providing that "Each Resident's consent to treatment and care is obtained in accordance with legislation and current best practice guidelines".

With regard to the Deputy's query about the assessment of assets and savings and the situation pertaining to the family home, I assume this is in the context of an application for nursing home subvention. That being the case, the means assessment is governed by the Health (Nursing Homes) (Amendment) Act 2007 and it takes all of the applicant's assets and savings into account. However, there is an asset disregard of €11,000 which is applied at the outset. In the case of a couple, the HSE will make the assessment based on half of their combined means.

The principal residence is only taken into account for three years. An income is imputed at a rate of 5% per annum and divided by 52 to get a weekly rate. However, if a spouse or child of the person under the age of 21(or certain other relatives as set out in the legislation) is residing in the principal residence, it will not be taken into account. The legislation also provides that the HSE may, at its discretion, refuse to pay subvention where:

(a) the applicant's assets exceed €36,000,

(b) the applicant's principal residence is valued at over €500,000 (where the property is in the Dublin area) or over €365,000 (where the property is outside of the Dublin area) and the principal residence is not occupied by the applicant's spouse or certain relatives who satisfy the conditions set out in the Act and the applicant's annual income is not less than €10,400, or

(c) the applicant does not fall within a) or b) but has an annual income in excess of €36,000.

However, the HSE's National Guidelines for the Standardised Implementation of the Nursing Home Subvention Scheme stipulate that no application should be automatically refused solely on the grounds of the house value or assets alone. All relevant applications should be processed in full and the means assessment undertaken. The HSE's Nursing Home Subvention Guidelines Information Booklet and the Nursing Home Subvention National Guidelines 2007 include information for patients and relatives detailing different situations that might arise.

Finally, the Nursing Homes Support Scheme Bill 2008 – A Fair Deal – is currently making its way through the Houses. This new Scheme will ultimately replace the current subvention scheme. An Information Leaflet, Frequently Asked Questions and Examples document in respect of the new Scheme are all available for patients and their families on the Department of Health and Children website or by contacting the HSE Helpline or the Department.

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