Richard Bruton (Dublin North Central, Fine Gael)
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Question 97: To ask the Minister for Health and Children if she will issue guidelines clarifying the obligations of patients in nursing homes whose resources have been exhausted and who face mounting deficits in their payments to the nursing home; the obligation of the patient's next of kin, the provider and the State in respect of the financial shortfall involved; and the protection there is in the case of persons who have given up their home and exhausted all their savings that liability can not be pursued in respect of their next of kin who are not in a position to pay the cost. [17162/09]

Áine Brady (Kildare North, Fianna Fail)
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The cost of private nursing homes is set by the nursing home and is not determined by the Department. The Health Service Executive can pay an approved subvention to the nursing home of the applicants' choice and the payment of the balance of the nursing home fee is a matter between the patient and the nursing home under the contract of care agreed between these parties. In order to qualify for a subvention, an individual must be: a) sufficiently dependent to require maintenance in a nursing home, and b) unable to pay any or part of the cost of maintenance in the home. In order to determine this, they must undergo a means assessment which takes account of their income and assets.

The existing subvention scheme is governed by the Health (Nursing Homes) (Amendment) Act 2007. Under the Act, the maximum amount for basic subvention is €300 per week. The Act also provides for an enhanced subvention to be paid. However, there is no maximum amount set for enhanced subvention. The amount paid is at the discretion of the HSE and will vary depending on the following criteria:

• the assessed means of the applicant,

• the cost of care in the individual case compared to the level of fees in the locality,

• the amount of basic subvention payable,

• the amount of resources available for the scheme,

• the need for the HSE to ensure that the available resources are distributed in a way that supports applicants as evenly as possible across the country.

Medical card holders are entitled to retain their medical card when they move into a private nursing home. In such circumstances, the HSE must continue to make a General Practitioner (GP) service available to the patient free of charge and they retain the right to choose their own GP in the same way as if they were living in the community.

Finally, the Minister has acknowledged that the current system of Nursing Home Subvention does not provide adequate supports for some people. It was with this in mind that work commenced on the Nursing Homes Support Scheme, A Fair Deal. You will be aware that the legislation completed Committee Stage in the Dáil on 12 March 2009. It is the Minister's intention to progress the legislation through the Houses of the Oireachtas with a view to implementing the scheme later this year. Unfortunately it is not possible to give a more specific timeframe at present.

The Fair Deal 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 re-mortgage homes to pay for the cost of nursing home care. It aims to render private long-term care affordable and anxiety-free, and ensure that no-one has to sell their home during their lifetime to pay for their care. The Fair Deal will equalise State support for public and private long-term care recipients. 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, private or voluntary nursing homes. This will meet one of the objectives of Towards 2016, namely that State support should be indifferent as to whether a person is in public or private care.