George Lee (Dublin South, Fine Gael)
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Question 103: To ask the Minister for Health and Children her long-term plans for the provision of public nursing home care; and if she will make a statement on the matter. [39370/09]

Áine Brady (Kildare North, Fianna Fail)
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In 2005, my colleague the Minister for Health and Children, in conjunction with the Minister for Social and Family Affairs, established an interdepartmental working group to examine the current arrangements for supporting long-term care and to identify policy options for a financially sustainable system of long-term care. The group reported to the Government in January 2006 and its recommendations have informed a number of key policy developments. With regard to nursing home care, the group offered a number of important recommendations across the areas of capacity, equity and affordability, and long-term financial sustainability.

In relation to capacity, the group recommended that a comprehensive needs analysis of long-term nursing home and respite care requirements for older people should be undertaken. On foot of this recommendation, the HSE, in conjunction with Prospectus, carried out an assessment of bed capacity requirements in the areas of long-stay, dementia-specific and respite care beds over the period 2006-2008. It looked at both immediate capacity requirements across the sector and projected requirements to 2036.

The assessment found that, assuming 4.5% of people over age 65 require long-term nursing home care, there was a national over-provision of long-stay beds in 2006. However, there was an under-provision of such beds in some parts of the country. It concluded that a significant increase in capacity will be required by 2036, even assuming the percentage of people over age 65 requiring such care was reduced to 4%. It also found there was a significant requirement for replacement, refurbishment or up-grading of existing public bed stock in order to meet modern standards.

The capacity assessment provides an objective, evidence-based blueprint for the future development of nursing home care and has already informed the development of a significant number of projects under the HSE's Capital Plan and the Fast-track Initiative. Over the period 2007 to 30 July 2009, 333 additional and 68 replacement beds have been provided nationally. A further 603 additional and 521 replacement beds are planned for the remainder of 2009 and 2010.

With regard to the issues of equity and affordability, the interdepartmental working group recommended a new policy approach in relation to supporting people in need of long-term nursing home care. Its recommendations informed the commitments within the current social partnership agreement, Towards 2016, that:

All relevant public services should be designed and delivered in an integrated manner around the needs of the care recipient based on a national standardised needs assessment. Care needs assessments should be available in a timely, consistent, equitable and regionally balanced basis;

Where community and home-based care is not appropriate, quality residential care should be available;

There should be appropriate and equitable levels of co-payment by care recipients based on a national standardised financial assessment;

The level of state support for residential care should be indifferent as to whether that care is in a public or private facility;

No current resident of a nursing home, public or private, should be put at a disadvantage by whatever new co-payment arrangements for residential care are introduced;

These commitments are realised in the new Nursing Homes Support Scheme, A Fair Deal, which commenced on 27 October 2009. The new scheme seeks to offer assurance to people in need of nursing home care that such care will be affordable and will remain affordable for as long as it is needed. It is complemented by another key development namely, a new regime of registration and independent inspection by HIQA of all residential care settings for older people which commenced on 1 July this year.

As such, this year has seen ground-breaking change within the nursing home sector. There is, for the first time, a single, comprehensive system of registration and inspection for all nursing homes - public, private and voluntary, and a single, comprehensive system of financial support covering all nursing homes - public, private and voluntary. All future developments in respect of nursing home care will have to be considered in the context of these fundamental reforms.

Finally, the interdepartmental working group also highlighted the need to consider long-term financially sustainable funding options to support the future provision of long-term care services (both community-based and residential) having particular regard to demographic trends. This requirement to examine financially sustainable funding models was reiterated in Towards 2016 and preliminary work by the Department of Health and Children has commenced.