Tommy Broughan (Dublin Bay North, Independent)
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300. To ask the Minister for Health the pricing controls in place for private nursing homes under the fair deal scheme; if all necessary services such as chiropody, and so on are included in service provision; if there are extra charges for other services and the oversight his Department has in this regard; and if he will make a statement on the matter. [32590/16]

Helen McEntee (Meath East, Fine Gael)
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The Nursing Homes Support Scheme (NHSS) is a system of financial support for people who require long-term nursing home care. Participants contribute to the cost of their care according to their means while the State pays the balance of the cost.

The legislation underpinning the Nursing Homes Support Scheme (NHSS) requires each private nursing home to negotiate and agree a price for long-term residential care services with the National Treatment Purchase Fund (NTPF) should they wish to be an approved nursing home for the purposes of the Scheme. The NTPF has statutory independence in the performance of its function, and negotiates with each nursing home on an individual basis.

The NHSS covers the cost of the standard components of long-term residential care which are:

- Nursing and personal care appropriate to the level of care needs of the person;

- Bed and board;

- Basic aids and appliances necessary to assist a person with the activities of daily living; and

- Laundry service.

A person's eligibility for other schemes, such as the medical card scheme or the drugs payment scheme, is unaffected by participation in the NHSS or residence in a nursing home. Other medical or therapy services such as chiropody are not funded by the NHSS. In determining the services covered by the NHSS it was considered very important that the care recipient and the taxpayer would be protected and would not end up paying for the same services twice. For this reason, medications and aids that are already prescribed for individuals under an existing scheme are not included in the services covered by the NHSS, as this would involved effectively paying twice for the same service.

Although the NHSS covers core living expenses, residents can still incur some costs in a nursing home, e.g. social programmes, newspapers or hairdressing. In recognition of this, anyone in receipt of financial support under the NHSS retains at least 20% of their income. The minimum amount that is retained is the equivalent of 20% of the State Pension (Non-Contributory). An operator should not seek payment from residents for items which are covered by the NHSS, the medical card or any other existing scheme.

Part 7 of the Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) Regulations 2013 stipulates that the registered provider of the nursing home must agree a contract in writing with each resident on their admission to the nursing home. This contract must include details of the services to be provided to that resident and the fees to be charged. Residents should never be charged fees which are not set out in the contract. The Department of Health and the HSE are not a party to such contracts which are concluded between each resident and their nursing home.

Registered providers of nursing home care are obliged to provide an accessible and effective complaints procedure. Concerns about additional charges should in the first instance be taken up with the nursing home provider. The Office of the Ombudsman can examine complaints about the actions of a range of public bodies and, from 24 August 2015, complaints relating to the administrative actions of private nursing homes. The Office of the Ombudsman normally only deals with a complaint once the individual has already gone through the complaints procedure of the private nursing home concerned.

The Review of the Nursing Homes Support Scheme, published in July 2015, looked at the issue of additional costs in private nursing homes and made the following recommendations:

- Nursing homes should have a published fee schedule showing all the costs associated with being a resident.

- Consideration should be given to introducing a new provision under the scheme to prohibit the levying of additional charges for any service or facility from which residents can not readily opt out without penalty while remaining as residents of that facility, or in which they cannot participate because of their level of dependency.

- Consideration should be given to including in the price contracts with facilities, details of what additional charges are proposed, of the opt-out arrangements that exist for residents and confirmation that residents will not be charged for extra services that they cannot participate in because of their dependency or lack of capacity.

An Interdepartmental/Agency Working Group has been established to progress the recommendations contained in the Review. A specific date has not been set for the Group to conclude its work, but an initial report on its progress was submitted to the Cabinet Committee on Health in September 2016.