Written answers
Tuesday, 11 July 2017
Department of Health
Nursing Homes Support Scheme Review
Billy Kelleher (Cork North Central, Fianna Fail)
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527. To ask the Minister for Health the progress made in implementing the recommendations of the review of the nursing home support scheme, a fair deal, in tabular form. [32961/17]
Jim Daly (Cork South West, Fine Gael)
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The Nursing Homes Support Scheme (NHSS) is a system of financial support for those in need of long-term nursing home care. Participants contribute to the cost of their care according to their income and assets while the State pays the balance of the cost. The Scheme aims to ensure that long-term nursing home care is accessible and affordable for everyone and that people are cared for in the most appropriate settings.
When the NHSS commenced in 2009, a commitment was made that it would be reviewed after three years. The Report of the Review was published in July 2015. Arising out of the Review, a number of key issues have been identified for more detailed consideration across Departments and Agencies.
An Interdepartmental/Agency Working Group has been established to progress the recommendations contained in the Review. This Group is chaired by the Department of Health and includes representatives from the Department of the Taoiseach, the Department of Public Expenditure and Reform, the HSE, the Revenue Commissioners, and when required, the National Treatment Purchase Fund (NTPF). These recommendations include:
- Examining the treatment of business and farm assets for the purposes of the financial assessment element of the Scheme;
- The implementation of administrative reforms to the Scheme (Chapter Four of NHSS Review);
- A review by the NTPF of present pricing arrangements in private residential facilities.
This work is currently underway.
The following is the position in relation to administrative reform recommendations contained in Chapter four of the Review, as of 30th June 2017.
| No | Recommendation | Position – June 2017 |
|---|---|---|
| 1 | Centralise certain elements of the scheme where appropriate, with built in appropriate management and training processes to ensure customer service is maintained | Following consideration, this recommendation is not being progressed at this time as agreed with the NHSS Inter Departmental Working Group. The elements of the Scheme relating to this recommendation are functioning well. |
| 2 | Consolidate local NHSOs (from 17 to 4) | Work in Progress |
| 3 | Develop a web based form to enable nursing homes to submit invoices electronically | Work in Progress |
| 4 | Centralise the processing of invoices | Following consideration, this recommendation is not being progressed at this time as agreed with the NHSS Inter Departmental Working Group. The elements of the Scheme relating to this recommendation are functioning well. |
| 5 | Centralise the calculation of loan repayments | Following consideration, this recommendation is not being progressed at this time as agreed with the NHSS Inter Departmental Working Group. The elements of the Scheme relating to this recommendation are functioning well. |
| 6 | Clarify for how long the application form/documentation and the CSAR form remain valid without any new processes or medical checks | Implemented |
| 7 | Provide additional information regarding nursing homes to assist with the process of identifying one that is suitable | Following consideration, this recommendation is not being progressed at this time as agreed with the NHSS Inter Departmental Working Group |
| 8 | Review documents and application forms with advice from the National Adult Literacy Agency to ensure they are sufficiently user-friendly and informative and that they include clear guidance on where relevant information/documentation can be obtained | Implemented |
| 9 | Consider whether any additional questions should be included in the application form | Implemented |
| 10 | Make sample completed application forms available | Implemented |
| 11 | Include in the application form a mechanism for an applicant to authorise a representative to submit the application on their behalf | Implemented |
| 12 | Consider the need to establish an NHSS Best Practice Group (consisting of NHSO/national office staff) to share experiences and agree on best practice | Implemented |
| 13 | Consider splitting application form into two parts to avoid delaying the care needs assessment while financial information and documentation is being assembled | Following consideration, this recommendation is not being progressed at this time as agreed with the NHSS Inter Departmental Working Group. The assessment process works well and delays do not usually arise in this part of the application process. |
| 14 | Standardise informal advice provided to applicants regarding the nursing home loan, including clarity re legal aspects | Implemented |
| 15 | Provide advice regarding the possibility of claiming tax relief for medical expenses/nursing home fees | Implemented |
| 16 | Review current letter templates and, where possible, replace with alternative, quicker forms of communication | Work in Progress |
| 17 | Review content of correspondence to ensure it is as clear as possible | Work in Progress |
| 18 | Examine the possibility of scanning/electronic transmission of forms and documentation from NHSOs to the national office | Following consideration, this recommendation is not being progressed at this time as agreed with the NHSS Inter Departmental Working Group |
| 19 | Clarify that the involvement of a solicitor is not required in order to apply for the loan | Implemented |
| 20 | Consider making it a condition of availing of the loan that the required details, including the PPSN of the responsible person are provided | Implemented |
| 21 | Complete analysis of home ownership levels | Implemented |
| 22 | Establish what databases exist that may contain useful data for the financial assessment and establish the access by NHSOs to these, including standard operating procedures, requiring review, of such information sources | Work in Progress |
| 23 | Develop a consistently applied standard operating procedure for the initial financial assessment based on available resources of information | Implemented |
| 24 | Introduce a policy of undertaking random spot checks of financial data | Work in Progress |
| 25 | Follow up with the Revenue Commissioners on the scope for improved validation of declarations of income/assets | Work in Progress |
| 26 | Consider the options to encourage realistic valuations of declared property assets | Work in Progress |
| 27 | Standardise procedures in relation to reviews across NHSOs and ensure that all available information is utilised and accessed | Implemented |
| 28 | Consider amending legislation to provide for fluctuating values of assets and incomes | Changes to the Scheme which require legislative implementation will be addressed collectively once all relevant Review recommendations have been considered. |
| 29 | Continue to operate the national placement list in chronological order | Implemented |
| 30 | Increase time for recovery of loan to 18 months | Changes to the Scheme which require legislative implementation will be addressed collectively once all relevant Review recommendations have been considered. |
| 31 | Amend definition of ordinarily resident to ‘those who have been living in Ireland for at least a year’ | Work in Progress |
| 32 | Consideration should be given to whether a cap should be applied to the charge for nursing home care based on non-residential productive assets which are passed on to a direct family member after, or in the five years prior to, the death of an NHSS participant, and where the new owner carries on the farm or other business as their principal livelihood | The 2015 NHSS Review recommended examination of the position of family farms and businesses. Subsequently a commitment was included in the Programme for a Partnership Government to deal with this issue. This examination is ongoing and at an advanced stage. It is important to remember that the NHSS is largely underpinned by primary legislation, and as such any changes to the Scheme will require legislative implementation. I have committed to prioritising and fast tracking this examination of family farms and businesses and bringing forward changes to the legislation to deal with the uncertainty that is being felt by farming and business families in line with the Programme for a Partnership Government. |
The Review of the NHSS also recommended a review of pricing mechanisms by the NTPF, with a view to:
- Ensuring value for money and economy, with the lowest possible administrative costs for clients and the State and administrative burden for providers;
- Increasing the transparency of the pricing mechanism so that existing and potential investors can make as informed decisions as possible; and
- Ensuring that there is adequate residential capacity for those residents with more complex needs.
A Steering Committee has been established to oversee the review of the pricing system for private long-term residential care facilities. This Steering Committee is chaired by the NTPF and includes representatives from the Department of Health, the Department of Public Expenditure and Reform, and the NTPF, and work in this area is ongoing and well advanced.
A Value For Money and Policy Review of the differences in the comparative cost of public and private long-term residential care is expected to commence in 2017 to assess reasons for and components of current cost differentials.
An initial report on the progress of the NHSS Review recommendations was submitted to the Cabinet Committee on Health in September 2016.
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