Written answers
Tuesday, 16 January 2018
Department of Health
Nursing Homes Support Scheme
Billy Kelleher (Cork North Central, Fianna Fail)
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837. To ask the Minister for Health the action that has been taken to implement the 2015 review of the nursing homes support scheme recommendations on the administration of the scheme, in tabular form (details supplied). [55016/17]
Billy Kelleher (Cork North Central, Fianna Fail)
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838. To ask the Minister for Health the action that has been taken to implement the 2015 review of the nursing homes support scheme recommendations on the price of long-term residential care, in tabular form (details supplied). [55017/17]
Billy Kelleher (Cork North Central, Fianna Fail)
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839. To ask the Minister for Health the action that has been taken to implement the 2015 review of the nursing homes support scheme recommendations for future service provision, in tabular form (details supplied). [55018/17]
Billy Kelleher (Cork North Central, Fianna Fail)
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840. To ask the Minister for Health the action that has been taken to implement the 2015 review of the nursing homes support scheme recommendations on residential care capacity, in tabular form (details supplied). [55019/17]
Jim Daly (Cork South West, Fine Gael)
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I propose to take Questions Nos. 837 to 840, inclusive, together.
When the Nursing Homes Support Scheme (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.
Work is on-going across the range of recommendations and many of these have been completed and operationalised. A number of the recommendations in the Review relate to the identification of specific areas of the Scheme that require further and considerable detailed analysis and review. One of these recommendations included a detailed 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.
The Review also recommended that a Value For Money (VFM) and Policy Review of the differences in the comparative cost of public and private long-term residential care be undertaken. Work on the scoping of this review began in late 2017. Detailed work on the VFM review wil commence in 2018 and is expected to be completed in 2019.
The following table provides the current status in relation to the consideration of the recommendations contained in the review.
Review of Nursing Homes Support Scheme
Progress in Actions
| No. | Recommendation – Administration of Scheme | Position – January 2018 |
|---|---|---|
| 1 | Centralise certain elements of the scheme where appropriate, with built in appropriate management and training processes to ensure customer service is maintained | This recommendation is not being progressed at this time as agreed with the NHSS Inter Departmental Review Group |
| 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 | This recommendation is not being progressed at this time as agreed with the NHSS Inter Departmental Review Group |
| 5 | Centralise the calculation of loan repayments | This recommendation is not being progressed at this time as agreed with the NHSS Inter Departmental Review Group |
| 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 | This recommendation is not being progressed at this time as agreed with the NHSS Inter Departmental Review 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 | This recommendation is not being progressed at this time as agreed with the NHSS Inter Departmental Review Group |
| 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 | This recommendation is not being progressed at this time as agreed with the NHSS Inter Departmental Review 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 | Requires legislative change. This may be considered as part of amendment for 2018 |
| 29 | Continue to operate the national placement list in chronological order | Implemented |
| 30 | Increase time for recovery of loan to 18 months | Requires legislative change. This may be considered as part of amendment for 2018 |
| 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 | Amendment to legislation planned for 2018 |
| No. | Recommendations on Price of Long Term Residential Care | Position January 2018 |
|---|---|---|
| 1 | Nursing homes to consider offering access to a ‘house’ doctor in each facility. | This is for individual Nursing Homes to consider |
| 2 | A person in a long-term residential care setting should receive the same level of other health services as they would if they remained in their own home and it is important that this policy is implemented consistently by the relevant HSE personnel. | Residents in Long Term residential Care are entitled to the same level of service as those who remain in their own homes |
| 3 | The existing system of agreeing prices facility by facility should continue for the immediate future. | The NTPF continue to negotiate the cost of care in private Nursing Homes registered under NHSS |
| 4 | Within 18 months, the NTPF should review the present system and submit future pricing proposals to the Minister for Health with a view to:- i) Ensuring that there is adequate residential capacity for those residents who require higher level or more complex care; ii) Ensuring value and economy, with the lowest possible administrative cost for the State and administrative burden for providers; iii) Increasing the transparency of the pricing mechanism so that existing and potential investors can make as informed decisions as possible | The NTPF was asked to conduct the pricing review by the Secretary General in January 2016. This review is well advanced and a report is expected to be submitted to the Minister for consideration in the first half of 2018 |
| 5 | The cost of public long-term residential care should be based on a pricing model that is objectively and consistently formulated, and which takes account of and accurately quantifies unavoidable price distortions. | The NTPF has statutory independence in the performance of its function, and negotiates with each nursing home on an individual basis. |
| 6 | It is important that the position of section 39 voluntary agencies be addressed. A clear plan must be developed by such facilities, supported by the HSE to agree their purpose and function and where necessary to get the cost structures into line within a reasonable and specified timeframe. | Work in progress |
| 7 | Nursing homes should have a published fee schedule showing all the costs associated with being a resident. | Minister Daly has requested that NHI request its members to make proposed contracts of care (containing fee schedules) available to potential nursing home clients at enquiry stage |
| 8 | 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 the level of their dependency. | The inter departmental working group has been asked to examine the issue of additional charges. This is currently being examined by a Department of Health/HSE Group. |
| 9 | 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 charges for extra services that they cannot participate in because of their dependency or lack of capacity. | As above |
| 10 | It may continue to be necessary for the HSE to make additional payments in circumstances where very specialist care is required. Engagement with acute, disability and other services is required to give a more comprehensive service for this co-hort. | This HSE approach is continuing to operate. |
| 11 | The HSE should publish the cost of care on an annual basis. | The weekly cost of care for private and voluntary nursing homes is published following agreement being reached with the NTPF |
| 12 | The HSE should continue to review the costs in its facilities to examine if facilities can be made more cost efficient. The review should start with the most expensive nursing homes and then cascade down. | HSE continue to review the cost of care in their Nursing Home Facilities |
| 13 | A value for money and policy review will be undertaken of HSE public long-term residential care facilities to examine the extent to which cost differentials with care in private facilities can be attributed to patient dependency characteristics or other objective factors for which a higher level of cost is justified. | A VFM review will be undertaken by the Department of Health. Scoping commenced on this in 2017 and detailed work will commence in 2018 |
| No. | Recommendations for Future Service Provision | Position January 2018 |
|---|---|---|
| 1 | Development of a community based model of care that includes: a) access to short-stay community beds, b) sufficient home help and home care packages, c) Intensive home care packages, d) Integration and communication links between the acute hospital and community services, e) Access to the expertise of the consultant geriatrician team when required with additional supports from the voluntary sector. | Additional resources have been provided in recent years to strengthen supports, in particular for homecare and transitional care, to facilitate speedier discharge from acute hospitals. The Integrated Care Programme for Older Persons will, in 2018, consolidate progress to date within the existing 12 pioneer sites in accordance with the 10-step integrated care framework. Home support services from 2018 onwards will be delivered through a single funded model. |
| 2 | Addressing the uneven availability of home care. | The Department is currently engaged in a detailed process to develop plans for a new statutory scheme and system of regulation for home care services. |
| 3 | Developing clear and effective linkages and co-ordination between acute hospitals and home care services, including the development of an IT System. | This will be part of the statutory homecare scheme currently being developed |
| 4 | Reviewing, simplifying and standardising procedures for assessing, approving and procuring home supports across the system. | This will be part of the statutory homecare scheme currently being developed. |
| 5 | Providing additional short-stay beds, particularly in areas that are most relevant to major acute hospitals. | Additional resources have been provided in recent years to strengthen supports, in particular for homecare and transitional care beds, to facilitate speedier discharge from acute hospitals. In 2018 a further approx €6m has been provided for additional transitional care and bed capacity |
| 6 | Including day care beds as appropriate in planning future services. | Currently accounted for in Service Planning |
| 7 | Explore the potential of assistive technology in possible collaboration with researchers and industry. | The HSE have explored and encouraged the take up of assistive technology. |
| 8 | Exploring the potential of a collaborative approach across the Departments of Health, Environment, Community and Local Government to provide appropriately supported sheltered housing. | The Department of Health and the Department of Housing, Planning and Local Government are collaborating on a policy framework for supported housing and support for a demonstration project on supported living. |
| 9 | Considering the extension of the boarding out model where appropriate. | The HSE has examined this model and the Department will consider same in due course |
| 10 | Maintaining and fostering links with the voluntary sector which can make an important contribution in supporting older people to remain in their own communities. | This relationship is being maintained and a National Positive Ageing Strategy Stakeholder Forum was established in 2017 |
| 11 | Evaluating the Older People Remaining at Home (OPRAH) project with a view to applying learning from the project to other areas. | Learning from OPRAH will be considered on an on-going basis including in the context of inter alia the development of a Statutory Home Care Scheme |
| 12 | Considering ways to bring greater clarity and consolidation to budgets for older person’s community services. | The home care and home help services have been streamlined into one single funded home support service. This will improve the efficiency of the system and also improve oversight by making performance data clearer and easier to understand. |
| No. | Recommendations on Residential Care Capacity | Position January 2018 |
|---|---|---|
| 1 | The Department of Health continues to progress the project to identify and assess the various options available to encourage the provision, including the upgrading and refurbishment, of long-term residential care facilities for older people. | 5 year Capital investment programme for Community Nursing Units 2016-2021 is on-going |
| 2 | The implications for HSE residential facilities of the relevant standards should be clarified with a view to agreeing an approach that achieves the best achievable outcome for residents. | 5 year Capital investment programme for Community Nursing Units 2016-2021 is on-going |
| 3 | Detailed consideration should be given to whether there is potential for new models of collaboration between the public and private sectors. | 5 year Capital Investment programme for Community Nursing Units includes a number of CNU’s for Public Private Partnership |
| 4 | The potential of sheltered housing and assisted housing models should be considered in consultation with the Department of Environment, Community and Local Government. | Collaboration with the Department of Housing Planning and Local Government is on -going and includes the development of a demonstration project for supported living |
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