James Browne (Wexford, Fianna Fail)
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343. To ask the Minister for Health the position regarding a person whose fair deal contribution plus their prescription charges exceed their weekly pension sum received; and if he will make a statement on the matter. [2884/18]

James Browne (Wexford, Fianna Fail)
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344. To ask the Minister for Health his plans to address the problem of nursing homes seeking mandatory contributions from persons who are in the fair deal scheme; and if he will make a statement on the matter. [2885/18]

Jim Daly (Cork South West, Fine Gael)
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I propose to take Questions Nos. 343 and 344 together.

The Nursing Homes Support Scheme (NHSS), commonly referred to as A Fair Deal, is a system of financial support for people who require long-term residential care. Participants contribute to the cost of their care according to their means while the State pays the balance of the cost.

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. 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 involve effectively paying twice for the same service.

Although the NHSS covers core living expenses, residents can still incur some costs in a nursing home, such as 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 the private or voluntary 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.

I have met with both Nursing Homes Ireland and Age Action to discuss this issue in detail. In order to improve the transparency of these additional charges, I outlined that a schedule of charges should be provided to potential residents on enquiry to an individual nursing home, rather than at the point of admission. Nursing Homes Ireland undertook to advise their members to do so. I have also recently met with the National Treatment Purchase Fund, the Office of the Ombudsman and HIQA to discuss this matter further.

I have asked the Interdepartmental/Agency Working Group established to oversee the implementation of certain recommendations contained in the 2015 Review of the Nursing Homes Support Scheme to also consider this matter and examine the options that might be available, as part of its ongoing work. As part of this work, Officials from the Department of Health and the HSE are to preform an examination of the issue of additional charges in nursing homes. They will report their findings and recommendations to the Interdepartmental/Agency Working Group for consideration.

In the past week I have met with the Competition and Consumer Protection Commission (CCPC) who are undertaking a project to develop guidelines for the contracts between nursing homes and their residents. I fully support the CCPC in this work and I have already asked my Department to engage with the CCPC as required to assist with its work. In that regard, officials have already met with the CCPC project team to assist with its enquiries.

In relation to the Deputy's reference to prescription charges, I can confirm that from the 1st January 2018 the prescription charge for all medical card holders is €2, with a monthly cap of €20. The Programme for a Partnership Government contains a commitment to reduce the cost of medicines for Irish citizens and further reductions in the prescription charge may be considered in the future, having regard to the funding available.