Neasa Hourigan (Dublin Central, Green Party)
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1480. To ask the Minister for Health the number of inspections of public and privately run nursing homes carried out by the Health Information and Quality Authority in 2021 and to date in 2022 in relation to their compliance with ventilation regulations and standards; if he is satisfied that infection prevention and control measures as they relate to ventilation are being appropriately enforced in public and privately run nursing homes; and if he will make a statement on the matter. [63372/21]

Mary Butler (Waterford, Fianna Fail)
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The Chief Inspector of Social Services in the Health Information and Quality Authority, (HIQA), is the statutory independent regulator in place for the nursing home sector, whether a HSE managed or a private nursing home. The Chief Inspector adopts a risk-based approach to regulation, prioritising monitoring, inspection and enforcement, based on the assessment of the risk, including the type of inspection undertaken. The approach to inspections typically includes a mix of announced and unannounced, as required. In 2020 there were 392 inspections, in 2021 555 took place. 

Regulation 17 the Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) Regulations 2013 requires a nursing home to have “ventilation, heating and lighting suitable for residents in all parts of the designated centre which are used by residents”. Regulation 27 states that the “registered provider shall ensure that procedures, consistent with the standards for the prevention and control of healthcare associated infections published by the Authority are implemented by staff”. Furthermore, both the National Standards for Residential Care Settings for Older People in Ireland and the National Standards for Infection Prevention and Control in Community Services set out requirements in relation to adequate ventilation. The Chief Inspector, in discharging their duties, determines through examination of all information available to them, including site inspections, whether a nursing home meets the requirements set out by the Regulations and the National Standards. 

The registered providers of nursing homes are responsible for ensuring that bedroom accommodation, communal and dining spaces are well ventilated and not overcrowded, while balancing this requirement against the comfort needs of residents. 

Public Health and Infection Prevention & Control guidelines, published by the Health Protection Surveillance Centre, provide information on the prevention and management of respiratory infections in residential care settings. It remains critical that adherence to the established infection prevention and control (IPC) practices, including basic IPC measures, is maintained. Public health advice remains that strict adherence to IPC is a key measure to mitigate the spread COVID-19. 

This guidance is kept under continuing review as new evidence and data emerges with the latest guidance coming into effect on 17 January 2022.

Imelda Munster (Louth, Sinn Fein)
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1481. To ask the Minister for Health if the HSE intends to ensure that all future contracts with nursing homes contain provisions ensuring that residents who are medical card holders are not charged for items or services which are covered by the medical card; if consideration has been given to seeking to similarly resolve the matter with regard to existing contracts; if he has considered addressing the matter through legislation; and if he will make a statement on the matter. [63373/21]

Mary Butler (Waterford, Fianna Fail)
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The NHSS, commonly referred to as 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.

The Comptroller and Auditor General's Report of May 2020 recommended that the Department of Health, in conjunction with the HSE, should consider reviewing the cost components of long term residential care to ensure that all relevant costs are identified and included. The Department has agreed to this action, and officials within the Department of Health are engaging with their counterparts in the HSE to explore the development of an appropriate process for reviewing the cost components.

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. However, whilst nursing home residents should not be charged for items provided by the medical card, they may also choose to access such services privately.

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 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 Competition and Consumer Protection Commission (CCPC) is an independent statutory body with a dual mandate to enforce competition and consumer protection law in Ireland. CCPC’s mission is to promote competition and enhance consumer welfare. The CCPC has published consumer protection guidelines for contracts of care in long-term residential care services for older people. The guidelines set out the obligations and responsibilities that providers must adhere to under consumer protection law and are aimed at providing greater transparency, clarity and certainty for consumers.