Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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608. To ask the Minister for Health if he will outline the regulations for the fair deal in respect to extra costs incurred by families, which nursing homes are invoicing for, outside of the flat rate fee issued by the HSE; and if he will make a statement on the matter. [8220/23]

Mary Butler (Waterford, Fianna Fail)
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The Nursing Homes Support Scheme (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.

Data from HSE indicates that, on average, NHSS residents cover around 30% of their cost of care, with the state covering the remaining 70%. This proportion is based on the assessment of residents' assets and income, rather than on the cost of providing their care, and has remained stable over recent years.

Costs not covered by the NHSS include those individually incurred for items like social activities, newspapers and hairdressing. This may also include medical services such as therapies and some medical equipment. 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.

It is important to state that residents of nursing homes should enjoy the same levels of support and access to services for which they are eligible as when they lived in their own homes. It is acknowledged that the reason they require 24 hour levels of support is due to their level of dependency, which in turn may require access to clinical services including hospital and other outpatient appointments in the community.

Although the NHSS covers core living expenses, residents can still incur some costs in a nursing home, as set out above. 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).

The Department of Health does not currently hold data relating to additional charges in private nursing homes; these vary according to each individual nursing home depending on the services offered. It is important to note that it is private nursing homes who hold responsibility for delivering care to their residents in line with their terms of registration and the relevant regulations under the Health Act 2007.

Nevertheless, the Department of Health is currently reviewing the available evidence and considering various policy options with relation to additional nursing home charges.

It is clear that, under the terms of the NHSS Act 2009, private nursing homes should not levy additional charges on NHSS residents for services coming within scope of the Nursing Home Support 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. Where an individual is not satisfied with the response they receive, they may wish to take their complaint further by seeking a review from the Office of the Ombudsman.

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 complaint’s procedure of the private nursing home concerned.

The Competition and Consumer Protection Commission (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.