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Dáil Éireann díospóireacht -
Wednesday, 28 Nov 2001

Vol. 545 No. 2

Adjournment Debate. - Nursing Home Subventions.

I am delighted to have the opportunity to raise on the Adjournment the ongoing threat to the elderly of evictions from nursing homes because of the failure of the Minister for Health and Children to allow health boards to pay subventions at rates to meet each individual set of circumstances.

Services for older people in Ireland fall short of adequate standards. They are characterised by huge gaps, by queues and waiting lists and by unaffordable costs. The facts are: the population aged over 65 in Ireland is growing rapidly and is forecast to increase by 400,000 by the year 2030, an increase of 50%; at present, less than half of full time carers receive any financial support from the State; access to long-stay residential care is highly arbitrary and inequitable and an adequate preventative health strategy has not been developed to manage the problems of older age.

Older people must be encouraged to live in their own homes and communities with the adequate supports available to them. In the Southern Health Board area there are 18,000 elderly people living alone and only 35% receive home help. In addition, there are currently only 187 public health nurses serving the entire population of elderly in the Southern Health Board region. Many families with an elderly relative very often find that the necessary support required to keep an elderly person at home is not there and the family is often left with no alternative but nursing home care. At the moment the total number of elderly receiving the nursing home subvention in the Southern Health Board region is 721. The average subvention is only £131 per week with families often struggling to make up the shortfall of up to £300 per week.

At present, less than half of full-time carers receive any financial support from the State. In the Southern Health Board area there are only 76 respite beds, which serve the entire elderly population. This week again patients fear that they are facing discharge from a private nursing home in Cork while, at the same time, families throughout the country are accumulating massive debts with private nursing homes simply because we have a Minister for Health and Children who is failing to make decisions on the review of the nursing homes subvention scheme undertaken by his Department in association with the Department of Finance. The Minister's failure to make decisions means we are now in a crisis where elderly people are being threatened with eviction and families are living in fear. The Minister is well aware of this serious situation but is failing to act.

The Minister publicly said in early June that he would not be bounced into a decision regarding enhanced subventions but his failure since then to make decisions means that elderly persons are afraid they will be bounced out of nursing homes. The Minister, who is a member of the Government with vast resources at his disposal, is effectively abandoning the elderly. The very people who built our economy are now being left in a hopeless situation. The Minister's failure to act has also brought about a situation where a high percentage of acute hospital beds in all public hospitals are occupied by elderly people who cannot be discharged back home because they need nursing care. They cannot be accommodated in nursing homes because the beds are not available. This results in seriously sick people being unable to get into hospital and obtain treatment because of the occupied beds.

This situation is making the waiting list crisis even worse so I am now asking the Minister for Health and Children to take immediate decisions to increase allocations for health boards right throughout the country so that the nursing homes subvention scheme can be implemented as recommended by the Ombudsman's report, which was scathing in its criticism of the Minister and his Department. The Minister must also make immediate decisions on the expenditure review of the nursing homes subvention scheme undertaken by his Department in association with the Department of Finance and completed since last June. I also demand that the Minister guarantees here tonight that he will make the resources available to the health boards to implement the Ombudsman's recommendations in relation to the refund scheme for families who were obliged to sell family properties and exhaust family savings for their elderly parents and relations because of irregular decisions made by health boards arising from directives from the Department of Health and Children.

I thank Deputy Allen for raising this matter. The Health (Nursing Homes) Act, 1990, which came into effect on 1 September 1993 has two principal objectives. The first is to ensure high standards of accommodation and care in all nursing homes registered under the Act and the second is to provide a new system of nursing home subvention so that dependent persons most in need of nursing home care will have access to such care. Under the Health (Nursing Homes) Act, 1990, health boards provide subventions to assist persons in meeting the costs of nursing home care. However, it was never intended that subventions would meet the full costs involved. Apart from contracts entered into under Article 22.3 of the Nursing Homes (Subvention) Regulations, 1993, which allows a health board enter into an arrangement with a private nursing home, the placement of a person in a private nursing home and the fees charged are private arrangements between the nursing home and the individual resident.

The Nursing Homes (Subvention) Regulations, 1993, are administered by the health boards and the Eastern Regional Health Authority. A health board may pay more than the maximum rate of subvention relative to an individual's level of dependency, for example, in cases where personal funds are exhausted. Articles 22.3 and 22.4 of the Nursing Homes (Subvention) Regulations, 1993, permit health boards to contract beds in private nursing homes and to pay more than the maximum rates of subvention in such cases. However, the application of these provisions is a matter for the individual health board concerned in the context of meeting increasing demands for subventions within the board's revenue allocation as notified annually in the letters of determination. This is in keeping with the provisions of the Health (Amendment) (No. 3) Act, 1996.

Significant additional funding has been provided by Governments since its introduction in 1993. In 1994, in the first full year of the operation of the nursing home subvention scheme, £12 million was made available. In 1997, when the Government came to office, £27 million was allocated. This year, an additional £14 million was provided by my Department, bringing the amount available for the scheme to £52 million.

As a member of the Southern Health Board, Deputy Allen will be aware that the board has received a significantly increased number of claims from patients for enhanced payments in accordance with Articles 22.3 and 22.4. It is a matter for each board to determine the extent to which it can meet such claims consistent with its requirement to live within its overall revenue allocation and taking account of the fact that such enhanced payments are discretionary. However, in the interest of avoiding hardship to individual patients, my Department has been in regular contact with the board in an effort to find a solution which would take cognisance of the considerations outlined above. A solution has been found to meet the most immediate individual problems and discussions are continuing in an effort to reach agreement on a more long-term approach to the issue.

What is the solution?

The Minister of State, without interruption.

However, it should be noted that the nursing home subvention regulations do not specify a maximum amount to be paid in respect of enhanced subvention. A decision relating to the amount to be paid is a matter for each health board, following assessment on a case by case basis and bearing in mind their obligation to comply with Article 20 of the Nursing Homes (Subvention) Regulations, 1993, as well as the Health (Amendment) (No. 3) Act, 1996. Article 20 of the Nursing Homes (Subvention) Regulations provides that if, under section 31 of the Health Act, 1970, the Minister specifies a limit on the expenditure to be incurred in providing services under the Act, a board may pay such amounts as would enable it to contain its expenditure within the specified limit.

As the Deputy will be aware, in line with a Government decision, an expenditure review of the nursing home subvention scheme has been undertaken by my Department in association with the Department of Finance. It is the intention to bring forward proposals in due course in relation to whatever additional measures may be necessary arising from the expenditure review and the Ombudsman's report, together with experience gained from the operation of the scheme since its inception in 1993. As announced in the health strategy, which was published on Monday, it is also the intention of my Department to amend the nursing home subvention scheme to take account of the expenditure review of the scheme and to introduce a pilot home sub vention scheme in consultation with the Department of Social, Community and Family Affairs. This will be carried out in the context of an integrated approach to meeting the needs of ageing and older people.

No solution has been found.

There is no provision for supplementary questions.

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