Deputy Andrew Boylan gave me notice of his intention to raise the reason patients in private nursing homes in Cavan are not entitled to any subvention payments from the North-Eastern Health Board in the same way as are nursing homes generally and whether the Minister for Health is aware of the crisis in Cavan regarding the care of the elderly.
Adjournment Debate. - Nursing Home Subventions.
Thank you for the opportunity to raise this matter in relation to the care of the elderly in my county. I acknowledge the Minister's presence to deal with this matter.
We have a crisis in my county in relation to the care of the elderly. It gives me no joy to say that. I have been making the case for a number of years that there is an ongoing problem. I want to acknowledge the marvellous work being done in St. Felim's, the health board hospital, by the nursing staff. But for their care and attention the position would be much worse. That nursing home is full at all times and there is a waiting list of 80 patients at any time. Health board officials will say this is not true, but I challenge them that I have made my own inquiries in the hospital and have received many representations.
There are three private nursing homes in the county at Virginia, Bailieboro and Belturbet. They have an average of about 20 patients and they do marvellous work. These nursing homes too are full. If there is no need for them, as the health board say, why are all the beds taken? The cost of staying in one of these nursing homes ranges from £165 to £185 per week. That is a reasonable charge when compared with the average around the country. These are commercial enterprises. People are turning to these nursing homes in desperation.
I want means testing of cases made to the health board for assistance. I do not want an open ended scheme. There are elderly people who would like the facility of a private nursing home, but some people must seek State care when everything else has failed. I reject the notion that the younger generation do not care for the elderly. It is not true. There never has been a better commitment to the elderly. There are cases, however, where a point is reached when there is nothing to do but turn to an institution. Failing the health board institution, they turn to the private nursing home.
An elderly patient in receipt of old age pension of about £55 per week may have no other income. The pension income is made available to the nursing home but there is a shortfall of perhaps £115 a week. In-laws are rallying around who are often in poor circumstances themselves. The person who is expected to make up the balance may also be an old aged pensioner. Fear and worry set in and a bad case is made critical.
There are no nursing homes in Cavan to which subventions are payable. I would ask the Minister to pay a subvention on an individual basis where a case is made for help. I am not asking that the whole balance be made up. The relatives are asking for some help, a subvention of perhaps £40 or £50 a week which could be added to the pension income of the patient, thus reducing the shortfall. The relatives would be prepared to meet the remaining outlay. We are talking about people who have given much to this country and who should have dignity and comfort in their old age.
I want to mention the case of an elderly old aged pensioner who has no other income and no immediate family. That person is being kept in a nursing home in Cavan for the cost of the old age pension alone. That is not economical and the nursing home are not expected to do it. St. Felim's Hospital cannot take that patient. There is nowhere else for him to go and the nursing home will not turn him out on the road. Surely the Department of Health should make a subvention available. The nursing home is prepared to meet a portion of the cost if the Minister will make a contribution of £45 or £50. If a place were available in the hospital the cost would range between £200 and £300 per week.
I have been making this case consistently in letters to the health board and by way of resolution at meetings of Cavan County Council. I do not seem to be making any progress. I am grateful for the opportunity of raising the matter tonight and I assure the Minister that the facts are as I have stated. I hope the Minister will indicate an improvement.
I am much impressed by Deputy Boylan's impassioned plea and I recognise his sincerity in this matter.
The North-Eastern Health Board make arrangements for residential care for patients for whom such care is necessary either by placing them in health board geriatric homes or hospitals or in subvented nursing homes. The North-Eastern Health Board paid a total of £275,000 in subvention to nursing homes for patients in the North-Eastern Health Board region in 1991.
Some private nursing homes throughout the country are approved to receive subvention payments under section 54 of the 1970 Health Act. However, no new nursing homes have been approved for subvention since 1980 and less than 30 per cent of private nursing homes throughout the country are in receipt of subvention.
Where it is assessed by the North-Eastern Health Board that nursing home care is necessary for certain dependent persons, these are placed in subvented nursing homes in the North-Eastern Health Board region or in subvented beds in nursing homes outside the North-Eastern Health Board region. The drafting of regulations to provide for a new method of subventing patients in nursing homes under the Health (Nursing Homes) Act, 1990, is at an advanced stage.
Discussions are already taking place with the chief executive officers of the health boards and when these are complete we will begin discussions on draft regulations with nursing home interests and groups representing the elderly. When the subvention and other regulations which are required to bring the Nursing Homes Act into effect have been finalised, the Act can be commenced. It is my intention to bring the Act into effect as soon as possible.
Nursing homes are only one option for providing residential care for the elderly and the nursing home situation in Cavan has to be placed in the context of the overall provision of beds and services for the elderly by the North-Eastern Health Board. In Cavan alone the health board provides 254 long stay geriatric beds in St. Felim's geriatric home and 40 places in the health board welfare home. In addition there are six respite beds for the elderly which were used by 75 patients in 1991 and there are 170 acute beds in Cavan General Hospital, many of which are used by patients over 65 years of age. There is a very high ratio of elderly patients in that area.
In practice the North-Eastern Health Board treat the counties of Cavan and Monaghan as a common catchment area for health services. In addition to the health board beds provided in Cavan, there are an additional 393 health board beds available for the elderly in Monaghan, consisting of the geriatric home in Castleblayney containing 204 beds, which is a lot; 40 welfare beds and 149 beds in Monaghan General Hospital, which are mostly occupied by the elderly.
The situation of private nursing homes in Cavan should be placed in the context of the overall provision of care for the elderly by the North-Eastern Health Board, particularly in the Cavan/ Monaghan area. As my Department have said, it is not true in this context to say that there is a crisis.
I shall reconsider the points made by the Deputy, but as regards the overall care of the elderly in Cavan, the North-Eastern Health Board established a steering group to consider the needs of the elderly arising from the recommendations contained in the report The Years Ahead — A Policy for the Elderly. That group has now reported. Plans have been made for the provision under the following categories of sufficient places in line with norms set out in the document: assessment beds, rehabilitation beds, day hospital beds, extended nursing care beds, welfare home beds and beds for the severely mentally infirm. It is intended that the assessment beds will be provided by the utilisation of existing unopened beds at Cavan General Hospital, with the rehabilitation unit located as near as possible.
The major recommendation of the steering group is the relocation of the present heavy dependency/extended care beds from the old St. Felim's Hospital to the now disused St. Joseph's Hospital, Lisdarn, which will be redesigned and refurbished. That will be done. These plans are a priority of the North-Eastern Health Board and will be implemented as soon as finances permit.
With the additional budget funding provided for the elderly in 1990 and 1991 the North-Eastern Health Board were able to do the following in the Cavan area: provide improved home care services by the employment of extra nurses, home helps and so on and the provision of a range of home care equipment; develop and equip a unit for respite care at the Dr. Jack Sullivan Welfare Home in Cavan; develop facilities at St. Felim's Hospital to cater for demential patients.
I recognise the points made by Deputy Boylan and I shall ask my Department to again examine the position. If the Deputy could give me more information I should be delighted to discuss it with him and determine ways in which we could make further progress. I thank the Deputy for bringing the matter to my attention.