Charles Flanagan
Question:12 Mr. Flanagan asked the Minister for Health if he intends introducing an elaborate system of means testing in the matter of the subvention payable to nursing homes in respect of resident patients.
Ceisteanna — Questions. Oral Answers. - Nursing Homes' Subvention.
Proinsias De Rossa
Question:39 Proinsias De Rossa asked the Minister for Health if it is intended to implement regulations regarding subventions for dependent people in nursing homes on 1 May 1993 as indicated by him to Dáil Éireann on 10 March 1993; if he intends to place the regulations before the House for approval prior to their implementation; the interest groups, if any, he has consulted regarding the regulations; if he will confirm the details of the draft regulations as published in The Irish Times of 7 April 1993; if it is intended that the income of children of a dependent person will be taken into account when assessing means of a dependent person; if his attention has been drawn to the serious concern expressed by families already supporting dependent relatives at the implication of the new regulations; and if he will make a statement on the matter.
I propose to take Questions Nos. 12 and 39 together. The Health (Nursing Homes) Act, 1990 provides for the registration by health boards of all nursing homes, enhanced powers for health boards in ensuring high standards of care in nursing homes and a new system of subventing persons in nursing homes. Regulations have been drafted which set out the conditions under which a person may qualify for a subvention under the Act to include an assessment of means of the person applying for the subvention.
The objective of the new scheme of nursing home subventions is to ensure that the new subventions are paid to those most in need. For this reason it is necessary to have a means test which will assess fully the financial position of each person who applies for a subvention. The proposed assessment of means takes into account the income of the person applying for subvention and the value of assets owed by the person. If the person applying for subvention has a spouse, that person's income will be assessed jointly with the applicant's in accordance with the principles and practice of the social welfare code.
Under the regulations, as currently drafted, health boards may not take into account the income of an adult daughter or son in deciding whether a person is eligible for a nursing home subvention. However, it is proposed that health boards may take the income of adult daughters or sons of the person who is eligible for a subvention into account in deciding how much the subvention should be. The circumstances in which health boards may make these inquiries will be limited by the subvention regulations.
The proposed new system of subvention will replace existing arrangements which have been criticised by the Working Party on Services for the Elderly, the National Council for the Elderly and other groups active on behalf of the elderly.
The Deputy will appreciate that the funds allocated for the new subvention scheme must be distributed in an equitable manner to ensure that subventions are paid to those most in need. The proposed assessment of means and circumstances has been designed to ensure that this will be the case, by taking into account the financial situation of and resources available to those applying for subvention. The same means test will be applied in all health boards to ensure an equitable approach throughout the country.
I had hoped to implement the Health (Nursing Homes) Act, 1990 by 1 May 1993, provided that negotiations had concluded with interest groups on the draft subvention regulations by that date. Negotiations are continuing with the nursing home associations and other interest groups about the new system of subvention. I will implement the Act as soon as these negotiations have been concluded.
To ensure as broad an input as possible to the draft subvention regulations, I have consulted with those organisations with an interest in the nursing home sector and in the welfare of the elderly. The following groups have been consulted on the draft subvention regulations: the Irish Private Nursing Homes Association; the Federation of Catholic Voluntry Nursing Homes; the Council of Homes; the Jewish Home of Ireland; the National Council for the Elderly; the Association of Nursing Homes; the Alzheimer Society of Ireland; An Bord Altranais; Age Action Ireland; the Carer's Association and the Irish Association of Older People.
Under section 14 of the Health (Nursing Homes) Act, 1990 a regulation made under that Act must be laid before each House of the Oireachtas as soon as it is made. Each House may pass a resolution annulling the regulation within the following 21 days on which that House sits.
I presume that the article in The Irish Times of 7 April 1993 to which Deputy Proinsias De Rossa refers is the one by Padraig Ó Moráin entitled “Nursing Homes Benefit may be means tested”. The article is misleading. The draft regulations do not permit health boards to take the income of adult sons or daughters into account in deciding whether an applicant is eligible for a nursing home subvention. It is proposed that health boards may take the income of an adult son or daughter into account only in deciding the nature and amount of subvention to be paid to an applicant. The purpose of this provision is to ensure that the additional funding made available to implement the Act is used to help those without sufficient funds to pay for nursing home care.
I am aware of the concern of some families supporting relatives in nursing homes in relation to the draft subvention regulations. I would like to assure these families that the proposed new system of nursing home subvention will enable health boards to pay a greater contribution towards the cost of nursing home fees than is at present available if a family is experiencing genuine difficulties in funding the care of an elderly parent.
The maximum amounts of subvention under the draft Nursing Home (Subvention) Regulations are under negotiation at present. The draft subvention regulations, including the procedures for the assessment of means and circumstances, are available from my Department if Deputies wish to check them.
The Minister's rather lengthy reply might well have been contained in one line, in that he has confirmed to the House what he had already circulated to some private groups within the community, which is that he intends to proceed with a rather elaborate and outrageous system of means testing that will deny thousands of people throughout the community redress under the provisions of the Health (Nursing Homes) Act, 1990. I put it to the Minister that, in effect, he is ensuring that very few people will qualify for a subvention under the provisions of that Act. Would the Minister elaborate on the condition that the means of sons and daughters will be taken into consideration in the assessment and say whether such will apply in the case of sons and daughters who may be living outside this jurisdiction? For example, would he say what will be its application in the case of sons and daughters who, for one reason or another, may have fallen out with the applicant and will not be in a position to provide the relevant health board with the requisite information to allow a subvention be assessed? I put it to the Minister that it is an outrageous attack on thousands of carers throughout the community.
I must appeal for brevity at this stage. There are two questions remaining and time is fast running out.
The Minister has abused the time of the House twice with his replies.
I can understand Deputies opposite being excited. On the first question Deputy Flanagan accused me of being negligent and, on this one, of being outrageous. I notice that Deputy Carey is becoming excited. I shall explain exactly what is the position, because I know Deputies opposite are much more concerned with hearing silly statements than hearing reasonable answers.
That is arrogance. The Minister has been only ten weeks in office and is becoming arrogant.
Yes, arrogance.
At least Deputies opposite recognise that I have been in office ten weeks only.
The Minister has been asked a series of questions. He ought to be allowed reply with courtesy and consideration.
I am interested in endeavouring to do the greatest possible good with the resources available to me. For example, this year I succeeded in getting £4 million to implement the provisions of the Health (Nursing Homes) Act, 1990, which has been on the Statute Book for quite some time. Henceforth we shall have a proper system of nursing home subvention. I am determined that the money available to me will go, in a targeted fashion, to those most in need. It is important that we do not have an open-ended scheme, leading to anybody, regardless of their income, availing of scarce State money. I reiterate that the only factors taken into consideration in assessing eligibility will be an applicant's medical condition, his or her income and that of a spouse. They are the only criteria used in determining eligibility. In determining the scope and scale of the actual subvention, it is reasonable to take into account the income of sons and daughters——
Why?
——if they are in a position to help. I put it to Deputies opposite that it is a natural Irish thing to support elderly relatives; we have always done it in the past and I think it is something most families will want to do in the future. If there are sons and daughters who are not in contact with elderly parents, who are abroad or who have lost contact with them even within the country, there will be no question of that in any way affecting the level of subvention being made available.
There will be an awful lot of carers disappointed with——
I must insist that we proceed to deal with Question No. 13.
The Minister is worsening the position.