Skip to main content
Normal View

Dáil Éireann debate -
Tuesday, 24 Oct 1995

Vol. 457 No. 4

Ceisteanna—Questions. Oral Answers. - Nursing Homes' Subventions.

Trevor Sargent

Question:

16 Mr. Sargent asked the Minister for Health the plans, if any, he has to revise the current means test for subvention to residents in nursing homes to take into account the cost of extras such as medical aids for incontinence, particularly where such costs are not covered by medical cards. [15519/95]

(Limerick East): The subvention scheme which accompanied the Health (Nursing Homes) Act, 1990 was implemented on 1 September, 1993 and ensures that those most in need of care in a nursing home, and without the means to pay for it, receive assistance towards the cost.

With regard to the Deputy's query, I have no plans to revise the means test for subvention for the following reason. A person in receipt of a nursing home subvention is entitled to items which are covered by the subvention, including incontinence wear. Article 16.1 of the Nursing Homes (Subvention) Regulations, 1993, provides that a registered proprietor of a nursing home shall not seek any additional payment from a subvented patient for any service which is considered to be essential to the maintenance of a person in a nursing home and common practice in a nursing homes. Among the services which are considered to be essential to the maintenance of a person in a nursing home are incontinence wear and bedding, laundry service and aids and appliances necessary to assist a dependent person with the activities of daily living.

Earlier this year officials of my Department wrote to the health boards regarding this matter asking them to advise each proprietor of a registered nursing home in their area of the requirements of the nursing homes regulations, informing them that they may not seek additional payments from subvented patients for services such as incontinence wear and aids and appliances.

Does the Minister agree there is some difference between theory and practice in the scheme as operated by nursing homes? Does he recognise the need for additional, continuous consultation on this latest form of subvention? Does he intend to continue with its reappraisal since there may remain some anomalies to be ironed out?

(Limerick East): The chief executive officers of all health boards meet monthly to review certain matters, some of which we refer to them from time to time. They are at present reviewing the operations of the provisions of the Health (Nursing Homes) Act, 1990 because, as Deputy Sargent said, while it has worked very well it operates very unevenly. While it is of great benefit, certain anomalies need to be ironed out. I can give the Deputy an assurance that a general examination of its operations will be undertaken. Almost £16 million is being expended now on subventions; even though the implementation of the scheme began only recently. That is a significant amount of money being expended to aid patients in nursing homes.

Does the Minister realise the terrible predicament in which a member of staff and management of a nursing home are placed when required to supply certain types of medical aids, particularly those relevant to the specific care of the elderly? They have to ask a patient's already hard pressed family to supply such aid or aids without being able to seek reimbursement under a medical card? Is the Minister taking that need on board or is he considering some other recourse for such people?

(Limerick East): If a subvention is given to a person in need of incontinence wear, in the amount of subvention granted, the relevant health board should allow for the fact that incontinence wear constitutes a cost. Therefore, rather than claim such cost on a medical card, it should be incorporated in the subvention. If there is a case or cases along the lines described by the Deputy, an appeal should be submitted to the relevant health board to raise the level of subvention to cover that cost. This should be the approach rather than further extending the benefits of medical cards to persons in nursing homes.

Does the Minister agree there may be a practice developing whereby the buck is passed between entitlement under a medical card and what should be supplied by the Eastern Health Board? Does the agree some very clear guidelines ought be drawn up rather than endeavouring to arbitrate between different sources of funding, ultimately causing great misery and sometimes enormous embarrassment to the relevant nursing homes?

(Limerick East): There always are difficulties but the nursing homes are private and have an economic cost below which they cannot operate, which is why the Health (Nursing Homes) Act, 1990, was introduced in the first place. I know of many nursing home proprietors who had been catering for a number of patients well below the economic cost. Therefore, when the subvention was first introduced, those proprietors were simply recovering lost ground, when not all of the subvention went to a patient's benefit, much of it having been absorbed by increased nursing home charges. We are at present examining the overall position. However, Deputy Sargent's question appears to be prompted by a particular case or cases. The way to resolve such difficulty is not to seek extension of the relevant medical card for incontinence wear but rather to appeal the level of subvention so that an increased subvention can be allocated by the relevant health board to cover the extra cost which, accordingly to him, is not now covered and cannot be met by the patient's relatives.

As the Minister will be aware, in the vast majority of nursing homes, private ones in particular, in very many cases the subvention is paid by the relevant health board. While I know the Minister is very concerned, as are all Members, that the highest standards would be maintained in nursing homes, with safeguards and guidelines clearly in place and enforced by all health boards, in view of a number of recent publicly quoted cases— including that in Cork this morning— can he outline to the House the manner in which the guidelines and regulations under the Health (Nursing Homes) Act, 1990, are being enforced within the different health board areas?

(Limerick East): I could had I adequate notice of that question but I am now being asked for a legal opinion on how the provisions of the Health (Nursing Homes) Act, 1990, should be applied, the Deputy having tied in her question to a particular case in Cork. I do not want to travel down that road. Responsibility rests with the relevant health boards. When one considers the overall number of nursing homes, it will be seen we have received complaints about very few. As I said to Deputy Batt O'Keeffe in the course of an Adjournment debate last week, the case in Cork is at present being investigated. When I have that report to hand I will communicate with whichever Members have raised the matter with me and will furnish the House with the relevant information.

Do health boards exercise quality control before allocating subventions to private nursing homes under this scheme?

(Limerick East): Under the recent Nursing Homes Act, nursing homes that were operational before its introduction were allowed a certain period of time to comply with the terms of the Act and were then licensed by the health boards. The health boards, under the terms of the Act, have a statutory obligation to ensure that nursing homes operate in accordance with the Act. That is separate from the issue of subvention. Even if a nursing home does not have any patients in receipt of a subvention it still has to comply with the Act.

During the summer, in consultation with the proprietors of the nursing homes, the health boards and other interested parties, I announced a set of guidelines of "best practice" for nursing homes. However, those guidelines are optional rather than mandatory. The provision of mandatory guidelines is enshrined in the Nursing Homes Act. Not only are the health boards involved with ensuring standards but they have a statutory obligation to ensure that those standards are maintained.

The Minister stated that he is interested in best practice, best efficiency and intent on people not being excluded from the provisions or falling through the net. Could he reflect, therefore, on the feasibility of extending the cover under the medical card scheme, given that it will be more focused on the need which must be met rather than putting money into a general coffer for a particular nursing home or the system in general? This would serve people who may not be residents of nursing homes and who should not be forgotten in considering this issue. Those responsible for operating the nursing homes would understand the reason for that.

(Limerick East): If the Deputy reflects on this issue, and considers the medical conditions of many people in nursing homes, he will see that it would be very difficult to control an arrangement where an individual patient on a medical card could be provided with an unlimited supply of incontinence wear——

On medical advice?

(Limerick East):——in a nursing home where there would be many patients without medical cards. A control issue is involved in this matter and it would be impossible for any agency such as a health board to monitor it. The element of cost involved in incontinence wear is included in the subvention. If difficulty is experienced in a particular case, the subvention should be increased under appeal rather than attempting to extend the service by way of the medical card scheme.

Top
Share