Other Questions. - Care of the Elderly. – Dáil Éireann (28th Dáil) – Thursday, 7 Dec 2000

Other Questions. - Care of the Elderly.

Michael Creed

Question:

14 Mr. Creed asked the Minister for Health and Children if his attention has been drawn to the fact that in view of the inadequacy of public beds for geriatric patients requiring long-term care, private nursing homes are very often in a position to pick and choose the patients they will admit giving rise to a situation where on occasion patients who require above average medical/nursing attention find it impossible to secure admission; and if he will consider pursuing an appropriate response in this situation, especially where subvention has been approved. [28749/00]

Michael Creed

Question:

34 Mr. Creed asked the Minister for Health and Children if he will increase the rate of nursing home subvention. [28750/00]

Bernard J. Durkan

Question:

165 Mr. Durkan asked the Minister for Health and Children the plans he has to increase nursing home subvention; and if he will make a statement on the matter. [29140/00]

Dr. Moffatt

I propose to take Questions Nos. 14, 34 and 165 together.

There are approximately 11,500 extended care places in public facilities throughout the country. I fully accept the need to further develop extended care facilities for older people. Between 1998 and 2000, over 400 additional places have been provided in community nursing units. A programme to develop new community nursing units and refurbish and extend community hospitals forms part of the national development plan. Over £200 million has been provided for facilities for older people during the lifetime of the NDP. Over 1,500 additional places in community nursing units will be provided under the NDP.

The role of the health boards in relation to private nursing homes, as provided for in the Health (Nursing Homes) Act, 1990, is two-fold – first, to ensure high standards of accommodation in the homes and, second, to operate a subvention scheme towards the cost of nursing home care. Under the nursing homes Act, health boards are empowered to pay a subvention where a person has been assessed on the grounds of means and dependency. It is important to point out that, subject to a means test, a person will only be entitled to a subvention if they fulfil the dependency criteria laid down in the subvention regulations, 1993. The question of admission to a private nursing home is a matter between the patient and the owner of the nursing home.

The amount of funding allocated to supporting people in private nursing homes has been significantly increased by this Government in recent years, from £23.8 million in 1998 to £33.1 million in 1999 and to £38.5 million in 2000. A further £14 million is being provided in 2001, bringing the total funding available to £52.5 million. Some £5 million of this additional funding will be used to provide for an increase in the number of people in receipt of subvention for higher levels of dependency, resulting in more people receiving the higher rate of subventions.

My Department and the Department of Finance have undertaken an expenditure review of the scheme and a report will be completed shortly. Following consideration of this review, decisions will be taken with regard to the most effective use of the remaining £9 million available for the scheme in the current year.

Mr. Creed

First, does the Minister of State accept that the average cost of a nursing home bed is in excess of £250 per week, and that a non-contributory old age pensioner with the maximum current subvention is at least £50 short of what is required to fund his or her accommodation in a private nursing home? In light of that, will the Minister make a simple policy decision to increase the level of subvention to ensure that subvention, plus a non-contributory old age pension, will meet the required fees for a private nursing home? Second, has the Department made a determination as to the required number of geriatric beds? That is surely a simple calculation. If that decision has been made, what is the shortfall in terms of the State's obligation to provide beds? We appear to have put all our eggs in one basket in the sense of incentivising private nursing homes to provide beds but we do not retain any control over their admission and there are people being approved for subvention who will not be taken because private nursing homes can cherry-pick patients due to the demand. That is leading to a situation where neither the State nor the private nursing homes are providing the required accommodation for elderly people.

Dr. Moffatt

I agree with the Deputy that the average cost per week ranges between £250 and £500, depending on the part of the country one is talking about. I am glad to say that the Minister has announced that the maximum subvention will increase by 25% to £150 which will help—

Mr. Creed

So depending on where they live, a person could still be £250 short.

An Ceann Comhairle

Deputy, allow the Minister to answer.

Dr. Moffatt

The contributory pension increasing to £106 will help also.

Mr. G. Mitchell

If they live in Dublin they could be worse off.

Mr. Martin

Twenty-five per cent is a substantial increase in any one year.

Dr. Moffatt

It is the first time since 1993 that anything has been done with subvention and the pension was increased considerably in yesterday's budget. On the required geriatric beds, our main aim is to keep people at home as long as possible.

Mr. Creed

The Minister is doing that very well.

Dr. Moffatt

Most people would rather wait at home. That is the preferred option. Old people—

Mr. Creed

There are people who require accommodation but the Minister is keeping them at home because he will not provide beds for them.

An Ceann Comhairle

The Deputy should allow the Minister to answer. We cannot proceed with Question Time in this manner. The Minister should be allowed to reply.

Dr. Moffatt

Most people would like to wait at home if they are provided with home care, respite care, physiotherapy, occupational therapy, etc. but there is always a percentage that have to go into nursing homes and currently we have over 11,000 public beds and over 12,000 private beds in nursing homes. I agree with the Deputy that there is a risk in regard to cherry-picking in that private nursing homes may not be inclined to take in heavy dependency patients, but that is something we have to examine and that is the reason we have to retain an adequate number of public beds also.

Mr. Creed

In light of the Minister's acceptance of the point about the risk of cherry-picking, will he, in consultation with the umbrella body representing the proprietors of private nursing homes, consider introducing a voluntary code of practice? Patients who have a heavy dependency with limited financial resources are currently being obliged to remain at home in circumstances that are entirely inappropriate. I accept that the optimum policy is to support people for as long as possible in their communities, but those who require geriatric care cannot get it either from the State or private nursing homes. These people have been examined and are determined to have a subvention entitlement and high medical dependency but they still cannot get access to geriatric care. In terms of public funding, we have an obligation to deal with this issue.

Dáil Éireann debate - Thursday, 7 Dec 2000