Long-stay charges can be made under two sets of regulations. Charges can be made under the Institutional Assistance Regulations, 1965, where the patient receives shelter and maintenance rather than treatment. These charges apply from the date of admission and are payable by all patients who are in receipt of incomes including medical card holders and persons with dependants. Charges can also be made under the Health (Charges for In-Patient Services) Regulations, 1976, as amended by the Health (Charges for In-Patient Services) (Amendment) Regulations, 1987. These regulations enable charges to be made towards the cost of providing hospital in-patient services for persons with income who have been in receipt of such services for more than thirty days or for periods totalling more than thirty days within the previous twelve months. Medical card holders and persons with dependants are exempt from these charges.
In practice persons in health board long-stay care do not usually hold medical cards as the board meets the cost of all of the person's health needs and, thus, the person ceases to qualify for a medical card in accordance with the criteria laid down in section 45 of the Health Act, 1970. In deciding the amount to be contributed, health boards have regard to the person's individual circumstances. Allowance is made for any financial commitments the person may have and a reasonable amount is left to meet the person's personal needs. Charges may be waived if, in the opinion of the chief executive officer of the appropriate health board, payment would cause undue hardship. The role of the health boards in relation to private nursing homes as provided for in the Health (Nursing Homes) Act, 1990, is twofold, firstly, to ensure high standards of accommodation in the homes, and secondly, 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, as provided for in the Nursing Homes (Subvention) Regulations, 1993 to 1998, which set down the requirements for this assessment. 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.
As the Deputy is aware, the provision which allowed for the assessment of the capacity of the adult sons and, or, daughters of older people who applied for nursing home subventions to contribute towards the cost of their parents' nursing home care was revoked from the 1 January, 1999. (S.I. No. 498 of 1998 refers). My Department advised health boards of this change in the regulations on 22 December, 1998. I am not aware of cases where this practice has continued. Nevertheless, if the Deputy has information she would like to bring to my attention, I will arrange to have the matter investigated.
