Skip to main content
Normal View

Dáil Éireann debate -
Wednesday, 20 Jun 2001

Vol. 538 No. 4

Adjournment Debate. - Nursing Home Evictions.

I thank the House for the opportunity to raise this very important issue this evening. Elderly patients are being threatened with eviction from nursing homes because of the Minister's failure to make decisions regarding increased allocations to health boards to introduce an enhanced subvention scheme.

Eleven patients are, this week, facing discharge from a private nursing home in the Minister's constituency in Cork. Last week, an elderly man faced eviction from another nursing home in Cork. At the same time families throughout the country are accumulating massive debts with private nursing homes simply because the Minister is failing to make decisions on the review of the nursing homes subvention scheme undertaken by his Department in association with the Department of Finance.

The Minister's failure to make decisions means we are now facing a crisis whereby elderly people are being threatened with eviction and families are living in fear and trepidation. The Minister is well aware of the serious situation but is failing to act. He is on record saying he would not be bounced into a decision regarding enhanced subventions. His failure to make decisions means elderly people are effectively being bounced out of nursing homes. The Minister, who is a member of the Government with fat resources at its disposal, is effectively abandoning the elderly, the very people who built the economy. They are being left in a hopeless situation.

The Minister's failure to act has also brought about a situation where a high percentage of acute hospital beds in all our public hospitals are occupied by elderly people who cannot be discharged home or to nursing homes because of a lack of nursing care.

They cannot be accommodated in nursing homes because the beds are not available. Therefore, seriously sick people cannot get admission to hospital and cannot get treatment because the beds are occupied.

This situation is making the waiting list crisis even worse, so I now ask the Minister for Health and Children to take immediate decisions regarding increased allocations to the health boards to ensure that the nursing home subvention scheme can be implemented, as recommended in the Ombudsman's report which was scathing in its criticism of the Minister and his Department. The Minister must also take immediate decisions on the expenditure review of the scheme, recently undertaken by his Department in association with the Department of Finance.

Will the Minister indicate when he will make the resources available to the health boards, especially the Southern Health Board, where there is a crisis so that it can implement the Ombudsman's recommendations on the refund schemes to families who are obliged to sell family properties and exhaust family savings for their elderly parents and relations because of what may be termed irregular decisions by health boards as a result of directives from the Department of Health and Children? He is aware of the situation in Cork where 11 elderly people in their seventies and eighties are sick with worry because of the threat to their future. I urge him to make a decision on the allocation to the Southern Health Board so that their plight and the plight of dozens of families throughout the region can be resolved. These people are sick with worry because of the crisis that has arisen with regard to family resources.

The Health (Nursing Homes) Act, 1990, which came into effect on 1 September 1993 has two principal objectives. The first is to ensure high standards of accommodation and care in all nursing homes registered under the Act and the second is to provide a new system of nursing home subvention so that dependent persons most in need of nursing home care will have access to such care. Under the Health (Nursing Homes) Act, 1990, health boards provide subventions to assist persons in meeting the costs of nursing home care.

However, it was never intended that subventions would meet the full costs involved. Apart from arrangements entered into under Article 22.3 of the Nursing Home (Subvention) Regulations, 1993, which allows a health board enter into an arrangement with a private nursing home, the placement of a person in a private nursing home and the fees charged is a private arrangement between the nursing home and the individual resident. There are currently three maximum rates of subvention payable – £90, £120, £150 – in accordance with three levels of dependency – medium, high, maximum – which are eligible for subvention. The new rates represent a 25% increase since 1 April and is the first time the rates have been increased since the introduction of the scheme in 1993.

Apart from the basic rates of subvention, a health board may pay more than the maximum rate of subvention relative to an individual's level of dependency, for example, in cases where personal funds are exhausted. Articles 22.3 and 22.4 of the Nursing Home (Subvention) Regulations, 1993, permit health boards to contract beds in private nursing homes and to pay more than the maximum rates of subvention in such cases. However, the application of these provisions is a matter for the individual health board concerned in the context of meeting increasing demands on the subvention scheme within the board's revenue allocation as notified annually in the letters of determination. This is in keeping with the provisions of the Health (Amendment) (No. 3) Act, 1996, which the Deputy's party introduced when it was in Government.

I am aware that the issue of paying enhanced subventions has been raised in the Southern Health Board area. I am also aware of, and concerned by, the threat by some nursing home owners to discharge patients. Article 15.2 of the Nursing Home (Subvention) Regulations, 1993, provides for a minimum 14 days notice in the event of a person being discharged from a nursing home. The purpose of this minimum period of notice is to facilitate the exploration of all avenues prior to the discharge of a person from a private nursing home and to ensure that alternative arrangements can be made. I am disappointed to learn that in this instance it appears that all avenues were not explored prior to older people, who may be vulnerable, being issued with notification of discharge.

They were.

I was not informed.

The health board was.

I was not informed at any stage that these people were going to be discharged except through the media.

The Minister was aware of the accumulated debts.

The Minister without interruption.

I was not informed of the situation regarding these individuals. I understand, however, that officials from the Southern Health Board have been in regular contact with the owners and administrators of the nursing homes involved.

There is no point in the Minister washing his hands of the matter.

I am not going to. I am advised by the board that a meeting between board officials and owners and administrators of the private nursing homes involved will take place on Friday next and officials of my Department are also in regular contact with the board's officials to monitor the situation. There was no need for those letters of discharge to be issued and they should not have been issued.

What about the other ones?

We have made huge additional resources available to the Southern Health Board this year.

On a point of order, letters were sent to the Minister—

That is not a point of order. The Deputy should resume his seat.

No silver words will hide the truth.

The facts will explain. Funding for the nursing home subvention scheme has increased significantly in recent years. When the Government took office in 1997 the funding for the scheme was £27.8 million. By 2000 that figure had risen to £38.479 million and an additional £14 million has been made available for 2001, bringing the total available for the scheme this year to £52 million. Overall an additional £13 million has been allocated to the Southern Health Board for 2001 for services to the elderly. I do not accept that resources do not exist to prevent the discharge of these people next week.

Deputies will be aware that in line with a Government decision, an expenditure review of the nursing home subvention scheme has been undertaken by my Department in association with the Department of Finance. It is my intention to bring proposals to Government in relation to whatever additional measures may be necessary arising from the expenditure review, the Ombudsman's report, together with experience gained from the operation of the scheme since its inception in 1993. In the meantime, I wish to assure the Deputies that my Department will continue to liaise with all the health boards on a regular basis during the course of 2001 in relation to the operation of the scheme.

Top
Share