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Dáil Éireann debate -
Thursday, 28 Jun 2001

Vol. 539 No. 3

Written Answers. - Nursing Homes.

Nora Owen

Question:

56 Mrs. Owen asked the Minister for Health and Children the way in which he will deal with the Ombudsman's report regarding nursing homes, with particular reference to the recommendation that all medical card holders should be entitled to full-time care in either private or public nursing homes. [19367/01]

The report of the Ombudsman into the nursing home subvention scheme identified a number of issues relating to the operation of the nursing home subvention scheme. It is my intention to bring proposals to Government in relation to whatever additional measures may be necessary arising from the Ombudsman's report, the recent expenditure review of the subvention scheme, together with experience gained from the operation of the scheme since its inception in 1993.

Our immediate priority is to ensure that the two aspects of the regulations that have the most direct impact on nursing home patients and their families are fully addressed without delay. Arrangements have already been made to enable nursing home patients and their families who may be due payments arising from the provisions in the regulations relating to the retention of one fifth of the rate of non contributory old age pension for personal use to be refunded speedily.

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 deleted from 1 January 1999. As the Deputy is aware, it has been decided that moneys should be paid to those who were adversely affected by this provision. It is anticipated that these payments will cost in the region of £6 million.

A group representing the Department and the health boards-Eastern Regional Health Authority has been established to ensure that this process is carried out on a uniform basis as speedily as possible. However, as you can appreciate, this will be a complex exercise involving, inter alia, difficult issues of traceability, and it may take some time to complete. Nevertheless, I can offer assurance that every effort will be made to make payments as quickly as possible.
Persons who hold medical cards are entitled to a wide range of services free of charge, including general practitioner services, prescribed drugs and medicines, all in-patient public hospital services in public wards including consultants services, all out-patient public hospital services including consultants services, dental, ophthalmic and aural services and appliances, and a maternity and infant care service.
Persons in receipt of long stay or extended care may be charged under the Health (Charges for In-Patient Services) Regulations, 1976, as amended by the Health (Charges for In-Patient Services) (Amendment) Regulations, 1987, or under the Institutional Assistance Regulations, 1965. The former 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 30 days or for periods totalling more than 30 days within the previous 12 months. Medical card holders and persons with dependants are exempt from these charges. The practice has been that, persons in health board long stay care have not usually held 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 criteria laid down in section 45 of the Health Act, 1970. With regard to the extension of medical cards to over 70s, my Department is examining the implications of this with a view to ensuring an equitable situation is in place in relation to the application of charges in respect of long stay or extended care.
Under the Institutional Assistance Regulations, 1965, charges are made 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.
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 whole issue of eligibility is being examined in the context of the new health strategy that is currently being prepared in my Department and is expected to be completed mid-year.
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