Dáil Éireann debate -
Tuesday, 3 Jul 2001

Vol. 540 No. 1

Adjournment Debate. - Nursing Home Subventions.

Mr. Farrelly

I thank the Leas-Cheann Comhairle for allowing me raise this issue. It is close to his heart, having been a former Minister for Health. It relates to subventions and the assessment of families living in the family home. In the case of a family member still resident there, the home is considered by the health board as available for renting. This clause must be dropped. It is causing much hardship to family members who require nursing home care.

Subvention is paid to those who need care under three headings: a minimum care sum of £95 per week, which was increased recently; a medium care sum of £120 per week; and a maximum care sum of £150 per week. Everybody welcomes the increases in the moneys because there had been no increases for seven or eight years.

The regulation states that a house belonging to an individual who might be applying for subvention, when a family member still lives there, is available for renting. It is unfair for the local health board to state that the house is available for renting and that there must to be an amount of money derived in this manner as income to go towards care.

Does the Minister not think this regulation is draconian, taking into consideration the recent decision of the Ombudsman, who said that family members are made pay unfairly, and that health boards are sorting out the backlog of applications for repayment of money? Is this not an example of flawed legislation?

I was in contact with the health board this morning. People who have applied for the refund of money, because of the health board regulations, will have no money available to them. No case will be dealt with until August this year. Three months ago, the Ombudsman made a recommendation and we are still awaiting results in this regard. The health board informed me that the Department of Health and Children is the culprit.

Will the Minister say if he is prepared to change the regulations? They are wrong in terms of determining people's income when family members are living in the family home, especially when one considers that the health board is stating, under the regulations introduced by the Department, that a house in the country, which it might not be possible to rent, has to be regarded as worth £80 per week and that this sum will lower the subvention.

I am sure the Leas-Cheann Comhairle knows exactly what I am saying, coming from a rural constituency like myself. The problem to which I am referring is serious and requires action on the part of the Department and the Minister. The Leas-Cheann Comhairle is also from a rural constituency and knows what I am talking about. There is a serious problem that requires action from the Department to address it, not another report from the Ombudsman.

Minister of State at the Department of Health and Children (Dr. Moffatt)

I thank the Deputy for raising this matter.

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 contracts 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 are private arrangements between the nursing home and the individual resident.

The Second Schedule of the Nursing Homes (Subvention) Regulations, 1993, sets out the general rules for the assessment of means in respect of an application for a nursing home subvention. "Means" for the purposes of these regulations are the income and the imputed value of assets of a person in respect of whom a subvention is being sought and the income and imputed income of his or her spouse.

The residence of a person seeking a subvention is treated as a special asset and is not taken into account in certain circumstances, i.e., if it is occupied immediately prior to, or at the time of the application and continues to be occupied by a spouse, son or daughter under 21 years or in full-time education or a relative in receipt of certain benefits from the Department of Social, Community and Family Affairs. The purpose of this regulation is to avoid causing undue hardship where the home of a person seeking subvention is occupied by a dependent relative.

While section 13 of the regulations provides that a health board may impute an annual income equivalent to 5% of the estimated market value of the principal residence of the person, this is only invoked if the residence was not occupied immediately prior to or at the time of the application by a dependant as I mentioned earlier.

It should be noted that means are assessed for this scheme to ensure that the available funding is directed at those older people who have the greatest need of financial assistance. Nonetheless, as the Deputy will be aware, 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 the intention of the Minister for Health and Children to bring proposals to Government in relation to whatever additional measures may be necessary arising from the expenditure review and the Ombudsman's report, together with experience gained from the operation of the scheme since its inception in 1993.

In addition, sons' and daughters' income is no longer assessed since January 1999. That has been disregarded.

The Dáil adjourned at 10.55 p.m. until 10.30 a.m. on Wednesday, 4 July 2001.