Written Answers. - Nursing Homes.
Richard Bruton
Question:
137
Mr. R. Bruton
asked the
Minister for Health and Children
the way in which his Department can justify making charges to medical card holders in long stay nursing homes; the way in which he can justify requiring that medical card holders who require long stay care to seek that care at their own expense in private nursing homes; and if he will make a statement on the matter.
[20526/01]
Medical card holders in receipt of long stay or extended care may be charged 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. The over-riding consideration in applying long-stay charges is that persons with means who are in receipt of long-term care should make a contribution towards the cost of their maintenance.
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 two fold – 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 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.
Earlier this year, the Ombudsman published a report on the nursing home scheme. The Ombudsman's interpretation of the Health Act, 1970 is that any person in need of nursing home care has a statutory entitlement to be provided with this service by a health board. However, the Department of Health and Children would point out that the provisions of the Health (Nursing Homes) Act, 1990 clearly provided for the establishment of a system of subvention based on means and ability to pay. Nonetheless, it is accepted that the position regarding entitlements in this context is complex and that, in the interest of equity and transparency, it should be made more clear. In this regard, the whole eligibility framework for health services generally is one of the issues to be addressed in the new health strategy currently being prepared by my Department.
An expenditure review of the nursing home scheme has recently been undertaken by my Department in association with the Department of Finance. The Deputy will be aware of the shortcomings in the operation of the scheme highlighted in the Ombudsman's report and a number of measures have already been taken to deal with some of these problems. It is my intention to bring proposals to Government in relation to whatever further measures may be necessary arising from the findings of this review and the report of the Ombudsman and experience gained from the operation of the scheme since its inception in 1993.
