Under the Health (Nursing Homes) Act 1990 health boards provide subventions to assist persons in meeting the costs of nursing home care. Successive Governments have indicated 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.
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.
While total expenditure on the nursing home subvention scheme was just over €30 million in 1998, it will amount to almost €110 million in 2003, an increase of 267%.
The board of the Southern Health Board received a significantly increased number of claims from patients for enhanced payments. It is a matter for the board to determine the extent to which it could meet such claims consistent with its requirement to live within its overall revenue allocation and taking account of the fact that such enhanced payments are discretionary. However, in the interest of avoiding hardship to individual patients, my Department has been in regular contact with the board in an effort to find a solution.
I am advised by the Southern Health Board that there are currently 518 people on a waiting list for enhanced subvention. Of these, 190 have received an enhancement and are awaiting further enhancement, 174 are in receipt of basic subvention plus an additional allocation under Article 10.6, and 154 are in receipt of basic subvention alone. There are currently 530 people in receipt of enhanced subvention and the average enhanced payment is €364.34 per week. The average enhanced rate of subvention payable in the Southern Health Board area is considerably higher than the rates payable in other health board areas. The Southern Health Board has also an over-reliance on private nursing home beds because of a shortage of public long-stay beds and I hope the PPP programme being piloted in the Cork area will address this problem.
I am advised by the Southern Health Board that it reviews the position regarding enhancements on a weekly basis and that it is kept under review. The board has informed my Department that it has continued to process applications for enhanced subvention since June 2002 and there is, therefore, no basis for the claim that applications are not being processed.