Dáil Éireann debate -
Thursday, 22 May 2003

Vol. 567 No. 3

Written Answers. - Nursing Home Subventions.

Róisín Shortall

Question:

165 Ms Shortall asked the Minister for Health and Children the regulations regarding the treatment of a patient's family home whereby the patient is the sole resident and another family member is living there in respect of the financial assessment of elderly patients seeking a public nursing home bed or a nursing home subvention; and if he will make a statement on the matter. [14208/03]

Minister of State at the Department of Health and Children (Mr. Callely)

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. For the purposes of these regulations, "means" 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 the person's spouse. In calculating the means of an applicant, Paragraph 2 of the Second Schedule provides that a health board shall take all sources of income into account, including income from rentals. 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.

Article 8.1 and paragraphs 12 to 14 of the Second Schedule of the Nursing Homes (Subvention) Regulations 1993 deal with the assessment of the residence of a person in respect of whom subvention has been sought for the purposes of determining the amount of subvention to be paid. The residence of the person seeking a subvention is treated as a special asset and is not taken into account in certain circumstances; for example, if it is occupied by the spouse of the person seeking a subvention or by a son or daughter less then 21 years of age or in full-time education or by a relative in receipt of the old age non-contributory pension or a disability allowance type payment. The purpose of this rule is to avoid causing undue hardship where the home of a person going into nursing home care is occupied by a dependent relative. If the principal residence is not occupied by a relative falling into the above categories, a health board may impute an annual amount of 5% of the estimated market value of the residence as income.

Section 22 of the regulations set out an exclusion whereby a health board may refuse to pay a subvention to a person if his or her principal residence is valued at a sum equivalent to €95,230.35 or more and is not occupied by a spouse, a son or daughter aged less than 21 years or in full-time education, or a relative in receipt of the disabled person's maintenance allowance, blind person's pension, disability benefit, invalidity pension, or old age non-contributory pension and the person's income is greater than the equivalent of €6,348.70 per annum. My Department's current examination of a number of aspects of the nursing home regulations includes a review of the value of the principal residence for the purposes of the exclusion clause.

Róisín Shortall

Question:

166 Ms Shortall asked the Minister for Health and Children the entitlements of persons in need of full-time nursing home care; the circumstances in which a person is entitled to free nursing home care; the circumstances in which a person is required to pay for nursing home care; if there are guidelines given to social workers, geriatricians and others as to the advice such patients can be given regarding their entitlements; the circumstances in which the income of the family is taken into consideration; if there is a standard means test applied by all health boards in respect of subvention; if this varies between health boards; if he will request each of the health boards to produce a leaflet or booklet outlining entitlements to nursing home care; and if he will make a statement on the matter. [14209/03]

Minister of State at the Department of Health and Children (Mr. Callely)

A person in need of extended care may apply to his or her local health board for admission to a public long-stay facility. Admittance to such a facility is based primarily on medical need. Alternatively, such a person may decide to seek care in a private nursing home and to apply for a subvention towards the cost of that care.

Charges for extended care in a public long-stay facility can be made under two sets of regulations, the first of which is the Health (Charges for In-Patient Services) Regulations 1976, as amended by the Health (Charges for In-Patient Services) (Amendment) Regulations 1987. These 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 in the previous 12 months. The regulations provide that a charge is made at a rate not exceeding the person's income. Medical card holders and persons with dependants are exempt from these charges.

Charges may also be made 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. 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 private nursing homes as provided for in the Health (Nursing Homes) Act 1990 is twofold – first, to ensure high standards of accommodation in the homes and, second, to operate a subvention scheme towards the cost of nursing home care. Under the Nursing Homes 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 subvention will be payable only if they fulfil the dependency criteria laid down in the Subvention Regulations 1993.

With the exception of persons applying for subvention, following determination by the chief executive officer of a health board under Article 4.3 of the subvention regulations, a person must apply for a subvention prior to entering a private nursing home. Article 11.1 of the Nursing Home (Subvention) Regulations provide that a decision on payment and the amount to be paid must be advised to the applicant within eight weeks of the completed application. It is also open to a person to request that a board outline the charges to be imposed on a patient prior to admittance to a health board extended care facility.

My Department is currently examining a number of aspects of the nursing home regulations including a review of the value of the principal residence for the purposes of the exclusion clause. As the Deputy is aware, the Ombudsman's report on the nursing home subvention scheme asserted that, under the 1970 Health Act, any person in need of nursing home care has a statutory entitlement to the provision of this service by a health board. As my Department advised the Ombudsman in its response to the draft report of the Ombudsman, its view is that the Health Act 1970, as amended, distinguishes between eligibility for a service and entitlement to a service, although the two terms are often used interchangeably. This view is supported by legal advice available to my Department.

The uncertainty that undoubtedly exists about eligibility and entitlement should be resolved. The health strategy acknowledged this and set down a commitment to introduce new legislation to provide for clear statutory provisions on entitlement for health and personal social services. As part of the implementation process, a review of all existing legislation is ongoing in my Department. The outcome will inform the approach to the drafting of a new legislative framework on entitlements. I expect this review will be completed in the current year and that proposals for reform will be submitted to Government. Social workers and other health professionals working with the various health boards would be familiar with the policies in place and would be able to advise or direct patients on how to obtain such information.

Articles 9.1 and 9.2 of the Nursing Homes (Subvention) Regulations, 1993 allowed health boards to assess the ability of the adult sons and-or daughters of older people who apply for nursing home subventions to contribute towards the cost of their parents' nursing home care. The subvention regulations were amended from 1 January 1999 and the provision to assess the capacity of adult sons and/or daughters to contribute towards the cost of nursing home care of their parent was deleted. The ability of adult sons and/or daughters to contribute towards the cost is no longer assessed. In assessing the means of an applicant for subvention purposes, the health board is subject to the Nursing Home Regulations 1993. In assessing an individual's means, however, the health board can exercise a certain amount of discretion under the regulations. As already stated, my Department is undertaking a review of the nursing home regulations. Some of the issues raised by the Deputy will fall to be considered as part of this review.