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Dáil Éireann debate -
Tuesday, 10 Nov 2009

Vol. 694 No. 1

Nursing Homes Support Scheme.

I ask the Minister for Health and Children to clarify matters causing confusion around the operation of the fair deal scheme as it operates with nursing homes and to allay fears that a transition will leave patients and their families without financial cover at that time. Will the Minister clarify the uniformity of operation of the scheme through the HSE? Patients have been told that they will not be covered under the scheme until assessments are complete, and then only from the date of approval, which by implication could cost them six weeks billing, which the patients and families may be unable to meet. Will the Minister give direction in the matter?

I am effectively asking the Minister for Health and Children to clarify the confusion surrounding the operation of the fair deal scheme and to allay fears that the transition from hospital to home will leave patients and their families without financial cover. I am also asking her for clarity and uniformity to be applied in the operation of the scheme by the HSE. Will she confirm that no patient admitted on a doctor's advice will have to wait until the medical assessment before proceeding? If a discharged patient has to be readmitted after four months, will a previous approval be used? This was the case when a patient was readmitted under the subvention scheme. When a patient is admitted as an emergency to a nursing home, will the scheme apply from the time of the emergency, providing an application is lodged on the same day?

Last week families in counties Roscommon and Leitrim had great difficulty in getting definitive information from the local HSE office. A member of a family was treated for a serious illness in Sligo General Hospital and got two weeks of nursing home care under the winter initiative. The patient was confined to bed and without a doubt needed full-time nursing home care. When the family applied for nursing home subvention under the fair deal scheme, they were informed that financial assistance would not be available until medical assessment was carried out by the HSE medical team.

They were also informed that cover would only commence from the date of approval following medical assessment, which could take weeks and result in a massive nursing home bill that the family would be unable to meet. When I pointed out that the process could take several weeks I was told that under the new scheme, families will be liable for far more costs than under the subvention scheme.

Will patients be able to transfer automatically from the subvention scheme to the fair deal scheme or will they have to be assessed again? There is much confusion and many people in local areas are interpreting rules in different ways. There is significant confusion. When we contacted the Minister for Health and Children's office we were told there is no difficulty but on the ground there is much confusion. Is the problem with the Department or in the way local offices are interpreting the rules? The confusion must be cleared up.

I thank Deputy Feighan for raising this issue, as it is important that matters such as this are completely understood so that potential applicants to the nursing homes support scheme can make fully informed decisions.

As the Deputy is aware, the nursing homes support scheme commenced on 27 October and the HSE is now processing applications under the scheme. It is administered, and applications are processed, in accordance with the Nursing Homes Support Scheme Act 2009 and the HSE's guidelines on the standardised implementation of the nursing homes support scheme, which were approved by the Minister for Health and Children. This framework ensures a consistent approach across the HSE in the processing of applications.

The HSE has indicated that the expected timelines for processing applications and making a determination regarding financial support will vary according to individual circumstances and complexities. However, on average, the following timelines are estimated in cases where the submitted application is fully and correctly completed: a straightforward application for State support should take one to two weeks and a straightforward application for ancillary State support, or the nursing home loan as it is commonly known, should take three to four weeks.

In the initial months following the introduction of the scheme, the HSE will have to deal with a large volume of applications from both existing residents and new entrants. However, this should not impact negatively on existing residents due to the safeguards provided within the primary legislation. The legislation provides that applicants to the scheme who were in nursing home care on the date the scheme commenced shall have their State support backdated to that date.

Furthermore, anyone in receipt of subvention prior to the commencement of the scheme will continue to have that paid while their application is being processed. Once the application has been determined, the backdated State support will be netted off against the subvention already paid. In practice, what this means is that people will not be paid twice for the same care but will have State support paid from 27 October 2009.

For new entrants to nursing home care, the HSE's guidelines on the standardised implementation of the scheme state that subject to overall resources, people who enter nursing homes after the commencement of the scheme will have their financial support paid either from the date that the application was made or from date of admission to the nursing home, whichever is the later. At this point I emphasise that the scheme is voluntary and is underpinned by an important commitment that anyone who was in a nursing home when the scheme commenced cannot be made worse off by its introduction.

Such individuals can choose whether to transfer to the new scheme. Therefore, anyone who was in a public or voluntary nursing home, or in a contracted bed in a private nursing home when the scheme commenced, can continue with their existing arrangements. Anyone who was in an approved private nursing home and in receipt of subvention when the scheme commenced can choose to transfer to the nursing homes support scheme or retain current subvention arrangements.

If a person is in a private nursing home which is not approved for the purpose of the scheme, he or she can retain current subvention arrangements or opt to apply for the scheme and change to a nursing home participating in the scheme. A list of the nursing homes participating in the scheme is available on the HSE website. Finally, if a person was in an approved private nursing home when the new scheme commenced, he or she does not need to apply for a care needs assessment; instead, the person can commence the process by applying for the financial assessment.

I hope this explanation has clarified the issues raised by Deputy Feighan.