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Seanad Éireann debate -
Thursday, 11 Jun 1992

Vol. 133 No. 5

Adjournment Matters. - Nursing Home Costs.

I welcome the Minister. This is my first time to meet him in the House since his appointment and already he is making an impact on the Department of Social Welfare. I thought he would be the one to disentangle the difficulties in the Department, that he would introduce co-ordination and I am glad that he has already set about ensuring a streamlined social welfare service.

I put this matter down for the Adjournment debate because elderly people are affected and I know the Minister shares my concern that elderly people would not be under stress at the end of their days. It has come to my attention that because of the lack of geriatric beds in public hospitals a significant number of elderly people are being forced into private nursing homes. By and large these people are in receipt, of old age pensions amounting to £60 or £65 a week. Fees in nursing homes are in the region of £120 a week so there is a gap between what they receive and the amount demanded of them in private nursing homes.

I have a number of cases on file which suggest that elderly people in nursing homes pay their way by spending any savings they have put by. In the country especially, old people had a habit of putting money aside for their funeral expenses and they now find that this money is required to maintain themselves in nursing homes. There may be no wage earner in the families of some of these elderly people and family members endeavour to meet the equivalent of a mortgage repayment of £50 or £60 a week from unemployment assistance. This is an unfair encumbrance on necessitous people.

In my motion I have homed in on the supplementary welfare allowance. The Oireachtas passed the Nursing Homes Bill which in my view indicates an intention and a desire on the part of Government to ensure that funding is made available for elderly people who are obliged to live in nursing homes. Unfortunately to date funding for nursing homes that qualify under the regulations has not been made available.

Supplementary welfare allowance, within the social welfare system is seen as an allowance that bridges a gap, that caters for what we term "emerging needs". If an employed person with a mortgage to pay loses his or her job and payment of the mortgage becomes difficult, a supplement is often made available to make up the shortfall. If somebody, through unforeseen circumstances, falls into other payment arrears, a supplementary allowance may be made available. If somebody cannot obtain a public authority house, then a supplementary welfare allowance may be made available to ensure that they have a roof over their heads.

I raised this matter at Southern Health Board level with the programme manager for community care who considered that according to the guidelines issued by the Department of Social Welfare this aspect of care for the elderly was not covered under the terms and regulations pertaining to supplementary welfare allowance. I would like the Minister to take a look at this emerging need. None of us wants to see elderly people end their days under major stress and funds are a worry to them. They like to pay their way; they hate to leave debts behind them and they hate in particular to be an encumbrance on their families.

The Minister may say that many of these people and their families can well afford to pay and I concede that. There is, however, a small group in dire need of assistance and I ask him to look at the regulations, to regard this as a major emerging need and to extend the provisions of the supplementary welfare allowance scheme so that assistance can be given to elderly people in need.

I thank Senator O'Keeffe for his welcome to me. He has raised an important matter which is going through my Department but may involve the Department of Health also.

The legislation governing payment of supplementary welfare allowance provides that "every person in the State whose means are insufficient to meet his needs and the needs of any adult or child dependant of his shall be entitled to supplementary welfare allowance". This provision applies to all those deemed eligible by health boards who administer the scheme on behalf of the Department of Social Welfare. The full range of services available under the scheme are open to those eligible including, for example, assistance with rent or mortgage interest payments or for assistance with a range of exceptional needs which may arise. These payments are available in equal measure to the elderly as they are to other applicants for the allowance.

The supplementary welfare allowance is one of a number of income support schemes financed by the Department of Social Welfare to which the elderly have access. What are generally referred to as the "free schemes", for example, free travel, are highly prized by the elderly and contribute in no small way to their well-being. It is worth noting that recent studies by the Combat Poverty Agency and the ESRI acknowledged that the position of the elderly has improved significantly in recent years and that as a group they are now generally considered to be at low risk from poverty. These reports attribute the improvement to the "substantial increases in social welfare old age pensions, as well as the wider coverage of occupational pension schemes".

I understand that Senator O'Keeffe wishes to refer, in particular, to the position of older persons who are domiciled in private nursing homes with respect to their entitlement to supplementary welfare allowance.

Article 8 (1) of the Social Welfare (Supplementary Welfare Allowances) Regulations, 1977 provides that "an allowance shall not be paid to or in respect of a person who is maintained in an institution". For the purposes of the supplementary welfare allowance scheme, the term "institution" is defined as "a hospital, convalescent home or home for persons suffering from physical or mental disability or accommodation ancillary thereto, any other establishment providing residence, maintenance or care for the persons therein". In the context of the supplementary welfare allowance scheme private nursing homes are deemed to be institutions and, therefore, the allowance is not payable to residents of such homes. Residents of private nursing homes can, of course continue to receive their other social welfare entitlements such as old age pension and free travel.

There is an exception allowed for in article 8 (2) of these regulations which provides that where a person in receipt of supplementary welfare allowance is admitted and maintained in an institution, the health board can, where it considers it proper to do so, continue to pay supplementary welfare allowance to cover rent, hire purchase or credit sale agreements or reasonable personal expenses. This provision allows a person who is institutionalised to maintain, for example, his accommodation or other commitments for the duration of this stay.

The general provision of subventions for nursing homes is the responsibility of the Minister for Health. The existing legislation is the Health (Homes for Incapacitated Persons) Act, 1964 and the 1985 Regulations made under this Act; however, the Health (Nursing Homes) Act, 1990 created a new legal framework for nursing home care in this country.

Under the new Act all nursing homes in the both the private and voluntary sector will be obliged to register with health boards with a view to ensuring uniform standards of accommodation and care in all nursing homes throughout the country.

The Act also provides for the payment of subvention in respect of dependent elderly people who require nursing home care but who cannot afford to pay for it. Subvention will be paid subject to an assessment of the dependency of the person and an assessment of the person's means and circumstances. The provisions in relation to the payment of subvention will be contained in the Nursing Homes Subvention Regulations which will come into effect with the 1990 Act.

The Act also gives explicit authority to health boards to make arrangements to board out elderly people who are too frail to live on their own. The Boarding Out Regulations, which will be implemented with the new Act, specify standards of accommodation and care in homes in which people are boarded out. I understand the Minister for Health intends to introduce the necessary regulations to give effect to this legislation at the earliest possible date.

What Senator O'Keeffe says about private nursing homes applies in my constituency also. It is one of the fastest growing industries in my part of Ireland and there is an ever-increasing demand for nursing homes since beds are not available for the elderly in public hospitals. In the long term the State will have to take account fo this fact.

I have made my views known in the past about the carer's allowance, etc., and I hope that in the future the State will integrate the two. There would be considerable saving if all could pull together but this is a matter for the Minister for Health rather than the unfortunate Minister for Social Welfare who has other demands.

I thank the Minister for his explicit response. I am disappointed we cannot alleviate the immediate problem but I exhort the Minister in the context of the Nursing Homes Bill to consult with the Minister for Health to ensure that there is an early resolution to the problem and ask him to bring forward the Act.

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