Seanad Éireann debate -
Wednesday, 6 Jul 1994

Vol. 140 No. 20

Adjournment Matters. - Nursing Homes Subventions.

Mr. Naughten

Health boards have experienced major difficulties in providing funding for nursing homes as required under the Health (Nursing Homes) Act, 1990. My motion calls on the Minister for Health to provide adequate funding to health boards to meet their commitments under the Act. The nub of the problem as that the Minister and the Department have failed to treat the scheme as demand led.

The scheme was introduced in November 1993 by the Minister but the Government failed to provide funding for it. There is little point introducing a scheme and not funding it because that merely misleads the public and those who provide the services for older or underprivileged people who need nursing home facilities. The Western Health Board area received £424,000 for this scheme in 1994. The estimated cost of the scheme to the health board this year is £1.49 million.

I regret that the Minister for Health, Deputy Howlin, is not here. There is little point in tabling and discussing motions in this House when the Minister responsible fails to attend. It is a slight on this House. I understand those points were made earlier today, but I reiterate them. The Seanad must examine this situation where Ministers can ignore motions relevant to their Departments. I mean no disrespect to the Minister of State at the Department of the Taoiseach, Deputy Tom Kitt, who is here tonight. However, I want answers from the Minister for Health. I want to know what he is prepared to do to meet his obligations under this Act.

We are dealing with elderly people in nursing homes, some of whom went in on the clear understanding, as a result of a press release, that they would qualify for funding from the Department of Health. However, the nursing homes are not receiving that funding. As a result, these people and their relatives are concerned about their future. I know people in those homes who do not know when they will be told to leave because the health board is not able to meet the bills due to lack of funding. Relatives are concerned because they do not know when they will get a telephone call asking them to remove their loved one from those nursing homes to other accommodation.

It is a scandal that the Minister and the Government should introduce a scheme without providing funding for it. There is no point in the Minister saying there was a miscalculation. Anyone could have told him that. When the Bill was going through the Houses in 1990, I said that its one flaw was that it did not provide for funding. The chickens are now coming home to roost. The Minister has no alternative but to provide funding for this scheme, which must be treated as a demand led scheme. There is no point in the Minister telling a health board that he will give it only a certain amount of money under one heading. Every £100,000 given to health boards is earmarked for a project and the chief executive officers cannot borrow money except within defined limits laid down under section 30 of the Health Act, 1970.

I cannot understand why the Minister has ignored this weaker section of the community and left it in limbo, so that people do not know how long they will be kept in nursing homes. Every nursing home in the west is experiencing extreme difficulties. Some 42 nursing homes are owed £66,000 for the month of April. The May bills have also not been paid because of a lack of funding from the Minister for Health and the Government. This must be dealt with.

As Senator Finneran knows, the Western Health Board applied years ago for homes for the aged in Strokestown, Roscommon and Ballinasloe. However, they have not been funded by the Department of Health. Counties Mayo and Galway were more lucky because those areas were given a number of homes for the aged. In the absence of homes for the aged, we have no option but to provide assistance under the Health (Nursing Homes) Act, 1990, for people who cannot get into those homes. The Western Health Board applied for homes in these three towns, but it has not received funding for them. If it had, it would not be in the difficult situation it is in today.

In the Second Stage debate on the Health (Nursing Homes) Bill, which took place on Thursday, 9 November 1989, Deputy Howlin said to the Minister for Health that:

The Minister has, by his policy, deprived health boards of adequate resources and the consequence of that has been that in every health board region geriatric and district hospitals have been closed and the number of public beds available to the elderly has diminished year after year.

This has not changed. The Minister is obliged to provide funding to the health boards under this Act. There is no point in the Minister telling the health boards that he has given them some money, but they must get more from savings. That is unacceptable. I call on the Minister to make the necessary funds available to all the health boards so that they can meet their obligations and to treat this as a demand led scheme.

Mr. Finneran

I thank Senator Naughten for allowing me to share his time to make a few brief comments on the crisis in the implementation of the Health (Nursing Homes) Act, 1990. I congratulate Senator Naughten on his appointment as chairman of the Western Health Board and wish him well during his term of office. He is a long serving and diligent member of the Western Health Board. I have no doubt he will do a good job as chairman.

The Health (Nursing Homes) Act, 1990, was aspirational. I spoke about that in this House at the time. One is on shaky ground in introducing an Act without knowing the costs for a year. If an Act provided for any person to become a patient of a private nursing home and to apply to the relevant health board for subvention, and the means test was positive, the health board would be obliged to make a subvention. That aspiration would have the support of public representatives, the Houses of the Oireachtas or local councils throughout in the world. However, such legislation also creates problems for any Government or Minister. An extension of the prescribed relatives allowance and the carer's allowance or a variation of those two allowances would have been more helpful than introducing legislation to cover private hospitalisation of elderly people who needed full time care. The provision of extra beds in homes for the aged could also have been an answer.

The 1990 legislation is now being implemented by the health boards. However, its costs are handed back to the Department of Health, which may not have realised the full cost of the legislation. Any open ended legislation will create complications such as those in the Health (Nursing Homes) Act, 1990. However, we have a responsibility to implement this legislation.

Many families, especially those who have already got places in nursing homes for their elderly relatives, have experienced trauma as a result of the non-implementation of the Act. Many of them are now at crisis point and a direct response is necessary. I ask the Minister immediately to honour the bills that have been sent to the health board. Otherwise we will put the people who run the nursing homes out of business because they are running on a pretty tight schedule as they are. We are also causing terrible problems for families who have got a place for their relatives. We cannot allow that to happen. This is too serious a matter to allow it to continue. If some review is needed in the future, so be it, but the Minister should act now on the outstanding bills.

My colleagues and I call on the Minister tonight to honour the invoices that are sent from the Western Health Board in particular. If there are problems with the Act or its implementation let us discuss them, but let us deal with the present problems and take that worry away from the families and the nursing home owners.

Minister of State at the Department of Foreign Affairs (Mr. T. Kitt)

I thank Senator Naughten and Senator Finneran for speaking on this issue. We are all from the west here, including you, a Leas-Chathaoirleach. I am anxious to reply to the points made on behalf of the Minister, Deputy Howlin, who unfortunately could not be here this evening.

The Health (Nursing Homes) Act, 1990, which the Minister for Health was pleased to bring into effect on 1 September 1993, has two principal objectives. First, to ensure high standards of accommodation and care in all nursing homes registered by health boards under the Act and, second, to provide a new system of nursing home subvention so that dependent persons most in need of nursing home care would have access to such care.

A person applying for a subvention is assessed on his or her level of dependency and means to determine whether he or she qualifies for a subvention. The dependency of the person is assessed to establish whether the person applying for subvention needs nursing home care and if so, the level of care required. There are three maximum rates of subvention payable in accordance with the three levels of dependency which are eligible for subvention.

If an individual falls within these levels of dependency, a means test is then applied to determine whether the person qualifies for a subvention payment. The assessment of means takes into account the income of the person and the value of his or her assets in determining how much the person can contribute towards the cost of nursing care. Based on the assessment of the person's dependency and means, a health board determines whether the person qualifies for a subvention payment.

The maximum subvention rates payable under the new scheme are £70, £95 or £120 per week depending on the level of dependency of the person applying for a subvention. These rates represent a substantial contribution towards the costs of care in a nursing home and are a major improvement on the situation which existed prior to the implementation of the nursing homes Act when most persons in nursing homes were receiving no subvention. The implementation of the Act is an important step in honouring the commitments in the Programme for a Partnership Government.

A total of £9 million has so far been made available for the implementation of the nursing homes Act. Funding was allocated to health boards on the basis of the size of the nursing home sector and expected demand under the new subvention scheme. It would appear that demand in the Western Health Board area for nursing home subvention has been higher then expected. Discussions have taken place between officials of the Department of Health and the Western Health Board to establish the extent of the problems facing the board. The Department of Health is monitoring the situation closely. Senators can be assured that the board will continue to meet its statutory obligations under the Act.

The Minister for Health has been in contact with the health boards to establish the extent to which the boards are up to date in payments due in respect of subvention approved under the Act. All of the health boards with the exception of the Western Health Board have paid invoices for subvention from nursing home proprietors up to 31 May, with the exception of some homes which have yet to provide tax clearance certificates or who are having difficulties with registration. In the case of the Western Health Board, arrangements are being made to have all outstanding invoices cleared as a matter of urgency.

The outcome of the operation of the Act must be consistent with the health strategy. The elderly should for as long as possible be maintained in dignity and independence in their own homes. The health boards' primary obligation is to support individuals and families in achieving this very desirable objective. The scheme is not designed to encourage institutional care as a first option. It is designed to help those whose level of dependency cannot be accommodated other than in a nursing home or similar facility. It would be regrettable if the Act were to achieve an outcome other than that which was intended.

The Minister for Health is aware that the Health (Nursing Homes) Act will not be implemented without a few problems arising. I very much appreciate what the Senators have said with regard to the Act and the early stages of implementing it. The Department of Health set up an implementation group which includes representatives of the Irish Private Nursing Homes Association as well as members of the Federation of Catholic Voluntary Nursing Homes, the National Council for the Elderly, the health boards and officials of the Department. The purpose of the group is to highlight problems at an early stage and to resolve them in a way which meets the concerns of all parties. The group has met on over eight occasions and has reported good progress in all areas of implementation.

Private and voluntary nursing homes fulfil an important role in providing high quality care for our dependent elderly population. The nursing homes Act is strengthening the bonds of partnership between public health services and private nursing homes so that they can provide the best care and facilities for the elderly who need residential care.

Mr. Naughten

I asked whether adequate funding would be provided for this scheme and whether it would be treated as a demand led scheme. Regrettably the reply does not answer that. I mean no disrespect to the Minister of State present, I know he is reading a prepared reply. We spoke about this issue this morning. Someone from the Department of Health who would be able to answer that question should be here. I regret very much that the question is not answered.

The Seanad adjourned at 8.50 p.m. until 10.30 a.m. on Thursday, 7 July 1994.