I am aware that different arrangements apply to financial contributions from people availing of public long-stay care as opposed to those accommodated in private nursing homes. Under the Health (Nursing Homes) Act 1990 health boards may pay a subvention to assist a person in meeting the costs of private nursing home care. However, it was not intended that a subvention payment would meet the full costs of private nursing home care.
As regards people availing of public long stay care, charges can be made under two regulations. They can be made under 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 periods totalling more than 30 days within 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.
As the Deputy is aware, the Ombudsman, in his report on the nursing home subvention scheme, asserted that under the Health Act 1970 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 and entitlement to a service, although the two terms are often used interchangeably. This view is supported by legal advice available to the Department.
The health strategy, Quality and Fairness — A Health System for You, acknowledges the need to clarify and simplify eligibility arrangements and sets down a commitment to introduce new legislation to provide for the introduction of clear statutory provisions on entitlement and eligibility. A review of all existing legislation in this area has been carried out in my Department which will inform the approach to the drafting of new legislation in this area.
In line with a Government decision, an expenditure review of the nursing home subvention scheme was undertaken by the Department of Health and Children in association with the Department of Finance. The review was carried out by Professor Eamon O'Shea and the objectives of the review were, inter alia, to examine the objectives of the nursing home subvention scheme and the extent to which they remained valid, to assess the service delivered and to establish what scope, if any, existed for achieving the programme objectives by other more efficient and effective means. Professor O'Shea's report, Review of the Nursing Home Subvention Scheme, was launched in June 2003 simultaneously with the Mercer report, Study on the Future Financing of Long-Term Care in Ireland, which was commissioned by the Department of Social and Family Affairs.
As the Deputy will be aware, my Department has established a working group comprising of all stakeholders to review the operation and administration of the nursing home subvention scheme following on from the publication of the O'Shea report. The purpose of the review is to develop a scheme which will be transparent, offer a high standard of care for clients, provide equity within the system to include standardised dependency and means testing, be less discretionary, provide both a home and nursing home subvention depending on need, be consistent in implementation throughout the country and draw on experience of the operation of the old scheme.
As part of the overall clarification of entitlements as promised in the health strategy and in tandem with the work of the working group on the nursing home subvention scheme, my Department will attempt to resolve the current differences in approach between the consideration of individuals' ability to pay under the various regulations in this area.
