Government policy is to support older people to live in dignity and independence in their own homes and communities for as long as possible. Where this is not feasible, the health service supports access to appropriate quality long-term residential care. Access to appropriate quality long-term residential care is underpinned by both the system of registration and inspection of nursing homes and the financial support available under the Nursing Homes Support Scheme.
Essentially, our aim is to ensure that people are being cared for at the point of lowest complexity. People should only be entering a long-term nursing home when they have passed the point of being able to be cared for at home. This means that only the most highly dependent people should be in long-term nursing home care. One of the key priorities identified in the HSE's National Operational Plan 2013 is the progression of a Single Assessment Tool for older people. This standardised framework will ensure that there is a robust, equitable standardised care needs assessment nationally. It will also allow resources to be targeted towards those with the greatest needs and enable supports and services to be designed in the most appropriate way possible. The Nursing Homes Support Scheme applies to public, private and voluntary nursing homes and includes a principle of resident choice, i.e. the resident chooses their nursing home themselves, subject to the availability of a bed and the ability of the nursing home to meet their care needs. When a person selects a particular nursing home, that nursing home will carry out an assessment to ensure that it can meet the person's care needs. It is a matter for each private nursing home to determine, having regard to its Statement of Purpose etc., whether it can meet the persons care needs. Patients in acute hospitals that have difficulty finding a nursing home that can meet their particular care requirements are generally those that are most highly dependent. In the majority of cases, this category of patients are ultimately accommodated in public nursing homes. The Department is working closely with the HSE to develop an overall plan regarding future public nursing home provision for the Minister’s consideration. The plan will reflect regional need and have regard to the current severe financial constraints, restrictions on public sector staffing and recruitment and the on-going need to meet service and safety standards; all of which pose challenges for community nursing units across the country.
The Deputy will be aware that the Nursing Homes Support Scheme is currently the subject of a review. The terms of reference for this review are as follows: taking account of Government policy, demographic trends and the fiscal situation; to examine the on-going sustainability of the Nursing Homes Support Scheme; to examine the overall cost of long term residential care in public and private nursing homes and the effectiveness of the current methods of negotiating/setting prices; having regard to 1 and 2 above, to consider the balance of funding between long-term residential care and community based services; to consider the extension of the scheme to community based services and to other sectors (Disability and Mental Health), and to make recommendations for the future operation and management of the Scheme. The review will look at possible alternative models of care. Work will continue on the review in the coming months with a view to completion by end 2013-early 2014.