Nursing Home Services

Wednesday, 26 February 2014

Questions (234, 235, 236, 237, 238, 239, 240, 242, 243, 244, 245, 246, 247, 248, 249)

Michael Healy-Rae

Question:

234. Deputy Michael Healy-Rae asked the Minister for Health with regard to nursing homes, the way demographic changes will be addressed; and if he will make a statement on the matter. [9857/14]

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Michael Healy-Rae

Question:

235. Deputy Michael Healy-Rae asked the Minister for Health with regard to nursing homes, the proposals he has to deal with the likely shortfall in beds. [9858/14]

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Michael Healy-Rae

Question:

236. Deputy Michael Healy-Rae asked the Minister for Health the roles of public and private operators in the nursing home sector; and if he will make a statement on the matter. [9859/14]

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Michael Healy-Rae

Question:

237. Deputy Michael Healy-Rae asked the Minister for Health with regard to nursing homes, his proposals for alternative and complementary models of care; and if he will make a statement on the matter. [9860/14]

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Michael Healy-Rae

Question:

238. Deputy Michael Healy-Rae asked the Minister for Health his view of the role of nursing homes in the continuum of care model; and if he will make a statement on the matter. [9861/14]

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Michael Healy-Rae

Question:

239. Deputy Michael Healy-Rae asked the Minister for Health his views that uncertainty of the future of the fair deal and the weekly rates to be paid to nursing home operators have been cited by the banking sector as some of the key impediments to lending to the nursing home sector at present; and if he will make a statement on the matter. [9862/14]

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Michael Healy-Rae

Question:

240. Deputy Michael Healy-Rae asked the Minister for Health his views on the lack of transparency and dominant negotiating position enjoyed by the National Treatment Purchase Fund, and a flat rate of fees irrespective of the levels of dependency and acuity identified as some of the key weaknesses in the current nursing home support scheme; and if he will make a statement on the matter. [9864/14]

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Michael Healy-Rae

Question:

242. Deputy Michael Healy-Rae asked the Minister for Health his views on affording the opportunity for fair right of appeal independent of the National Treatment Purchase Fund with regard to nursing homes; and if he will make a statement on the matter. [9866/14]

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Michael Healy-Rae

Question:

243. Deputy Michael Healy-Rae asked the Minister for Health with regard to nursing homes, his views on the way the level of investment required to bring the public provision of long-term residential beds is substantial, €1.68 billion, and the ability of the Exchequer to make this investment is seriously under question. [9867/14]

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Michael Healy-Rae

Question:

244. Deputy Michael Healy-Rae asked the Minister for Health his plans to ensure that all public nursing home beds can become Health Information and Quality Authority compliant by the July 2015 deadline; his views on whether this is now a realistic or desirable objective; and if he will make a statement on the matter. [9868/14]

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Michael Healy-Rae

Question:

245. Deputy Michael Healy-Rae asked the Minister for Health with regard to nursing homes, if the deadline for the Health Information and Quality Authority compliance will be extended; and if he will make a statement on the matter. [9869/14]

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Michael Healy-Rae

Question:

246. Deputy Michael Healy-Rae asked the Minister for Health his views on ensuring that a uniform and consistent application of existing and future standards is brought to bear on all nursing home operators, both public and private; and if he will make a statement on the matter. [9870/14]

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Michael Healy-Rae

Question:

247. Deputy Michael Healy-Rae asked the Minister for Health his plans regarding a budget for funding nursing home care that recognises the costs of providing resident centre care but which is sustainable in the context of an ageing population. [9871/14]

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Michael Healy-Rae

Question:

248. Deputy Michael Healy-Rae asked the Minister for Health his views that the current fair deal budget is inadequate in the context of an ageing population, with associated higher dependency levels, recent decisions to divert money from the NHSS to support home care packages and other community facilities, for short-term financial gain, will be at the expense of much higher social and economic costs now and into the future and will further increase the delays in securing long-term residential care for those who need it most; and if he will make a statement on the matter. [9872/14]

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Michael Healy-Rae

Question:

249. Deputy Michael Healy-Rae asked the Minister for Health his views that the fair deal for nursing homes remains intact; and if he will make a statement on the matter. [9873/14]

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Written answers

Minister of State at the Department of Health

I propose to take Questions Nos. 234 to 240, inclusive, and 242 to 249, inclusive, together.

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, including the provision of financial assistance under the Nursing Homes Support Scheme (NHSS).

Our approach to future provision for our older people is not a short-term one as has been suggested. We are acutely aware of the demographic trends and of their implications for future service provision and these are under active consideration. The NHSS Review, which will be published in the coming months, will contribute to this process. 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.

It is expected that the Review will be completed by Q2 2014 and the report will then be made publicly available. As the Scheme is statutory based, the implementation of recommendations arising from the review may require amendments to the NHSS Act 2009.

Residential care in Ireland is provided through a mix of public, voluntary and private provision. It is worth highlighting that the budget for long-term residential care in 2014 is €939m. It is estimated that this will support over 22,000 people this year in public, private and voluntary nursing homes. In order to be an ‘approved nursing home’ for the purposes of the NHSS, all private and voluntary nursing homes must negotiate and agree a price for the cost of care with the National Treatment Purchase Fund (NTPF). This is a necessary feature of the Scheme due to the commitment by the State to meet the full balance of the cost of care over and above a person's contribution. The NTPF has statutory independence in the performance of this function and, in carrying it out, it must ensure value for money for both the individual and the State. If price negotiations break down a three stage review process, developed by the NTPF, can be invoked. Details of the process are set out on the NTPF website.

We are committed to the provision of a quality public nursing home service underpinned by a regulatory system of registration and inspection. It is the responsibility of the Health Information and Quality Authority (HIQA) to assess whether residential services are providing high quality, safe and effective services and supports to residents, and to ensure that any issues or deficits are addressed to the satisfaction of the Authority. In this context the HSE is concentrating on applying the limited funding available for capital works in the most effective way possible to meet residential need now and in the future.

While there will of course always be a need for long-term residential care, older people have consistently said that they want to be facilitated and supported to stay in their own homes and communities for as long as it is viable for them to do so, and it is Government policy to develop this approach. Accordingly in 2014 there is an enhanced focus on home and community supports. Provision for community and home-based services are being strengthened by €23m to allow more people to stay in their own homes for longer. This is in addition to the budget of €315 provided for home help and home care package services which are delivered to some 56,000 people at any one time.

The Government for National Recovery, 2011-2016 commits to developing and implementing national standards for home support services, which will be subject to HIQA inspection. Primary legislation and resources will be required for the introduction of a statutory regulation system for home care services. This is being considered in the wider context of the licensing of Public and Private Health Service Providers. In the meantime, the HSE is already progressing a range of measures to ensure that home care services, provided either directly by the HSE, or through external providers with HSE funding, operate to a high standard. These measures will have a very significant impact on overall standards.

I would also like to advise the Deputy that one of the key priorities identified in the HSE's National Service Plan for 2014 is the implementation of a Single Assessment Tool (SAT) for older people. This standardised framework will uniformly assess dependency levels, 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 first phase of implementation of the SAT will commence in 2014 with a minimum of 50% of all new entries to the NHSS, Home Care Package and Home Help Schemes assessed by the SAT in the last quarter of 2014, with full implementation of SAT by the end of 2015.

The needs of our older people are, and will remain, a very high priority for this Government. The funding that is available for services for older people must be balanced across all of the various service areas in a way that achieves the best possible outcomes for the greatest number of service users and prioritises areas of greatest need as far as possible. Resources that are available will continue to be applied to provide the best possible mix of supports and services.