I understand that the Deputy's question refers to care in a community hospital rather than an acute hospital and that, accordingly, residential support services maintenance and accommodation contributions are payable in certain circumstances under subsection 67C(1)(a) of the Health Act 1970 which provides that:
"Subject to subsections (3) to (6) and section 67D, a person provided with residential support services, whether provided by the Health Service Executive or on behalf of the Health Service Executive, shall pay a financial contribution, in accordance with regulations made by the Minister under this section, towards the costs of maintenance or accommodation, or both, associated with the provision of such residential support services."
On 1 January 2017, a "long-stay" residential support services maintenance and accommodation contributions framework under sections 67A to 67D of the Health Act 1970 and the Health (Residential Support Services Maintenance and Accommodation Contributions) Regulations 2016 replaced the former system of long stay charges for in-patient services, which had been in place from July 2005 until 31 December 2016 under the (now-repealed) section 53 of that Act.
As indicated in the Oireachtas in June 2013 by the then Minister for Health James Reilly TD,
"A key and well-established principle is that persons who are provided with residential care should make an affordable contribution towards the cost of their maintenance and accommodation. Quality service provision is expensive and it is fair and equitable that all those in receipt of publicly funded residential care make appropriate payment toward the maintenance and accommodation costs associated with providing such services, if they can afford to do so. Funding derived from maintenance and accommodation contributions will continue to be directly applied by the HSE towards the provision of health services.”
Residential support services maintenance and accommodation contributions apply to all forms of residential support services, other than acute in-patient services and nursing home services provided to those supported under the Nursing Homes Support Scheme (Fair Deal). In line with the system of charges it replaced, residential support services maintenance and accommodation contributions:
- apply to the maintenance and accommodation elements only of services which are provided by the HSE or by agencies funded to provide services on behalf of the HSE under section 38 of the Health Act 2004.
- become payable when a person has already received at least 30 days of residential support services during the immediately preceding 12-month period. Accordingly, each episode of rehabilitative care might not necessarily result in a contribution requirement.
The Health (Residential Support Services Maintenance and Accommodation Contributions) Regulations 2016 (as amended) provide for the rates of income-based contributions which are payable towards accommodation and maintenance costs. In accommodation such as a community hospital where full-time nursing and/or medical care is provided, the current contribution rates payable are subject to a maximum of €25.57 daily (€179 per week) for a person whose income is €223 per week or more.
Affordability and the avoidance of financial hardship are built-in features of the residential support services maintenance and accommodation contributions provisions. In all cases, the contribution rates are based on sliding scales, with proportionally lower contribution rates applying to those on lower incomes. Additionally, section 67D of the Health Act 1970 provides that the HSE may reduce or waive a contribution where appropriate, in order to:
- avoid undue financial hardship on the part of the service user and/or on the part of the service user’s dependants,
- advance a service user’s identified needs (e.g. care plan objectives), or
- take account of separate contributions (if any) made by a service user towards his or her maintenance or accommodation costs.
To assist in the fair application of the framework, the HSE has published, and periodically updated, national guidelines for the correct determination of the contributions and comprehensive waiver guidelines (approved by the Ministers for Health and Public Expenditure and Reform) on the individual circumstances where such contributions may need to be reduced or waived. The guidelines specify that service providers must have regard to the individual circumstances of each service user and his or her dependants. The guidelines ensure that the applicable contribution may be reduced or waived where appropriate, taking account of each person’s income and necessary outgoings, including reasonable regular financial commitments, with a view to ensuring there is no unfair burden on the service user or on his or her dependants.
The features of the residential support services maintenance and accommodation contributions framework ensure that it is reasonable and fair and that each service user's contributions are based on what he or she can afford, taking account of the service user's individual circumstances.
The HSE publishes detailed supporting documentation in relation to residential support services maintenance and accommodation contributions on its website at www.hse.ie/longstaycontributions.