Dáil Éireann Debate, Tuesday - 12 December 2023
831. Deputy Jim O'Callaghan asked the Minister for Health the main initiatives he has taken to develop and expand health services for older people since 27 June 2020; the additional funding provided in successive budgets; his plans for 2024; and if he will make a statement on the matter. [55291/23]
View answerIn 2020 the overall funding available to the HSE for Older Persons was €1.97 billion, next year the overall funding available will exceed €2.6 billion. A wide range of core services will be provided for older persons including home support, day care, community supports in partnership with voluntary groups and intermediate care as well as long-stay residential care when remaining at home is no longer feasible.
Investment in social care services has been a substantial priority for this Government. The delivery of home support hours is increasing year on year. In 2024 we expect to deliver 22 million hours of home support. This is more than has ever been delivered before. Over many years, both day care and the meals on wheels service has proven to be important components of the community services offered to older people, particularly in rural communities. We are building on recent investment to support these services by investing an additional €2.2 million in 2024 for day care services and an additional €1 million for meals on wheels nationally.
The HSE, in preparing its National Service Plan, will examine how services, including relevant KPIs, can be progressed within the overall increased envelope of funding for older persons services.
Significant progress has already been made in implementing the recommendations of the Nursing Homes Expert Panel, and many short and medium-term recommendations have already been implemented and mainstreamed into normal operations. Four Expert Panel Progress Reports have been published to date, as well as an implementation progress update in October 2023, and all are available on the Department’s website:
www.gov.ie/en/publication/c7f5b-covid-19-nursing-homes-expert-panel-report-implementation-oversight-team/#progress-reports
Key areas of progress include:
• The Patient Advocacy Services was extended to private nursing homes from 1 November 2022.
• Work has continued in the development of a Safe Staffing and Skill mix Framework for the sector and the final report is due to be completed in Q1 2024.
• Palliative and end-of-life programmes for nursing homes was launched in 2022 and continues to provide training and education across the nursing home sector.
• Dedicated IPC and Safeguarding teams for nursing homes continue to provide specialist services across the 9 CHOs.
• Community Support Teams continue to support private nursing homes.
• Over 100 places funded on postgraduate gerontological nursing training courses for the academic year 2022/2023, with funding secured in 2024 to provide a further 220 places.
The Government has provided substantial support to the private and voluntary nursing home sector over the pandemic:
• Over €151m of financial support has been provided to private and voluntary nursing homes through the COVID-19 Temporary Assistance Payment Scheme (TAPS).
• The provision of free PPE and oxygen to private nursing homes continues, costing approximately €77 million to date.
• A €10 million scheme (TIPS) was established last year to support private and voluntary nursing homes with increases in energy costs, covering 75% of year-on-year cost increases up to a monthly cap of €5,250 per nursing home. This scheme was extended for a second time to the end of June 2023, with a further short-term extension under review.
Nursing Homes Support Scheme Rental
The insertion and commencement of Section 45D of the Nursing Homes Support Scheme (Act 2009) as amended, will increase the amount of rental income that nursing home residents can retain under Fair Deal from 60% to 100%. This change to the scheme will be implemented from 1 February 2024.
Prior to 1 November 2022 participants in the Fair Deal scheme were able to rent out their homes or other assets, however all rental income was subject to assessment at 80% like all other income (such as pension income). Recognising that this may act as a disincentive against renting out a property, the Government approved a policy change to the Nursing Homes Support Scheme, 'Fair Deal', to remove a disincentive for applicants to the Scheme to rent out their principal residence after they have entered long term residential care. The rate of assessment for rental income from a principal residence, effective from 1 November 2022, was reduced from 80% to 40%. This means that for someone renting out their principal residence, they retained 60% of the income accrued from that rental and 40% is assessed under Fair Deal. This policy change addresses the commitments made under Housing For All Action 19.8. The change was made through a Committee Stage amendment to the Department of Housing, Local Government and Heritage’s Regulation of Providers of Building Works and Building Control (Amendment) Bill 2022 and became operational as of 1 November.
Following a review period, as per the conditions of the amended legislation, the insertion of Section 45D into the Act will permit nursing home residents to retain 100% of the income accrued from renting the principal private residence, effective from February 2024.
It should be noted that this provision will only apply to income generated from rental of the principal private residence - any rental income received from a property which is not from a principal residence will continue to be treated as general income and assessed at 80%.
Regulation of home support providers
The Programme for Government commits to "Introduce a statutory scheme to support people to live in their own homes, which will provide equitable access to high quality, regulated home care". Work is ongoing within the Department to progress this commitment.
The Department of Health is currently developing a regulatory framework for providers of home support services with the aim of ensuring that all service users are provided with high quality, regulated care. This will comprise of primary legislation for the licensing of home support providers; regulations which will set out the minimum requirements that a home support provider must meet to obtain a licence; and HIQA national standards.
Development of the primary legislation is now at an advanced stage with the Bill having been placed on the autumn legislative programme priority list for drafting. Transitional timelines for the registration of home support providers under this framework are currently being finalised with further details to be available following publication of the General Scheme.
The draft regulations are at an advanced stage informed by a public consultation, which concluded on 4 August 2022. The analysis of submissions has been carried out by the Institute of Public Health (IPH) which demonstrated strong agreement in relation to regulation of home support service provision. A report on the findings of the public consultation was published in January 2023. Legal advice and engagement with key stakeholders (HIQA, HSE, Private and Voluntary Providers, and service user representative groups) will assist with final revisions to regulations for providers of home support services.
In addition to this, HIQA has initiated the process of developing standards for home care and home support services.
Strategic Workforce Advisory Group on Home Carers and Nursing Home Healthcare Assistants
Addressing the shortage of care workers in Ireland is an urgent priority for the Government.
To this end, the cross departmental Strategic Workforce Advisory Group on Home Carers and Nursing Home Healthcare Assistants was established in March 2022 to examine and formulate recommendations to address the challenges in frontline carer roles in the home support and long-term residential care sectors. The Report of the Strategic Workforce Advisory Group on Home Carers and Nursing Home Healthcare Assistants was published on 15 October 2022, and it contains 16 recommendations. Implementation of these recommendations is underway and is being overseen by a cross-departmental Implementation Group, chaired by the Department of Health. The group met most recently in October and a progress update was recently published: www.gov.ie/en/publication/66dd1-strategic-workforce-advisory-group-on-home-carers-and-nursing-home-healthcare-assistants/
Dementia
Since my appointment as Minister for Mental Health and Older People in 2020, I have made dementia a priority. Through successive budgets, I have worked to prioritise Government funding for the development of dementia diagnostic and post-diagnostic services, in line with the recently-published Dementia Model of Care.
Through Budget 2024, I have continued to prioritise dementia by providing an additional €500,000 to increase the provision of in-home dementia day care, for people who cannot, or do not wish to, attend centre-based day care. This was first introduced during the COVID-19 pandemic and is universally viewed as beneficial, improving both the quality of life of clients and providing a break for family carers. 52 dementia-specific day centres have also opened.
Alongside this, I allocated €300,000 in funding to the Alzheimer Society of Ireland to provide weekend activity clubs for people with young onset dementia. This new service will have the benefit of also providing respite to the family carer. Up to 120 people with dementia and their families are expected to benefit from this weekend service.
Furthermore, in Budget 2024 I announced that a minimum of 18% of all new home support hours are now ringfenced for people with dementia.
Going forward there will be a strong focus on dementia-specific services, which have developed in recent years, like the Memory Technology Resource Rooms and National Dementia Adviser Service which provide invaluable information and supports to people with dementia and their family carers to help them adapt to a dementia diagnosis and continue to live as well as possible.
Commission on Care
On 3 October 2023 the Government approved the proposal put forward by the Minister for Health and I for the establishment of a Commission on Care for Older People. The Commission will examine the provision of health and social care services and supports for older persons and make recommendations to the Government for their strategic development. In addition, a cross-departmental group will be established under the auspices of the Commission to consider the supports for positive ageing across the life course and to develop a costed implementation plan for options to optimise these supports. The Commission will be comprised of independent experts and will be supported by a secretariat from the Department of Health. In Budget 2024, €1.243 million has been allocated to support the work of the Commission, which will formally commence in early 2024.
Both Minister Donnelly and I were delighted to announce the appointment of Professor Alan Barrett, Chief Executive Officer of the Economic and Social Research Institute (ESRI), as the Chairperson of the Commission on Care for Older People. This appointment marks a significant milestone in the Commission’s formation.
Safeguarding
To further strengthen the framework for safeguarding adults at risk, the Department of Health is at an advanced stage of developing an overarching national policy on adult safeguarding in the health and social care sector. This overarching national policy will build on existing adult safeguarding policies and structures for the sector and address potential policy and legislative gaps and will align with the provisions of the Assisted Decision-Making (Capacity) Act 2015. The Department plans to commence a public consultation shortly and will announce details in the near future. Legislation as required to underpin the policy will be prepared subject to its approval by Government.
