Jim O'Keeffe
Ceist:12 Mr. J. O'Keeffe asked the Minister for Health his views on the position of the elderly who need institutional care and who cannot obtain this in a public institution but who cannot afford it in a private nursing home.
Ceisteanna — Questions Oral Answers. - Private Nursing Homes.
Michael Bell
Ceist:24 Mr. Bell asked the Minister for Health his views on whether the delay in implementing the Health (Nursing Homes) Act, 1990, is reasonable considering the fact that 20,000 elderly are currently in residential care; and if he will make a statement on the matter.
Paul Connaughton
Ceist:42 Mr. Connaughton asked the Minister for Health if his attention has been drawn to the tremendous financial hardship that arrears of private nursing and retirement homes are experiencing because of the currency crisis; if he has an ad hoc fund available for nursing homes who have severe financial problems, not of their own making; if his attention has further been drawn to the tremendous positive social aspect of such retirement homes in local areas; and if he is in a position to help such nursing homes overcome short term financial problems.
Godfrey Timmins
Ceist:55 Mr. Timmins asked the Minister for Health if he intends to provide financial assistance for private nursing homes and/or the patients of such establishments; if so, the form it will take; and if he will make a statement on the matter.
John Connor
Ceist:148 Mr. Connor asked the Minister for Health the present number of recognised private nursing home beds; and the number or percentage of these beds which will receive subventions in the current year under the phased introduction of the Health (Nursing Homes) Act, 1990; and if he will make a statement on the matter.
I propose to take Questions Nos. 12, 24, 42, 55 and 148 together.
Concern for the most vulnerable in society is an underlying theme in the Programme for a Partnership Government. The dependent elderly are among the most vulnerable in today's society. It is recognised that the current system for subventing dependent elderly persons in nursing homes is in need of rationalisation and improvement.
As I indicated in my contribution to the budget debate last Thursday, a provision of £4 million has been made available in my Department's Estimate this year to permit the phased implementation of the Health (Nursing Homes) Act, 1990. This Act creates an important new legal framework for nursing home care in this country. The Act provides for the registration of voluntary and private nursing homes by health boards and introduces a new system for the subvention of dependent people in nursing homes. The new system of subvention which will be introduced under the Act will redress many of the current problems in relation to subventions in nursing homes. Drafting of the regulations needed to implement the Act is at an advanced stage. I hope to commence the Act by 1 May, provided that agreement can be reached with the interest groups who will be consulted on the regulations.
There are over 300 private nursing homes in the country with a capacity of more than 5,500 beds. Just under half the private nursing homes are currently receiving subvention from health boards under sections 26 or 54 of the Health Act, 1970. It is not possible to say at this stage what number or percentage of these beds will be occupied by persons in receipt of subvention this year under the new Act. The position should become clearer closer to the implementation date of the Act.
I recognise that private nursing homes have an important role to play in the care of elderly dependent people. I regret, however, that I have no funds available to help proprietors of such homes who may be experiencing financial difficulties because of the recent currency crisis.
This is the Year of the Elderly. Will the Minister agree that it is an absolute disgrace that old and infirm people are being shuttled from pillar to post to find a bed in the latter part of their life? The Minister's reply does not give them any great hope because it has not focused on the question of resources. In Cork a private nursing home is closing down because of lack of resources. Will the Minister guarantee that in this Year of the Elderly the necessary resources will be made available to ensure that old and infirm people will not be treated in this disgraceful fashion?
I remind the Deputy that I have been six weeks in office and that this Act was passed in 1991. I am determined to implement it with all possible speed. To that end, included in the Programme for Government was the phased implementation of it and £4 million was included in the Estimates. It will cease to be an objective and will become a reality, thanks to the commitment of this Government. I am very much aware that this is the Year of the Elderly and I provided £440,000 for activities to underscore the Year of the Elderly and solidarity between generations. Regarding the specific home the Deputy raised, that establishment was very significantly funded last year by the Southern Health Board. It has received more funding than any other private nursing home in the Southern Health Board region.
How many beds have been vacated in the acute hospitals arising from the first £500,000 made available? How many beds will be made available from the remaining £4 million? How were the nursing homes picked to which these elderly long-stay patients were moved from the acute hospitals?
It is an extraneous question but I will be happy to answer it. On coming into office I was most anxious to provide proper nursing care for elderly patients not in need of acute care in the general hospital service in Dublin. Within a fortnight of coming to office I provided £500,000 for nursing home care. This was done through the Eastern Health Board and the selection was a matter for them. They found nursing homes and moved the patients in accordance with their own wishes.
How many beds have been made available?
I do not have the figure in front of me. I hope that the allocation has made a significant impact in freeing up beds in acute hospitals and improving the throughput. It is something that I will be reviewing during the course of the year to ensure that the most appropriate type of accommodation is available to each patient admitted to the health services.
Does the Minister recall that when he was on this side of the House he was party to saying to the then Minister that if he did not have this in place by February he would resign, and that the then Minister agreed to that?
He did resign.
In respect of the subvention to nursing homes, the maximum now is £42 a week. On my calculations what is provided for this year would not increase that by more than a maximum of £25. Does the Minister not accept that £65 will go nowhere near meeting the average weekly cost of such homes of probably £250 a week?
I would appreciate the Deputy recognising the alacrity with which I approached this problem on coming to office. The notion of setting a deadline for 1 May for the implementation is one that the nursing homes organisations regard as very optimistic. The drafting of the recommendations and negotiations are ongoing at a very tight pace and the nursing homes organisations whom I have met have been very appreciative of the speed with which I want to operate and spend this money.
In relation to the subvention, it is individual patients who are being subvented as opposed to the bed which was the case in the past. The level of subvention would be a matter for negotiation with the nursing homes organisation in the context of the funds available to me.
It is £25 a week.
Let me bring these matters to finality. Deputy Allen and Deputy Jim O'Keeffe have been offering and also Deputy Liz McManus, for a final question. Let us have brevity; I have some Private Notice Questions to deal with also.
When does the Minister propose to introduce the regulations that will allow the full implementation of the Nursing Homes Act which passed through this House two or three years ago? Will the Minister also agree that he did not give the full facts when he referred to the St. Mary's Nursing Home in Cork when he stated that it was being funded at a certain level by the Department through the Southern Health Board? Would he agree that it is one of the few nursing homes that deals with medical card holders, that patients, even those aged 99 years, are now, as a result of failure to fund adequately, in danger of being sent from pillar to post around our county? Instead of paying lip service to the care of the elderly would the Minister now take real steps to avoid a major tragedy?
I did ask for brevity.
I am very disappointed that the Deputy would regard the long awaited implementation of the Nursing Homes Act as lip service. It is concrete——
Where are the regulations?
The regulations are currently being drafted. I am six weeks in office——
The Minister's Department has been negligent. Three years have gone by.
Perhaps the Deputy would allow me to respond.
I want to dispose of Question Time in an orderly fashion. I still have some Private Notice Questions to deal with and if we are not going to have order, I will do something else.
The Deputy should welcome the long awaited implementation of the Nursing Homes Act. I am six weeks in office. This Government gave a commitment; it will deliver on that commitment and the Deputy should have the good grace to acknowledge that fact.
We have not got the regulations yet.
The regulations will specify the subvention rate. I have no intention of announcing the subvention rate until I have had proper discussions which are ongoing now; I have had my first meeting with the nursing homes associations already. My objective is to have the discussions concluded within the next couple of weeks, to leave April for the drafting of the regulations and the bringing of the regulations before Cabinet for my signature so that the Act will be implemented from 1 May. That is a tight order which has been welcomed by the nursing homes owners, by the elderly in this Year of the Elderly, and it should be welcomed by the Opposition.
It is long overdue.
I want an idea of the extent of the problem. I am speaking of the elderly who need institutional care who cannot get into a public institution and who cannot afford a bed in a private nursing home. Could the Minister tell me how many approximately fall into this category? How much would it cost to provide institutional care in a public institution, public hospital or private nursing home for those? Finally, when will those moneys be made available to ensure that the problem is dealt with and we can at least do justice to our elderly.
There are currently 300 private nursing homes with approximately 5,500 beds. Until the service is made available I will not know how many people will want to use it.
Surely the Minister can find out?
There are people currently being catered for at home with families and in geriatric homes who may well want to opt for this new service. The service will be put in place and it will be monitored. I am hoping that there will be a significant improvement in the geriatric provision this year which should be welcomed by all concerned in this Year of the Elderly.
I certainly welcome the legislation and I do not want to pre-empt it, but it appears to be a reactive short term measure and I am rather surprised at that. I thought the Minister would give us a longer term view. In view of the ageing population which we have, and will have increasingly in the future, what long term plans does the Department have in relation to this whole area? It seems that what is happening is that the Department is reacting to certain crises particularly affecting the elderly when it is seen that we must allocate money quickly. However, the longer term implications of the demographic changes in our population are not being considered in any strategic way.
This is certainly not a knee-jerk reaction. This Act has been on the Statute Book for some time and I want it implemented. Notwithstanding that, there are a number of other initiatives. I am advised by a statutory council for the elderly who have a function to advise in relation to the ageing process and how to make preparation for that. I would hope to address that with a longer view. No later than last month there was a significant major conference on the whole ageing process, on the ageing of Europe, held in this city. I look forward to reading the papers from that conference and there will be a number of other initiatives in like fashion throughout this important year.