Dáil Éireann díospóireacht -
Tuesday, 3 Dec 1996

Vol. 472 No. 3

Adjournment Debate. - Nursing Home Subventions.

Mr. M. Smith

Major medical advances and improvements in nutrition, housing, sanitary and water facilities have meant that people are living on average almost ten years longer than at the beginning of this century. This has meant that we have a growing ageing population, and the need to continue to improve the services for these people is of paramount importance to all of us in public life and to those providing that care.

Those who are old belong to a generation that did not enjoy for the greater part of their life anything like the kind of facilities which are available now. In my constituency we are fortunate to have a standard of nursing and medical care of excellent quality in the Hospital of the Assumption in Thurles and in a range of nursing homes.

I want to refer this evening to two cases that have been brought to my attention. I am not asking the Minister to investigate the cases individually but to see how subventions to nursing homes could be reviewed in such cases. One is the case of a very old gentleman, all of whose family of five have now retired and on pensions. These five individuals, dedicated to their father have, for the past year, raised from their own meagre pensions £20 a week to keep their father in a nursing home. Their case was examined recently and they were advised that they would receive a subvention of about £23 a week. Notwithstanding financial constraints and demands on the health services, this is something that should be remedied.

The second example relates to members of families who should, in the normal way, contribute towards the maintenance of their parents and relations from whom they received the benefits we all receive from good parents, including, in some cases, inheritances of one kind or another but who, because they have left the area, or for other reasons, refuse to be involved in contributing to the maintenance of their parents. In such circumstances the members of the family who remain at home may find themselves stretched to the limit to try to cope with the full cost. There are more and more examples like this. I am advocating a lack of responsibility on the part of those who should share the responsibility, but when one family has to carry a burden that is excessive, a way should be found to lighten the burden.

The midwest region has made a major contribution to improving the services in the hospitals and community care areas. I accept it is not possible to meet all the demands but if we cannot find a way in good economic times to look after the aged perhaps some of the other issues we tackle should be set in priorities. I make that appeal to see what can be done to improve the situation.

Mr. Noonan

(Limerick East): I thank the Deputy for his remarks and for drawing my attention to two categories of cases which perhaps the nursing home scheme does not fully take into account. The Health (Nursing Homes) Act, 1990, which came into operation on 1 September 1993 has two principal objectives, first, to ensure high standards of accommodation and care in all nursing homes registered by health boards under the Act and, second, to provide a new system of nursing home subvention so that dependent persons most in need of nursing home care have access to it. The Act is a major step forward in ensuring that dependent elderly persons will be well cared for and provides the health boards with another option in meeting the needs of the dependent elderly locally and in a flexible manner.

A person applying for subvention is assessed on his or her level of dependency and means to determine whether he or she qualifies for a subvention. The maximum subvention rates payable under the new scheme are £70, £95 or £120 per week depending on the level of dependency of the person applying for subvention. These rates represent a substantial contribution towards the costs of care in a nursing home and are a major improvement on the situation which existed prior to the implementation of the Nursing Homes Act when most persons in nursing homes did not receive any subvention.

In 1995 just over £15 million was made available to the health boards to fund the subvention scheme. This sum was repeated in 1996. Earlier this year some health boards informed my Department that they were experiencing difficulties in meeting their obligations under the Act. Additional funding was allocated to these boards and the total funding available now stands at just under £17 million. It should be noted that since the introduction of the Act to date, over £48 million has been made available to the health boards to fund subventions. By 30 September 1996, 17,775 applications for nursing home subventions had been received and 9,515 had been approved. My Department continues to monitor the financing of the subvention scheme closely to ensure that the funding made available will support the level of subventions approved. As the Deputy may be aware, changes have been made to the subvention scheme under the Health (Nursing Homes) Act, 1990, by amending regulations which came into effect on 31 July 1996.

The first change increases the threshold above which the circumstances of a son or daughter are assessed by a health board to establish if he or she is in a position to contribute towards the cost of care in a nursing home of a parent who has qualified for a nursing home subvention. This amendment will have the effect of reducing the amount of time spent by health boards in assessing the circumstances of sons or daughters who are clearly not in a position to contribute towards the nursing home costs of a parent. Sons and daughters who are in a position to contribute towards the cost of a parent's nursing home fees should do so and the State recognises this contribution in the tax relief it gives on such payments.

The second change is to permit health boards to contract beds in nursing homes above the number contracted on 1 September 1993 and to pay more than the maximum rates of subvention payable in such cases. This amendment is to facilitate health boards which do not have sufficient accommodation in their hospitals and homes to meet the needs of those requiring nursing care and which have traditionally relied on the nursing home sector to meet their need.

I am aware that differences of interpretation have arisen in relation to the obligation on health boards to disregard a sum equivalent to one-fifth of the old age pension in calculating the amount of subvention to be paid. My Department will shortly clarify the situation to ensure that each applicant retains such a sum for his or her personal use.

A nursing home subvention is not intended to cover the full cost of a nursing home fee but to provide assistance towards the cost of nursing home care for those who cannot do so from their own resources. I am aware that certain difficulties are being encountered by some providers and persons seeking nursing home care. I will continue to endeavour to address these problems, and the issue of increasing the subvention rates, within the resources available to me.

The provision of subvention under the Act must be consistent with the current health policy that the elderly should be maintained in dignity and independence in their homes. The scheme, therefore, must be based on medical advice about the most appropriate care setting in individual care cases. I assure the Deputy I will continue to honour the commitments set out in the health strategy, Shaping a Healthier Future, for the development of services for the elderly both in the community and residential care.

If the Deputy has particular cases in mind where he believes anomalies exist perhaps he would write to me to bring them to my attention and I will have them dealt with as favourably as possible.