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Dáil Éireann díospóireacht -
Wednesday, 18 Jun 2014

Vol. 844 No. 2

Nursing Home Support Scheme (Amendment) Bill 2014: First Stage

I move:

That leave be granted to introduce a Bill entitled an Act to allow for the provision of a home care package to a person who qualifies for and is being offered long-term residential care in circumstances where a suitable home care package can be devised for that person and such package is less costly on the State than the long-term residential care being offered and to provide for related matters.

I thank the Ceann Comhairle for allowing me to bring forward this Bill today. State policy is that elderly and infirm people should be catered for, in so far as possible, in the comfort and security of their own homes. If someone reaches the point at which they are too old or infirm to look after themselves, or for their family to look after them without support, there are two routes open to them. The first option is the fair deal scheme where someone goes into a nursing home, they pay the appropriate contribution and are supported by the State. The second option is a home-care package. As the fair deal is on a statutory basis, people have an absolute right to it if they fulfil the relevant criteria.

The home-care package, alternatively, is on a discretionary basis. Unintentionally, State policy has directed more people to the fair deal scheme than should otherwise be the case. In other words, the balance is incorrect. Another issue with the home-care package is geographical. It depends on whether the various ingredients which make it up are available in the locality where the patient resides. Local health officials may determine that, because the necessary ingredients are not available in one locality, they have no option but to opt for the fair deal scheme. Ironically, in the age of austerity, it costs the State approximately three times as much to provide a fair deal package as it does to provide a home-care package.

There are exceptions, but generally speaking it costs three times as much. What I propose is that if the home-care package were put on a statutory basis, whereby people meet certain criteria and have an absolute right to it, then more people would opt for the home-care package with a considerable saving to the Exchequer. Existing home-care services are sporadic and inconsistent. They are not patient driven and there are significant geographical disparities in the availability of services. Often it depends on where one happens to live. There is no transparency in eligibility criteria and decision-making. It is entirely at the discretion of the health service. As a result, many elderly infirm people have little choice but to opt for nursing home-care at far greater cost to the Exchequer.

The ultimate solution to this is to amend the legislation providing for the fair deal to have a similar set of criteria for a home-care package. Obviously the health criteria should be the same, but the financial criteria would be different to reflect the various cost structures of looking after somebody in a nursing home as opposed to at home. We are drafting legislation to encompass this. In the meantime the Bill would provide a temporary solution, whereby if somebody is assessed for the fair deal he or she would have a right to request that a home-care package be put together, the health service would be compelled to put the home-care package together, and the patient would be entitled to receive it, as opposed to the fair deal, if it is cheaper to the State to provide it. This makes perfect sense and I do not see how the Government can oppose it. The Department of Health should take measures to bring forward similar legislation if I cannot get this through the system soon enough. It would present a considerable saving to the Exchequer and enable more people to be cared for in the comfort, security and safety of their own homes.

Is the Bill opposed?

Question put and agreed to.

Since this is a Private Members Bill, Second Stage must, under Standing Orders, be taken Private Members' time.

I move: "That the Bill be taken in Private Members' time."

Question put and agreed to.
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