I propose to take Questions Nos. 248 and 249 together.
The Nursing Homes Support Scheme encompasses a Care Needs Assessment which identifies whether the individual has sufficiently high care needs to warrant nursing home care or whether their care needs can be met in the community. The purpose of the assessment is to ensure that long-term residential care is the most appropriate option for the particular individual.
The Care Needs Assessment is carried out by appropriate healthcare professionals appointed by the HSE. An assessment may be completed in a hospital or community setting and includes consideration of the following:
the individual's ability to carry out the activities of daily living, e.g. bathing, shopping, dressing,
the medical, health and personal social services being provided to the person or available to the individual at the time of the assessment and generally,
the family and community support available to the individual, and
the individual's wishes and preferences.
The Nursing Homes Support Scheme Act 2009 defines "long-term residential care services" as maintenance, health and personal care services. The services which fall within the scope of long-term residential care are:
nursing and personal care appropriate to the level of care needs of the person,
basic aids and appliances necessary to assist a person with the activities of daily living,
bed and board, and
Under the scheme, the cost for each public nursing home is determined using the definition of "long-term residential care services" underpinned by an agreed set of cost components which have been laid before the Houses of the Oireachtas. The cost of care is reviewed on an annual basis. When the review was carried out in 2010, the cost of care reduced in approximately 80% of public nursing homes. The 2011 review is underway at present. Given the very significant differences between the average cost of care under the scheme in public and private nursing homes, and in the absence of evidence to the support such a difference, the Minister for Health considers that it will be necessary to identify ways of achieving further significant reductions in public nursing home costs either as part or outside of the review.
The National Treatment Purchase Fund (NTPF) has statutory responsibility for the negotiation of prices in private and voluntary nursing homes. The NTPF is independent in the performance of this function. The NTPF may examine the records and accounts of nursing homes and has particular responsibility to ensure value for money for both the individual and the State.
The cost of care for each nursing home that is participating in the NursingHomes Support Scheme is published on the HSE's website at: http://www.hse.ie/eng/services/Find_a_Service/Older_People_Services/nhss/. At present, the weighted average cost of care is approximately €1,275 in a public nursing home and €900 in a private nursing home.
Following the examination of the Scheme, the Minister for Health is considering a range of increased governance and monitoring arrangements and it is hoped to convey these to the HSE within the next few days. These will include issues already signalled by the Minister such as a clinical audit of the Common Summary Assessment Report (CSAR) process to establish the levels of dependency for those accessing care and to attempt to explain the unforeseen increase in average length of stay.