Dáil Éireann - Volume 557 - 20 November, 2002
Adjournment Debate. - Nursing Home Subventions.
Mr. Crawford Mr. Crawford
Mr. Crawford: I thank the Ceann Comhairle for allowing me to raise this important matter and the Minister for coming to the House.
I put this matter down as a direct result of a telephone call from a councillor colleague in the far west of Cavan last night. I was frightened by the case of a man over 80 years old, with a medical card and old age pension, who has been living in a nursing home for the last two years. His wife lives alone in a traditional country cottage and has to provide €60 out of her pension to retain that person in the home. The health board had rightly demanded that the nursing home carry out repairs to the home, which obviously cost it money, and it had to increase its charges. The health board subvention section has said it does  not have any money and it has put this man on a waiting list. It has indicated that if money becomes available, it will subvent that extra €60. That is extraordinary.
I was present in the House yesterday when various Ministers outlined the massive funding that had been given to different areas. A total of €8.2 billion is available to the Minister for Health and Children this year, with a budget of €8.9 billion predicted for next year. That is sizeable funding in anybody's book. The people on this side of the House have not argued about the amount of money available but about the way it is being spent. One cannot help but wonder why a woman who lives alone in her declining years, who has given a lifetime's service to this country, has to pay €60 out of her pension to retain her very ill husband in a nursing home. I emphasise that it is not an expensive nursing home. It is one of the smaller ones in County Cavan but it is doing an excellent job. A cousin of mine who reached the age of 104 remained there for many years. The service this nursing home provides is tremendous.
In the same discussion I was informed of a case involving an 82 year old lady who benefited from the home help service and had a visit from a health board official. As we all know from our parents or otherwise, elderly people always like to offer a cup of tea to visitors and, despite the problems faced by this woman, she made a gallant effort to make a cup of tea for the health board official. Unfortunately, in doing that she showed that she had some ability and she subsequently lost her home help. How low can we go in terms of looking after those who kept this State going when times were not so good and when there was no Celtic tiger?
I know of another case where an aged person had their ten hours home help service cut to five. Is this an era of good management or one in which the rich get richer and the poor get poorer? I know of many other cases, including one involving a 95 year old lady who has a full pension, medical card, etc. This woman's daughter is being asked to pay a sum of money also in spite of the fact that she is looking after her own seriously ill husband. Where will all this stop? We used to have a caring society. These questions would not have been asked many years ago but these people are being forced to pay this money.
I am advised that the subvention budget is overrun, but there should not be a limit on the subvention budget. If the elderly need care and nursing homes are available, and the means test criteria have been met, there should not be a waiting list for subvention. Whatever way the massive amounts of money available to health boards have to be redirected, the elderly, the disabled and those who need home care should not be discriminated against.
Minister of State at the Department of Health and Children (Mr. B. Lenihan)
 Minister of State at the Department of Health and Children (Mr. B. Lenihan): I thank the Deputy for raising this matter on the Adjournment. The various specific cases referred to by the Deputy were not comprehended in the notice of the matter which the Deputy indicated he intended to raise on the Adjournment. I take it from what the Deputy said that the first matter he outlined is the one that was brought to his attention recently, and I will arrange for the offices in my Department to examine that matter and revert to the Deputy on it. I will instruct them to read the “blacks” of the debate in the morning to see if they can address the issues raised by the Deputy, which appear to be raised in the context of the Estimate provision for this year rather than the announced provision for next year.
As I am sure the Deputy is aware, under the Health (Nursing Homes) Act, 1990, health boards provide subventions to assist persons in meeting the costs of nursing home care. It was never intended that subventions would meet the full costs involved. Apart from contracts entered into under the Nursing Home (Subvention) Regulations, 1993, which enable health boards to enter into arrangements with private nursing homes, the placement of a person in a private nursing home and the fees charged are private arrangements between the nursing home and the individual resident.
The 1993 regulations are administered by the various health boards. A health board may pay more than the maximum rate of subvention relative to an individual's level of dependency, for example, in cases where personal funds are exhausted. Articles 22.3 and 22.4 of the Nursing Home (Subvention) Regulations, 1993, permit health boards to contract beds in private nursing homes and to pay more than the maximum rates of subvention in such cases. However, the application of these provisions is a matter for the individual health board concerned in the context of meeting increasing demands for subventions within the board's revenue allocation as notified annually in the letters of determination. This is in accordance with the Health (Amendment) (No. 3) Act, 1996.
Significant additional funding has been provided since the nursing home subvention scheme was introduced in 1993. In 1994, in the first full year of the operation of the scheme, £12 million, or €15.24 million, was made available. This year, the additional funding provided by my Department has brought the amount available for the scheme to €102 million.
As the Deputy will be aware, in line with a Government decision, an expenditure review of the nursing home subvention scheme has been undertaken by my Department in association with the Department of Finance. It is the intention to bring forward proposals in relation to whatever additional measures may be necessary  arising from the expenditure review, together with the experience gained from the operation of the scheme since 1993. As announced in the health strategy, it is also intended to amend the nursing home subvention scheme to take account of the expenditure review of the scheme and to introduce a pilot home subvention scheme in consultation with the Department of Social and Family Affairs.
On the issue of the home help service, I regard this service as an integral part of community support services for older people and substantial additional funding has been provided in recent years to improve the service. It is my intention that the development of the home help service will continue to receive priority so that it can be extended to cover more applicants.
Government policy in relation to health services for older persons was outlined in the report, The Years Ahead, and reaffirmed in the review of that report which was published in 1997.
We value our older persons and we must place particular emphasis on an approach which aims at maintaining them in dignity and independence at home, restoring to independence at home those older persons who become ill or dependent, encouraging and supporting the care of older persons in their own community by family, neighbours and voluntary bodies, and in providing a high quality of hospital and residential care for older persons when they can no longer be maintained in dignity and independence at home.
Our commitment to these principles has been clearly demonstrated by the additional resources allocated to services for older persons in the past five years. In 1997, an additional £10 million was provided, increasing to £36 million in 2000, £57 million in 2001 and €87 million in 2002. Since 1999 a number of additional allocations have been made to develop community services for older people: €7.5 million to enhance the scope of the home help service; €12 million for the improvement of community support structures, specifically geared towards the support of older persons in their homes through a range of measures; €6 million for carers support and in 2000, as a once-off measure, an additional £2 million was provided to health boards specifically to make available aids and appliances; and €3.5 million has been provided to a number of voluntary groups, such as the Alzheimer Society of Ireland, for the provision of day care services, and the Carers Association.
The health strategy acknowledges that the Irish population is ageing at a rapid rate. Most Members of the House are well aware of the statistical change that is under way in this regard. Under the public private partnership initiative, the Government has provided for 850 beds in 17 units divided between the Eastern Regional Health Authority and the Southern Health Board in the coming years.
 When the Minister meets with voluntary organisations who lobby on behalf of older persons, they generally tell him that they can see an improvement on the ground in the services being provided for older people. Happily, it is only on rare occasions that there is a waiting period for nursing home subvention or home help. I will provide additional funding for services for older persons in 2003.
Dáil Éireann 557 Adjournment Debate. Nursing Home Subventions.