Dáil Éireann - Volume 628 - 29 November, 2006
Health (Nursing Homes) (Amendment) Bill 2006: Report Stage (Resumed).
Debate resumed on amendment No. 15:
In page 11, line 11, to delete “Executive,” and substitute the following:
(iii) except in exceptional circumstances, not sooner than 12 months after the commencement of the payment of a relevant subvention,”.
Mr. S. Ryan Mr. S. Ryan
Mr. S. Ryan: I support this amendment. Most of the points on it were made the last day. Perhaps the Minister of State will respond and we will take it from there.
Mr. S. Power Mr. S. Power
Mr. S. Power: Amendments Nos. 14 and 15 were not accepted on Committee Stage. The Health Service Executive, would have to be in a position to view the degree of dependency and the means of the dependent person at any time as both dependency and financial circumstances can change significantly at any time in a 12 month period, or a lesser period. This provision represents no change from the position laid out in the 1993 subvention regulations.
Mr. S. Ryan Mr. S. Ryan
Mr. S. Ryan: It is not quite good enough to state there is no change in the practice. The practice in regard to subvention and the need for it are critical. There is a major problem at present. The Minister and the Minister of State promised further detailed legislation to deal with this issue but we have not seen it. Perhaps the Minister of State will give a solemn commitment in respect of that Bill today.
The explanatory memorandum states the purpose of the subvention scheme is to provide financial assistance to persons towards the cost of maintenance in a private nursing home while the Bill defines subvention as a payment towards the  cost of the care and maintenance of a dependent person in a nursing home. That differs from the 1998 regulations which simply state that the payment of subvention is towards the cost of nursing home care. The main problem is the financial assessment. This amendment seeks to change it but the Minister of State is not prepared to accept it.
Mr. S. Power Mr. S. Power
Mr. S. Power: Are we on amendments Nos. 14 and 15?
Acting Chairman Acting Chairman
Acting Chairman: We are on amendment No. 15.
Mr. S. Ryan Mr. S. Ryan
Mr. S. Ryan: We are talking about the value of a person’s house and its valuation. How will we provide the subvention? That is a major problem as far as I am concerned. We had hoped the Minister of State would look more favourably on the amendment which was dealt with on Committee Stage but I regret he is not prepared to do so.
Mr. Healy Mr. Healy
Mr. Healy: I concur with Deputy Seán Ryan. Even at this late stage I ask the Minister of State to reconsider this Bill. Even what is good about the current situation is being undermined by this Bill. In the past officials of the Health Service Executive had discretion but that will no longer be the case.
The situation in respect of the nursing home subvention is completely unwieldy and unfair. Currently I am dealing with the case of two elderly brothers who are both on non-contributory old age pensions and who are both medical cards holders. Both of them were told there are no long-stay public beds for them and they applied for, and received, the maximum subvention. However, if one adds the maximum subvention they are receiving from the HSE in South Tipperary, which is €240 each per week, to their non-contributory old age pension, it amounts to approximately €420. The nursing home is charging them €500 each per week, although they are not paying it because they do not have it.
These two brothers have no savings and live in a local authority rented house. Furthermore, if they want to hold on to the house while they are in the nursing home, they must pay rent for it. The HSE and this Government are asking them to pay €80 each per week which they do not have because they cannot fully fund them in a nursing home or provide them with public beds. That is unfair, unreasonable and unforgivable at a time when this country is awash with money.
Earlier this year the Minister for Finance told me that in the ten years in which this Government has been in power, there has been a budget surplus of €39 billion. Despite the availability of that money, we cannot look after two old age pensioners, who are medical card holders and local authority tenants, when they get old. Even with their pensions and the HSE subvention, they  are still €80 each per week shy of the nursing charge. It is unfair and unbelievable but it is true. This is not an isolated case; it is happening on a regular basis. Even at this late stage I ask the Minister of State to withdraw this Bill and bring forward a proper scheme of subvention which would at least fully cover people such as those about whom I spoke or else provide enough public beds for such people.
Caoimhghín Ó Caoláin Caoimhghín Ó Caoláin
Caoimhghín Ó Caoláin: I support the amendment tabled by Deputy Twomey. In the same vein as was argued heretofore, the whole basis for the computation of subvention entitlement is giving rise to real hardship for families. Even in the brief period since we adjourned Report and Final Stages of the Bill I have personal knowledge of real hardship being experienced. Some families have had to make serious decisions on the care of loved ones. Despite every appeal, it has transpired that in the case to which I refer, a family was forced to withdraw its loved one from residential care. As a consequence, the wife of the man in question had to set aside her work to give direct and full-time care.
There are serious issues involved in assessment. We need to loosen up significantly on the computation method and allow greater discretion in specific cases of hardship. Many examples of hardship have been flagged here. However, let me tell of what happened in the case to which I referred. In the short time since that woman took her husband home, the tremendous pressure she was under and the severity of the change in lifestyle were, I believe, contributory factors to her being killed in a road traffic accident, within a couple of weeks of returning her husband to her personal full-time care. That family has gone through untold trauma.
These personal experiences, the hurt and pain of individuals and families in terms of the provision of care, the harshness of the computation system of entitlement to subvention and the extent of support, must make us realise that people deserve the most accommodating, compassionate and humane response from our system of support provision within our overall health services. Sadly, this is lacking in many instances. I have found it difficult to speak of the case I have mentioned.
It is not good enough that the Government should reject in cold and judicious terms the sound appeals of Opposition voices for a new regime to apply in the area of subvention, its computation and delivery. I support the amendment.
Mr. Neville Mr. Neville
Mr. Neville: The aim of the amendment is to enable the HSE to allow patients receive subvention for a specified period. The difficulty is that the payment of a subvention can be queried almost immediately, within months or days of a person receiving it. This situation does not apply in other  areas, so why should it apply here. Decisions are made to grant medical cards for a minimum period of from a year to five years, depending on circumstances. Therefore, the HSE could surely examine all circumstances of a person and grant subvention for a period of not less than one year. The subvention could be applied in the same way as medical cards are applied. It has not been unknown for a medical card to be granted for life because of a person’s circumstances and the understanding those circumstances would not change for the lifetime of the person.
Deputy Healy has a good point and perhaps the Bill should be re-examined. There is much disquiet on the issue of the calculation of the value of the family home. One of the exemptions covers a relative of an applicant in receipt of a contributory old age pension which is the relative’s sole income. We could have a situation where a 79 year old brother and his 80 year old sister live together and the sister goes into the nursing home. The brother who is on a contributory pension may also have an occupational pension and therefore the calculation would come into play and 5% of the family home would be taken into account. In those circumstances that person might be forced to sell his home.
The situation is similar in cases where children care for their mother or father over many years and receive the carer’s allowance. If the parent goes into a nursing home, the carer may return to employment. I know people who left jobs to care for relatives and who, though at pension age, will not get a contributory pension because they did not make contributions while working as carers. Although the carer may have spent 20 or 30 years caring, if he or she has returned to work to provide a livelihood, the house will be calculated as means to determine the income of the nursing home resident.
I foresee difficulties with the application of this principle. The Minister of State has said the previous level of discretion will remain, but that will not happen. He knows as well as I do that we deal with officials who are very careful to ensure they act in accordance with legislation. Not to do so, would put them in a position where they might be questioned about decisions they made contradictory to the legislation. Any ignoring of section 7B by any official of the HSE would be tantamount to saying the HSE does not accept the decision of the Oireachtas that this regulation or approach to means testing should apply.
We hope, at budget time there will be an examination of the issue of nursing home subvention because difficulties that did not exist previously have arisen for families. I know a person who returned to Ireland after being forced to emigrate and work all his life in England. After a while at home the person had to enter a nursing home and now all his money has been spent and the nursing home is putting pressure on him to leave.
 Debate adjourned.
Sitting suspended at 1.30 p.m. and resumed at 2.30 p.m.
Dáil Éireann 628 Health (Nursing Homes) (Amendment) Bill 2006: Report Stage (Resumed).