Wednesday, 20 October 2010
Seanad Eireann Debate
Senator Maria Corrigan: I thank the Cathaoirleach for the opportunity to raise this very important issue. I welcome the Minister of State, Deputy John Moloney. The introduction of the fair deal nursing home repayment scheme has been a very welcome development. It has brought considerable peace of mind to individuals and families who are trying to plan for the future and were concerned as to how they might meet the ever-increasing costs of nursing home provision. I welcome it.
The issue I am raising appears to be somewhat of an anomaly. It relates to older people who are in need of nursing home care and who are suffering from an age-related disorder such as Alzheimer’s or senile dementia and who at the time they require care or after they have been admitted to a nursing home, their disorder results in a deterioration in their condition and it is felt they need a higher degree of support in order to keep them safe. Concerns then exist as to whether the level of support they are receiving is adequate. It is then recommended that they are moved to a higher support unit.
In such instances what is occurring is that, even where such individuals have been eligible and approved for the fair deal scheme, if they are moved to a higher support unit, the nature of which, as the Minister of State may be aware, will often come under the auspices of the Mental Health Act, it may not be deemed to be an approved centre for the fair deal scheme. In those instances the financial support from the fair deal scheme ceases to exist. Families suddenly find themselves facing bills of up to €1,200 or €1,300 per week for the level of support required. This can occur in situations where the higher support unit may be in the same building and may even be on the same campus.
I am aware of an example in my constituency, the Bloomfield Nursing Care Centre, an excellent facility which has received tremendous support and funding from the Government. There are a number of nursing home residents and part of the facility is approved under the fair deal scheme. Yet, the moment a resident is required to move to a different corridor he or she is no longer eligible for the scheme and the financial support of the fair deal does not follow him or her even though he or she remains in the same building. I spoke to a constituent today who has already paid in excess of €300,000 in fees and the family savings have run out. The family is now concerned about how it can continue to meet the cost of care of their mother.
I wish to ask the Minister of State whether we can put a proposal on the table which would see us extend the fair deal to approved centres which are specifically for older people who require high support. That could take place in a nursing home or an adjacent facility. Section 3(1) of the Nursing Home Support Scheme Act 2009 contemplates that a fair deal could be extended, not alone to approved nursing homes. It states:
Centres, such as the one to which I referred, which provide the high level of support required by people who are in the later stages of Alzheimer’s would meet that designation and therefore could be designated as approved centres under the fair deal scheme, and thus alleviate a considerable source of anxiety for families. Is the Minister of State aware that under the fair deal scheme the person contributes to the scheme, whether with the value of his or her assets or property? It is a way to alleviate the concerns people have while they are alive as to how their care will be financed.
Minister of State at the Department of Health and Children (Deputy John Moloney): I thank Senator Corrigan for raising this issue which relates to the nursing homes support scheme, the fair deal scheme.
The nursing homes support scheme is a system of financial support for individuals in public, voluntary and approved private nursing homes. The scheme is available to anyone assessed as needing long-term nursing home care, including dementia-specific nursing home care. However, it does not cover long-term residential care in other settings, such as mental health and disability facilities. As the Senator is aware, the scheme commenced on 27 October 2009. To date, over 15,800 applications have been received and over 11,600 of these have been processed to completion. The HSE is continuing to process applications on a daily basis.
In order to qualify for the scheme, all private nursing homes must negotiate and agree a price for the cost of care with the National Treatment Purchase Fund. This is a necessary feature of the scheme due to the commitment by the State to meet the full balance of the cost of care over and above a person’s contribution. The price agreed with the National Treatment Purchase Fund covers all residents entering the nursing home regardless of the level of their care needs.
For individuals applying to the scheme, the first stage in the application process is a care needs assessment. This assessment is carried out by appropriate healthcare professionals appointed by the HSE. The results of the assessment are submitted to the HSE in the form of a report called a common summary assessment report. Applicants to the scheme are given a copy of this report. A person must be assessed as needing long-term nursing home care to qualify for financial support under the scheme. In addition to the care needs assessment, the nursing home will carry out its own assessment to determine whether it can meet an individual’s particular needs.
Once an individual’s application has been approved and their chosen nursing home has confirmed their admission, the HSE immediately arranges for payment of financial support on the applicant’s behalf to their chosen nursing home. Financial support will continue to be paid for the duration of the individual’s time in care. In the event that a person’s needs change after they enter a nursing home, the HSE can carry out a review of the care needs assessment.
The HSE can undertake this review on its own initiative or at the request of the individual. Where the review indicates that a person’s needs have changed and it is decided their needs are best met by transfer to another nursing home or to a different unit within the same nursing home, his or her financial support can be transferred with him or her. This may result in a higher level of support being paid to the individual. This feature of the scheme ensures flexibility and allows a person to continue to receive financial support in the event that a nursing home can no longer cater for his or her care needs.
Senator Maria Corrigan: I thank Minister of State for his response and have two comments. The first relates to the first section of his response in which he indicated the fair deal will not extend to mental health or long-term residential facilities. I am not asking for an extension to the scheme. Rather, I refer to free nursing home type settings or settings that are specifically for the support of older people. In cases where people require high level support and where there is an involuntary restriction on a person’s individual freedom who then comes within the remit of the Mental Health Act, I ask that some flexibility be shown in that regard in accordance with the section of the Act to which I referred. I ask that such centres, where they are adjacent to nursing homes or part of nursing homes but because of the nature of the high support they provide fall under the provisions of the Mental Health Act, have some flexibility and could also be designated as an approved centre under the fair deal scheme.
I ask the Minister for clarification on the final part of his answer. I am a little confused. I am very happy to see it and if I sent the answer to many centres they would be very happy to see it because it will allow them to believe they will receive money. I know from experience with a constituent that this is not happening. I know of one constituent who was in a nursing home and had financial support, but because the person’s needs changed, the person had to change where they were resident and had to pay for that.
I ask the Minister to clarify whether this is a new development which will be introduced in the future. My understanding is that the fair deal scheme cannot extend to parts of a nursing home which are not approved centres, even where they are in the same building or on the same campus. If they fall under the Mental Health Act and are in the same centre, and it is purely for the purposes of providing a higher level of support, the financial support will not follow.
Deputy John Moloney: The Senator’s understanding is correct. The response is also correct, however, as support can be transferred provided the person is going from one nursing home to another. I take what the Senator has said as something that the Department and the Minister and Ministers of State at the Department must recognise as a huge anomaly. I recall visiting some months ago with Senator Corrigan the facility to which she referred. If I remember correctly, the situation there has been that beds are available and it is a very upmarket facility. I remember spending some time going through it all and realising that while we have people on waiting lists for such accommodation, especially in the mental health area, the sad reality is that under the legislation people cannot apply for the fair deal in this context. To be fair to the Minister, Deputy Harney, she is aware of this and at a recent meeting in the Department we grappled with how to resolve it, not only in the specific case brought to our attention by Senator Corrigan but everywhere, particularly where we consider taking people out of institutionalised settings. Often centres are on the doorstep of institutionalised settings.
In a nutshell, while the response is correct, the money does not follow a person transferring from a nursing home to an unapproved centre. The challenge facing us is to rectify this. It is very important and is an issue which the Minister, Deputy Harney, has placed on the agenda in the Department.
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