Mary Butler (Waterford, Fianna Fail)
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The Nursing Homes Support Scheme (NHSS), commonly referred to as Fair Deal, is a system of financial support for people who require long-term residential care. Participants contribute to the cost of their care according to their means while the State pays the balance of the cost.

The NHSS covers the cost of the standard components of long-term residential care which are:

* Nursing and personal care appropriate to the level of care needs of the person;

* Bed and board;

* Basic aids and appliances necessary to assist a person with the activities of daily living; and

* Laundry service.

Costs not covered by the NHSS include therapies, more specialised aids and appliances, social activities, transport and individual items and services such as specialised laundry, newspapers and hairdressing. A person's eligibility for other schemes, such as the medical card scheme or the drugs payment scheme, is unaffected by participation in the NHSS or residence in a nursing home. In determining the services covered by the NHSS it was considered very important that the care recipient and the taxpayer would be protected and would not end up paying for the same services twice. For this reason, medications and aids that are already prescribed for individuals under an existing scheme are not included in the services covered by the NHSS, as this would involve effectively paying twice for the same service.

Residents of nursing homes should enjoy the same levels of support and access to services for which they are eligible as when they lived in their own homes. It is acknowledged that the reason they require 24-hour levels of support is due to their level of dependency, which in turn may require access to clinical services including hospital and other outpatient appointments in the community. It is important to acknowledge that older people living at home are expected to arrange transport to and from medical appointments, which in the majority of cases is provided by family and friends. Similarly, it is understood that in most cases in nursing homes, family members bring residents to medical appointments.

The Department of Health does not currently hold data relating to additional charges in private nursing homes; these vary according to each individual nursing home depending on the services offered. It is private nursing homes who hold responsibility for delivering care to their residents in line with their terms of registration and the relevant regulations under the Health Act 2007. It is clear that under the terms of the NHSS Act 2009, private nursing homes should not levy additional charges on NHSS residents for services coming within scope of the Nursing Home Support Scheme.

Part 7 of the Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) Regulations 2013 stipulates that the registered provider of the nursing home must agree a contract in writing with each resident on their admission to the nursing home. This contract must include details of the services to be provided to that resident and the fees to be charged. Residents should never be charged fees which are not set out in the contract. The Department of Health and the HSE are not a party to such contracts which are concluded between each resident and their nursing home.

It is hoped that a number of recent initiatives will improve the integration between nursing homes and the broader health system, which may lead to a reduced need for out-patient appointments. From March 1 of this year, a new community based mobile X-ray service will be available to residents in nursing homes and Community Nursing Units nationwide. This service aims to reduce the number of older patients attending Emergency Departments.

In addition, it is expected that all patients transferring from acute hospitals to nursing homes will be assessed by, and necessary care interventions delivered by, ICPOP (Integrated Care Programme for Older People) and the wider care team, as appropriate. It is anticipated that these interventions will have an impact on unnecessary transfers from nursing homes to acute hospitals.

Furthermore, it is noted that the CEO of the HSE has indicated his intention for primary care services that are available to people living in their own home to be equally available to people living in nursing homes, both public and private.

Finally, the Department of Health is currently reviewing the available evidence with regard to additional charges and a focused piece of work to examine the issue is underway. There are a number of separate factors driving this issue and potential actions to address each of these are being considered.