THE LONG-AWAITED legislation for a new system of nursing home funding, which allows older people and their familes to pay nursing home fees from their estates after they die, has been published by the Department of Health.
The "fair deal" scheme had been due to come into effect last January but was delayed because of legal difficulties surrounding applications for people who no longer had the mental capacity to look after their own affairs.
Although this legal problem has been resolved, Minister for Health Mary Harney indicated yesterday that the Nursing Homes Support Scheme Bill would be unlikely to proceed through the Dáil this year. The scheme is not now expected to come into force until the middle of next year.
Under the scheme, people moving into a nursing home will pay a maximum of 80 per cent of their income towards the cost of their care, based on a Health Service Executive (HSE) assessment of their assets.
If this does not cover the cost, the State pays the remainder and can recover this cost from the sale of the person's house after their death. These costs are levied only up to 15 per cent of the value of the house and their recovery can be deferred until after the death of a spouse, cohabiting partner or dependent child or relative.
The scheme aims to prevent people from entering nursing homes unless they have a high level of dependency. Everyone, whether going into a public or private home, will have to undergo an assessment to see if they require nursing home care, and both the medical and social situation of the applicant will be assessed.
People with low dependency needs would be given homecare packages and other supports to allow them to stay at home for as long as possible, said Ms Harney.
The scheme will also stop people from remaining in hospital when they no longer require acute care, as it will be applied to hospital beds as well as nursing home beds.
The scheme is voluntary and will apply to both public and private beds. It will replace the existing nursing home subvention scheme which resulted in a wide disparity in the amount of money paid by elderly people for nursing home care. New and existing nursing home residents can apply.
The scheme represented a "fundamental overhaul" of the long-term residential care system, Ms Harney said. Until now, residents in public nursing homes had 90 per cent of their care paid for by the State while those in private nursing homes paid about 60 per cent of the costs themselves, she said. "Clearly that was a very unequitable situation and was adding to the great stress that older people endured when they were going into long-term care."
Fears that family businesses, including farms, would be broken up after the resident's death have been allayed by a provision excluding assets transferred more than five years before entry into the nursing home from assessment.
"This is to encourage the transfer of businesses and farms to younger people," the Minister said. "We want to encourage early transfer on to a new generation of young people."
However, she said the legal issues which delayed the Bill had not related to constitutional property rights but to the management of the affairs of people with "diminished capacity". The Bill provides for a relative to apply to the Circuit Court to be appointed as a care representative, to represent the interests of a nursing home resident who does not have the capacity to make decisions.
Age Action says it is concerned the scheme might result in older people being refused care.
Spokesman Eamon Timmins asked: "If the Bill is introduced, does it mean that an older person who is medically assessed as being in need of full-time medical and nursing care, but who refuses to sign up to the new charging arrangement . . . would be refused essential care by the State?"
