The Tánaiste and Minister for Health, Mary Harney T.D. today set out the details of the wide-ranging new services being funded with the €150m package announced by the Minister for Finance in yesterday’s budget
The Tánaiste said,
‘This will mean a major improvement in home and community-based support for older people. Thousands of older people needing care will receive new services and support next year.
‘I am determined to put in place comprehensive health and social care for older people, in a way that is reliable, that respects and values older people, and that is fair financially to older people, their families and taxpayers alike.
‘This is the largest ever increase in funding for services for older people. The initiatives I am setting out today underline the Government’s commitment to older people and putting them at the centre of health policy in the future. The investment package is focused on caring for people at home, where they want to be. It is a major step in focusing new resources on home care first and foremost, while still supporting appropriate residential care. This is in line with international trends and also reflects the growing independence of older people who want to stay living in their communities.
‘It is entirely right that we should devote substantial additional resources to services for older people. They have made a great contribution to our society and to our present-day economic and social success. In this way, we are saying that the next generations value their contribution and will respect their needs and their continuing role in our society.’
Seán Power T.D., Minister of State with special responsibility for older people, has welcomed the announcement of additional funding and indicated that it represented an approach to caring which would bring significant improvement to older people.
The Tánaiste set out the details as follows:
This new investment involves additional resources of €150 million in a full year (€110 million in 2006 and €40 million more the following year).
Reflecting the new emphasis on home and day care, almost three quarters (€109 million) of the full year costs are being committed to community care supports.
The attached table sets out the extra resources under each heading for 2006 and 2007.
The additional funding, coming on top of the extra funding for disability, mental health and primary care in the Estimates for 2006, is part of government policy to develop the general community/primary care programmes so that acute hospitals and residential care will not dominate extra investment for health care, as they have in the past.
This investment is a response by the Government to older peoples’ preference to be cared for at home rather than going into residential care. Very often that may require some additional home help or more developed home support, including various therapy services. All the evidence shows that families caring for elderly relatives continue to provide care in partnership with the support services put in place for those that require it. It is estimated that 28% of nursing home residents have a low to moderate dependency level and many of these residents might very well have continued to live at home if the right supports had been made available to them at the appropriate time.
The Report of the Long Term Care Funding Group, an inter-departmental Group established earlier this year by the Tánaiste and Minister Seamus Brennan, will be presented to Government shortly. The work of the Group has informed the decision- making process regarding the additional supports set out below.
1. Home Care Support Packages
Home care packages deliver a wide range of services and have been piloted successfully in several regions in recent years. They include the services of nurses, home care attendants, home helps and the various therapists including physiotherapists and occupational therapists. A home care package will vary according to the care needs of the person so that, for example, there might be a greater emphasis in some packages on home care assistants while other packages may require a greater level of therapy and nursing.
The priority will be older people living in the community or who are inpatients in an acute hospital and who are at risk of admission to long term care. The home care packages will also be available to those older people who have been admitted to long term care and who now wish to return to the community. In addition, the packages will be offered to people who are already using existing core services, such as home helps, but need more assistance to continue to live in their community.
The packages are delivered through the HSE, by a range of providers including the Health Service Executive itself, voluntary groups and the private sector. The scheme will be as flexible as possible and highly responsive to the real needs of the individual so that where a family or friends of an older person wish to provide these services, they will be encouraged to do so, with support, and linking in with the HSE, voluntary or private sectors.
About 1,100 home care packages are provided to people at present. By the end of next year a total of 2,000 additional home care packages will have been provided. This will amount to a trebling of the current service provision.
The 2,000 packages will support more than 2,000 persons as, for example, individuals could in some cases need a care package on a temporary basis. The major thrust of this initiative is to be directed at older people. However, there will be some flexibility, so that a person who is under 65 and may need home care may receive it, as appropriate.
2. Home Helps
Home Helps are an essential part of supporting older people at home and thereby delaying or preventing admission to long stay residential care. They also help to keep people out of acute hospitals or help their early discharge from hospitals.
There is a continuing demand for home helps because of the increased number of older people. An additional €33 million full year cost is now being allocated for this programme (€30 million of which will be for 2006). This represents a significant increase over the Estimates provision of €112 million for 2005.
The additional funding of €30 million will provide 1.75 million more home help hours.
As with home care packages, it is expected that these additional resources will be implemented in a flexible way by the HSE so that particularly vulnerable individuals, who need a home help, but who are under 65 years of age, can access the service.
3. Day/Respite Care Centres
Day care and respite care are an integral part of delivering a comprehensive community service for older people.
The service provided may include
- A mid-day meal and a bath and physiotherapy, occupational therapy, chiropody, laundry and hairdressing
- Social contact amongst older people
- Respite for family members and/or carers
- Social stimulation in a safe environment for older people with mild forms of dementia
The provision of €9 million in a full year will allow for an additional 1,325 places per week in such centres. The number of older people who will benefit from these new places will be substantially more than 1,325, since, over the whole year, one place can provide a service for more than one person.
The investment of €9 million will allow for additional programmes for specific needs such as activity therapy. It will also mean that many day care centres can open for five or seven days a week, rather than two or three days as is often the case at present.
There will be an investment of €7 million in 2006 with the balance of €2 million being provided the following year.
4. Specialist Palliative Care
- €9m is being allocated to specialist palliative care, including home care and community initiatives in 2006. A further €4m is being allocated in 2007 to develop the service, giving a full year cost of €13m. The funding provides for:
- €1.9 million to open 6 palliative care beds at Blackrock Hospice under the management of Our Lady’s Hospice in Harold’s Cross (24 extended beds will also be provided at Our Lady’s Hospice).
- 10 new palliative care beds in Milford Hospice – €1.9m.
- €1m – increased funding for St Francis Hospice in Raheny.
- €2 million for the development of palliative homecare an community based initiatives throughout the country. This level of funding will also facilitate the HSE to develop action plans in accordance with the recently published Needs Assessment on Palliative Care for Children, and to introduce targeted pilot projects which will provide experience based knowledge and baseline information to assist in the further development of services.
- Development of palliative care services in the midland, western and southeast areas. This will continue to develop services and build capacity. ◦Southeast: €1.2m
◦Midlands and Western: €1million
5. Meals on Wheels
There will be a significant increase in the resources available to the “meals on wheels” service. An estimated €10 million was spent on the service in 2004 and additional funding of €2.5 million will be provided next year together with a further €2.5 million in the following year making for an increase of about 50% on the 2004 level. Again, this is part of the range of services which help support older people to continue living in their own homes.
6. Sheltered Housing
The Tánaiste strongly supports the development of sheltered housing accommodation for older people, as it provides a real alternative to residential care and reflects the desire of older people to live with as much independence as possible. To support the development of sheltered housing, a full year commitment of €1 million will be allocated, split evenly between 2006 and 2007, to provide front line health service support for sheltered housing, such as therapists and public health nurses.
7. Other Initiatives in Primary/Community Care for Older People
The Tánaiste will ask the HSE to develop proposals in the Primary and Community Care areas which are new ways of delivering service and/or reflect best practise elsewhere.
The proposals should reflect the very significant emphasis on home care and involve non-statutory agencies working in partnership with the HSE.
A total of €4 million, €2 million in each of the next two years, is being provided by the Tánaiste to the Health Service Executive for such initiatives to improve and increase service delivered to older people.
8. Elder Abuse
A total of €2 million is being allocated to address the issue of elder abuse, again split evenly between 2006 and 2007. This level of funding will facilitate the implementation of the full range of recommendations contained in the Report “Protecting Our Future.” About €2.5 million has already been made available in recent years towards implementing the Report.
It will also provide for the development of a research function in this area.
9. Development of the Nursing Home Subvention Scheme and Additional Long Stay Bed Capacity
A total of €20m is being allocated to the Nursing Home Subvention Scheme for residents of private nursing homes. This represents an increase of 14% over 2005, which has an estimated spend of €140 million.
The €20m is a 2006 full year cost and will go towards supporting increasing numbers entitled to basic nursing home subvention as a result of a substantial change upwards in the means test limits, reducing waiting lists for enhanced subventions and bringing greater consistency to the different levels of enhanced subvention support throughout the country.
€8m is being provided to cover the cost of 250 extra nursing home beds which the HSE is already in the process of sourcing from private nursing homes.
The Tánaiste is updating the subvention scheme for payments to people in nursing homes. The purpose of this change is to make the assessment criteria for subventions, which have not been updated since 1993, reflect the major changes in property values.
The property ceiling that was set at €75,000 (€95,000) in the 1993 Nursing Home Subvention Regulations is now being increased (having regard to the Department of the Environment, Heritage and Local Government house price indices ) to €500,000 for Dublin and €300,000 for the rest of the country. The assets ceiling is also being increased to €36,000 from £20,000 (€25,359). Previously, the first £6,000 (€7,618) of an applicant’s assets would be disregarded when applying for a subvention – this is now being increased to €11,000.