1. ‘Review of the Care & Welfare Regulations & Financing of Long-term Care under the Nursing Homes Support Scheme’ NHI Annual Conference - 10 th November 2011 Presentation by Geraldine Fitzpatrick, Services for Older People

2. Government Policy Government Policy is to support older people to live in dignity and independence in their own homes and communities for as long as possible and, where this is not longer possible, to support access to quality long-term residential care  Approx 4.5% of older people in Long-term Residential Care  95.5% living in the Community The Programme for Government contains a number of commitments designed to further this policy objective.

3. Programme for Government 2011-2016 a)Additional funding each year for more residential places, Home Care Packages, more Home Help and other professional community care services. a)Eligibility criteria for Home Help and Home Care Packages to be consistently applied. b)Develop and implement national standards for home support services which are subject to inspection by HIQA. c)Invest in the supply of more and better care for older people in the community and in residential care.

4. Funding Budget 2011 provided an additional €8m for Home Care Packages and €6m for long-term residential care. Long-term Residential Care The total funding available for long-term residential care since 2008 is as follows: Funding for 2012 is being negotiated in the context of the Comprehensive Expenditure Review being carried out by the Department of Public Expenditure and Reform. 2008 (€m)2009 (€m)2010(m)2011(€m) €920€909€979€963

5. Review of the Nursing Homes Support Scheme Scheme due for review after 3 years in operation – 2012. This will ensure that established and validated trends and statistics will be available in order to inform the work. Review will look at: ongoing sustainability of the Scheme, relative costs of public versus private provision, and balance of funding between residential and community care. Programme for Government commits to review the scheme with a view to developing a secure and equitable system of financing for community and long term care.

6. Challenges for 2012 1.The Department’s best estimate is that almost €1.5bn in savings will be required from the health sector from 2012-2014. 2.Demograpic Trends – approx. 510,000 people >65 at present versus an estimated 750,000 -775,000 in 2021. 3.The Average Length of Stay has increased. 4.Nursing home costs have risen. 5.Universal Health Insurance is being introduced. The financing of social care will have to be considered in that context.

7. Quality and Safety The Health Act 2007. Establishment of HIQA Care and Welfare Regulations Registration Regulations. National Standards 1 July 2009 –HIQA commences new statutory independent registration and inspection authority.

8. Review of Regulations Dept. decided to carry out a review of the Care and Welfare Regulations to examine issues that have arisen since the introduction of the regulatory regime. Dept. anxious to utilise the experiences and knowledge gained since July 2009. Group established -NHI, HSE and the Federation of Voluntary Catholic Nursing Homes. Meetings held with HIQA Consultation Process

9. Some issues examined The system for the handling complaints/ independent appeals process. Requirements concerning maintenance of records- including medical records, information set out in schedules and ways of avoiding duplication. Community Care Homes-24 hour nursing.

10. Some issues examined (contd.) Interaction with other statutory agencies with a view to ensuring consistency with Regulations and other legal requirements. Contracts Moving towards a Restraint Free Environment.

11. Update National Policy on Restraint published. Dept/HRB expects to publish paper on indicators or measures of non-restraint in older people in nursing homes by end of year. Drafting of amendment regulations advancing-some issues remain to be teased out. Next Steps Legal oversight of draft regulations Submission to Minister Regulations Introduced during 2012