Bernard Durkan (Kildare North, Fine Gael) | Oireachtas source

My apologies for leaving the meeting for a short time but I had to make a number of emergency calls. I agree with the comments of the last speaker in regard to home care. I have a couple of questions for the witnesses. In regard to the private providers, how is that system working? Has it been assessed in terms of operation, efficiency and cost? Is it cost-effective? I recognise that it is better for provision to be made in this way rather than for the system to take it on board but I would like to know whether it is effective, cost effective and efficient. By "effective" I mean effective to the person receiving the care.

This is a cross-departmental issue. I note that in recent times there have been a number of refusals of carer's allowance to people who would appear to me to be eligible. Some people are reluctant to have strangers in their home. They have a built-in resistance to it, which I can understand. It is important that in situations where family members take time off work to care for an elderly or sick relative they are paid for doing so by the relevant Department. I am doing all I can to ensure this is done. In the case of dementia, it is not possible to dismiss a person's need based on appearance and so on. These cases are not easy to deal with because those concerned require care, attention and constant supervision.

In regard to regulation, is Ms Spillane satisfied with the extent to which the regulations are likely to be applied throughout the system, particularly in terms of contracted carers? The current system is welcome in that households are now visited a number of times throughout the day by different carers as opposed to the previous system whereby a single carer was assigned to a particular household for a number of years, often to the detriment of his or her own health and thus leading him or her to also needing care. We need to be conscious of the carer in the household nearing the situation where he or she will also need help and assistance.

To what extent will the care in the home scheme be extended by way of the existing carer in the home and the contracted carer system? In other words, how is it proposed to meet demand? The fair deal scheme is cumbersome, to say the least, and it is unlikely to improve. What I cannot understand is why at a time of scarcity in terms of residential care beds the HSE is attempting to close down existing units. Despite the increase in demand, a number of residential beds are being closed or used for purposes other than catering for the additional demand. I am aware of two public nursing homes where this is happening.