Dan Neville (Limerick West, Fine Gael)

I am glad of the opportunity to discuss the Bill. I welcome the Tánaiste to the House and I look forward to her contribution.

The Bill deals with the Supreme Court decision on charges made to the elderly and doctor-only medical cards. Had it not been for the work of the Fine Gael leader, Deputy Kenny, and Deputy Perry, the issue of the illegality of charging elderly people in nursing homes would never have been raised. The Government has argued that the illegality goes back to 1976. The Supreme Court decision suggests that the illegality became much clearer after the passage of the 2001 Act, which was brought in as part of the Government's pre-election spree and the implications of which were not fully thought out. The Comptroller and Auditor General's report of 2001 revealed that the decision on the over-70s medical card was taken by the Department of Finance in the days before the 2001 budget with little or no consultation with the Department of Health and Children.

There is evidence that following enactment of the 2001 Act, the Southern Health Board provided the Department of Health and Children with legal advice it had received on long-stay care. The then Minister, Deputy Martin, referred to this legal document in an interview, claiming he did not read it, while the Tánaiste referred to it in the Dáil.

The issue of the over-70s medical card and charges in public nursing homes was raised at a high level meeting attended in December 2003 by the then Minister, Deputy Martin, the Minister of State, Deputy Callely, who at the time had responsibility for the elderly, and the Minister of State, Deputy Tim O'Malley. The minutes of that meeting show that long-stay charges for the over-70s were discussed. This is clear evidence that the Health Act 2001 which introduced the over-70s medical card was considered a problem in terms of long-stay charges. The then Minister, Deputy Martin, claimed to have left the meeting when the issue was being discussed, but the two Ministers of State at the Department remained. We are aware of what has been discussed in the Dáil on several occasions regarding the information received by the Ministers of State, if the Minister was not there. That information and the minutes of the meeting, which were only two pages long, were put on the record of the House by the Tánaiste.

People on non-contributory pensions will receive repayment and their means will be assessed against those pensions. In other words, old age non-contributory pensioners in public nursing homes will be penalised because Health Service Executive will refund the moneys perhaps to their bank accounts and if the income of pensioners goes over the threshold of €20,000 as a result, their pensions will be reduced. The Department of Social and Family Affairs will claw back the moneys which the State has refunded to those pensioners.

In a response to Deputy Stanton, the Department pointed out that it has collected €5.4 million from pensioners' wills in 2004 and the same amount in 2003. That is an aside, but the point is that pensioners with no other income or assets above the means threshold who choose to save their pensions and the moneys they will now receive will be penalised when they go above the threshold. The Department of Social and Family Affairs will interpret the refund as means, treating it similar to assets from property and inheritance when assessing means. Elderly people are legally obliged to inform the Department of Social and Family if their means change so that their pensions can be reviewed. They sign up to this when they apply for non-contributory pensions. The upcoming refunds should not be included as assets in the assessment of the means of those in receipt of the non-contributory pension or other payments such as the disability allowance. What is the position of people with intellectual disabilities or those in similar categories? Will they be means tested if they receive a refund? I ask the Minister to take that issue on board

A number of years ago, I dealt with the case of a medical card holder who needed incontinence wear. The person was admitted to a private nursing home and the refund for incontinence wear was withdrawn. The issue was taken up with the health board at the time, which refused to make a refund or to recognise that there was an anomaly. The anomaly was that incontinence pads were not covered where medical card holders were admitted to private nursing homes. However, prior to admission, they were covered. Following numerous representations to, and pressure on, the Department and the Mid-Western Health Board, the position changed in April 2003.

Medical card holders charged for incontinence wear in private nursing homes prior to April 2003 should be refunded. It is discriminatory to refund medical card holders availing of public beds. One of the criteria for not refunding the cost of incontinence wear in private nursing homes is entitlement to nursing home subvention. If an elderly person is in receipt of nursing home subvention, he or she is entitled to a refund. The position is contradictory and unfair. If this issue was examined as thoroughly as the issue of illegal charging, it would also be found to be illegal. Will the Minister comment on this in her reply?

Earlier the Irish Wheelchair Association made a submission to the Oireachtas Joint Committee on Health and Children. Its representatives raised an important issue relating to medical cards for people with disabilities. They pointed out that wheelchair users, in particular, and others with limited mobility face additional costs associated with specialist products such as mobility and communications aid and additional expenditure on specialist transport, heating and so on. Despite the additional costs, their medical card threshold is the same as that for non-disabled people. This leads to people with disabilities not attending doctors when ill, resulting in late diagnosis of their conditions. Will the new medical card address this issue, given the new guidelines regarding what can be considered in individual cases other than means?

The association's representatives also referred to the benefit trap faced by people with disabilities. They are dissuaded from taking up employment but they made a number of recommendations. The income limit for medical card eligibility should be increased significantly for people with physical disabilities while, under the back to work initiative, medical card entitlement should be extended to five years for people with disabilities. The transfer of entitlement to aids and appliances to a cost of disability payment should not be affected by employment.

I have raised other issues relating to the elderly on a number of occasions. I refer to the Minister's examination of the housing aid for the elderly scheme and her discussions with the Department of the Environment, Heritage and Local Government. This issue raises its head regularly in our constituency clinics. Elderly people wait for years for simple work to be done to their houses to enable them to live in comfort when they have needs due to their age. The disabled person's grant scheme is operated by local authorises but that has been brought into disrepute recently, although my experiences with Limerick County Council have been positive.

However, the same cannot be said of the housing aid for the elderly scheme and its objectives. When the Bill was introduced to abolish the health boards, the Minister was emphatic that the issue of representations by public representatives would be recognised as part of the change from health boards to the Health Service Executive. I made a representation on behalf of an elderly person living alone on 4 March 2003 and I outlined the reasons he needed work done to his house. This need was recognised by the health board and the community welfare officer who examined the case. However, following two years of frustration I tabled a parliamentary question to the Minister to find out when the work would be done. The question was passed on to the Health Service Executive and I received a reply, which stated, "I wish to confirm that an application for housing aid is at present with the housing aid department in Limerick and they are awaiting final input into the process from the relevant services". For the past two years the case has been with the Limerick health services but I want to know what action is planned. Having not obtained the information locally, the Minister directed the question to the Health Service Executive. I am now told it is with the housing aid department in Limerick, something that I have known for two years. Surely the Tánaiste and Minister for Health and Children must accept that it flies in the face of her commitment to the House, especially on Committee Stage of the previous health Bill regarding the abolition of the health boards.

Regarding the elderly and nursing homes, there is obviously growing pressure because of the needs of our aging population. There are inadequate resources in the public sector to deal with the demand for nursing home services from people with limited means. The area needs considerable examination to ensure people who are elderly and need inpatient or nursing home care are treated with dignity and respect in examining their situation.

There are a few matters that I wish to raise, the first being the subvention, which has not been examined for the best part of four years. It is an obvious statement, but it is worth saying that the cost of nursing homes has increased dramatically, having more than doubled in the past four years. The nursing home subvention element has not increased to match it, and that is putting enormous pressure on families and especially the residents themselves. We now have people in need of nursing homes whose families are considering social housing for them because of the pressures. There must be a review of the nursing home subvention payment which, as we were informed this week, averages €150 per week. In the context of nursing homes costing more than €600 per week, that is inadequate.

I also wish to raise the issue of the enhanced, top-up nursing home subvention. The disparity between areas in that regard is totally unacceptable. It is approximately €50 in the mid-west, while in the former Eastern Health Board area it is €650. How can one justify such a disparity in the enhanced nursing home subvention payment? It is paid after all aspects of a person's circumstances have been examined and it becomes quite obvious that there is a serious financial issue involved which determines that an enhanced nursing home subvention should be paid by the regional health executive.

We must introduce clarity and equality to the area. If the Tánaiste and Minister for Health and Children says to me that in certain areas of the country nursing homes are much more expensive than in others, that is a fair argument. We need transparent information to show why the rates should be different, but there is no such information or analysis. It is done on an ad hoc basis in each health board area. If, as it now transpires, the disparity between nursing home costs is not as pronounced as some years ago, with prices for many nursing homes across the country reaching the levels found in the former Eastern Health Board area, there is a need for a full and comprehensive examination of subventions and payments for the different categories, including the basic and enhanced payments.

I would like to raise the repayments of moneys to those illegally charged in nursing homes. I will deal with one area for the purpose of illustration and leave those who are psychiatrically ill and perhaps long-term in-patients. I understand — I hope the Minister will correct me if I am wrong — that a person must claim for the repayment that he or she is owed by filling in and signing forms. Some might not be aware of that or competent to do so. The State has an onus and legal responsibility to repay the moneys owed to everyone. If I have moneys and owe someone, I have a restitutive responsibility to repay him or her.

I would appreciate the Tánaiste explaining the procedure for making the payments. If it is a form-filling exercise, those more informed and able will be in a position to avail themselves of their rights, but those whom I have mentioned, who have a disability, including an intellectual one, or are in long-term psychiatric care, will be less likely to claim and receive their entitlements.

I would also like to quote from Age and Opportunity regarding how we approach age, ageism and the elderly:

Focusing on aging as representing a constellation of problems that require interventions ignores older people's own resilience in the face of difficulties and their own capacity with proper resources for organising themselves and devising their own solutions at the individual and collective level.

We miss out on that where the dignity of elderly people is interfered with. Someone is ill in a hospital and there is a decision to make because he or she can no longer live in the community and must go to a public or private nursing or welfare home. There is a debate between the consultants, the family and the hospital ward, but the elderly person is not often consulted. The quotation concerns the need to ensure the elderly are consulted and recognised rather than disregarded as an adjunct to a problem; that should not happen.

See this speech in context