Seán Power (Kildare South, Fianna Fail)

——has been established by the Department to develop the standards for residential care settings for older people. Membership of the group comprises officials from the Department, the HSE, the SSI and the Irish Health Service Accreditation Board. The group will commence the development of standards for the inspection of both public and private residential care for older people and, in doing so, will consult with appropriate and interested parties. In addition, the Irish Health Services Accreditation Board has examined the development of accreditation standards for both public and private residential care for older people.

The Government's commitment to the development of a comprehensive range of services for older people can be demonstrated clearly by outlining the resources made available in recent years for service developments. From 1997 to 2005, inclusive, additional spending on health care services has been in excess of €300 million. This funding is being used for a variety of services, including the nursing home subvention scheme, home care grants, the home help service, the elder abuse programme and support to voluntary organisations.

In addition, the Tánaiste and Minister for Health and Children, Deputy Harney, announced a €150 million package to expand and improve services for older people and palliative care in 2006 and beyond. This will mean a major improvement in home and community-based support for older people. A comprehensive health and social care service will be developed in a way that is reliable and that respects and values older people. This is the largest ever increase in funding for services for older people. These initiatives set out the Government's continued commitment to older people and putting older people at the centre of health policy now and in the future. The investment package is focused on caring for people at home, in accordance with their expressed wishes. 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 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 current 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. This new investment involves additional resources of €150 million in a full year, that is, €110 million in 2006 and €40 million more the following year. Reflecting the new emphasis on home and day care, almost three quarters or €109 million of the full year costs are being committed to community care supports.

This investment is a response by the Government to older people's 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 who 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 budget package provides for a number of initiatives, including home care support packages. These 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 without this support would have to be admitted 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, 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. Approximately 1,100 home care packages are provided to people at present. By the end of this 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 in the scheme so that a person who is under 65 years and may need home care may receive it as appropriate.

Home helps are an essential part of supporting older people at home, 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 hospital. There is a continuing demand for home helps because of the increased number of older people. An additional €33 million full year cost is 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.

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, physiotherapy, occupational therapy, chiropody, laundry and hairdressing; social contact among older people; respite for family members and-or carers; and 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 the two or three days that 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.

There will be a significant increase in the resources available to the "meals on wheels" service. An additional €2.5 million will be provided in 2006 together with a further €2.5 million in 2007. Again, this is part of the range of services which help support older people to continue living in their own homes. In the provision of meals on wheels we depend on the voluntary support of individuals and organisations to bring the meals to people. Often this is the only outside contact these people have. While the meal is necessary and appreciated, the social contact is also most important. It is a service that brings great comfort to those who receive it and it is one we are happy to support by providing additional funding this year and in the years ahead.

The Government 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.

In addition, the HSE will be asked to develop proposals in the primary and community care areas which are new ways of delivering service and-or reflect best practice elsewhere. The proposals should reflect 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 for such initiatives to improve and increase services delivered to older people. We are seeking initiatives that will make a difference.

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, and will provide for the development of a research function in this area. Approximately €2.5 million has been made available in recent years towards implementing the report.

With regard to the development of the nursing home subvention scheme and additional long-stay bed capacity, a total of €20 million 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 €20 million is a 2006 full year cost and will go towards supporting increasing numbers entitled to basic nursing home subvention, reducing waiting lists for enhanced subventions and bringing greater consistency to the different levels of enhanced subvention support throughout the country.

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