Dan Neville (Limerick West, Fine Gael)

I welcome the opportunity to speak on this issue. I am pleased that the Minister with responsibility for the elderly is here. The State can be judged on how it deals with its most vulnerable people, our young people, those with disabilities and our elderly. In all these areas the Government has failed dismally to provide the quality of life our most vulnerable deserve.

Our most vulnerable elderly, those in nursing homes and those incapable of independent living have been the most neglected. This is manifested in many ways, including the neglect of the home help service and the lack of step-down beds for those leaving hospitals. There is pressure on families to accept people from hospitals who are not physically ready to go back into their community.

One of the worst areas of neglect is the control and inspection of nursing homes. The regulations on nursing homes were hailed as a panacea that would ensure the elderly in nursing homes would have a basic standard of service and quality of life. Without an independent statutory based inspection regime, these regulations are useless. They are not worthy of the paper on which they are written. It is obvious the current inspectors have failed to produce reports that are accessible and available to the public, the nursing home residents and their families, who on numerous occasions have spoken at Deputies' clinics of their concerns about the treatment of our elderly in nursing homes. I am sure the Minister of State has experience of this, particularly on account of his responsibility in this area. He must agree there is serious concern in this regard.

The Government has no commitment to care of the elderly in the community or in the residential sector. The Minister has dragged her heels on the issue. The proposals put forward by Deputy Twomey will protect the elderly in every area of society. The Government has made repeated promises in this regard. It has regularly stated that it recognised the problem and would deal with it. Legislation was promised before the end of 2005, but nothing happened. In April 2005, the Tánaiste gave commitments in the health strategy Quality and Fairness — A Health System For You, as did her predecessor in the social partnership agreements of 2003 and 2004. In An Agreed Programme for Government of June 2002 another predecessor gave a similar commitment. On the establishment of the social service inspectorate on a statutory basis, we were promised an extension of this remit to other social services, including residential services for older people. However, nothing has been done.

There is growing pressure on people with regard to the cost of nursing home facilities. Charges have increased dramatically in recent years, but no attempt has been made by Government to address this. The current subvention levels came into effect in 2001. Nursing home charges have increased substantially in the past five years, yet the subvention does not reflect the proportional support envisaged in 2001 for the cost of nursing home care. A formula was determined in 2001 that worked out the subvention in proportion to the costs at that time. This has not been updated. The Minister of State should immediately revise the three rates of subvention payable at the three levels of dependancy, medium, high and maximum.

I was extremely disappointed that despite some indications this would be reviewed, the Minister of State informed me yesterday there are no plans to increase subvention rates at present. Will the Minister of State revisit this issue and respond to the pressures placed on nursing home residents and their families?

As life expectancy grows, it is important to give particular consideration to the mental health needs of older people and to provide a comprehensive range of services appropriate to their needs. Unfortunately, our current psychiatric service for the elderly is totally inadequate. It is no response for our elderly with psychiatric and emotional difficulties. People of advanced years are faced with stresses and challenges resulting from the loss of people closely attached to them, changes in their vocational and social roles and the depletion of their general health and physical capacities.

There are only 62 acute designated assessment and treatment beds for mental health services for older people. Some are in specially designed locations with acute general hospital units. Others are available from the mental health service for older people on request from the general psychiatric area rather than being specially designated for the elderly. There are just seven day hospitals providing a service for fewer than 100 places and only 469 continuing care beds. There are major gaps in current mental health services for older people. These include absence of mental health services for older people in many catchment areas, incomplete multidisciplinary representations in almost all existing mental health services for older people's teams and lack of specialised assessment and treatment in most acute admissions. There is inadequate accommodation in continuing care facilities under mental health legislation. I would comment further on this if I had the opportunity. There is a lack of dedicated day hospital facilities in almost all services and a lack of services on recovery and positive coping skills in existing service positions.

The Minister of State must as a matter of urgency give priority to establishing comprehensive specialists for mental health services for older people where none currently exists. There is an urgent need for physical resources essential to service delivery. Acute beds and continuing care service headquarters and community based day facilities should be provided for the elderly with mental health difficulties. We need a full examination by the Minister of State on the needs of the elderly with psychiatric difficulties, much of which come with age, and of the difficulties experienced by people dealing with them.

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