Dan Neville (Limerick West, Fine Gael)

I welcome the opportunity to speak on the Bill and to deal specifically with some aspects. Like other contributors I am concerned about the need to ensure there is proper care for the elderly.

The delay in bringing the legislation before the House has been remarked on by many speakers. It is unfortunate that the elderly have had to wait such a length of time since this matter was first raised by Deputy Perry. They have had to wait until now to see some movement on the moneys illegally deducted from them which the State has a duty to repay. If the boot were on the other foot and the patients or their families were obliged to pay the State moneys for services, a time interval of this duration would not be tolerated under any circumstances. Many people have asked me whether the repayment had been made, why they did not get it and so forth. People do not understand why there has been such an extensive delay in bringing this legislation before the Dáil.

No doubt there is a need for proper funding of care for the elderly. The elderly population is growing. One in 20 old people will need long-term care at some time in their lives. Much of this will be for a relatively short period — three to five years on average. It is important that the State identifies, plans and finances proper care for the elderly.

We see a growing difficulty with nursing homes. The subvention system has not been reviewed for six years and a great deal has changed in the interval. Most of all, the cost of nursing home care has grown substantially and the level of subvention has not increased proportionately. Will the Minister of State comment on the need for a full re-examination of nursing home subventions?

People have great difficulty in understanding the approach being taken by the Health Service Executive and the Department towards the public-private use of long-term care for the elderly. There should be clear criteria on who is eligible for long-term public care, with clearly outlined reasons for any refusal of an application. The present situation seems very vague and it is difficult to understand how decisions are arrived at. Such matters should be very transparent. This would assist public representatives who can only tell constituents at present that HSE policy is to steer people towards private nursing homes. While the HSE considers admitting people to public nursing homes, neither the criteria involved nor the examination of applications is transparent. There is need for much greater transparency to remove much of the suspicion, including many of the incorrect reports we get as well. There is no way to examine the systems for determining whether a person qualifies for a private or public facility.

I have long been concerned about the mechanisms for consulting elderly people in hospital on their treatment and discharge. In most situations discussions take place between the family and the consultant or the hospital authorities. Often the patient is ignored or not informed about what is happening. This is wrong and very disrespectful to the individual patient. Just because people are elderly does not mean they do not have views, stresses or concerns about their conditions. While some families keep their elderly relatives informed, in many cases families are not in a position to reassure elderly patients who are admitted to hospital for strokes, heart attacks or other serious problems in regard to their future. In many cases it is obvious that patients are not in a position to return home and their future is often discussed at one remove from them. That is an area we should examine to ensure that the approach taken to patients aged 85 is as inclusive as it would be in terms of patients aged 25 or 35.

The maintenance of people in their homes for as long as possible should be seen by the Minister and the HSE as an investment rather than a cost because it is preferable to paying nursing home subventions and the cost of public nursing homes. Home helps could be used much more effectively and more extensively to assist people to stay in their homes. I heard of a case recently where the home help of somebody in receipt of five hours of home help was unable to continue and another person was obtained who lived six miles away. The person in receipt of home help was informed that their home help hours would be reduced to three hours and they would have to pay for the travel expenses of the new home help.

Despite numerous assurances following discussions in this House we have not moved towards integrating and rationalising the area of special housing aid for the elderly, essential repairs grants and disabled person's grants for people aged over 65 years. The present system is confusing and leads to a waste of resources. Work should be completed by local authorities according to clearly set criteria and a proper budget should be supplied which would considerably reduce the administration of the system.

Essential repairs grants can be quite effective in improving the housing conditions for the period of an elderly person's life. The special housing aid for the elderly scheme has a similar function but is much more cumbersome in terms of completing the work and although the cost to the person concerned is less, delays are more likely. The disabled person's grant is similar to the essential repairs grant but the need for an occupational therapist's report and other requirements before a decision is made can result in considerable delays and makes the system cumbersome. We need an overall policy on the level of care to which elderly people are entitled. The denial of moneys to people that is outlined in the Bill does not augur well for the State's approach to the elderly. This must change.

I wish to address the issue of people with medical cards in private nursing homes, to which some of my colleagues have also referred. Has the Department examined the situation whereby elderly people are in private nursing homes who were refused admission to public nursing homes despite the fact that they had medical cards? Does the Minister of State accept he has some responsibility for this area? Events may proceed in such a fashion in the courts that it is decided there is some responsibility for the State towards those with medical cards who were refused beds in public nursing homes and went into private nursing homes.

I am aware of many people with medical cards who went directly to private nursing homes because they were advised by hospital authorities, doctors and others that it was pointless applying for long-term care beds in public nursing homes. As a result, these people made the decision not to apply for those beds. As a politician I have often advised people that the chances of obtaining a bed in a public nursing home are very small and that in the interests of the patient and because of the delay in the decision making process, it would be advisable to go to a private nursing home. Many people have not applied for long-stay beds in public nursing homes even though they have medical cards.

Those who will benefit from the repayments outlined in the Bill are, for the most part, in the final years of their lives in long-term care and do not have much time to enjoy the refund. It is disappointing that there has been such a delay because many people who would have had some enjoyment from the refund have now passed on without having had the opportunity to do so. In reply to what the Minister of State said about the average length of a person's stay in a nursing home, it is two to three years, which is not a long time.

I understand the Department of Health and Children has made ex gratia payments of €21 million to 10,800 people. As the Minister of State, Deputy Seán Power, pointed out, the HSE, which assists the new organisation responsible for making the payments, will have to pay people who are alive first, which amounts to 10,000 people. The Minister of State may be correct but I understand that repayments are due to up to 5,000 deceased people who have died since the first legislation appeared in November 2002. If the Government continues at this rate, most eligible people will have passed away before the payments begin. The Supreme Court reinforces this in its statement that whatever expectations may exist, it is an indisputable fact that the Bill will affect many people who are old, poor, disabled, mentally and physically ill and in many cases will have all these conditions. Such patients will have little or no capacity to understand their rights under the legislation or to protest against the unlawfulness of the charges nor will they have the pleasure of enjoying the refunds being made by the Government.

The explanatory memorandum provided with the Bill consists of one page. We are accustomed to receiving detailed information in explanatory memoranda to Bills whereby sections of the legislation are explained in more detail. The Government has had more than a year in which to prepare this legislation and I expected the explanatory memorandum to be more detailed. Many of us are not very legally literate when it comes to reading legislation——

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