Catherine Murphy (Kildare North, Independent)

This legislation will rationalise some matters for the Health Service Executive, but it will not change many matters locally. The aim of the Bill is to standardise the system under which subventions are organised by the HSE throughout the country, but it will serve to standardise an inadequate system. As we are all aware, the subvention that is made available meets just a fraction of the cost of nursing home care. The rates in my part of the country, with which the Minister of State, Deputy Séan Power, is familiar, range from approximately €850 in cases of low dependency to well over €1,000 in cases of higher degrees of dependency. They also vary between nursing homes. If people qualify for subventions, they must make up the bulk of the money themselves. What occurs in reality is that their families end up making up the difference by contributing to the cost of their nursing home care. In some cases, the family home is sold or rented. That is the reality as I see it.

When I meet families who are trying to work these things out, I find myself sitting down and doing the maths with them. If one half of a couple is ill and needs 24-hour care, the other person often must make heroic efforts to care for them. Carers can often make themselves ill in such circumstances. I find it quite difficult to give such people any comfort in terms of the maths. If one has an income of just over €12,000, one is entitled to the full subvention, which falls far short of the cost of nursing home care. A person who invested in a pension and now has an annual income of approximately €25,000 might have to spend €52,000 per annum on nursing home care without being entitled to a subvention. It is almost impossible to do the maths on that one. People often must sell or rent the family home in such circumstances, which is an awfully big step. If one has spent one's life paying off a mortgage, one's memories can be associated with a particular home and one's family might still come to that home to visit one. If one half of a couple is still well, it is hard for him or her to decide to walk away from the family home by selling or renting it as part of an effort to cover the costs of his or her partner's nursing home care. That is the unpalatable reality of the circumstances in which many people find themselves.

Elderly people do not want to be a burden on their families. They want to be as independent as possible. The impossible financial situation I have described causes many of them to feel they are nothing but a burden. They worry about the length of time their money will last for. People in their early 70s think about how long they will live for and whether their money will be enough to cover the cost of their care It is a major concern for older people and the members of their families, most of whom are in gainful employment and therefore unable to act as full-time carers now that the proportion of women in the workforce has increased. The levels of community care which existed in the past are no longer available.

In 1999, which was the international year of older people, the UN asked countries to sign up to a charter for older people. When Ireland signed the charter in 2000, it agreed to meet 18 obligations or principles, three of which I will mention. Principle 11 was: "Older persons should have access to health care to help them to maintain or regain the optimum level of physical, mental and emotional well-being and to prevent or delay the onset of illness". Principle 13 was: "Older persons should be able to utilise appropriate levels of institutional care providing protection, rehabilitation and social and mental stimulation in a humane and secure environment". Principle 14 was: "Older persons should be able to enjoy human rights and fundamental freedoms when residing in any shelter, care or treatment facility, including full respect for their dignity, beliefs, needs and privacy and for the right to make decisions about their care and the quality of their lives". As Deputy Gormley said, decisions are often taken out of the hands of elderly people.

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