Ivor Callely (Dublin North Central, Fianna Fail)

I am pleased to have the opportunity to speak on the Bill before the House as it deals with the very important issue of subvention for nursing home care. The Bill is designed to address two areas, namely, to ground the existing regulations in primary legislation and to standardise a scheme across the country. These are two worthy initiatives.

I am delighted to see my successor, the Minister of State, Deputy Seán Power, my good friend and colleague, and some familiar faces from the Department of Health and Children here as well. I take the opportunity to pay tribute to all the committed people involved in the provision of service, whether in administration or delivery. As regards the subvention scheme being implemented by the Health Service Executive, I understand it is designed to provide financial assistance towards the cost of private nursing home care for older people who require it. This Bill will ensure that the existing arrangements are grounded in primary legislation and implemented across the country through a standardised scheme.

I do not suppose anybody has asked why it is the Health (Nursing Homes) (Amendment) Bill 2006. I asked this question before and initiated some queries in the Department while I was there in that regard. Equally, I put down a marker as regards the HSE. As someone who has been involved in the delivery and provision of health services over many years, all I can say about the HSE is that the jury is out. I am hearing this at many different levels. I am monitoring its progress. Everyone wishes that whatever mechanism is in place improves delivery, but the jury is out in that regard.

The question on the Bill is: why does it have to be a nursing home and why does it have to be private? We are talking about the cost of nursing home care at whatever figure one wants to pick, €700 for a person who requires a certain level of support or it could be €1,700 for someone requiring another level — particularly if specialised support is involved for Alzheimer's disease, dementia and so on. We are telling people that we will give them money towards the cost of care if they go through a process and asking them to fill out the appropriate forms, sell their family homes etc. This is done only on the provision that the person is taken out of the family home, away from their loved ones, and put in the care of others. I argued this point while I was in the Department. We initiated private home care subvention. For the life of me I do not see why we cannot be somewhat more innovative when introducing primary legislation.

This Government has repeatedly stated its commitment to older people. This commitment is evident in the consistent measures being introduced by the current Minister of State, Deputy Sean Power and — I shall exclude myself — many other people who are involved. A genuine commitment exists. As regards the general body of older people, this Government has increased State pensions and other secondary benefits in budget after budget. It has gone even further in recognising the contribution of older people to the economy and their community. It has given an extra €100 per week earnings disregard, following retirement.

I applaud those older people who remain active. Previously I mooted the idea of a register of volunteers to harness the good work of the great number of older people who wish to participate in community activity. We really should tap in to the commitment of such people and have some co-ordinated structure by way of a register of volunteers. I applaud and commend all the older people at different levels, who are actively involved in supporting others. One name occurs to me, which I have mentioned in the House before, Mr. Tommy Condren, a man in his 70s, who has driven the community development, Carleton Hall. Where one might expect others to drive the project, this man is doing it for the benefit of all the people in the community, young and old. There are many good people such as Mr. Condren in the community. We should recognise them, have that register and harness what is there.

I recognise that the time can come when older people need assistance and support in their daily lives. Some older people stay in their homes with the aid of the support services and or their families and friends. I am somewhat concerned, however, about the personal care packages, PCPs, we designed. There were a number of secondary benefits to PCPs, assistive technology and so forth. I would love to have a briefing on the development of PCPs. They can prove to be beneficial. However, for some patients whose needs are greater, further decisions may be required if PCPs are not able to provide the level of support required. It may be necessary to decide to send a person for assessment for nursing home care. I support what has been said about that being a difficult decision.

Stroke victims may be seriously debilitated for a period after the stroke but following rehabilitation may be well enough to return home. Unfortunately, what has happened in some cases is that following pressure to make the difficult decision to go into a nursing home, even though people wished to return home when their situation had improved, they were then faced with a decision to sell the family home to cover the cost of that care. That was wrong. People are in nursing homes or acute hospital settings who are recommended for long-stay care on the basis that they can return home when they get better but at the same time the screw is being turned and they are told they have to sell their family home. This just does not add up.

We must be aware of the limit on public nursing home beds. People need to avail of alternative care. Why must nursing home care be private? What is to prevent me from taking my mother or father home if I am prepared to do it — God rest my father, he is dead — or any other relative? What is to prevent any individual who wishes to bring a relative or other old person into his or her home to provide nursing home care at a time when it has been recognised that there are insufficient nursing home beds? When we are putting legislation in place, why can we not be a little more innovative and allow the subvention to be paid to people who will undertake the job? A process is in place so nobody will con the system. Only a small percentage of people would try to do this anyway and surely we can put a safety net in place to prevent this occurring?

It has been recognised that the cost of private nursing home care can be considerable and outside the financial capability of some people. In those cases, subventions are paid to contribute to the cost of the care. This is a vital part of how we take care of older people and we should ensure that people know their entitlements and how to claim them. We should take the stress out of the system and remember that older people and their families who are claiming the subvention are only doing so because of a need for extra care and because they do not have the means to pay for it themselves.

Subventions are provided by the HSE areas to assist persons in meeting the cost of nursing home care. I understand that it was never the intention that subventions would meet the full costs involved. Three rates of subvention are payable; €114.30 for medium dependency, €152.40 for high dependency and €190.50 for maximum dependency. I understand that enhanced subventions are also considered. It is difficult to explain this to individuals. There is a better way.

These rates were unchanged on budget day. The threshold for qualification for subventions was revised last year to reflect the changing economic climate and, in particular, rising house prices. The asset threshold above which a subvention may be refused has increased from €20,000 to €36,000 and the threshold for principal residence value above which subvention may be refused has increased from €75,000 to €500,000 or more, if the house is located in the Dublin area, and €300,000 or more where the residence is outside the Dublin area, where the applicant's income is greater than €9,000, previously €6,300.

The questions I have relate to sections 2 and 7. I have made my point on section 2. We should make the system a little easier in terms of removing any anomalies that exist. It should be recognised that property values in the Dublin area differ significantly. For example, on the road behind where I live and the road in front of where I live the house of one elderly person in a home could be worth €1 million while the house of another resident of the home may only be worth €500,000. An imputed income of 5% of the market value of the principal residence shall be taken into account. Does it matter whether a person's home is worth €1 million or €500,000 if he or she is on social welfare? The value of their home is of no benefit to people in this situation. I do not know how we will make this apply. A later reference in the Minister's speech stated that something had been added "for the purposes of consistency". If we are seeking consistency in terms of income I suggest more work remains to be done in terms of the 5% in regard to the market value of the principal residence.

The Bill defines a number of aspects of subvention and details how an application for subvention must be made. It is vital that this process is simple and accessible to those who require subvention and that it should take into account the vulnerability of older people who may require nursing home care. We should eliminate any unnecessary stress or difficulty in the application process. The level of subvention available is dependent on the level of medical need and the basis on which different levels of subvention are provided should be clearly defined so that the applicant is not in any doubt as to why and how a level of subvention is awarded.

The financial situation of the applicant is also a factor in awarding the subvention and the Minister of State has clarified how much income an applicant for subvention may have. This is useful for applicants and their families. In cases where an applicant is not awarded subvention, or not at the rate at which they hoped to qualify, it is important that the appeal system to the HSE is transparent and speedy. Being refused a subvention or not getting the amount for which one had hoped can be distressing for an applicant and his or her family and carers. It is in everyone's best interest to have any queries or questions resolved quickly. It is vital that older people who are in need of assistance are given all the supports and care they require, and that they are kept informed at every stage of the process and feel they have ownership and control over their lives.

From what we are told by the medical professions, more beds are required urgently for long-stay care. I detest the over used phrase of "bed-blockers", as it makes it appear as if these older, vulnerable people who are in need of care are somehow conspiring to prevent other patients from accessing services at the hospital in which they are deemed to be bed-blocking. It is not the fault of older people who are vulnerable and in need of additional care that there is nowhere for them to go. That responsibility lies with us in this House.

More nursing home beds are needed but also long-stay facilities right across the board, whether they be personal care packages, home care packages, assistive technology supports or the use of the thousands of people out there and their beds who would make themselves available should some level of subvention be available to them.

It is frustrating for people like me who recognise the needs that exist, such as on the north side of the city of Dublin. I was involved for a period in the proposed development at the orthopaedic hospital in Clontarf. That hospital has a tremendous caring record, as it deals with a high proportion of older people who have had orthopaedic operations. It allows patients to access additional short-term care while not having to rely on nursing homes, which may not be available. The hospital has been waiting for confirmation on a 120-bed extension. It has been a long time coming and I will push for a decision to be made within weeks. The application is with the Department for approval and I ask that the hospital team and I should be advised of the decision as quickly as possible. The extension will be a vital resource for older people in north Dublin and it will have a positive knock-on effect for northside hospitals. I refer to the purpose built day hospital required at Beaumont hospital. There has been much toing and froing about this but funding has been allocated. Will the Minister of State confirm the delivery of this project because I fear the money may have been used for other purposes? What is the position on the allocation, utilisation and implementation of the funding allocated for this purpose?

It is essential that those who need to access subvention should have confidence in the system and that the application process should be clear and uncomplicated. The vulnerability of older people must not be exploited through substandard nursing home care. Older people and their families must feel confident that the care provided is of the highest standard. Older people with medical cards who are forced into such care because other forms of care are not available must not be penalised. The cost of private nursing home care is an issue of grave concern. According to Age Concern Ireland, nursing home care in the greater Dublin area is the most expensive in the State but I cannot understand the reason for this. My constituents deserve the same level and standard of care as older people elsewhere but, for some reason, charges have increased recently. Subvention levels should reflect the costs of care.

Regardless of cost, the high standard of nursing home care is vital, not only for older persons accessing it but also their families. Public confidence in nursing home provision is vital. I congratulate Paul Costello of the Irish Nursing Homes Organisation who has repeatedly called for improvements and who has ensured standards are applied and maintained within his organisation. The focus should be on what is best for older people. They have contributed a great deal to society, their families and communities and caring for them in old age should be a priority. The Government has done much for older people through various increases and the implementation of other measures.

I welcome the Tánaiste and Minister for Health and Children's view that the Government should give every assistance to older people who wish to remain in their own homes. The supports necessary to make this happen may be expensive and difficult to resource but it is vital that older people should be given the choice for the sake of their dignity and control over their own lives. This is not always the easiest option as it requires co-ordination between different agencies. It may also require support from family members and friends but it is the best option as long as the older person feels confident and comfortable in his or her own home. According to an ESRI survey, four out of five adults felt it was important to be cared for in one's own home. This view is shared by many groups, including the North Dublin advocacy group. This group has done significant good work and it has been waiting on confirmation of funding for more than 12 months. I cannot understand why this is the case and this should be addressed. I congratulate Bob Carroll, chairman, and all involved in the National Council on Ageing and Older People, which issued a report earlier this week entitled, Improving Quality of Life for Older People in Long-Stay Care Settings in Ireland.

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