Peter Kelly (Longford-Roscommon, Fianna Fail)

I welcome the opportunity to contribute to the debate on the Health (Nursing Homes) (Amendment) Bill 2006. Care of the elderly is a vital issue. I believe that we should seek to maintain older people in dignity and independence at home in accordance with their wishes. Insofar as practicable we should aim to restore to independence at home those older people who become ill or dependent. We must encourage and support the care of older people in their communities by families, friends, neighbours and voluntary bodies. However, cases will always arise in which there will be a need to provide high quality hospital and residential care for older people when they can no longer be maintained in dignity and independence at home.

This nursing homes legislation will ensure that the existing subvention scheme for private nursing home care is grounded in primary legislation and will help the HSE to implement the scheme on a standardised basis throughout the country. I am sure most people would welcome that because we sometimes hear stories of differing subventions between HSE regions. Funding of €6.35 million was allocated for the first full year of the nursing home subvention scheme in 1994. In 2006, total funding is €160 million, including an additional €20 million allocated in the 2006 budget for the scheme.

The Bill contains provisions for applications for prescribed subventions, assessments of degrees of dependency and means of applicants, determinations of subvention applications, reviews of degrees of dependency and means of dependent persons who are paid subventions, and appeals against decisions of the HSE. The provision of an appeals mechanism is welcome because people sometimes believe they have been mistreated and I am sure the HSE will look sympathetically on appeals. People will not go to the bother of appealing unless they believe they have a right to do so. The Bill also provides for obligations on proprietors of nursing homes to notify the HSE of the death or discharge of dependent patients in receipt of subvention, recovery of payments of relevant subventions procured through fraud or misrepresentation, and the making of regulations, transitional provisions and guidelines to be issued by the HSE. There is no doubt that affordable residential care for older people is a key issue. We all regard supporting older people to stay in their homes and communities as a key policy priority, thereby moving away from the practice of placing people in residential care as a first option. Research has shown this is the expressed wish of the majority of our older people. I welcome the significant package announced by the Tánaiste after the budget. The budget allocated additional funding for services for older people and palliative care amounting to €150 million, comprising €110 million for 2006 and €40 million more for 2007. There is no doubt that this will mean a major improvement in home and community-based support for older people. Thousands of older people needing care will receive new services and support next year.

I welcome the Government's determination to put in place comprehensive health and social care for older people in a way that is reliable, that respects and values older people and that is financially fair to older people, their families and taxpayers alike. For those who say older people have been neglected by this Government, I say that the budget gave the largest ever increase in funding for services for older people, and rightly so. The initiatives that were set out today make a commitment to older people and put them at the centre of future health policy. The investment package is focused on caring for people at home, where they want to be. The investment package 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 also reflects the growing independence of older people who want to stay living in their communities. It is wholly appropriate that substantial additional resources be devoted to services for older people. They have made a great contribution to our society and to our 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 Bill concerns people in institutional care but I believe, as recommended in the Mercer report on long-term care, that there should be a built-in bias towards home care solutions while retaining a capacity for financing care in institutional settings. The funding of long-term care will make many demands of us, our economy and our society. The Mercer report also made the point that there is no blueprint available for the funding of long-stay care from a comparison of developments and trends in other countries. It said that there are general pointers from developments in other countries that may be helpful in planning change here. The state is usually involved in the funding of long-stay care, mostly within a cost-sharing framework that encourages people to choose home care over residential care. The report found that the need to promote and encourage family responsibility for their dependent elderly kin through increased spending on community care and more flexible support mechanisms for carers is recognised in most countries. It also found that the importance of controlling access to expensive, long-stay facilities is accepted in all countries.

Another report by the National Economic and Social Forum made a number of recommendations last year. Among them was to bring public spending on care services for older people up to at least the OECD average of 1% of GDP over the next five years, at an additional cost of €500 million. Estimated public expenditure here on care services for older people in 2004 was just under €1 billion, which equates to 0.67% of GDP. This recommendation is worth exploring though it must be pointed out that sometimes GDP comparisons between Ireland and other OECD countries are not entirely valid. In other countries, GNP and GDP is about the same whereas in Ireland GDP is about 20% greater. GNP is a more relevant benchmark. Perhaps in the context of maintaining sound fiscal policies, the Minister for Finance and other interested Ministers could examine increasing spending on care services for older people to 1% of GNP.

Sometimes we look at older people only in terms of care. We need a new, positive agenda for older people. The NESF report also called for the development of a national action plan on ageing and for moves to root out ageism and promote positive ageing. Ireland still has a young population by comparison to our European partners but ultimately it is likely that we will have a similar age balance. There is no doubt that older people have a major contribution to make and it is vital that we facilitate them in making it. I gather that in the UK a few years ago B&Q opened an experimental store staffed entirely by over-50s. Fears that they would not be able to cope with shifting pots of paint were soon dealt with, and there were no problems in training the staff to use computers. The over-50s store did better than other B&Q stores in almost every way. Profits were higher by a fifth, staff turnover was six times lower, there was more than a third less short-term absenteeism and, most remarkably of all, theft reduced by more than half. The NESF report also rightly points out that the development of policy and practice regarding care for older people should be considered in an international context. Current trends in this regard emphasise the importance of including older people in the policy-making process, mainstreaming ageing issues into national development frameworks and optimising older people's opportunities for social participation. Rather than sectionalise old people we need to integrate them. There has also been a general shift towards person centred community or home-based care and making services more consumer-friendly and standards-driven.

The report by the National Economic and Social Forum also highlighted the key role played by the United Nations in the development of international policy understanding of ageing. The UN's second world assembly on ageing agreed the Madrid international plan on action on ageing in 2002. This plan promotes an intergenerational policy approach that pays attention to all age groups with the objective of creating a society for all ages and a shift from developing policy for older people towards the inclusion of older people in the policy-making process. The UN identified three priority directions, 18 issues, 35 objectives and 239 recommendations.

The NESF also points to the need to develop a national strategy on caring. This means supporting informal carers in their work, as well as providing funds for the social infrastructure so necessary to allow older people to continue living at home. Respite care, day care, day hospitals and rehabilitation facilities are important elements of the social infrastructure, as are visiting services such as public health nurses and home helps.

I acknowledge at this stage the work done by the Minister for Social and Family Affairs, Deputy Brennan, in advancing the cause of carers. Since 1997, weekly payment rates to carers have been greatly increased, qualifying conditions for carer's allowance have been significantly eased, coverage of the scheme has been extended and new schemes such as carer's benefit and the respite care grant have been introduced. The numbers in receipt of the carer's allowance increased from 16,000 in 2000 to 25,318 at the end of February 2006. Funding has risen from €99 million to more than €223 million in that time. Expenditure on carer payments — carer's allowance and carer's benefit — increased more than five-fold, from €46 million in 1997 to €232 million at the end of 2005. The carer's allowance has been increased by €90.16, or 101% for those under 66 years, and by €110.16 or 123.3% for those under 66 since 1997.

I know many people feel there is more that can be done, but the Minister has made significant progress over the past 18 months. I know many people wish to see the means test for carers abolished. As with other social assistance schemes, a means test is applied to the carer's allowance to ensure that limited resources are directed to those in greatest need. This means test has eased significantly over the years, notably with the introduction of the disregard of spouses' earnings From April this year, a couple with two children can earn up to €32,925 per annum and still receive the maximum rate of carer's allowance. The same couple will be able to earn up to €54,400 and receive the minimum rate of carer's allowance as well as free travel, the household benefits package and respite care grant.

Apparently, complete abolition of the means test would cost an estimated €140 million in a full year. It is important to have an open mind on this issue but it is debatable whether such a proposal could be considered to be the best use of resources. I know the Minster believes the view of some support organisations is that if this kind of money were available, it would be more beneficial to carers if it were invested in the type of community care services that would support them in their caring role, such as additional respite care facilities, more home helps, public health nurses and other such services.

The policy options for a financially sustainable system of long-term care are currently being examined. No doubt there will be significant cost implications. Numbers in care are projected to rise from 84,000 three years ago to 144,000 in 2031, and 203,300 by 2051. We will have to make some financial decisions. It is important we get the balance right.

Older people are an example to us all. They are friendly, courteous, honest, decent and religious, and they deserve all they get. They do not bother or annoy anyone. They are not greedy. I compliment nursing staff and management for their caring and understanding. I welcome the Nursing Home (Amendment) Bill.

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