Paul Connaughton Snr (Galway East, Fine Gael)

Maybe. The next best way is when people are able to stay in their own home and be looked after by their own families. That happens all over the country every day but, for people for whom that is not possible, nursing homes, which we are discussing, become relevant. There are two different types of nursing homes: the State-run geriatric homes and private nursing homes, a relatively new industry. If we had a debate like this 20 years ago, most people would hardly have known what a private nursing home was, as there were so few of them at the time. If people were given the choice when they got old, they would prefer to remain at home, a view echoed in the debate.

Like every other Member, I have had occasion of speaking to people in nursing homes. This is not in any way a slight on nursing homes, as most of them are extremely well run, but I have often heard people in nursing homes saying they are grand, have everything they want, but would rather be at home. That is the most natural thing for people to want, which is why the objective of this Government is wrong. As many of my colleagues said, there are many older people who are almost self-sufficient. When people get old there are little things we take for granted, such as when a person is crippled with arthritis and cannot put on his or her shoes or make a cup of tea, but that does not mean the person has to be in a nursing home. Everything else about their health could still be all right, which is why the home help system has been such an extraordinarily good thing.

Most families get only two, three, four, five or six hours free a week. There are 24 hours in every day and, when that is broken down to two hours every day at most, what the home help can do is important but very limited and not enough. We always have to worry about value for money in this House but, even if the revenue for that system was doubled, it would be great value for money, because keeping people in their own homes basically means the subvention does not have to be paid. If people go to State-run homes, it costs about €1,000 or €1,500 a week. One might imagine that the right thing to do was to increase the funding on that level, but the next category for which funding should be increased is at the subvention level. I have not heard that raised here and it may have been overlooked, but it is a big issue in County Galway, my part of the world.

As is well known among the elderly, what is available at the top end of the subvention, if a person qualifies under all headings, is €190 a week. There is an enhanced subvention, which I shall talk about. Of the older people I know, although admittedly as the years go by there will be smaller numbers of them, there is a significant number of them without a thing in this world except for their old age non-contributory pension. That is the way it is if they were in non-insurable employment or self-employment. There has been much talk about how gracious the Government was towards those people in the last budget, with an extra €188, but if that is added to €190 it comes to a sum well under €400. I do not know of any nursing home, even in the west where the fees charged are generally lower than in other regions, where the minimum charge is below €600 per week. Several of them charge €700 to €900 per week. Where does that leave a person who when his or her pension and subvention are taken into account must still make up a shortfall of €200 or €300 to meet the cost of the nursing home care per week? I receive several telephone calls on this issue every week. It is not so bad for people who have families who can pay the shortfall but many families find it extraordinarily difficult to make ends meet. Everybody understands this and I will not waste the time of the House talking about it. By the time people pay their child minder, mortgage and car repayments and all the other bills, they have nothing over to pay for the care of another person. They might want to, but they are not able to afford to do so. How will this legislation assist poorer people who want to use the private nursing home service?

A great deal of good work has been done by the private nursing home industry, although as in every other industry there are blips. Unless the people who wish to use this service in the future are funded by something far greater in value than the State old age non-contributory or contributory pension, the future for this industry is not as rosy as it might appear. In some parts of the country the occupancy level in nursing homes is high and elderly people have to wait to get a place in them. However, I know of a number of nursing homes where places are available and one could walk in off the street and get a place.

The private nursing home concept will form an integral part of how we treat the elderly in the future. A great feature of private nursing homes, which has not been lost on the elderly, is that they are located in local towns and villages. In my town of Mountbellew and in many other towns in east Galway people who are in good health are able to meet their neighbours in the town and return to the nursing home in the evening. It is a lovely concept that elderly people can meet and talk to the people they were born and reared with. That is an excellent idea. I hope the Government will ensure that concept will not be pulled asunder on the basis that people will not be able to afford to use this service.

Even with the level of the subvention, people have to pay a large amount per week to make up the shortfall to meet the cost of their care. I pay a sincere and strong tribute, as other Members have, to the people who run this service for HSE western area. They are humane and do the best they can. I might have time later to refer to the manner in which, under the Bill, eligibility is decided for the granting of a subvention on financial or medical grounds. As in the case of all schemes, provision must be made, and included in legislation if possible, for hardship cases, of which there are many. There is not a family in Ireland, the members of which do not at some stage experience something unforeseen.

I know of a 58 year old married woman who has had two or three serious illnesses and she now cannot be cared for anywhere else other than in a private nursing home. This woman does not have a pension, given her age she does not quality for an old age pension, and she was not entitled to an occupational pension because she has been sick for many years. Her husband has a part-time job and is well paid but only on the basis of working part-time. On the basis on which means are calculated, the subvention awarded in this woman's case is only €100 per week. The cost of her care in a private nursing home is €600 per week. Where will a family such as that get €500 every week of the 52 weeks in the year, perhaps for the next ten years for all we know, to meet the cost of this woman's care? If the woman cannot be kept where she is, she will have to take up a bed in one of the geriatric State run homes and that will be even more costly. The family members have said to me time out of number in recent months that even if they could get €200 or €300 together they could manage to meet the cost of the care. They would walk the earth for their mother, but in terms of the cost they have to meet for her care, they are not able to walk that far. That is the problem they face. I do not see anything in this Bill that will give them any great hope. Provision for hardship cases might make bad law but we have to deal with them as we encounter them.

Account is taken of the assets a person has at his or her disposal at a given time. I assume that provision in regard to 5% of the value of the house the person owned will be foregone in this legislation. I have a difficulty with that requirement. The type of house in which most elderly people live is certainly not a manor or a castle. When an elderly person has to move to a nursing home or any other home, it is almost impossible to rent the person's home, even if he or she wanted to do so in that it is not fit for renting. Because the person is the registered owner of the house, a 5% value was applied to it under the old scheme. That requirement should be seriously reviewed as there is no need for it.

In regard to how we treat the elderly in terms of taking account of the totality of the problems they face, a society is judged, and correctly so, on the manner by which it treats its elderly. We live in a world where the pace of life is fast moving. Thankfully, many of us are in jobs that are reasonably well paid and, more important, we have been extraordinarily lucky in enjoying good health all our lives. However, for the many people who were not so lucky, they fear the thought of growing old. This country always had great credibility in terms of looking after the interests of the elderly, but our system is breaking down big time. I have been long enough in this world to remember the wonderful chain of affection that existed between parents, grandparents and grandchildren but sadly in this nuclear age that chain is badly broken.

I fully support the idea that, irrespective of which party or parties are in Government, it is not possible to supply all the various services without the help, guidance, love and care of the family members of the elderly person concerned. One's sons or daughters may not be able to help one financially but there are many other ways they can help. A point that is not made often enough is the great debt of gratitude children owe to their parents for what their parents did for them down through the years. Most families accept that without any trouble, but there is a certain cohort of people who glibly say they want to do their best for their aging parents, while they shrug their shoulders and say that unfortunately there is nothing they can do. That is just not good enough.

There are certain principles and objectives that any Government worth its salt must bear in mind. The provision of services for elderly people should not relate to how well or how badly the economy is doing. This is an important aspect of the debate on the care of the elderly. When people are a certain age they have an actual right to a certain level of care, consistent with their various abilities or disabilities, below which they should never be asked to accept. This country has not yet arrived at that stage, although some of its services are excellent.

I would like to highlight an important aspect of any debate on nursing homes. Many people have referred to the problems in this sector. As I said in this House some months ago, the nursing homes with which I am familiar are well run and I do not receive complaints about them. In that context, however, it is hugely important for the Department of Health and Children and the Government to ensure that what I call "flying squad" inspections take place at the drop of a hat. Inspectors should be able to call to nursing homes in any part of the country, on any day of the week and at any hour to ascertain who is responsible for what and to determine whether everything is above board. That is the only way for us to ensure that the system that serves the elderly people of this country, for whom we are striving today to do the best we can, remains straight, honest and proper. I know some people will think that is a heavy-handed way of doing business, but I do not accept that. If the system is working as well as I think it is, nobody other than the cowboys who are operating in this sector should have any problems with "flying squad" inspections. An episode of "Prime Time Investigates" that was broadcast some months ago showed that not all nursing homes are being run as well as they should be. I would like to refer to two other matters, but my time is up.

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