Jerry Cowley (Mayo, Independent)

I am glad to have an opportunity to speak on this important Bill. It is difficult to know where to start when speaking about an issue of such fundamental importance to everyone concerned. As we are all getting older, it is inevitable, unless something happens to us in the meantime, that we will all need some support in our old age. I use the term "support" because nursing care is a subset of support. The basic difficulty in this regard is that the Government has lacked vision in its efforts to give older people the support they deserve. Its handling of the elderly support system has succeeded in medicalising and institutionalising the care and, more appropriately, the support of older people.

When the Minister of State, Deputy Seán Power, introduced the Bill before the House, he said there was a legal imperative to sort out the private nursing homes subvention payment system, which no more than 5% of the population will require. The debate on older people should not start without a recognition that 95% of older people will not end up in nursing homes and, therefore, will not require the services of such a home. If one were to arrive from Mars to examine the debate in this country, one would swear that there was very little in this country other than nursing homes. That is the reality of the situation. I accept that massive resources are being invested in nursing homes to remedy the mismanagement that has taken place. I accuse the Government of medicalising the care and support of older people. Perhaps I will have a chance to speak about another way of approaching this issue later in my contribution.

We need to bring some order to the total chaos in the elderly support system. Older people who require the services of a nursing home, as 5% of the population will do at some time, are caught between the devil and the deep blue sea when they try to work out where exactly they stand. The Department of Health and Children and successive Governments stand indicted in this matter. There is no clarity in the system. Anyone who knows older people as I do is aware that they like to be well organised, to have everything clearly set out, to cause as little trouble as possible and to have everything in order. I refer to a wonderful generation of people who have done so much for this country. The system that is in place to support them is totally chaotic, unfortunately. No matter where one goes in this country, one will not have a clue about one's entitlements in this regard.

I pay tribute to the many excellent and professional people employed by the Health Service Executive, particularly in my locality, who do a really excellent job, for example in assessing older people for subvention payments etc. The same praise cannot be given to the system as a whole, unfortunately, because it suffers from a lack of direction and vision, through no fault of the staff I have mentioned. I sincerely believe that one gets a different subvention rate in one part of the country than in another. I accept there are three basic categories, but we should bear in mind a further category, the enhanced subvention that may or may not be paid. This Bill refers to the enhanced subvention, but I would be happier if it brought some order to the chaos that exists in this regard. I know the Minister of State plans to introduce an amendment, which will outline the exact subvention rates, later in the legislative process. Older people need to know for certain exactly how much they will pay.

I am not criticising private nursing homes in any way. Many of them have been developed in recent years as a result of Government policy. Such nursing homes are profit-driven, however. Communities have a large part to play in supporting older people. The desire of people to turn a bob has been prioritised in this sector, as it has in many other facets of life in modern Ireland. It has taken precedence over the wonderful potential of communities to look after their own people. As someone who is involved in supporting older people in their own communities, I have to say the supports which are available to communities do not incentivise them to get involved in such activity. The needs of the vast majority of people — the 95% of people who do not end up in nursing homes — are being totally and utterly ignored. We need to take an overall view of the support of older people in modern Ireland, rather than concentrating on the 5% of people who end up in nursing homes, who represent just one aspect of the issue.

We should think about investing from the start, for example, by supporting the 85% of people who wish to remain in their own homes. No more than lip service has been paid to the well recognised group of people who need to be supported at home, although that has started to change in recent times. Just half a dozen home care packages were available in County Mayo last year, which was not enough to satisfy any home care arrangement.

As I said, the system has developed in the way it has as a consequence of the Government's policy of making the rich even richer. I am not in any way criticising nursing homes. I believe there are some really excellent nursing homes and the vast majority of people running them are very professional and do a good job. There are a few, however, as mentioned in this Chamber today, which are not as good. As in any calling there will be rogues and people who do what they should not do. The system encourages people to make profits. Private nursing homes are profit-driven enterprises. There is an alternative, namely, not-for profit community-based facilities. I look forward to continuing this debate.

See this speech in context