Jerry Cowley (Mayo, Independent)

I am grateful for the opportunity to speak further on this Bill.

There is a major problem with the subvention system. While the Bill addresses the situation regarding subvention for nursing homes, that is only part of the equation. One cannot discuss this Bill without talking more generally about what is happening to older people in this country. We must ask whom the system is serving. When one considers that only 5% of older people will require long-term care, one has to ask why the system is so much biased in favour of private nursing homes. That is the fundamental question. The answer lies in a complete fiasco and abdication by this State of its very onerous responsibilities to look after its older citizens. We are all getting older and will all require some type of support in our old age. The question is whether that support extends to the subset of care, but 5% of us will require long-term care, many in private nursing homes.

The Bill deals with the subvention system and regularising the position etc. It is an understatement to say the current situation is irregular. It is a total mismatch, a patchwork quilt of eligibility or ineligibility, whatever one may call it. There is total uncertainty. Nobody knows exactly what is the situation. Older people like certainty in their lives, but there is no certainty in this area. I blame successive Governments for their gross and utter neglect and incompetence in dealing with support for older people.

Old age is just the other end of young age. Just because one is old, that does not mean one needs to be in a nursing home, with doctors, nurses and so on. There is a great need for us to look beyond the medical model. I have talked of that for many years, and as someone working in the community as a general practitioner, I saw at first hand the sad silent migration of older people to institutions because there was nothing else for them. The people who needed our help most did not get it. Instead of getting help to stay in communities in which they lived all their lives, where all that they knew was — some had never even travelled outside those areas in their lives — they had to spend their sunset years in faraway places where they knew nobody. Just like the old Red Indians, they simply lost heart and died, because they were not in their homes and communities.

Nowadays, everyone is on the conveyor belt of life and all are very busy. Quite often, older people in institutions are left to their own devices, which I see all the time. I am not criticising those who look after older people in nursing homes or other public institutions. There are some very dedicated people who do a good job. There are, however, notable exceptions, such as Leas Cross. The Government has placed its emphasis on the wrong area. Considering that only 5% of the population will require long-term care at some point, why is the emphasis on care through nursing homes?

The Minister of State at the Department of Health and Children, Deputy Seán Power, is a fine and committed man. He stated Government policy was to support "older people to live in dignity and independence in their own homes and communities for as long as possible". That is fantastic, but he further added the Government supports:

long-term care where it is no longer possible. It was for this reason that the nursing home subvention scheme was introduced in 1993.

When an older person cannot live at home any longer or in his or her community, he or she is placed in a nursing home. Therein lies the rot and what is wrong with the system.

Who does the system serve? It does not serve older people. How is it that, long after independence, we have a system that does not serve the citizen? The citizen is supposed to come first in the republic. Does the system serve the person trying to make the shilling or does it serve the older person? The emphasis seems to be on the profit-driven sector.

I am not criticising the dedicated staff of private nursing homes but there is another way to provide care for older people by supporting them in their communities. Such a system of support, however, has never been in place. The report, Care of the Aged, spells out clearly that an older person should be able to stay at home. When that is no longer possible, the person should then be supported in the community through social housing. This has not happened. The choice is either stay at home or end up in a private nursing home, if one can afford it.

The State has abdicated its legal obligation to provide further nursing care. Every citizen has the right to a public nursing home bed. However, they are as rare as hen's teeth. That is why people do their damnedest to get their relatives into them. It is an unequal system. As the report, Care of the Aged, states, care at home is the best option. It is Government policy but the Government seems to have forgotten that. Various reports on the issue, such as Tom O'Malley's, refer to supporting older people at home and that many in public nursing home beds may well not deserve them. Every older person I know does not want to be a burden on his or her family, although it can be a labour of love for the family. The system does not help the older person to have the certainty he or she needs by giving him or her the necessary supports.

I was involved in establishing St. Brendan's village in County Mayo which supports older people in the community. It has support ranging from its day centre to low support sheltered housing, from medium support to high support. No matter how old or disabled the person is, he or she can stay in the community. It is very difficult for communities to establish such schemes because it is impossible to compete against the private nursing home sector.

Who does the system serve? Who does the Government serve? I am not only blaming this Government but also former ones. They have not served the citizen. The citizen, who should come first, is second class. Every facet of social life is given over to supporting the person making the profit. The Government has forgotten that it is the people who must be served. That was evidenced with the legislation on statutory rape. When parties get into Government, they instantly forget what it is all about, namely, people.

Recently I raised the matter of community care with the Taoiseach. He said the Government was considering introducing community zoning. The main difficulty for community care groups is securing land for schemes such as St. Brendan's village. I have seen many fine projects fail because a private developer bought up the site first. I have gone to banks and to Government seeking funds for such site purchases, yet I have seen suitable sites slip through the fingers of community groups because they could not raise the money. Many landowners are altruistic and would like to sell their site to a support scheme for older people in the community. However, they cannot wait forever for the money to be raised because they want to sell the land.

Although the Government's emphasis is on supporting private nursing homes, it must be remembered community matters too. If the Government is to follow its own policy, which is contradicted in the speech of the Minister of State, it needs to give community care schemes a chance. There should be a level playing field for them. Communities have proved it can be done. Group water schemes are one example. In rural Ireland, traditionally there was a cailleach in the corner for an elderly relative because the older person was always valued and looked after. However, where is the flat in Ballymun that can hold an older person? With increased urbanisation and smaller dwellings, there is no opportunity to keep a grandparent in the cailleach, the warmest place in the house.

I am encouraged by the Taoiseach's comments on community zoning. He stated Des Geraghty's social policy group has discussed it. It is an idea from the United Kingdom where open space land is used specifically for community purposes. I hope this is more than talk. Sheltered housing has fantastic benefits. Up to 20% of people in nursing homes should not be there. If there were adequate sheltered housing for them, they could be taken out of the nursing homes. However, it is difficult to secure sites for and funding to run such schemes. If the private nursing sector can do it, why not community groups? It is now estimated that only 5% of older people will require long-term care at some point in their lives. Why is the emphasis on keeping people in non-community, profit-driven nursing homes?

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