Damien English (Meath, Fine Gael)

It was interesting to read the speech of the Minister of State at the Department of Health and Children, Deputy Seán Power. He claimed the Government's policy is to help older people stay at home. He spoke, both at the beginning and end of his speech, of how great the Government is and how much it is doing. This is in a week when I have received 15 telephone calls from people because their fuel allowance has been stopped in one of the worst months of May for weather in my memory. I am 28 years of age but perhaps it was worse before I came along. It has been the coldest and wettest May in my memory, and still there are people whose fuel allowance has disappeared and who have no help towards the cost of fuel. The predictions are that the weather in June will not be great either. I hope the weather in July and August will be better, but the predictions are bad. If the Government is so helpful to older people, it would not be cutting their fuel allowance which does not break the bank. A little help towards the cost of keeping themselves warm and comfortable in their homes would be a good example of how committed the Government is to keeping elderly people in their homes. Incidentally, the fuel allowance is not large enough and does not reflect the cost of fuel. It does not help these people. The Government should look at that matter as another option to help people remain at home.

Before addressing the substance of the Bill and the area of nursing homes and subvention, we must realise that the Government has not increased the rates of subvention in the past five years. As I recall, the Government has not looked at or increased the subvention rates since 2000 or 2001. Even when it did change them, there was not much of an increase.

The cost of nursing home care, compared to that pertaining ten or 15 years ago, even five years ago, has increased dramatically. I am not familiar with any nursing home, in my county or any neighbouring county, whose charges are below €800 a week. Most of them charge €1,000 or €1,200 a week, and that is before account is taken of all the extra services and the cost of visiting specialists etc. While such care costs a minimum of €800, the maximum subvention is €190, although I am open to correction.

There are people of all ages in families struggling to raise such sums to try to make ends meet for the cost of a nursing home. I encountered one woman whose husband is a retired bank manager. He has been retired for 15 or 20 years and his pension income is not as high as one might think, just because he is a retired bank manager, it might be. She has forked out over €70,000 in the past three years on nursing home bills for her husband, who she would prefer to have at home. If she had savings of approximately €30,000, under this new proposal they would be assessed as income and she would be penalised in the context of the rate of subvention, and yet one could see €20,000 or €30,000 disappear on nursing home costs in a year. The Government needs a dose of reality in discussing subvention and the area of nursing home costs and care for the elderly because it is not in touch. I acknowledge it is improving the subvention rates a little as it goes along, but they are not matching the costs and the Government must face that fact. I am afraid no back-clapping should be allowed or considered until the Government matches the costs involved.

Family members are under immense pressure to come up with the cost of nursing home care. It might not be so difficult to cover these costs in the case of families of seven or eight such as those of years ago, but nowadays the average family consists of two or three earners who can contribute towards their parents' nursing home costs and due to today's society many persons do not have the option to keep their parents or their ill family member at home. Although many might like to, it is just not possible and they are forced to turn to the nursing home, which causes a serious drain on resources. With trying to fund their children's college fees, or their children's first homes because the price of houses are also so expensive, and trying to pay for their parents' care, family members are caught in the middle. They have their own expenses, their children's education and accommodation needs to look forward to, and their parents' care. We are asking the people in the middle to do too much and it is not possible. When we wonder about stress and mental illness and people having strokes and heart attacks at a young age, the answer lies in all the pressures of life on them from a range of sources. The Government cannot clap itself on the back or state that it is doing everything possible, and cannot state it is doing a great job for the elderly because it is not. It is as simple as that.

There is a need to clarify who takes on the responsibility when an elderly person becomes ill or cannot manage to stay at home and needs to go into a nursing home. Attempting to get answers about who is in charge or accountable from the health authorities would break one's heart or about to whom one must turn. Must one make 20 telephone calls to find out who pays the subvention. It is especially difficult where this involves different counties or health service areas. For example, if the children live in Kildare but grew up in Dublin, the parent decides to live with one of the children for six months and it becomes too difficult to the point that they cannot manage and must seek nursing home care, when one telephones the authorities to discover which of the areas, Dublin, Kildare or Meath, covers the subvention one is told one has reached the wrong person and to telephone somebody else. That happens regularly and I have dealt with that on many occasions because I live in the greater Dublin region and represent people in County Meath, many of whose parents are from Dublin, although the parents may have moved for a couple of years, their home is still in Dublin. Such cases are causing considerable problems. As the subvention comes out of one pot and is taxpayers' money provided by the Government, it should not matter who takes on the responsibility of paying it. It is not good enough that people spend a year trying to figure out who is responsible for paying subvention, with everyone concerned running away from it.

A one-stop shop for services for the elderly would be useful, where one could telephone one person in the HSE stating the needs of an elderly parent and asking that he or she take on the case and respond in a week outlining the entitlements and what can be done, rather than trying to chase up and get answers from across the board which is impossible. A one-stop shop where one could get the answers and where the health authorities would say that they will do what they can to help the caller. While one cannot give them everything, at least give answers, take on the responsibility to help and do this. They should state that the elderly relative has done his or her duty to this country and the health service is here to look after the case. That does not happen.

If there was enough support to keep one at home in the first place, the subvention rates and the cost of nursing home care would not be a problem. In my experience, the person needing nursing home care and family or friends would prefer if the person was able to stay at home, but it is not really an option. I will outline the different areas which would help. Our public health and community nurses in most areas, especially in the greater Dublin region, are under immense pressure and cannot do their job. They have a list of criteria which they are supposed to fulfil. They have a list of people who they are supposed to visit, which includes drop-in calls to the elderly to keep an eye on them. They cannot do that anymore. They can barely cope with the people coming out of hospitals, new-born babies etc. They are under immense pressure and they cannot cover the areas requested, in terms of keeping an eye on people, providing a back-up service and being there to help out.

The Minister must look at such primary care because that is where it starts. These people are unable to do that and we are asking too much of many of the nurses, who are doing immense work but cannot do everything. One will always deal with what comes to the door first. As public representatives will be aware, people are being passed over. There are people, especially the elderly, who are in need of help and who are not found in time. The difficulties are exacerbated because the health service does not have the staff to cope with the routine calls to check up on these people.

The Minister also needs to rearrange the geographical areas covered by public health nurses and other nurses assigned to the health authorities because they vary greatly from those covered by general practitioners. There is no co-ordination with the general practitioner services. There is a need for a system to align the nurses to the general practitioners on the basis of a group of patients rather than a geographical area. The current system does not work well and people fall between two stools.

I am fed up hearing from the Tánaiste and Minister for Health and Children, Deputy Harney, that she has increased the home help hours and the funding involved. The funding might have increased but the hours have not, and most people in the area I represent in County Meath have had their home help hours cut in the past few years. Last year and the year before the home help hours were slashed by half.

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