Tom Hayes (Tipperary South, Fine Gael)

They have all been cut, which creates problems for those trying to care for the older people who live with them. The country needs more public health nurses because they would reduce the cost of care to the State but, as Deputy Michael D. Higgins said, home help has been cut.

The quality of care has been discussed. Reports have surfaced about private nursing homes which failed to provide adequate care and found themselves in trouble with the authorities, which is as it should be. One half of St. Patrick's Hospital in Cashel, where there are 150 patients, is closed. We have lobbied for years for funding to open the other half because people live longer in such hospitals. I have visited it regularly and seen at first hand the care being provided. There are more people on the waiting list for St. Patrick's Hospital in Cashel than there are patients in it. The hospital is based on a model which works so the State should give people the chance to stay in such institutions and fund them accordingly. I beg the Government and the Minister of State to treat as models the many institutions around the country that have given great service over the years but have suffered cutbacks for various reasons. Every county should have one such hospital, if not two. It is vital that those owned by the HSE are developed and that more Exchequer funding is made available because they offer professional care.

Many people have difficulty with subvention rates. The rates do not seem to keep pace with the cost of a nursing home and it is a real problem. Hospitals should be graded to allow consistency of charges and a degree of control. People constantly petition us to review subvention rates because they find it difficult to maintain their elderly relatives in the community. The O'Shea report dealt with concerns about subvention rates, elderly people being forced into schemes and the lack of long-stay public beds in some areas of the country, which resulted in the inappropriate placement of some people and severe financial hardship for others paying for expensive private care. That needs to be addressed.

The report states that a significant number of elderly people in the subvention scheme are unable to maintain their payments and something must be done about it. Significant time costs are associated with the operation of the nursing home subvention schemes. Assessing people requires a great deal of administrative work and staff often have to ask the applicant for additional information, and to have recourse to other agencies for details in connection with an application. An application must go through a number of stages before a final decision can be taken. Simple cases can take four to six weeks to process. However, if additional information is required, the process can take longer. It should be a requirement that such decisions be made within a certain timeframe, as is the case with decisions on planning applications. I outlined a case in which a health board took nearly three years to make a decision on the subvention rate for one of my constituents.

I am disappointed the Bill does not address the wide range of issues affecting elderly people in our communities. Major issues have been addressed during the lifetime of this and other Dáileanna. I hope future legislation will address the full range of issues associated with care of the elderly in the community. We need to enable elderly people to remain at home by providing them with supports which enhance their quality of life. All of us, regardless of whether we like the idea, must face old age. We hear day in and day out how rich our economy is and how well-off we are. We need to implement existing plans which would make life easier for the elderly and tackle the hardship and drudgery experienced by those who provide care in the community.

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