Paul McGrath (Westmeath, Fine Gael)

I recall the American wakes that took place in the small villages in the 1950s, where many of the people who are now very elderly saw their children emigrate to England and America, never to return in many cases. Those are the elderly people who made sacrifices, gathering a few bob to give their children the chance to go. As my mother used to say, they lived on "the clippings of tin" to keep alive. Times were extremely difficult in the 1950s and 1960s. Now, when such people have a dependency on the State, we are pulling the rug from under them. This legislation is being introduced as something of a sticking plaster job. We have had difficulties as regards the repayment of moneys to various people, so the Government has decided to seal the door tightly in case of further crisis. Effectively, it is a battening down the hatches exercise, and that is why this is being introduced.

The Minister of State took the opportunity in his speech to outline what he believes will be a good propaganda campaign as regards how to look after the elderly. I know the Minister of State for quite a time and believe him to be a decent man. However, the way we are addressing the difficulties for the elderly is not up to standard at all. There was a flurry of activity towards the back end of last year, when the Tánaiste announced there was a new package for subvention, and that the threshold for housing in the Dublin area would be €500,000, as the cut-off point for nursing home subvention. In a rural setting the property valuation was to be set at €300,000. Those were to be the cut-off points. I talked recently to an officer in the health board and we discussed the whole question of subvention, with reference to a particular case. I asked him to confirm that in a rural setting the first €300,000 of income was to be disregarded. That was not the case, he said, but rather the perception. The spin doctoring made it sound like we were changing the system dramatically and that if one's property was worth less than €300,000, it could be disregarded, while it could be disregarded in Dublin if it was less than €500,000. Assets above that value would only be examined when assessing nursing home subvention.

Nothing could be further from the truth. No change was introduced by the Minister. Instead of saying that if one's assets are worth more than €90,000, one does not have a chance of getting subvention, we are saying that if one's assets are worth more than €300,000, one has not got a chance of getting subvention. In between, we have changed nothing. The window dressing does not work and people are not fooled by this anymore.

We must address the real issues. People would prefer to stay in their homes, if possible, or at least in their communities. We should facilitate them in doing that. If we look around the country, some excellent schemes have been built. A priest in County Clare pioneered a scheme with small villages where elderly people could live in sheltered accommodation within their community. This has worked very well and it has been done on a voluntary basis. It is the kind of model towards which we should move.

Will the Minister examine what has been happening in the UK for a long time? There is a major problem in that country due to the great number of elderly people and it has been addressed in a good fashion. I am sure there are deficiencies, just like there are everywhere else. However, I am aware of a scheme which operates there, with which I am impressed, consisting of two-storey town houses joined together along a row. One entered an outer door into a long corridor and there were many self-contained apartment units at the bottom of the corridor which were relatively small, about 600 or 700 sq. ft. The first floor also had self-contained apartments. There were facilities for a live-in caretaker, nurse or administrator. There was an intercom system in each apartment and, every morning, the caretaker could call each apartment to ensure the occupier was up and about. Each apartment had a pull cord so that if an emergency arose, the caretaker could be alerted.

The block also contained community rooms so that even though each unit was self-contained, the elderly people could come together on a regular basis to play bingo or to have their hair done. Lunch was available at a reduced cost two or three days a week. There were two or three extra available rooms which could be booked for family visitors. This system operated very well. It created its own little community and there was even an occasional wedding. People had come separately to the community, romance blossomed and couples went on to get married like Darby and Joan. Birthdays also added to the community spirit. There would be a little function in the community room with a birthday cake and so on.

This system delivered security for the elderly because there was only one outside door. It created a sense of community and back-up when it was needed. The financial arrangements involved were suitable. A subsidy was paid by the state towards the rent of these units so that it was in the reach of ordinary people to be able to pay their rent. Their rent was akin to what they might pay in a council house, but the block was not owned by the council. It was privately owned and operated mainly by pension companies. The block of homes with which I am familiar was owned by the local pension board of the gas works. That board had built and operated it and was able to make returns on it, yet it was subsidised accommodation with all the advantages I have just mentioned.

Let us contrast that to what is happening here. We have been running down the number of beds available. We have been reducing the number of public beds available for elderly people. In Mullingar, St. Mary's Hospital was built in 1841 and is one of two remaining in the country. The building is not ideal for a hospital and needs to be replaced, but it should be preserved as an administrative building or something. In recent decades, we have reduced the number of public beds from 250 to 120. We are making it more difficult for people to get in there.

We are forcing elderly people into the nursing homes at a time when their number is increasing. In 1995, there were approximately 400,000 people over 65 in Ireland. It is projected that the number of people over 65 by 2020 will grow to around 700,000. That represents a 75% increase over a 25-year period, which is very high. Various Governments have identified this problem and decided that more nursing homes must be built.

Incentives were given to the private sector to build nursing homes. Looking at the demographic trends, people in the private sector thought they would have many customers and they rushed to build nursing homes. However, many of these homes are finding it difficult to survive. I am aware of homes that are below capacity and are struggling to survive. I have a friend who runs a private nursing home and I am told that the critical mass for a nursing home is about 28 patients. To make it viable and to survive, 28 patients are needed owing to nursing cover and so on. Anywhere below that number leaves the owner in a difficult situation. Many beds are not being used, but the Government is not providing the wherewithal to use them.

What is the standard cost in a nursing home? In my area, it costs between €500 and €600 per week, and there may be extras on top of that. How does an ordinary person survive? The old age pension is a maximum of €190 per week. The subvention is a maximum of €190 per week, if the person can jump all the hurdles put in his or her way. That makes €380. A shortfall of €170 to €200 per week has to be met. From where can people get that and how can they manage to meet that cost? Based on what is contained in the Bill in terms of what the Minister proposes, some older people will have to sell their property and the assets it would realise would have to go towards funding their nursing home care.

The Acting Chairman and I are familiar with people who go into nursing homes. I have yet to meet a person who when going into a nursing home would say, "I am in here now to die — this is the last of it, the final furlong". Such a person would say, "I am in here for a little while until I get a bit stronger; I am going to build myself up over the next two or three weeks and I will be back home then". Such a person expects that he or she will return to his or her own home. How then can one countenance a situation where one would have to say to such a person that he or she will not return to his or her home because it must be sold to keep the person in the nursing home? What kind of a blow is that to such people? Is it appropriate that we should do that bearing in mind what has been said about how our elderly people have built up this State?

I wish to return briefly to the issue of St. Mary's Hospital in Mullingar. The most recent Government announcement is that the 120 beds in that hospital will be replaced by two 50-bed units on the site of that hospital and by a further 50 bed unit in Castlepollard. The proposed unit in Castlepollard has been promised for 20 years and I am sure it is simply yet another promise but we will have to wait to see if it will be delivered.

When our demographics point to our having many more elderly people in our State, should we be decreasing the number of public beds? There were 250 beds in that hospital and there are now only 120 beds in it. Will it be replaced with a 150 bed unit? I suspect that at some stage in the future there will be a 50 bed unit in Castlepollard and one 50 bed unit in Mullingar and the provision of the second unit that was mentioned will be put on the long finger. That is not good enough and provision in this respect should be addressed at the earliest possible time.

I wish to make a further point to which I ask the Minister of State to pay particular attention when replying to the debate. What is the position under the Health Act 1970 in regard to people who have to go to hospital or to a nursing home? We were promised in the 1970 Act, which is law, that hospitalisation would be free of charge for anybody, but that is not the case. It is not only I or other Members who have made that point, a former Ombudsman, Mr. Michael Mills, completed a specific report on this matter and obtained legal advice on it. He said that in his view the Nursing Home Act 1970, which is law, means people are entitled to be in nursing homes free of charge. How does the Minister of State reconcile that with what is in this legislation? How will he address that issue? Will he amend the 1970 Act to state that is not the case? We should not have such confusion. It will lead to further difficulties down the road. When a case on that basis is taken by a person and he or she cites the legal advice and the report of a former Ombudsman, will we all again be held indicted for not living up to our responsibility?

See this speech in context