Billy Timmins (Wicklow, Fine Gael)

The most contentious issue we associate with nursing homes and the care of elderly people is that which was highlighted recently, namely the nursing home inspections. Many of us have consistently raised this issue over many years, but it never received publicity until recently. A report may be on the desk of the Minister or someone else on how these inspections should be carried out and implemented. Given a year has passed since the bad publicity surrounding many private nursing homes, it is time a proper nursing home inspectorate was established. A considerable degree of good work is done by many nursing homes and many elderly and middle aged people are treated very well in them, but other nursing homes, particularly old converted buildings, convents or school houses, leave much to be desired. I have had relatives in nursing homes and I am familiar with the difference in standards across them. The standard in some is excellent and in others it is very poor.

Many people in nursing homes are vulnerable. They do not have the wherewithal or a mechanism to make a complaint. In many cases, there are afraid to make a complaint because they believe they will be moved on. I am familiar with a case where an individual in my constituency made a complaint about a nursing home, following which the family was asked to take their elderly parent out of the home. The family was reluctant to follow up on the complaint. I have taken up this issue with the Department and tabled parliamentary questions on it, but I found it difficult to get the bottom of it.

New nursing homes should be single storey structures and we should not permit them to be two-storey or multistorey structures. I am aware of a nursing home in Kilkenny that is an old two-storey building which was converted for that purpose. There is a lift in it and when part of the lift was damaged the spare part needed to repair it had to sent from Italy. The lift was of out commission for several days during the summer and the elderly people on the upper floor could not come down to the lower floor or go outside. They were basically trapped in the building and I fear to think what would have happened if there had been a fire. New nursing homes should be only single storey buildings. I do not know the provisions of the building regulations in regard to them, although I admit that most nursing homes I have seen are single storey buildings. I would like the Minister of State to examine that point.

In regard to the county development plan in Wicklow, where there are very restrictive planning practices, I put forward a proposal that nursing homes should be allowed to be located on greenfield sites, even if not connected to the main sewerage scheme. That proposal was accepted following much difficulty. An argument is often made that nursing homes should be located in towns where people have access to the church and other facilities. However, many people were reared and lived all their lives in a rural environment and they want to spend their time in a nursing home in a rural environment. Such provision should be encouraged. I am aware that some nursing homes are located in rural areas, although there are not many of them in my county, but I hope more will materialise in time.

The main purpose of this legislation is to put the concept of subvention on a legislative footing. Section 7B of the principal Act deals with that aspect under two issues, namely, dependency — in other words, the physical needs of a person — and the means of the applicant. I may have interpreted the section incorrectly and the Minister of State might clarify it. It refers to excluding 95% of the estimated value of the house and that 5% of the value of the house would be taken on board. I assume it will be taken on board as an income. If a person's house is valued at €1 million, the income one would be assessed as having is €50,000 a year. Perhaps I am misreading the section but that is my understanding of it. The section goes on to deal with the position in the case of threshold limits. For example, if a person has a principal residence the value of which is above €500,000 and if it is located in the Dublin area, he or she would perhaps be refused subvention and if a person has a house valued at €300,000 in an area outside Dublin city and county, he or she perhaps would also be refused subvention. I assume I am correct in my interpretation of that provision. This provision could exclude many people from qualifying for subvention. The average price of houses have increased by 270% in the past ten years across the country and in some places they have increased by300%. Taking the value of a person's residence into consideration is not a very exact science. The taking into account of property valuations will impact on people across the board because such means is not a tangible asset for people who do not intend to sell their property. If that is the case under this legislation, it means people living in the greater Dublin area will never qualify for subvention. The Minister of State might be able to clarify that provision in case I am misinterpreting it.

Deputy Paul McGrath mentioned in 1970 Act and a commitment that the State would be responsible for the welfare of older people and would provide facilities such as nursing homes. I have a letter from the Wicklow Active Retirement Association. The members believe that little or nothing has been done by the State to implement the commitment in the Health Act 1970, and it is difficult to disagree. They believe older people are being forced into private nursing homes, thus causing them and their families financial hardship. I do not have a difficulty with the many tax incentives put in place to encourage the building of private nursing homes. If people are willing to invest in them, that is fine. However, the amount charged for care is prohibitive. Given the tax reliefs and the subventions paid, the development of existing old district hospitals might provide better value for money.

Many older people already attend day care centres at these hospitals, so it might be a natural progression for them to move into care there when necessary. Hardly a week passes without me being contacted by someone trying to get a place in their district hospital. It is not that they want free care, rather that they want to be in the vicinity of people they know and to remain in the environment with which they are familiar. Many parts of the country do not have private nursing homes.

These district hospitals provide a good service and provide respite and step-down beds for people coming from acute beds thereby taking pressure off the main hospitals. However, the staff in these hospitals often have to struggle for resources. Despite the fact that facilities have improved tenfold over the past 20 years, the district hospitals face a constant struggle for more staff and beds. There are three district hospitals in County Wicklow: Baltinglass, Rathdrum and Wicklow town, and they are constantly looking for more resources. The local people want to use these hospitals rather than private nursing homes, irrespective of the payment issue.

The break-up of the old Eastern Regional Health Authority brought a change in the catchment areas for district hospitals and, as a result, we now have an imbalance in Wicklow. Approximately 90,000 people are in the catchment area for Rathdrum and Wicklow and about 12,000 in the Baltinglass catchment area. The Department should take another look at this. The policy of the Health Service Executive is to have no borders, so to speak. The catchment area for Baltinglass should revert to the old area because people in south Wicklow have attended day care there and had relatives there. Now that some of them may wish to access the hospital, they have been refused access and told to go on the waiting lists for Rathdrum or Wicklow. This makes little sense because there is already a greater demand on those two hospitals. If the numbers were broken down on a population basis, we would revert to the old system. I have raised the matter several times but have had no success to date. Therefore, I would appreciate it if the Minister would take the issue on board and do something about it.

The Bill has nothing to do with sheltered housing, but the issue is related to Government policy. The Wicklow Active Retirement Association has asked what sheltered housing is available for the area and how the association can go about acquiring it. We all know excellent funding mechanisms are in place for sheltered housing and they work well. We have seen many parishes and communities avail of this funding to build sheltered housing on parish or community grounds.

We should encourage the building of sheltered housing as an add-on or attachment to our old district hospitals because these already have a staff in place and provide a secure environment. Statutory bodies should be more proactive in this regard. Perhaps they should contact all the active retirement groups that have been set up in recent years and provide them with details on how to go about providing sheltered housing. There is possibly, if memory serves me right, 100% funding available for such schemes.

Many people cannot survive alone in their house but they do not want to go into a nursing home. They would prefer a type of halfway house and sheltered housing would meet that need. There is an excellent sheltered housing scheme in Carnew, County Wicklow, and in many other places throughout the country. However, many areas do not have these facilities nor the wherewithal to provide them. If we provided the information to the active retirement associations on how to go about sourcing funding for sheltered housing, most communities would be willing to provide sites. Most district hospitals have extensive sites and the sheltered housing could be on them.

Some people referred to the home care package which provides assistance to people in their homes. Many people do not want to leave their homes and would not have to if the home care package were enhanced and more readily available. Last year, I tried to source home care for some people in my area, but there was a limit on what was available and no more could be provided. We should allocate more funding to this area to make life easier for elderly people, thereby taking the pressure off having to provide nursing home subvention.

People often only need a mechanism to help them stay in their home. They might not want to go into a private nursing home, but they see no other solution and this often costs the State more. We must look after our elderly and our young people, and resources should never be the issue in this regard. We need to put this legislation and the infrastructure in place to provide people with an option. I repeat, not a week goes by without some family contacting me to find a place in the local hospital. Unfortunately, unless someone in a public bed dies, no place is available.

I broadly welcome the legislation. I compliment the many people working in public nursing homes and hospitals and those working in the many private homes, especially the two Cheshire homes in Shillelagh and Tullow who work with people with disabilities. Facilities have improved, but this is mainly as a result of proactive chairmen or executives in charge who know how to source funding and go about these improvements.

The Department should take a more proactive role in providing information to people on their entitlements, ranging from the small security alarm to family income supplement. There is a significant information deficit with regard to what is available. We often pat ourselves on the back for passing legislation, but the tangible results seldom filter down to the people because it takes so long going through the Department and the Health Service Executive that the people at the bottom do not get the information.

I wish to ask the Minister of State about another issue which is not directly related to the Bill but is related to the health area, namely, the provision of community first responders and defibrillators. I know he was at a recent successful launch in Kilcullen. It should be a legal requirement for nursing homes and public hospitals to have these. Many do not have this equipment which only costs €1,600. I have asked the Minister for the Environment, Heritage and Local Government on several occasions over recent years to make it a condition of planning permission for buildings that will attract over a certain number of people that defibrillators are provided and that it be a legal requirement for staff to be trained in their use. This equipment saves lives and would be of particular value in nursing home establishments.

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