Jimmy Deenihan (Kerry North, Fine Gael)

I am delighted to have the opportunity to speak on the Bill. I compliment the Minister of State, Deputy Seán Power, on bringing forward the Bill and on his commitment to older people since he became Minister of State.

We owe it to our older people to ensure they can live out their lives in comfort and in the confidence that the system supports and respects them. Some 11% of our population is over the age of 65. In 1986, we had approximately 390,000 people over 65 in the country. Today we have approximately 465,000, and that will have increased before the next census. It is estimated that by 2036 we will have more than 1 million elderly people. Government and State agencies face a major challenge to ensure that we put in place the services to cater for our increasing elderly population.

We owe it to our older people to provide services. These people built up our economy and produced the present generation and we must give them every support possible. It has been Government policy going back to 1990 to support older people to stay in their own houses for as long as possible. The welcome introduction of subventions changed that philosophy to some extent. It created the impression that the Government and agencies were anxious that people should go into residential care. However, we need to strike the balance between the incentive for people to stay in their houses for as long as possible and go into residential care when they have no other option.

While people may have reasons for wanting to leave the homes and communities where they have lived all their lives and go into residential care, generally older people want to stay in their own houses where they have community and local support. They want to remain in their own houses for nostalgic and family reasons. They may have been born there and generations before them may have been born there. They know the geography and the environment of the house. As they get older they know how to move around the house without sustaining injury. They like to look after furniture and other possessions they may have bought years earlier and to which they may have sentimental attachment. The house could contain old photographs that are important to them. They have accumulated memorabilia etc. All these matters are important for old people and they cannot take them into residential care. They generally need to leave almost everything behind. While they can bring a photograph album, they cannot bring furniture or pottery, for example, which is a source of comfort for many old people. It is important to give them the option to stay in their own homes for as long as possible.

Accommodation and hygiene facilities have improved considerably. In the 1960s many houses had no running water or toilet. Young people today would not understand that was the reality. There are now very few houses without running water, and basic toilet and bathroom facilities. However, they can be improved. A number of schemes are available to allow people improve their accommodation, including the essential repairs grant, disabled person's grant and housing aid scheme for the elderly. With the increase in building costs, at times it is impossible to get a builder to carry out house improvement or repair, because builders are so busy. Many of them are not prepared to take on small jobs like putting in a bathroom, repairing a room or even replacing a roof on a house. While at one time builders appreciated getting these types of jobs, now they are not interested.

The grant aid available is derisory compared with what should be available. An ordinary job is likely to cost at least €10,000. Generally people would get a grant of €5,000 for such a job, leaving them to make up the remaining €5,000 somehow. It is very hard for an old person to go to a bank or credit union to get a loan. Obviously elderly people are at a disadvantage because they might not live long enough to pay off the loan. Older people do not like to borrow money to make up such a deficit. Essential repairs should be at least 90% funded, with a small contribution from the householder in order to ensure that people can live in comfort with a roof that does not leak and have a decent toilet. The essential repairs grant generally covers only windows, roofs and doors, and does not cover basic facilities such as toilet facilities and showers. Although the essential repairs grant has been improved considerably and it is possible to get up to €20,000, it is still not adequate.

Older people need to be able to get a hot meal each day and they need good hygiene conditions. They need an accessible shower even more than having a bath, as they find it difficult to get into and out of a bath. They should have a decent shower at least and should have the facilities to cook at least one hot meal a day. In such circumstances, people live longer, more comfortably, and in better health and humour. While the disabled person's grant scheme has been improved, it should be reviewed further and made more generous. A very small number of people will benefit from it.

The housing aid scheme for the elderly, administered by the Health Service Executive, has been quite effective in the provision of storage heating, for example, and other minor repairs. It is not hamstrung by the same bureaucracy, as is the case with the essential repairs or disabled person's grants. It generally provides quick aid to elderly people to install heating, showers or for other minor jobs perhaps including adapting the house for disabled people. More provision should be made for the scheme. In my county the funds get exhausted after four or five months and there is a long waiting list. In some cases by the time people get the grant they may have already gone into residential care or may even have died.

The other aids for elderly people are the home help scheme and the carer's allowance. Last year in the southern region the hours of home help provided were cut considerably. People who were getting one hour's home help found it cut to half an hour. Those getting four hours' home help found it cut to two hours. When the country is flush with money, it is very difficult to explain to older people why the person, who comes to cook the dinner, wash the clothes, clean the house, keep them company and keep them abreast of what is happening in the locality, can only come for two hours instead of four hours, when in reality it should be six hours. The provision of home help should be extended rather than cut back.

I do not have the figure for the number of carers in the country. However, those in receipt of carer's allowance constitute only a small proportion of those who provide care and attention. Many carers do not receive recognition. They should have their work recognised within the PRSI system by treating it as an insurable occupation, even where the care is provided to a family member. Although the carer's allowance has been reviewed and improved and a more generous means test has been introduced with the result that more people qualify for the allowance, the scheme needs to be further reviewed to ensure more carers can access it.

If a person's home setting is physically appropriate and personnel are available to provide home support, it will encourage him or her to stay at home rather than enter residential care. The benefit to society is that this option costs less. The cost to the State of residential care is in excess of €1,000 per week. Keeping people at home, on the other hand, provides employment opportunities for local people who can supplement their income by offering home help services. The home help scheme is a good, well managed service offered by many community groups through FÁS. It should be extended and made more attractive.

The community has a major role to play in home care. Every reasonably sized community should have a facility for older people who wish to have a shower or hot meal, read the newspapers or interact with their peers. I am involved in a project in Knockanure, County Kerry, where a derelict school has been renovated to provide facilities for older people. We have installed a state-of-the-art shower room, laundry service and kitchen, as well as a multi-purpose open area which can be used as a restaurant, for adult education and entertainment purposes and to host functions for funeral or party groups. It can also be used by the Health Service Executive with nurses, doctors, chiropodists, physiotherapists and other health professionals able to visit the facility. Similar facilities are in place elsewhere, for example, in Mulranny, County Mayo, but additional resources are required to develop more of them. The Knockanure project is a good example of how community facilities can succeed and could serve as a model for other parts of the country.

When home and community supports are available, people are less inclined to enter residential care. However, for those with no other option, the nursing home subvention is not sufficient to cover the cost of residential care. Sufficient private nursing care beds are available, but an inadequate number of public beds means people cannot afford nursing home care, even with a subvention. Those unable to afford private care should be given the option of a public bed, but this is not feasible because so few beds are available. The result is the practice whereby the Health Service Executive contracts beds from private operators.

Residents of private homes must use their savings to fund the cost of care. Once these have been spent, they face the prospect of leaving the home either to return to their families or to avail of an alternative arrangement, of which there are few. The maximum subvention, including enhanced subvention, is approximately €300. Nursing homes must charge in excess of €500 just to survive and meet the costs of electricity, insurance, water and refuse charges, staff costs for nurses, carers, cleaners and so forth. For this reason, a number of them have closed in recent times.

The level of nursing home subvention needs to be reviewed because it is insufficient to allow people to maintain themselves in residential care. I am sure the Minister of State will have heard stories of people being placed under severe pressure to meet the costs of care, including being forced to sell their homes and use their savings. If a person has €100,000 in savings, it will be quickly eroded if the weekly cost of care, after subvention has been deducted, is €300. This is a major problem.

I recently learned of the retirement village concept, which has long been in vogue in Australia, New Zealand, the United States, Scandinavia and, more recently, Britain. A typical retirement village is located in a parkland setting of between 25 and 40 acres. It will usually consist of 150 to 200 individual houses and apartments grouped in courtyard style and clustered around a central garden area. A central services complex contains a wide range of communal services, including shops, restaurant, bar, chapel, library, therapy pool, gym and meeting and activity rooms. A nursing home with medium to high dependency care rooms provides 24 hour medical support to all village residents who also have access to physiotherapy and other services. All residential units have alarms connected to the medical centre and all residents are provided with a wide range of domestic and maintenance services. This type of retirement village is being developed forthe first time in Ireland in Carnelly Village,Clarecastle, County Clare.

The Department should examine the concept of the retirement village given its manifold benefits. For example, elderly people with a range of health problems and disabilities can live a normal domestic life in their own home with comprehensive back-up services. In addition, all services and requirements are met on site with residents having an option of accessible transport services to nearby towns, access to a wide range of activities, clubs and hobbies, 24-hour medical assistance and an on-site ambulance service. Facilities also include a 24-hour on-site security presence and daily assistance with domestic chores as well as delivery of meals if required, emotional support and assistance from qualified personnel and other services.

The best approach to care is to keep people at home for as long as possible for the reasons I have outlined, especially given the affinity of Irish people to their hearth and home. Home services and visits should be provided to ensure people are living comfortably and the community network, which provides support to those living at home, is strengthened. Where this is not an option, the possibility of moving to a retirement village or sheltered housing should be considered. The final option should be to move into residential care. Implementing this approach should be the Minister of State's objective. He has a further nine months in office in which to achieve it, after which he could well be replaced by Deputy Wall.

See this speech in context