Séamus Kirk (Louth, Fianna Fail)

I was in the Chair before the current Acting Chairman and listened to interesting contributions on this matter. In a few years, care of the elderly will be near the top of the pile of major policy issues for the Government of the day and will be a challenge for the Department of Health and Children. The solution to the accommodation needs of individuals who are in their golden years will not necessarily be found in the policy initiatives that will come directly from the Department of Health and Children. There are other Departments which will play a role in that regard and the need for collaboration and co-ordination of public policy is fairly obvious.

For a long time institutional care was seen by many families as the ready-made solution for the care of an elderly person with a certain level of dependancy who, where family help was not available, could not be looked after in a family setting. With the development the private nursing home matrix across the country, we all are aware that the cost of nursing home care is substantial. A stay in a nursing home, particularly on the east coast, is very expensive. In one way or another, either the families who have a responsibility for the elderly person or perhaps a combination of the families and the State through the contribution of the subvention scheme, are paying substantially for that care in a nursing home.

The effect of virtual full employment on the availability of family support means the extent of family help available in the home setting is not what it was in previous years. I remember talking to an official, originally from Sweden, at an OECD function somewhere in Europe ten or 12 years ago when I was a Minister of State in the then Department of Agriculture. When the subject of the care of the elderly came up in general chat, he told me that in Sweden family help to look after the elderly was no longer available and they had to look after the elderly in institutional care. In Ireland at the time, which is relatively recently, the thrust of family attitudes towards elderly parents was to keep them in a home setting as long as possible and I hope this continues to be the underlying attitude of family members. It is not always possible. We must be realistic. If people must go out to work and do not have helpers available to look after their elderly parents, the option of putting them into a nursing home is obviously considered.

With advances in medicine people are living longer. The longer people live, the greater the level of dependency increases. Once the level of dependency increases, it can be difficult to look after the elderly in a home setting.

A number of today's speakers raised the issue of day facilities and Deputy Deenihan referred to the development in County Kerry. There are two good examples of day facilities of which I am aware and they are ideal models for any development of such facilities. One is in the Acting Chairman, Deputy O'Sullivan's, constituency in Ballincollig in County Cork and the other is in Summerhill in County Meath. These are excellent examples of where, through the combination of the statutory and voluntary sectors, the provision of transport and a day care outlet can help considerably to keep senior citizens in a home setting. If people can be looked after in a day care facility when siblings are at work, it makes it much easier to look after them in the home setting for a much longer period. I am sure the officials and the Minister of State, Deputy Seán Power, are aware of these two projects. Lessons are clearly there to be learned from the experiences gained and gleaned from those involved with the development of these two projects. They provide a template to copy for people who are interested in developments in this area in other parts of the country.

There is a number of relevant schemes available such as the housing aid for the elderly scheme and the disabled person's grant scheme. We in County Louth have an excellent co-ordinator dealing with the housing aid for the elderly scheme who is getting great value for money and helping out many families by stretching his budget considerably through his good organisational and co-ordinating skills. Perhaps the scheme is not so successful in other parts of the country and there may well be a need to look at it to see whether it can be streamlined, enhanced or made more helpful to those who need modifications or adjustments to their home setting.

House design can pose a serious problem where an elderly person or a person with a degree of immobility or disability lives in a two-storey house, with deep stairs, where all the bedrooms are upstairs. In one case in Dundalk of which I am aware, a widow lived on her own in a fine three-bedroom house which was built in the late 1950s by the then Dundalk Urban District Council. The three bedrooms were upstairs and because of her arthritic condition she simply was not in a position to use those bedrooms and temporary sleeping accommodation had to be provided on the ground floor. There is a number of observations one can make about that. First, she was living in a three-bedroom house and there was serious underutilisation of the house as a unit and, second, the temporary accommodation led to conditions which were clearly unsatisfactory. While the housing aid for the elderly scheme personnel made changes and modifications, these did not entirely meet the needs of that person. If there was greater flexibility in the availability of housing, the quality of life of the individual could be improved considerably and perhaps the dwelling could be freed up for a young family which might need housing in the area. I recall speaking to some of the officials about this issue, particularly in the context of planning and the layout and design of a housing scheme. If, rather than providing for one house design only in a housing scheme, they could design developments to include different models within the same housing scheme, people could start off in a conventional house and with the passage of time, move to more person-friendly accommodation such as an OPD designed or purpose-built house thereby freeing up their house for others. I realise that with the enhanced asset value of housing, it is not so easy.

Deputy Wall referred to sheltered housing of which there are some excellent models around the country. There are two in south Monaghan which come to mind, one of which, in Lisdoon, I visited recently. It is a credit to the local voluntary committee which planned, designed and executed the project. It has 14 two-bedroom units and a community house including bedroom accommodation at a reasonable cost for visitors of elderly relatives living in the scheme. Of course it has kitchens and facilities for visiting HSE personnel. It is clearly a model for other similar developments around the country.

Local authority housing policy is also a relevant issue. For obvious reasons, local authorities think in terms of providing three-bedroom houses, whether through Part V or however, for young families, but houses for persons in their golden years are down the priority list. With the changes in demographics which are clearly coming and which have been quoted here by a number of speakers, it is necessary to examine the planning and design of housing schemes to make provision for the sheltered housing concept in as many villages and towns as possible, and to ensure people live as near as possible to basic community facilities such as shops and the church, particularly in the case of the elderly, and the school. Sheltered housing developments should be located as near as possible to such community facilities and that is an obvious policy objective.

I am another public representative who wrestles on a daily basis with the exigencies of the subvention scheme, which is, perhaps, too complex. I acknowledge that the State must bear a significant cost but the scheme is important in the context of helping families to support elderly relatives who need institutional care. It is a vital support, without which families would not get by. Means testing on the basis of the value of the family home is a thorny and sensitive issue but it must be recognised that, inevitably, such homes will be inherited and they are a significant asset. The State, in consideration of these matters, must take property into account. However, the simplification and streamlining of the means test as well as the widening of the eligibility criteria so that more people can avail of it should also be an objective. I commend the Minister of State, Deputy Seán Power, who has a deep personal interest in developing this area. If he remains in office for a long time, his workload will increase given the impending demographic changes.

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