Tim O'Malley (Limerick East, Progressive Democrats)

I welcome the opportunity to address the House on this important issue, which affects some of the most vulnerable people in our society. As the Minister of State, Deputy Brian Lenihan, mentioned earlier, the Department of Health and Children has a policy of maintaining older people in dignity and independence in their own homes, in accordance with their wishes, for as long as possible. Most older people are fit and well and lead full and independent lives. The Department is committed to providing a high quality of long-term residential care when that is no longer the case. That is the minimum we can do for older citizens, who have played a major part in helping Ireland to achieve the success it enjoys today.

Most long-term residential care is of a high standard and affords a good quality of life to older people who benefit from it. With the best will in the world, however, there will always be exceptions to the rule. As there will always be circumstances in which older people feel vulnerable or exploited, the Department is committed to developing quality standards and putting in place a robust inspection process for public and private nursing homes. The Minister of State, Deputy Brian Lenihan, has outlined the steps being taken in this regard, including the establishment of the Health Information and Quality Authority as well as the establishment of the social services inspectorate function on a statutory basis. The office of the chief inspector will have the function of registering and carrying out inspections, including inspections of services for older people. The Department has established a working group to set out the standards for residential care settings for older people. The HSE will continue to register and inspect private nursing homes under the Nursing Homes (Care and Welfare) Regulations 1993.

The Department of Health and Children is fully committed to developing the services needed to tackle elder abuse. Great strides have been made in recent years in developing supports for older people who feel defenceless. The report of the working group on elder abuse, Protecting Our Future, was launched on 11 November 2002. As elder abuse is a complex issue, it can be difficult to define it precisely. It may involve financial, physical or sexual abuse, or it may arise due to inadequacy of care. It is defined in the report as "a single or repeated act or lack of appropriate action occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person or violates their human and civil rights". It is hoped that the report, by defining elder abuse, has given older people who feel they are the subject of abuse in any shape or form the confidence to report their anxieties, as appropriate, to a social worker, a public health nurse, a member of the Garda or any professional or care worker. The Health Service Executive recently established a helpline service, which can be accessed by dialling 1850 241850, dedicated to dealing with allegations of elder abuse. It should encourage those who feel they are being abused in any way, or those who witness such abuse, to make the necessary contact and have their voices heard.

The importance the Government attaches to the issue of elder abuse is reflected by its allocation of €2 million in this year's budget to address it, split evenly between 2006 and 2007. Some €2.5 million has been made available in recent years to implement the recommendations of the report. The funding allocated over the next two years will facilitate the implementation of the full range of recommendations. It will help to put in place dedicated elder abuse officers and clerical support workers in each local health office area. It will also provide for the development of a research function in this area.

The report recommends that a senior case worker be appointed to each former community care area. It is anticipated that the HSE will recruit 27 senior case workers soon. One of the responsibilities of the senior case workers, in conjunction with appropriate health service providers, will be to assess suspected cases of elder abuse referred to local health offices. One of the recommendations in the elder abuse report was the establishment of a national implementation group. The group was established in December 2003. In 2005, the Department appointed a senior policy adviser and a secretary to assist the implementation group in its work. The HSE recently appointed a senior officer to assist the group with implementation issues.

The HSE has made good progress on the issue of elder abuse. It has implemented a number of the report's recommendations, including the establishment of steering groups in each former health board area to provide a common response to elder abuse throughout the State. The steering groups comprise representatives of the public sector, private organisations and voluntary organisations, including groups for older people. The groups are developing clear policies and guidelines for the protection of vulnerable adults, on foot of wide consultation with staff. They are progressing their work through the subgroups on legal aspects, policy and procedures and training.

The Health Service Executive has pointed out that awareness training for HSE staff has been provided in line with the report. It has been involved in awareness training with volunteer staff, including staff from the national senior citizens helpline. The issue of elder abuse is being incorporated into professional training courses including gerontology courses. A number of research projects have been undertaken, including the examination and review of medication for older persons in continuing care settings. In addition to these developments, a senior helpline was established with the support of the health boards in 1998. Since 1999, it has received thousands of calls from lonely older people nationwide. The service is confidential and non-directive and is available throughout the State for the price of a local call. The volunteers working on the helpline are all older people who have gone through a rigorous training provided in conjunction with the health authorities.

The helpline handles all manner of issues and is not geared specifically towards complaints about elder abuse, such as the helpline recently set up by the Health Service Executive. However, 5% of calls in 2004 related to elder abuse. These callers established a relationship of trust over a period with the older volunteers taking their calls. Many callers were often unable to seek external or professional intervention until they felt secure in discussing their situation.

The House will agree the Department of Health and Children has taken strides in tackling the issue of elder abuse. It has worked for the past several years, in conjunction with the HSE, to ensure awareness of the issue, both among the public and staff who come into contact with older people during the course of their work. The HSE has made good headway in putting in place structures at local and national level to deal with allegations of elder abuse. It continues to provide appropriate training to staff in this regard. The national implementation group continues to oversee the implementation of the recommendations of the report on elder abuse. The Department has allocated the highest level of funding for elder abuse for the next two years to ensure these recommendations become reality.

Developments in this area must be considered in the wider context of standards of care. The Department is committed to developing person-centred standards that reflect best practice and will ensure older people in residential care receive a level of quality care that is centred around their needs. The Department is putting in place the legislative structures to ensure these standards are complied with consistently in all residential settings for older people. Such developments cannot be achieved overnight, but the House will agree the Department is progressing well and is fully committed towards these ends.

These developments are taking place in the wider context of developments in services for older people. An interdepartmental working group was established to review several complex and fundamental policy issues in long-term care for older people. Some of these issues were the subject of the Mercer report on financing long-term care and the O'Shea review of the nursing home subvention scheme. Following consideration of the group's report, a series of key principles to inform policy were endorsed by the Government and incorporated in the new social partnership agreement, Towards 2016.

These principles include, for example, that there should be one, standardised national needs assessment for older people needing care. The use of community and home-based care should be maximised while sheltered housing options will be encouraged. Where residential care is required, it should be quality care and there should be appropriate and equitable levels of co-payment by care recipients based on a national standardised financial assessment. The level of support for residential care should be indifferent as to whether that care is in a public or private facility. The financial model to support any new arrangements must also be financially sustainable.

The agreement also describes a range of initiatives covering new arrangements for residential and community care for older people. Progress to date in progressing actions in the long-term care report includes the HSE developing a national standardised care needs assessment and a standardised financial assessment process for home care packages. A needs analysis of residential care requirements for older people has been finalised by HSE. National protocols for case management for home care packages are being developed by the HSE as part of the guidelines' roll-out. A planning exercise on staffing requirements for future developments for older people and the disabled is being undertaken by Department of Health and Children and the HSE. A cross-departmental team on sheltered housing will be established and chaired by the Department of the Environment, Heritage and Local Government. Work will include other groups such as the disabled. A steering committee will be set up to begin the preparatory work of evaluating the effectiveness of the additional home care packages.

Work is continuing on the development of a financially sustainable system of funding long-term care. Standard consultation with carers' representative organisations, on a cross-departmental basis, will be led by Department of Social and Family Affairs. The interdepartmental group has continued to meet to assist in drawing up proposals for a new policy on long-term care, based on the principles endorsed by Government and the social partners.

Deputies will agree these measures on elder abuse and the continuing work in developing a new policy on long-term care, as well as the budgetary and other measures outlined by my colleague the Minister of State, Deputy Brian Lenihan, outline the Government's commitment to improving services for older people.

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