Jack Wall (Kildare South, Labour)

A perusal of the policies pursued by this Government on long-term care for the elderly over the past ten years is enlightening. First, the Government has provided tax relief to encourage the development of private for-profit nursing homes. This has led to a very rapid growth in the number of private long-stay beds while the number of public long-stay beds has not been increased. Thus, we have effective privatisation by stealth. Second, the balance between public sector and private long-stay beds has changed radically. In the 1960s, four out of five such beds were in the public sector. Now, more than half are in the private sector. Third, because of the inadequate number of public sector beds, successive Governments have subsidised private beds in various ways, incurring a significant increase in costs over the past few years, instead of developing the wonderful services provided in geriatric services in the public sector. Fourth, the Government guaranteed a medical card to everyone over 70 years of age. According to the terms of the Health Act 1970, as confirmed by the Supreme Court, this meant free medical treatment and health care, including long-term residential nursing care. The Government disregarded the statutory framework and illegally charged the elderly for such care by way of deductions from their pensions. It must now reimburse those who were illegally charged for the care to which they were entitled without charge.

In 2005, this Government passed an Act making it legal to collect 80% of their pensions from older people in long-term nursing care in order to fund their care. The Minister is now building on this recent Act to put in place a system whereby older and infirm people will not only have 80% of their income, but also 15% of the value of their property, taken by the Government to fund their long-term residential care. Why should this group of people be treated differently from everyone else in terms of health care provision, especially when the vast majority of them have a medical card and could expect to receive free long-term health care? Further, most of these people have worked all their lives and made insurance contributions and are perplexed that they now have to pay for something they thought they had already paid for in the course of their working lives of service to the community and to the State.

Let no one from the Government side put forward the argument that there are now significantly more people in need of long-term care owing to an ageing population. It is clear that despite significant changes in population, the percentage of people in need of full-time care is remarkably stable. In the late 1960s and early 1970s approximately 5% of the population over the age of 65 required long-term care, while today it is approximately 4.6%.

There have been three recent reports on care of the elderly — the report of Professor Eamon O'Shea, which deals with the issue of funding nursing home care; the Mercer report, A Study to Examine the Future Financing of Long Term Care in Ireland; and the recent report of the National Economic Social Forum, Action Plan to Reform Care Services for the Elderly. We therefore have a plethora of analysis and information about this surprisingly small number of people, which today numbers some 20,000 people in total, and which is expected to rise to just 22,000 by 2011. Even by 2050, both Mercer and the NESF predict that Ireland will have fewer people over the age of 65 as a percentage of population than the European average. Further, the most recent CSO statistics show that our fertility rate is the highest in Europe, so that the number of young people will also be growing. These will be income earners paying tax and providing support for the elderly in the next 30 to 40 years. Moreover, long-term care is a misnomer since, according to the O'Shea report, 77% of those in such care are in a nursing home for three months or less. The Department of Health and Children's annual statistics also show that of those discharged from nursing home care in any one year, 20% die, but 63% are discharged back into the community. There are therefore few people who stay for years in long-term nursing home care. The average period of such care does not exceed three years, yet the Government continually states that these people or their dependants, depending on the category of dependant, will have to sell the family home to pay for the cost of caring for a small percentage of our aging population in nursing homes.

There is, of course, a severe financial crisis for those individuals who are unfortunate enough to need nursing home care, and for their families. They find, as the Minister herself puts it, that no person can be sure at present whether they will get a public or private bed or how much they will have to pay. This crisis has been created largely by the current Government's actions as outlined above and its manifest reluctance to invest in the provision of public nursing home beds. To argue that there is a severe financial crisis for the Government in providing for the adequate care of a cohort of 20,000 is patently ridiculous. To define as a crisis the future burden to the State of providing adequate residential care for older people is an example of ageism at its worst.

The Minister, Deputy Harney, should read the NESF report with great care and especially its focus on the need to root out ageism in society. It is a fact that older people remain quite healthy, independent and able to enjoy life until the end of their lives.

I was recently involved with a group of older people in Athy. It was wonderful to see their participation and all they wanted was for the entertainment, involvement and companionship to continue. Yet, the Minister picks out a small number of older people who require institutional care and proposes that not alone must they pay over 80% of their income but she will effectively charge them 15% of the value of their property in the form of a deferred tax payable after their death. This is an unbelievable and faulty position and it leaves behind groups of people such as bachelors, spinsters and carers who are not covered in any shape or form in the information provided by the Minister with regard to the nursing home subvention.

Reference is made to persons with a disability as being the only group excused from meeting the costs by means of their parents' estate. I reiterate that the family home is the one heirloom left to a family and it will still be under threat, despite what the Minister says. Her only explanation is a reference to a similar funding method operating in the United Kingdom. This is not a sound basis for advancing this method of financing the provision of long-term care and it is easily countered by the O'Shea report which points out that most European countries rely upon state funding for long-term care through either social insurance or general taxation.

The British Royal Commission on long-term care found that the costs of public provision for nursing home care for an older and healthier population can be met within the parameters of all reasonable forecasts of economic growth. For the past decade, Ireland has experienced unprecedented economic growth which has significantly exceeded that achieved in Britain in the same period. This fact undermines the Minister's argument which she mounts in an attempt to foist the system upon the older people needing long-term care from 1 January 2008.

The provision and funding of adequate nursing home care is only one part of the State's care for older people. It has been Government policy for many years that nursing home care should always be a last resort and that as many people as possible should be enabled to live an independent life in their own homes for as long as possible through adequate home care services such as home helps and meals on wheels. Despite the Minister's claims to the contrary, the Government has done very little to improve home care services. The number of home helps employed by her Department declined by 19% between 2001 and 2005, although I acknowledge that a significant increase in home help hours is promised for 2007.

Ireland ranks very poorly when compared to other countries in terms of home help services provided. An OECD study in 2005 shows that only 5% of Ireland's over-65s receive any home benefits compared to 15% in Australia, 18% in Norway and more than 20% in the UK. A study comparing home care in the Republic and Northern Ireland put the Republic's rate at 7% compared to 17% in the North. Furthermore, as the NESF report points out, Ireland spends much less of its total expenditure on care for older people than other OECD countries, spending just 0.67% of GDP compared to the OECD average of 1%. The NESF report recommends that Ireland should increase its expenditure on older people up to the OECD average, arguing that with a healthy economy and high growth rates, the country's finances can easily bear the extra cost.

The NESF report sets out a detailed programme for the development of comprehensive and well-integrated home care services. The key factors for older people themselves, according to a survey by the NESF, were housing and transport. Housing improvements such as better insulation and safer facilities are often needed and we must put in place a significant increase in the provision of sheltered housing. For the rural elderly in particular, good public transport services can make the difference between a good quality of life and total isolation. The rural transport initiative must be extended to cover the whole of rural Ireland. A recent statement by the Minister for Community, Rural and Gaeltacht Affairs, Deputy Ó Cuív, did not go down well with the people I represent and who want our rural transport initiative to service the hospitals, day-care centres and places where people can go to enjoy themselves or visit their loved ones. They did not want a night service which they regarded as being a security risk and which would cause further isolation.

Three further requirements for effective and comprehensive home care services which will enable older people to stay in their own homes — which is where they want to be — are the concept of the integration of services; statutory entitlement to services; and universal entitlement to services.

As any carer will tell one, there is currently little or no integration of the services provided by different Departments. The interdepartmental group on the needs of elderly people was established in 1992. The Health Act 2004 required that the HSE should integrate health and personal social services. The NESF demanded that the Departments of Health and Children and Social and Family Affairs should jointly establish a broad-based group to develop a national strategy for carers by January 2007. This is now due in March 2007. There is little sign on the ground of any activity from any of these groups, yet we know that there is now also a need to integrate housing and transport policy.

Both Mercer and the NESF argue that there must be statutory entitlement to home care services. This is to give those who need these services stability and security in the knowledge that their services will not be removed at the whim of a Minister, or more pertinently, the Minister for Finance, when money is tight and that they can claim a legal entitlement to them.

The universal entitlement to services will be greeted with horror by any Progressive Democrat Minister. The argument for universal entitlement in home care for the elderly is a simple and logical one, expressed most clearly in the Mercer report. More than 90% of older people in Ireland have an income of €254 or less per week. It is a waste of Civil Service time and money to undertake detailed and complex means testing of all older people just to pick out fewer than 10% of this particular group who have higher incomes. By far the most efficient and cheapest system in such a case is universal entitlement for all those who are shown by a needs assessment to require home care.

Older people and carers struggle with the many different means tests which are inflicted upon them to see whether they qualify for different services. Many of the tests are very discretionary and it depends on where one lives or who is administering the tests as to whether the service is provided. This is not a fair method of caring for a very vulnerable group.

In her approach to long-term nursing home care for older people, the Minister and her colleagues in Government have allowed a most unjust and unfair situation to develop in the past ten years. This has suddenly been called a crisis. Their response, surprisingly, is not to accept the clear and professionally researched recommendation of the Mercer report that long-term care should be financed by social insurance, PRSI. Instead the Minister picks on just one small, disadvantaged group, the older and infirm, and argues that they alone, despite being medical card holders, must pay for their health care services.

I wish to highlight the effect of this on these people. This is the only means tested payment of any of the Departments of Social and Family Affairs or Health and Children. It is highly flawed in that it does not cover family members who may have been resident in the family home for 40 or 50 years and when the parent dies in a nursing home, the outstanding bill could force that person to sell the family home. The home is the family heirloom, the one thing the parent or loved one wished to pass on to them.

The Minister is turning the whole social welfare and health care support system on its head. In any civilised society, it is considered the country's duty to provide financial support through taxation and PRSI for those who are disadvantaged and ill. Those at work make a regular contribution through PRSI while they can afford it so that when they are out of work or retired they will be able to receive the support due from their own contributions when needed. This is clearly a better way to fund long-term care for the elderly than trying to deprive those who worked hard for so long of the heirloom they want to pass on, the family home.

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