Chris Andrews (Dublin South East, Fianna Fail)

I am pleased to get the opportunity to speak on the Bill which is a milestone in terms of how older people are dealt with by the State and will have a significant impact on them.

As we get older, our health becomes more important to us and we begin to appreciate what we had. I notice a group of young people in the Visitors Gallery today. Many of us look enviously at the health and fitness of those younger than us. Health is important to everybody, but as one gets older it becomes more important and it is a concern when the body starts to fray and health deteriorates. This does not always happen gradually, but can occur quickly and can cause deep anxiety. This happens at a time when the older person's children have grown up and are now setting up their own families and living their own lives, but with their own stresses, concerns and challenges about their children. Older people may be concerned they see their children less because they are so engaged with their own children. This increases their anxiety.

This Bill will have an impact on this. The current system is unclear and in many ways unfair. The measures taken by the Government in the Bill will help to make things fairer. Fairness is what people want. As well as deteriorating health, older people often face increased social isolation. Although we have become more prosperous, notwithstanding the current downturn, people have become more isolated from mainstream society, particularly older people who feel cut off.

This is particularly true for older men. Older men do not seem to engage as much as women with community facilities and activities. I have noticed when active retirement associations have visited the Houses that they usually contain only approximately two out of 50 who are men and they are inclined to remain quiet. The women are significantly more active. The sense of isolation among older people is particularly acute among older men. This must be addressed. There are attempts being made to address it, but there is no magic wand. Older women deal better with ageing than older men and engage with community groups and activities to a larger extent.

Growing old is a traumatic and terrifying experience for many, particularly if they have no family or if, for whatever reasons, they find themselves isolated in a community in which they were not brought up. It is very difficult for these people to re-engage and become involved unless they have a strong personality. It is difficult to muster the strength needed to become involved at this time of life.

Many elderly people do not have families on which they can rely. Various circumstances have led to them finding themselves isolated without family. When people have families, the family usually does everything it can to lessen the difficulties of the older person. However, there often comes a point when there is no option but to say the family can no longer deal with the older person. I heard of the sad experience of a family, where the mother was experiencing some form of dementia. The family was concerned about her, but given the family circumstances they were not able to stay with her as much as they would like. It was when it came to the point of having to lock her into a room one night that they realised the situation was unacceptable and they could not carry on any longer. In the interest of the mother, whom they loved deeply, they had to give in and decide to let her go into a home. Such people feel a sense of failure when they have to let their mother or father or relative leave their home and their roots and put them into a nursing home.

Most experiences in public nursing homes are positive and families speak highly of the care provided. The difficulties that have been highlighted have been mainly in private nursing homes. This Bill will address such difficulties and ensure an equitable standard in these homes. It will ensure that what has been unclear will be clear. People will be able to understand and see how the system will work and how they will fit into it. They will understand how they will be able to care for their parents for the long term.

Given our economic difficulties, the simplest thing for the Government would have been to put this legislation on the long finger. While that could have been done, this Bill demonstrates the commitment of the Government to older people. The manner in which the issue pertaining to medical cards was communicated and handled was disappointing. Nonetheless, older people subsequently have told me that over the past 11 years, Fianna Fáil and the Government in many ways have acted as the trade union for older people. This legislation will reinforce such a view, will demonstrate the Government's commitment to protecting the elderly, who are the most vulnerable people in society, and will clarify matters that were unclear.

Furthermore, it will bring about change by allowing people to plan for and predict the future to a degree. Older people and families with older people who are reaching the age at which they will be obliged to enter nursing homes seek such an opportunity. They consider it to be comforting to know they can plan and predict what will happen into the future. It has been and continues to be unfair that assessments and financial supports vary so markedly across health board areas. It gives rise to scenarios in which close neighbours, who could be living across the road from each other, each must comply with different assessments, guidelines and payments. This is difficult to understand for the person who perceives him or herself to have been treated more harshly by a particular health board and is highly frustrating for the families concerned.

The pressure to secure adequate nursing home facilities is such that families may have no other option but to sell their family home. Moreover, this can take place although a child or son still lives there. The cost of meeting such charges is such that even large or well-off families find it a huge strain on their financial resources to be able to pay for nursing home care. Consequently, they find themselves being obliged to sell their home. Deciding that one's parent or loved one must enter a nursing home is one matter. However, when it is reinforced by being obliged to sell that home, it gives rise a great sense of failure, disappointment and sadness among family members. This also can vary, depending on the health board area in which one is living.

I refer to the doubt and lack of clarity on how one pays for public nursing home places, when one will be obliged to pay for it and who qualifies to get into them. Given the current economic climate, a great deal of uncertainty exists and this Bill will provide a degree of certainty to families, inasmuch as the State can. While the State will do whatever it can, ultimate responsibility comes down to families, which must take responsibility for their ageing loved ones and members.

As for the proposals, I found a newspaper report to be interesting. It stated the new proposals offer to take the value of the resident's home at the time of his or her application to enter nursing home care and to link this value to the consumer price index, not the housing market, which has changed. However, if the house prices should fall, as they clearly are at present, the resident or his or her care representative can apply to have the resident's financial assessment reassessed. This is a very positive measure.

Over the years there has been a blurring of the lines between the public and private sectors, which has had a great impact on the manner in which patients take their places in particular homes. A major difficulty has arisen in respect of the number of nursing homes and hopefully this Bill will clear the ground to ensure there are more nursing homes, particularly in the Dublin area. Recent reports have demonstrated that the number of nursing homes in south Dublin does not meet the demand. In effect, people living in south Dublin are obliged to travel significant distances to access public or private nursing homes. This gives rise to considerable inconvenience. For example, when one lives in the inner city or in Terenure, Rathgar or Rathmines and one's loved one, be it a mother, father, aunt or grandmother, is in a home in counties Wicklow or Kildare, visits will entail considerable journeys. Moreover, such distance will give rise to a sense of isolation and unhappiness with the service provided, irrespective of the micro-delivery of the service in the nursing home in question.

It is traumatic for families who are obliged to travel down the country to visit relatives. The family member may be notified of the visit but will then have to wait if there are delays, or even if the visit has to be cancelled due to traffic or other factors. The consequent sense of disappointment felt by person affected is hard for the family to take.

More nursing homes are required in the south Dublin area. While its population is both ageing and changing, a significant number of older people live there. I recently visited a service provider for older people in Rathmines, which two or three years ago used to cater for approximately 20 clients in the form of older people who visited for lunch, dinner and daytime activities. That number has more than doubled. While the general population is ageing, south Dublin is ageing significantly.

The infrastructure for older people is insufficient and this Bill will bring clarity, consistency and reassurance to them. It will allow people to plan and to predict what will happen. Moreover, it will enable them to plan their finances, which must be a good thing. The measure is designed to make the service provision for older people in nursing homes much more sustainable. The State will continue to meet almost 70% of the total cost of long-term care for the population. I welcome the Government's introduction of this measure during a difficult economic downturn. A recent NESC report on the developmental welfare state claimed the Bill will be tailored universalism. In the past few months, universal payments and their long-term impact during downturns have been debated. The Bill will not leave other people picking up the tab. Rather, recipients will pay for services on delivery. They will not be thrown out of their homes onto the streets, which would be traumatic, and they will get better care in public——

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