Michael Kennedy (Dublin North, Fianna Fail)

I welcome the opportunity to speak on this legislation, primarily because of its emphasis on accessibility and affordability. These are two of the most important elements of any measure taken relating to health care, and they have never been more important than with regard to nursing homes.

Like most of our colleagues in the Dáil, I have been flooded with queries relating to nursing homes over my time as a public representative. I appreciate the level of worry being felt by older people in Ireland about their future. There is no denying that the current nursing home system is far from perfect, as there is an abundance of private beds and a shortage of public beds. The associated cost of care depends on whether a patient is public or private and the availability of a suitable bed.

Reflecting on it, I realise the current system is an ad hoc collection of various local schemes, with varying degrees of subvention available depending on a person's circumstance and location. This inconsistency means there is little transparency and much confusion. It is impossible to determine the needs of patients and therefore no consistent information exists which would allow authorities to allocate particular beds to those with the greatest need.

Another consideration and a serious contributing factor to the need for this legislation is the growing number of older people relying on the State. The implications of this trend go across the board from social welfare to pensions and finally to nursing home provision. By 2036, the Government estimates that there will be an astonishing 1.1 million people over the age of 65, representing 22% of the population. One can imagine the cost of providing care for these people, especially under the existing scheme, where the State pays for a large proportion of the both private and public care. A fact which must be emphasised now is that the State will still fund the largest part of the case costs overall and that individuals are being asked to pay only a small contribution where they are able to.

The current nursing home provisions are the product of years of alterations and a failure on the part of successive Governments to grasp the system by the neck and shake some sense of consistency into it. What should be an easy and compassionate process is reduced to an overly complex, stressful and ultimately expensive ordeal. The Minister, Deputy Mary Harney, and her Department have addressed these difficulties and kept them to the forefront of their minds when penning the new legislation. The main selling point of the Bill is its simplicity, as it promotes transparency and equality. All those availing of the measures contained within will pay an identical proportion of their estate for their care. The fair deal is easy to understand and it will supersede the existing subvention scheme. Nobody who cannot afford it should be expected to foot the entire bill for their nursing home care, yet this is the aim of the current subvention system.

Unfortunately, the State cannot afford to fully pay for the care of the elderly. This issue is undoubtedly on the forefront of any older person's mind as they enter into a nursing home. I can only imagine their fears in terms of whether they are eligible for subvention or if they or their family can pay the rest of the bill. They will not want to be a burden to their family and may wonder what will happen if they cannot pay the bill. We frequently hear such concerns from our own family or neighbours. Such people would also wonder who will take care of them.

With the fair deal scheme, such questions are answered. Under the new scheme, an individual will make a financial contribution to care based on income and there is no distinction based on age. Their families and partners will not be liable for the expense of the care and once it is decided to apply to the new scheme, a care needs assessment will be carried out. The assessment includes an evaluation of patients' needs, including whether they can dress, feed and bathe themselves unaided, as well as their ability to communicate. Once a person's need is established, a means test will be carried out by the HSE and the individual's financial contribution assessed. The eventual figure arrived at will be a combination of 80% of a person's assessable income — their pension perhaps — per annum, along with 5% of their assets, possibly their savings over a year. There is a disregard set at €36,000 for individuals and €72,000 for couples, after which the 5% will apply. If the older person's assets include land or property, this element of their contribution can be deferred until after their death, and can be collected from their estate.

The 5% contribution will be applied per year for the first three years and, importantly, will be capped at 15%. That is an important issue. In the case of couples, this will be capped at 7.5%, where one person remains in the home. If a partner or other dependants remain living in the home, payment can be further deferred. If the individual in question is unable to make the decision to go into a nursing home, then he or she can be appointed with the approval of two medical professionals. In these cases, an application must be made to the local circuit court.

There is a certain level of confusion over whether, under the scheme, the State will move to take a person's house from the family after their death. This is not the case. If the deferred contribution option is chosen, the most the State will ever get from an estate is 15%. There is also a perception that this percentage could be increased, but it cannot be. It is capped at 15% for an individual and 7.5% per couple, where one partner remains in the home. While there has been confusion about it, we must stress that fact, which should put many people's minds at ease.

The new scheme provided for in this legislation will be implemented by the HSE with the assistance of the National Treatment Purchase Fund. Whilst the HSE is to be responsible for the care needs and financial assessments and then the provision of information on the available suitable home, the National Treatment Purchase Fund will be the agency to negotiate the price of beds. The price of care will then relate to the needs of the patient, with higher prices charged to those who need more care, which is in line with the equitable nature of the proposed legislation. It is worth noting that same-sex relationships and co-habiting couples are viewed as having equal rights under the scheme to those who are married.

The new scheme will make long-term care more affordable. It will remove anxiety thus providing older people with peace of mind. It will ensure that the same level of State support is available to everyone, whether they are public or private patients.

I look forward to debating subsequent Stages of this legislation, which I hope will have a quick passage through the House. As public representatives, we have all heard the concerns of those affected by the need for nursing home care. I hope all sides of the House will support the Bill expeditiously.

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