Michael Fitzpatrick (Kildare North, Fianna Fail)

I am pleased to speak on this Bill which provides the legislative basis for the new fair deal nursing homes support scheme. Entering a nursing home or a long-term care facility can be a source of significant anxiety and upset for older people and their families, neighbours and friends. At present, there are some 7,700 people in public long-term residential care and a further 15,200 people in private nursing homes. The legislation will make arrangements for financial support for almost 23,000 people who need long-term, comprehensive care.

Under the present system of nursing home subvention, some older people and their families undergo real financial hardship to pay for the cost of care. This can include having to sell or remortgage homes. It can put families under major financial and emotional strain as they seek the funds to pay for an elderly person's care; it is a particular strain on sons and daughters with young families. Under the new fair deal people will be asked to contribute to the cost of their care according to their means. This system is fair and it treats older people equally regardless of whether they are in public or private nursing homes.

Under the new arrangements people requiring residential care will be assessed to calculate their ability to contribute to care. Under the scheme, people requiring long-term residential care will contribute 80% of their assessable income, including pensions, whether for public or private nursing home care. Depending on the amount of a person's assessable income, there may also be a contribution of up to 5% of a person's assets. The system allows for flexibility as payment can be deferred until the settlement of the person's estate. This is a welcome measure in the Bill. This system is fair as no one will pay more than the cost of their care. Furthermore, people have the freedom to choose from an approved private or public nursing home.

While I welcome the provision for older people in residential care, I firmly believe that if older people so wish, they should be supported to live in their own homes for as long as is possible and feasible. I welcome the major investment in the largest expansion ever of services for older people. A few years ago, almost no older person received nursing or therapy care at home. This service was available only in a hospital or a nursing home. Last year, over 10,000 people benefited from home care. In addition to home care packages, we have expanded home help hours by more than 500,000 hours. In 2007, approximately 53,000 people were receiving home help services. Over 11.75 million home help hours were provided during 2007. Since 2004, the Minister for Health and Children, Deputy Mary Harney, and the Government have increased the budget for services for older people by €540 million.

I welcome the increase in nursing homes in Kildare which the Health Service Executive, HSE, regularly registers and inspects. It is good that clients can now choose their nursing home and that their families can be updated by downloading the home's inspection reports. In Kildare, there are more than ten nursing homes, over half of which are in rural areas. Location is important to patients and families. I welcome the location of nursing homes in rural areas where patients can enjoy a rural setting for their twilight years. Patients also want to be near family and friends.

In my local authority area, the council has pursued a policy of refusing permission for nursing homes on the edges of towns and villages, preferring to locate them in their centres notwithstanding the success of those located in rural areas. At the end of last year, the Minister opened a new nursing home on the edge of Maynooth which provides a quality service to that community and its patients and provides badly needed local jobs, equivalent to those provided by a medium-sized factory. Making more beds available will free up our acute hospital beds and allow our senior citizens to live near their families and friends in comfortable surroundings.

Residential care facilities are very important but we must realise that only approximately 5% of older people ever need them. They are usually required after a spell in hospital, when the patient is ready to leave the hospital but is not quite well enough to manage at home alone. They can also be the best option for an older person who is rendered incapable of living alone by illness or disability. I welcome the work of the hospitals, nursing staff and HSE in securing nursing home places for elderly patients. The HSE provides a wide range of designated support for people in their own homes but at times when these people need nursing home care, it can be hard to know what is available and to what one is entitled. The forum for older people, set up in 2006 and comprising almost all of the major national organisations with a special interest and expertise in services to older people, including the Department of Health and Children, the HSE, the National Council for Aging and Older People and many other organisations, provides a valuable service. The forum has developed proposals for service developments which dramatically improve the quality of life of people in residential units.

The provision of nursing home places and home care packages is only part of a comprehensive range of services to older people. It is important that we do not consider the service in isolation and that there are also home help and day care services, and domiciliary care centres. Furthermore, there is also a range of primary care services such as GP services, public nursing services, etc. We must prioritise improved support for expansion of community-based supports and improvements in the quality and availability of hospital and residential care.

Older people are a core priority for Fianna Fáil in Government. Last year, for the first time, we appointed a Minister of State with cross-departmental responsibility for older people. The health service is undergoing its biggest reform since the foundation of the State but improvements are being made. There are real problems yet to be overcome, however, for those awaiting service and their families.

Contrary to some commentary, most of those working in nursing homes, hospitals and community-based facilities provide an excellent service which at times is not recognised. We need them and it is important to recognise their service. Sometimes we hear about hospital-acquired infection. The Health Information Quality Authority, HIQA, national hygiene services review is welcome particularly for its findings on service delivery which validate the focus of the HSE on hygiene in the past two years. The HSE has recently put in place a significant number of strategic, structural and governance initiatives. Much good work has been undertaken and positive assessments made of hospital hygiene and, in particular, of service delivery areas such as hand hygiene, equipment, medical and cleaning devices.

The Bill is fundamental to meeting the commitment given in Towards 2016 that support should be equal for public and private care recipients. It offered assurances to the most vulnerable groups in our society, those in need of long-term nursing home care, that such care would be, and remain, affordable as long as it was needed.

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