Fergus O'Dowd (Louth, Fine Gael)

This is a very important debate, which deals with the future of those people currently in nursing homes, as well as with our own future. It is about where we and our families will end up, not just those fine people — some 30,000 of them — who currently reside in nursing homes.

Sickness comes to us all, and none of us will live forever. The Department estimates that 4.6% of the current population over 65 are in nursing home care. The total proportion of those who ultimately end up in nursing homes is comparatively quite small. By trying to keep our people out of nursing home care and by having effective, efficient, committed and dedicated community teams to look after our senior citizens, we will keep that number as low as possible. Nobody willingly wants to go into nursing home care, while two thirds of those in such care are deemed to be highly dependent.

The fatal flaw in this Bill is that it does not deal with the fundamental issue of sharing the cost burden of the nursing home. The penalty for being sick when elderly falls on the individual who happens to get ill. It does not respect such a person's income, qualifications or family background. Everybody who ends up in a nursing home must pay the costs, or else their family pays them. This Bill makes sure that if somebody is not lucky enough to have the money to pay for nursing home care, then 15% of the sale of that person's house plus a proportion of the person's assets per annum will go towards paying for his or her care. That is fundamentally wrong and unjust.

How we treat people in our society, especially the very young and the very old, indicates the value we place on the most vulnerable. Nobody is arguing that the cost of a long-term stay of a child in hospital should come out of the family income. Nobody is arguing that a women having a child in a hospital should pay for the child birth if she does not have health insurance. The State picks up the bill in that instance. Why should we victimise elderly people and insist that they must pay for their care, and if they cannot pay for it, insist that payment come from the sale of their homes? Not only must people sell their homes, but they must sell those assets at 15% of their value when they went into the home. People spend three and a half years, on average, in nursing homes. When a house is sold in line with this measure, 15% of its end value will be much more than 15% of its value when they went in. When this Bill was introduced, house prices were much higher than they are now. As this measure is fundamentally wrong and unjust, we must decide how to deal with it. I suggest that we should revisit the 2002 Mercer report on the care of the elderly, which included a number of recommendations. We should consider the introduction of an insurance scheme, for example, whereby a specific contribution is made as people age. That money should be ring-fenced and ultimately used to meet the cost of future care. As people go through their working lives, every single individual, rich or poor, should know that if and when he or she gets sick and needs to go into a home, all of us will share his or her pain. In such circumstances, everyone should make a contribution to the cost.

Nobody should have to sell his or her home. That is a fundamental and important aspect of this issue. People value their homes more than anything else. As we know, the Government is introducing legislation to try to ensure the banks will allow people to stay in their homes when they cannot afford to pay their mortgages. Everybody recognises the need for social justice in this regard. A deeper form of justice is at play when it comes to making sure that those who happen to end up in nursing homes do not have to sell their homes and bear the cost of it. I urge the Government to think again about this aspect of the legislation, which is fundamentally flawed. The proposed system is totally unacceptable to me.

Approximately two thirds of people in nursing homes are in high dependency categories. They may not be able to get out of bed, for example. Many of those who have Alzheimer's disease cannot speak or walk. In many cases, people in nursing homes have no means of expressing what is happening to them. They are extremely vulnerable. The HSE website provides evidence that time and time again, private nursing homes are unable to care for such people. They do not have enough staff on duty, particularly at night, to look after them.

I would like to refer to a HSE evaluation of 25 of the 26 complaints that were made about nursing homes in the Cork-Kerry region in 2007. The complaints related to non-accidental injuries, including trips, falls, fractures and bruising; dehydration; problems relating to pressure sores and wound care; lack of attention to residents' personal hygiene; poor standards of hygiene; inadequate care; an assault by a resident on another resident; absconding or leaving a nursing home; staffing levels; rough handling of residents; issues relating to contracts of care, including finances; poor communication between those in charge of nursing homes and families; and failure to summon medical care or to seek medical opinion. One of the evaluation's recurring themes is the care of residents with dementia or mental health problems.

I would like to mention some incidents in a specific nursing home in Cork. They are by no means unusual in Cork or anywhere else in the country, sadly. A patient with dementia suffered a fracture while in bed. Another patient, who had high levels of dependency, was allowed to rest on a broken bed. No explanation was given for the discharge of a patient, following respite care, who had an infected leg wound. In other cases, individual patients at the home were found to have an infestation of head lice, an untreated leg wound, to be suffering from dehydration, to have new and discoloured pressure ulcers and bruising on the body, to have a swollen and bruised right foot, to have scratches on the genitalia and a tear on the perineal area. A patient aged 94 with poor hygiene was admitted to Cork University Hospital. Cases were reported of rooms not being cleaned for new patients, soiled sheets being discovered and confused patients being allowed to enter rooms and rummage through other patients' clothes. Bells were not answered at night. In cases of falls, family members were sometimes expected to take patients to the local accident and emergency department. It was found that some clinical procedures at the nursing home were carried out in a rough manner or without the permission of the relevant families. That is a sample of what is going on.

I invite the Minister of State, Deputy Hoctor, to take the time to visit the website to get evidence of what is happening in many nursing homes. I wish to make it clear, in the interests of fairness and objectiveness, that a significant number of nursing homes provide an excellent and first-class service. However, an equally significant number of nursing homes are bad and some of them are absolutely appalling. If one was depending for one's evidence on the facts in the Leas Cross documentation that I obtained under the Freedom of Information Acts, one would not think there was anything wrong with the place at all. There was just one hint of a problem at the home. Many other nursing homes are just as bad as Leas Cross, if not worse. Despite what those on the other side of the House might say, nothing has changed. In my view, things have got worse. The only good thing that has happened is that the HSE is providing for out-of-hours inspections in some cases. Inspectors discovered some appalling things in a nursing home in County Cavan at 4.30 a.m.

The law has not changed. One of the key points I would like to make is that the law should impose a statutory duty and obligation on people, particularly those who work in nursing homes, who have evidence of elder abuse. They should be obliged to report such evidence to the relevant authorities. There is no such obligation at present. It should be a criminal offence for them not to report what they know to the HSE or the competent authorities. The problem at the moment is that we do not know about these things because they are not being reported.

The HSE's lack of accountability also needs to be considered. The HSE has a statutory duty of care to ensure that every nursing home in the State is inspected at least twice per annum. In previous years, I used to get those details when I tabled a parliamentary question on the matter to the Minister. Last year, however, the HSE responded by saying that it did not keep the information I was seeking, or that it did not have time to give it. In other words, it could not care less. It is appalling that there is such a lack of accountability or concern at administrative level within the HSE.

I have made a complaint to the Irish Human Rights Commission about the abuse of people's human rights that is taking place in nursing home care institutions. I received an answer from the commission today. I was sent a letter to the effect that a member of staff from the commission had spoken to the senior inspector of nursing homes within the Health Information and Quality Authority, whose name I do not immediately have to hand. As I understand it, the senior inspector informed the commission that the Minister for Health and Children has not yet signed the order to allow the authority to inspect private and public nursing homes. That is a disgrace. It was supposed to be signed in January, but it has not happened yet. I urge the Minister to sign it immediately. I have faith in the totally independent inspectorate that the Health Information and Quality Authority will put in place. The inspectorate does not have any statutory powers at the moment. It is not acceptable that we are continuing to rely on the structures that have been in place over recent years.

I would like to speak about the merits of public and private nursing homes in the context of a contribution made earlier by a Deputy, whose comments I respect. The Deputy in question suggested that the State now takes a neutral stance on the question of whether people should opt for public or private care. In other words, if somebody has to go into a nursing home, the State does not mind whether he or she goes to a State institution or to a private institution. That is unacceptable. It is an abrogation of the State's responsibility and accountability when it comes to the care of senior citizens. It is part of the ongoing policy of the Minister, Deputy Harney, to privatise the health services. There is absolutely convincing international evidence to suggest that private nursing home care is not as good as State nursing home care. The best care of all is not-for-profit care.

There is a way around all of this. The State has encouraged builders, etc., to invest in nursing homes. When such people build the infrastructure for a nursing home, they do not have the capacity to run it. That is what happened in the case of Leas Cross. The State needs to continue to encourage people to invest in the physical buildings, but it should run them. In the absence of the State, voluntary not-for-profit organisations should be encouraged to get involved. They should provide services in buildings that have been developed by others. While each nursing home would have to be run as a business, obviously, the money that would be made should be reinvested in the home's patients and clients. If there is a problem with the person who made the investment, he or she should be entitled to get an income from the home.

The present system, which has failed miserably and appallingly, is unacceptable. I ask the Minister of State, in her speech at the conclusion of this debate, whenever that is, to give the House a commitment that the final report from the Leas Cross inquiry will be debated in this Chamber. As the report has now been delayed by six months, I am sure it will include many recommendations, all of which should be brought into effect. That is critically important.

Other issues pertaining to nursing home care have been brought to my attention. One such issue is that the economic and social status of siblings living together, as many do throughout the country, is not recognised under the Bill. They are not classed as couples and are, therefore, charged individually, which may leave the sibling in the home particularly worse off. He or she cannot apply for financial hardship due to the conditions requiring him or her to be made part of a couple. That issue must be addressed.

Those involved in the care of the aged in our community have brought a number of other issues to my attention. A key point is whether people will be better off under this Bill than they were heretofore. The case has been made that the quality of care is not improving and I accept that is the factual position. The majority of clients who will be cared for in nursing homes under the provisions of this Bill will have high levels of dependency. A key point is that nursing homes do not have sufficient staff with the necessary qualifications to care for these people. Nursing home staff will not have the capacity to look after these very ill patients and the necessary facilities will not be in place. A key issue in the case of Leas Cross Nursing Home was that, while it was evident from television coverage or if one walked around it that it was a state-of- the-art building, patients with high levels of dependency who resided there were not properly looked after.

There is evidence that some people in the State system are being abused, namely, some people in some State-run or in HSE nursing homes. Cases of such abuse in Donegal have been brought to the attention of the Minister of State. A case is under investigation in an institution in Roscrea. I have not been able to obtain any further facts on it. Perhaps the Minister of State can advise what happened in that case, as the HSE was not in a position to advise me, other than to indicate that a serious investigation was carried out there. I would like to know its outcome.

The response I received from the HSE in one area was shameful and disgraceful. I inquired as to the reason a facility in Dundalk was not taking in any more respite patients during the summer. Under a freedom of information inquiry, I discovered the reason for this. It transpired that approximately a year ago when some agency nurses in a unit did not turn up for work and no nursing staff were available to look after the patients, domestic staff took on nursing duties. That happened over a period of time and it is well documented. The HSE decided it could not allow that situation to continue. It decided that it would not take in any more respite patients in order to reduce the exposure of patients to a lack of care arising as a result of agency nurses not turning up for work.

I was shocked to read about that. While I appreciate that the staff there tried to help out, they were not qualified or able to do the work. I submitted a question to HSE areas throughout the country seeking information on whether there is evidence of such practice occurring elsewhere and I have yet to receive a response from some. The HSE in Cork kindly replied to the effect that the processing of my freedom of information request would cost €50,000. That represents an obstruction in my trying to ascertain the facts. The Minister of State has responsibility for this area. I ask that she take up this issue with the HSE and inquire what other evidence, if any, there is of agency nurses not turning up for work resulting in patients, in some cases, in State institutions not being looked after properly. If domestic cleaning and caring staff are doing the work of nursing staff, that is not acceptable.

The situation is serious. The Government has not acted adequately or properly in this respect. If this Bill is enacted, I would be particularly concerned about provision for those people who may not have any income, other than their State pension, of whom there are thousands. I refer to people, in the main, currently in our State institutions. They are there mainly because their only income is their State pension, they do not have private insurance and cannot afford to go into a nursing home.

The sale of such a person's home, the only asset he or she has, will impact heavily on that person's family. Mary Murphy or Johnny Maguire, on going into a nursing home, will be told she or he will have to sell her or his home. That may be the only asset that person has to hand on to his or her family or relatives. It is a measure of the lack of respect we have for these people, if we do not say that should not happen. We would not ask such a person to sell his or her home if his or her child was sick in hospital. Neither would we ask such a person to do so to pay for his or her care if he or she was under the age of 65 and had been in hospital for a long time. However, once a person goes into State care or nursing home care, that person is told he or she must sell his or her home. There is a basic inhumanity in that process. I ask the Minister of State to reflect on those issues.

Under this legislation, the Minister of State is delivering these people into the hands of a negotiating team, the National Treatment Purchase Fund, who will negotiate with the nursing home owners the price of care. My evidence is that nursing home costs are increasing. People cannot afford to pay such costs. The HSE is not increasing subventions. Will the basic cost of care include cost of physiotherapy, speech therapy, patients' laundry, all those services the provision of which involves extra costs under the current system? Whatever amount the Minister will fix and whatever cost is negotiated, it will not be sufficient because the nursing homes will seek more and more money. My basic point is that they cannot provide adequate and proper care. Poor helpless people will find themselves in a worse situation than they are in at present.

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