Mary White (Carlow-Kilkenny, Green Party)

I welcome the Bill before the House. It has been a long time coming. We know that rushed legislation often is poor legislation. The patience in bringing forward this detailed Bill hopefully will result in a good Bill that is in the best interests of people who need to access nursing home care.

We all know that an issue such as the provision of care for the elderly is an emotive and important one. I have met many families in my constituency of Carlow-Kilkenny who were desperately trying to support a loved one in a nursing home, perhaps struggling to cover the cost of case with a subvention or the lack of it, paupering themselves in many instances to ensure that a much loved relative could have comfort and care at the end of his or her days. This Bill addresses that worry. I have no doubt there was a temptation to bring forward this Bill at an earlier stage so that the Government could provide the country with a new framework for nursing home care, but I believe this legislation will make sound investment for the future and remove much of the worry experienced by the families to whom I have spoken.

Having a relative in a nursing home is a tremendous wrench for a family, the move often deeply upsetting, the feelings of guilt uppermost in people's minds, even though we know with our minds, if not our hearts, that care is needed. That, added to the financial worry, results in a family being deeply stressed at such a time.

We knew that we had to have a new framework for care for the elderly in Ireland. It was much needed. With an aging population the demand for nursing home spaces has increased immensely, as has the provision of care. Currently, as the Ceann Comhairle probably knows, there are more than 18,000 private beds and approximately 9,000 public beds in the country, but huge regional disparities underlie these figures. Big shortages are to be found on the east coast and in other parts of the country such as in the north east and even with State subvention, beds are often 50% more expensive than the nursing home spaces, many of which are in the south west.

The current framework of nursing home subvention had to be replaced. The State is currently subsidising much of private nursing home care — 50% of private nursing home funding comes from the nursing home subvention scheme — caused in part by insufficient public nursing home beds. The regulatory impact analysis for this Bill stated that under the current system an individual who gets a public long-term care bed may be charged a maximum of up to 80% of the non-contributory pension; while every resident in public care has to pay the charges, which are capped regardless of means. The person availing of long-term private care, however, is subject to a rigorous means test. Some may be deemed ineligible for subvention, hence the anomalies in care to date. Problems also arise in our hospitals because of this framework. Many patients are kept in hospitals longer than necessary because there is a shortage of beds in nursing homes. This gave rise to that awful term, "bed-blockers", an obscene and degrading term which should not have been coined in the first place.

The new scheme, as outlined in this Bill, will provide for an accessible and far more equitable system. At the outset, professionals from the HSE will be required to conduct a comprehensive evaluation of people's care needs. This is vital if we are to ensure that care is targeted, appropriate and given to those who really need long-term residential care.

The principles underlying the financial assessment of people, and the State funding of care, as contained in this Bill, are that co-payment is calculated in accordance with ability to pay; that no one will pay more than the cost of care; that an initial amount of income will be disregarded; and that there will be capping of charge on people's principal private residence. These are all sound and will give us better care for our elderly. The principle that the State will guarantee the costs of nursing home care over and above 80% of a person's assessable income is something we can support.

The present inequitable and unsustainable system is addressed by the Nursing Home Support Scheme Bill. Long-term residents in nursing homes, who are on similar incomes, are unlikely to end up paying vastly different care costs as a result of this Bill. I commend the Bill to the House.

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