Seymour Crawford (Cavan-Monaghan, Fine Gael)

I welcome the opportunity to speak on this very important legislation which has been awaited for some time. It was known originally as the "Fair Deal Bill" and is now known as the Nursing Homes Support Scheme Bill 2008. Why was there a change of name? One must ask many questions about the nature of this Bill.

Deputy White spoke about the difficulty in getting patients moved from hospitals to nursing homes and that, as a result, individuals are being called "bed-blockers". This is an awful name and is completely unfair. Very often, such people are not able to move because of the difficulty with the present subvention system. It is possible that I know more about that than anybody else in the country because of the situation in Cavan-Monaghan. I say that without fear of contradiction because during the last election I talked to both my party leader and to the then leader of the Labour Party, Deputy Pat Rabbitte, about the situation in other constituencies to which they travelled. There did not appear to be the same pressure in other areas as there was in my immediate area. I have further proof of that because when people moved out of my immediate area, while remaining the responsibility of the Cavan-Monaghan grouping, nursing homes in Sligo could not believe the greater difficulty they had in dealing with the assessment office in Cavan. This was no fault of the people there who were just doing what they could with the money available to them. However, it was a different situation. I was glad the Minister of State referred to this in her speech. She admitted there was inconsistency between different areas. This is completely wrong and must be rectified. I hope the situation will be different.

However, after a cursory glance at this Bill, one must question how it might be. The initial budget for the fair deal Bill was €110 million but only approximately €50 million is to be allowed for this year. I imagine it was expected the Bill would take a long time to go through the system and that the money might not be needed. A ceiling will be put upon it and, if that is to be the case, we will return to a situation where somebody decides who will get a nursing home bed and who will not. That is a major worry to me.

Assessment is another issue that worries me. Assessment will be made by individuals in the health services and I have a serious anxiety about that. Assessments are made concerning home help that raise major questions. Who decides who will get two or four hours, or one hour, per week?

I will mention another issue in passing before giving more detail. I refer to the different groups that are allowed to benefit from the Bill. Section 4 defines a couple, for the purpose of the scheme, as a married couple, a heterosexual or a same sex couple, who have been co-habiting as husband and wife for at least three years. As somebody who lives in a rural area where there are a few other people like me who never married, I know several situations where there are brothers, or brothers and sisters, or sisters living together, perhaps for 30, 70 or 80 years, rather than for a mere three years. However, they are not entitled to be treated in the same way as those heterosexual couples and others mentioned in the Minister of State's speech. Same sex couples will get preference over family members who live together. There are all sorts of implications in this. There could be a situation where somebody retires early to look after a loved one. However, because that person is not the dependant of the loved one, he or she will not be treated in the same manner as same sex couples. That is a major issue.

There has been much talk over a long period in this House concerning legislation for the inspection of nursing homes and the need for independent inspection. That must be equal across all nursing homes, whether private or public. The majority of nursing homes I deal with are good and of high quality, for example, St. Mary's Nursing Home in Castleblayney. That home is absolutely brilliant. There are other private nursing homes that are of an equal standard, and almost as good as St. Mary's. However, when we come across other situations, and the subsequent investigations into those situations, we must raise major questions. I have an e-mail from a daughter about a loved one. This person did not die in the nursing home in question because friends of the family got her moved to Our Lady of Lourdes Hospital in Drogheda where she subsequently died. An inquiry was held but, although names, addresses and telephone numbers were supplied of people who had attended that nursing home and seen what had happened, they were never contacted. What sort of inquiry was that? It was totally unrealistic and irrelevant and gave only the account of the staff in the nursing home. It is a home which I normally have much time for because it usually does good work. A situation such as the one to which I refer is unacceptable and raises many questions about how investigations are carried out.

The Bill, and the length of time it has taken to get through the House are causes of much worry. People have been expecting it for a long time. A family approached me about 18 months ago. They had literature from a farming organisation of which I am a member, the IFA, stating that this great Bill would sort out everything. They had two loved ones going into a high dependency ward in a nursing home at significant cost to them. They thought this Bill would sort out everything. Although, thankfully, matters sorted themselves out reasonably well, in that context the situation was untenable and unfair to many people.

I am greatly concerned about some details in this Bill. Making fair what has been unfair and making consistent what has been haphazard is not good enough if it does not solve the problem completely. The capping of the money is very serious. This is a needs-led situation and nobody can tell how many people will need this type of support on any given day. The capping of the money is not on and must be examined. We can find €7 billion for banks that run riot, whereas only €50 million is allowed for the remainder of this year. How much will be allowed for next year? We have to live and see. Will the Bill operate on the basis that a finite sum is available? Will high dependency define up to the point of the ability of the State to pay? There will be differences in the ideas of HSE staff who will decide who will get a bed and when. That is unacceptable.

Nursing homes have different costs. While an ordinary dependency person can get a nursing home at €800, somebody who needs a high-dependency unit, for example an Alzheimer's disease patient, could pay up to €1,000 or €1,100, even in my home area. Will that be allowed for under this Bill? It is equally important. Many people in very poor circumstances are being asked to pay the difference between what a nursing home cost in 2007 and what it costs today, and they cannot afford it. It is putting tremendous pressure on them. I know an elderly person on an old age pension who lives just outside Monaghan town who is being asked to pay the difference out of his social welfare yet is expected to keep a car on the road to travel to and from that nursing home daily. This is unjust and I hope this Bill will rectify such situations, but I am not sure because the devil is in the detail.

The other issue about which I am worried is property, specifically farm holdings. A farmer may live a normal length of life and decide to hand over the farm holding to the son or daughter. If the holding is out of that person's name for five years it is no longer taken into account. On my way up the road this morning I was told of a situation where a young man's father dropped dead suddenly a couple of years ago. The man's mother had been in a bad accident 15 years ago, and while the father could cope, the family could not and she is in a nursing home at a very early age. I will not quote her age because I do not want to embarrass any family. As the property was transferred less than five years before the father's death, there are all sorts of complications. This Bill does not clarify how that family will cope. I hope through the detailed study of the Bill afterwards situations such as that can be clarified. Not everything is clear cut and goes the way the clerks expect it to, and that is just another example of serious difficulty.

I was glad that in the budget the Minister for Finance, Deputy Brian Lenihan, referred to the tax benefit for anybody staying at home and that is some relief. Some might argue that one house might be worth €1 million while another house is worth only €100,000; that is not fair. However I am much more concerned about the property issue. If a person is unfortunate enough to go into a nursing home at an early age as a result of disease or a stroke, the 5% comes off for every year that person is in a nursing home. This is very unfair and could create major problems. Taking a farming situation, if that went on for seven years it would take 35% of a farm holding. No son or daughter could raise that sort of money.

If the bank gets to know that the loved one who holds a title is in a nursing home, will it lend money to the young person running that property, shop or whatever other business? Some of these matters may be constitutional and raise questions. I appreciate that the Bill went through a long gestation period because of many of these issues, but there is still much concern. A few months ago one of my colleagues mentioned in a speech that he was worried about shares. Shares are not a major problem now, especially if they are in banks.

I want to return to the medical assessment, a serious issue about which I am very concerned. A person living alone in an isolated area may want to go into a nursing home earlier than somebody in a family situation with plenty of support and help. Will those circumstances be taken into account as part of the assessment? If not, we have a major problem. These issues must be clarified. Another issue was brought to my attention in recent days, that of somebody who has recently returned home from the US, the UK or anywhere else. Deputy Connaughton has dealt more than anybody else with the people who went away years ago, had to come home or wanted to come home and may not have any family. What is their situation? Will they be treated in the same way as a non-national who has been in this country only a few years? Will the fact that they were born and reared in this country and their wish to come home be taken into account? The person about whom I am talking, whom I met in the past few days, had two brothers in the US, both of whom are deceased. None of the three married and they have no families, yet all his family circle are in the region to which he has returned. He does not want a nursing home now, but if he wants one in the future what will be his situation? He would still carry the pension from the US, the UK or wherever he worked, but alone it would be insufficient and he is unlikely to have any property. That is an interesting question. There is another issue. If any person, including the Minister of State, has a second home here — I am not sure whether the Minister of State does or not — it is taken into account, but if a person has a home outside this country it is not taken into account. This is a strange situation and one over which there are major question marks. I hope I am wrong. Am I?

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