David Stanton (Cork East, Fine Gael)

I am pleased to contribute to the debate on this important Bill. However, I get a sense from the Bill and its accompanying documents that old people are viewed as a growing problem. The number of people aged over 65 has increased by 7.3% since 2002 and is expected to increase to more than 800,000 by 2025 and triple by 2050. Life expectancy is increasing. I would like to see this Bill put in the context of an overall philosophy of care for older people.

The Bill defines "long-term residential care services" as "a facility predominantly for the care of older people, which designation shall specify the health or personal care services to be provided at that facility" but nowhere is the definition of "older people" set out. Are they over the age of 60, 70 or 80? The provisions are vague in that regard. I remind the House that nursing home patients also includes chronically ill young people, many of whom are inappropriately placed.

In general, older people want to stay in their own homes for as long as possible. Home care packages are available but I would like to see an increased provision of sheltered housing and day care facilities. Nursing homes should be the place of last resort. People should be provided care in their own homes and day care for as long as possible, followed by sheltered housing. However, there is a dearth of sheltered housing around the country. Many people in public and private nursing homes would happily live in sheltered housing if they had the choice. We need to develop a continuum of care for older people.

Clearly, when somebody's health deteriorates to the point at which he or she can no longer continue to live alone, nursing home care has to be provided. However, an issue arises in regard to a patient's level of incapacity. Section 7(6) states:

A care needs assessment of a person shall comprise an evaluation of—

(a) the person's ability to carry out the activities of daily living, including—

(i) the cognitive ability,

(ii) the extent of orientation,

(iii) the degree of mobility,

(iv) the ability to dress unaided,

(v) the ability to feed unaided,

(vi) the ability to communicate,

(vii) the ability to bathe unaided, and

(viii) the degree of continence,

of the person,

These factors require several decisions to be made by multidisciplinary teams.

Section 7(11) states:

Where a care needs assessment is carried out, this shall not be construed as meaning that the Executive will provide or will arrange for the provision of any service identified in the assessment as being appropriate to meet the needs of the person or that the Executive has an obligation to provide or arrange for the provision of any such service.

I am not sure what that provision means. Is it an opt-out clause? It suggests that care does not have to be provided even if an assessment points to the need for it.

I am aware this is resource capped and I am interested to hear at what point these caps kick in. Section 10 deals with appeals. It is important such appeals are carried out by independent people. As pointed out by other speakers, the Bill provides that the Executive does not have to take into account a valuation provided by a property owner. I suggest that independent mediation should be provided for in this instance as in others where a dispute arises in respect of a valuation.

Section 10(7) refers to requests for information and states that 28 days be provided in that regard, which is a relatively short timeframe. The section states that the Executive may refuse to further consider an application if such information is not provided. I believe more flexibility is required and that the section should, perhaps, be reworded as often it can be difficult for a person to obtain the information being sought.

More clarification is required in respect of interest on land outside the State. Many people own property outside the State nowadays. I do not believe the Bill is clear in terms of how this issue will be dealt with. This section needs to be tidied up. The appointment of a care representative is important. The Bill states such person may be a member of a couple, a parent, child, brother, sister, nephew, niece, aunt or uncle of a relevant person. Often, elderly people who live on their own are cared for by a cousin or neighbour. The Minister of State might take another look at this provision. I know of elderly people, living on their own, who have no such relatives. I accept a care representative may also be a registered medical practitioner. However, an elderly person may have a cousin who is close to and good to them. Perhaps the Minister of State will consider taking into account such a person.

I believe there is a typographical error on page 28 wherein it is stated that the court shall not appoint a person to be a care representative unless it has before it a report. There appears to be something wrong there. I cannot make sense of it. The Bill makes reference to the Revenue Commissioners and states that they cannot act after 12 years. As far as I am aware the Statute of Limitations is six years. Perhaps the Minister of State will explain the reason for the provision of 12 years in this regard.

The Ombudsman is not mentioned in the Bill. Could the Ombudsman have a role here in the event of a dispute? I am aware the Health Service Executive comes within the remit of the Ombudsman so it might be useful to include somewhere in the Bill a reference to this. I did not come across such a reference although I may have missed it. Perhaps such reference is not necessary as the matter is covered by other legislation. The Minister of State, when replying, might state on the record whether the Ombudsman can be called upon to adjudicate or give an opinion on some aspects of the Bill if a dispute were to arise. It is not clear from the Bill whether that is possible although I believe it may be.

On ancillary supports and property, elderly people, having sought legal advice, may opt to transfer their property to a son or a daughter when they reach their early sixties, thus taking the gamble that five years will elapse following which the asset, having been transferred, cannot be touched by the State. Not everybody will have the wherewithal or legal advice to do that. People who do this may also include in the transfer a clause which provides that they may reside in the house for as long as they live. It could well happen that many houses belonging to older people will be transferred at an early stage to sons or daughters with a condition attached that they may reside in the house for as long as they want. However, ownership of the house will then lie with the son or daughter. Could this type of transfer get around this legislation? From my reading of it, I think it could. I am not sure how this issue can be addressed but it is important it is addressed.

I was told a number of years ago that construction of nursing homes in Denmark ceased in 1997. They may have built a great deal of them prior to then. Going back to my original point, their philosophy is to care for people in their own homes, sheltered housing, day-care and so on for as long as possible. Also, they have a national rehabilitation service which we do not have. Often, people here, many of them stroke victims, end up in nursing homes owing to a lack of rehabilitation. The philosophy on the Continent is that a person first be stabilised in an acute hospital and then moved to a rehabilitation unit. I have visited some of these units, which are amazing and provide all the services required. While we have an excellent rehabilitation centre in Dún Laoghaire there is a lengthy waiting list for admission to that facility. We all know stroke victims go downhill very quickly without early rehabilitation. I was amazed by the intensity of the service provided at the rehabilitation centre in Denmark and in other parts of Europe. The philosophy is to assist a patient to be as good as he or she can be and to return him or her, where possible, to the home or sheltered housing. A person here who suffers a stroke is taken to an acute hospital and usually ends up in a nursing home. In many cases, there is no need for this.

The National Treatment Purchase Fund will be involved in negotiating prices. I am aware that in some places commissions have been established to set maximum prices to ensure there are sufficient resources to run an operation, that standards are not impacted upon and that investors obtain a reasonable profit. The setting of prices may be an issue worth examining. It is important assessments are carried out quickly. There are two types of assessment involved, namely, the financial assessment and the medical assessment. It may be possible for a person to arrange for a financial assessment to be undertaken at an early stage. For example, a family who is aware a person will require nursing home care might require that such an assessment be undertaken, say, six or 12 months earlier. This would help to speed up the process. Often, people get ill quickly, a family cannot cope and a delay occurs in getting them into a nursing home. This is when the real stress builds up. I say that bearing in mind all of the services we need to put in place, including rehabilitation services etc.

We must be careful. There is a great deal happening in the property market. There have been massive changes in a short period and the value of property has fallen dramatically. The current situation is an awful mess. The system needs to be tightened up and clarified.

I look forward to the rest of the debate.

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