David Stanton (Cork East, Fine Gael)

I want to mention again the philosophy we should take on board when dealing with older people. We should not see older people as a problem, but that philosophy appears to permeate this Bill and the thinking in it. I urge Deputies from all sides not to refer to older people or think of them as a problem that should be hidden away in a nursing home. We must look at other solutions and ways of enriching the lives of older people. Most people want to live at home for as long as they can and all the supports necessary for that should be put in place.

I want to discuss the situation with regard to charging long-term residential care patients whose income is from disability allowance, which is paid at a lower rate than the maximum rate of the State pension. When new price regulations came into effect in January this year, many people with disabilities in long-term residential care had to pay 75% of their allowance towards residential care. I understand that some 32% of people with an intellectual disability in Ireland are in full-time residential care. This could amount to more than 8,000 people. Some 70% of people with an intellectual disability who are in residential care are under 55 years and they receive a disability allowance, not a pension. When the Government introduced the new charges, it contended that these rates are maximum charges and should be based on the assessment of need. However, Inclusion Ireland argues that people's needs are not always independently assessed and the maximum charge is routinely applied. Many people with intellectual disabilities could spend 50 years or more, their whole lifetime, in residential care as parents are often not in a position to provide appropriate care at the level required to adult children with intellectual disabilities.

I realise the current philosophy is to help people with intellectual disabilities to live in the community, as much as possible. That is the way it should be and we should try to move in that direction as much as we can. However, this is not always possible. Many older people only spend a few years in residential care because they are near the end of their lives. I suggest a different charging scheme could be implemented for people with intellectual and other disabilities which require them to live in residential care their whole lives. We need to consider this cadre of people who are separate to older people. The emphasis has been on older people, but I want to draw attention to the needs of people with intellectual and other disabilities who spend much of their time in residential care. We should tease out their needs on Committee Stage.

Inclusion Ireland noted that leaving people with an intellectual disability with just over €50 per week to spend after charges are deducted from their disability allowance does not promote inclusion in society. The charge has also been increased at a time when we still have no standards or independent inspection of residential services for people with an intellectual disability. I urge the Minister of State to take this matter on board.

Residential and inspection standards have been developed for older people living in residential nursing homes, and this is as it should be. Standards for residential services are vital, not just for nursing homes to prevent elder abuse cases, but also for people with disabilities in long-term care. I understand there are still no standards in place for residential institutions which cater for people with intellectual disabilities. The new charging scheme applies to these people, but the same standards do not. There is work to be done in that regard. Standards were due to come into effect in early 2009, but they are still not in place. This means there are no national standards or inspections available for these people.

The issue of funding is also crucial. Has the Minister or the Government ever considered some form of funding through the social insurance scheme for nursing home care? This could be funded through the PRSI system and could possibly replace the current private health insurance system. I understand the health levy amounts to a considerable sum and that it took in over €1 billion in 2007. The estimate for 2008 is €1,330 million. These funds currently are awarded to the Department of Health and Children and form part of the Vote of the HSE. Is there any stipulation with regard to how that levy is spent? Has the Government examined the possibility of raising it as a means for people to make a personal contribution towards future nursing home costs?

As I said previously, people needing nursing home care could sign their houses over to a relative while they are still fit and after five years that person would own the property and the State could not pursue nursing home charges on that property. There are, therefore, anomalies in the Bill. People who work hard all their lives and save will be hit, but those who do not, will not be hit. I look forward to Committee Stage.

See this speech in context