Ulick Burke (Galway East, Fine Gael)

Ba mhaith liom mo chuid ama a roinnt leis an Teachta John Perry.

Cuirim fáilte roimh an Bhille seo, An Bille fán Scéim um Thacaíocht Tithe Banaltrais 2008. É sin ráite, tá beagáinín imní orm maidir le nithe áirithe a bhaineann leis. Tá imní orm más í aidhm na scéime daoine scothaosta a chosc ó chúram cónaithe fadtéarmach mura bhfuil géarghá acu do chóir leighis. Tá cúpla ceist agam le chur ar an Aire. An ndéanfaidh an Rialtas geallúint dúinn go gcuirfidh sé dóthain airgid agus áiseanna tacaíochta ar fáíl ionas gur féidir le na daoine scothaosta seo fanacht ina dtithe féin agus i measc an phobail chomh fada agus is féidir leo agus go dtabharfaidh sé cúram dóibh? Fé láthair, is beag an cabhair atá le fáil do daoine scothaosta ar mian leo fanacht ina dtithe féin. An mbeidh dóthain airgid ag an rialtas áitiúil chun deisiúcháin a bhfuil géarghá leo a dhéanamh? An mbeidh deontas ar fáil a cabhróidh leis na daoine seo fanacht ina dtithe féin chomh fada agus is féidir leo? I dtaca leis an measúnú sláinte, an ndéanfaidh bord neamhspleách an measúnú chun a chinntiú go gcuirfear na daoine le mór-cleithiúnas isteach i dtimpeallacht cuí san ospidéal nó i dtimpeallacht leighis atá oiriúnach dá riachtanais agus cúram.

When the Minister introduced the first draft of this Bill in 2006, three issues of importance were announced. The aim was to make residential nursing home care for the elderly "accessible, affordable and anxiety free". It is important to realise, in the first instance, that such care was not made anxiety free. Many people were concerned about the details in the Bill and this led to the belief, true or false, that they would have to sell their homes if they wanted long-term care in an institution. Another concern arose very often as to whether one was sick enough to obtain nursing home care. It is in respect of the care needs assessment and the financial needs assessment that most concern now arises.

The Bill states a "suitable person" from the HSE shall assess the care needs of the elderly but this reference is too vague. It would be far better if an independent person were to carry out the assessments. This should also apply to the financial needs assessment. There is a conflict of interest in that the HSE will be appointing a person to assess the medical or care needs of those seeking long-term residential care.

Our experience shows the system that obtained heretofore was very much hit and miss and unfair. It is hoped this Bill will eliminate the inequities of the past. If so, most people will welcome it. However, when we refer to a "suitable person", there is a need for clarification. Since it will be a person in the HSE, there will be a risk that assessments will be unfair or, worse still, money-making exercises for the HSE.

We are told the implementation of this provision will cost €1 billion. I do not know on what this is based. We must realise that, over the next 20 years, or perhaps less, at least 10% of the population will be in need of long-term care annually. This percentage is increasing rapidly because of our increasing age profile and we must, therefore, ensure more resources are provided for the care of the elderly. If this is the case, we must evaluate the stipulation that a maximum of 80% of one's income and 5% of one's assets will be assessed.

The Bill states a "suitable person" will carry out the financial needs assessment. How is a suitable person to be found in every instance? It is accepted that the assessor will be found within the HSE unless he or she is to be totally independent. It is important that these issues be clarified, as a matter of urgency, by the Minister before the legislation is passed.

On the assessment of care needs, we are told the suitable person may be a registered medical practitioner, registered nurse or employee of the HSE. There is such variation here that questions arise as to an assessor's suitability. We would have to be concerned about this.

Subsection 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,

(b) the family and community support that is available to the person,

This list is very wide ranging.

All research carried out to date shows clearly that Irish people, in particular, do not have any notion about provision for long-term care while they are healthy and active. It comes as a shock to many that such provision might be required. This is why I asked the Minister of State the position in this regard.

Parallel to providing for long-term care in nursing homes, what provisions are we making for the retention in the community of those who require care? What supports are being provided for their retention for as long as possible in their homes or communities, in which they have lived all their lives? We have an opportunity to offer proper support to allow for this. I cannot see any aspect of the Bill that indicates this; it refers only to people's assessment. There is nothing so galling to an elderly person as to be told he or she is not sick enough to avail of nursing home support in the longer term.

By and large, the Bill is to be welcomed but I do not know whether any or all of the original three issues highlighted when the Bill was announced — accessibility, affordability and the provision of anxiety-free care — have been dealt with.

See this speech in context