Timmy Dooley (Clare, Fianna Fail)

I welcome the legislation and I thank the Minister of State and her team for putting together a progressive Bill. It was brought about by necessity following the debacle that manifested itself in the health repayments scheme, which was unfortunate, as an unfair and inequitable windfall resulted for some people, even though the scheme was necessary because of the complications that had arisen regarding the way in which payments were made using the pensions of patients who had received an excellent service in many facilities. It was disappointing to witness the zeal and vigour of those who pursued the funds, which were technically, but nonetheless incorrectly, charged. They sought repayments, even though their parents, grandparents or other loved ones had received excellent care for a small charge. That was disappointing but it happened. It was unfair and unnecessary and it flew in the face of the quality service delivered to patients.

This starved the Department of much needed funding to provide the services envisaged in this legislation and other services required by the elderly on an ongoing basis. However, that should be consigned to history. All of us had to learn an exceptionally expensive lesson because of a minor, technical issue. While Deputy Mitchell welcomed the longer reading of the Bill, it is probably right and fitting that this be done to ensure technical issues do not arise in the future, which could cost the State a significant amount and could result in funds being given to people on an inequitable basis.

The legislation is a fair deal, as it has been titled in some quarters. It is equitable and it seeks to bring uniformity to a complex and complicated system. The difficulty for many people up to now was it was unclear how some people succeeded regardless of need, income, standing in the community and so on in accessing publicly funded facilities while others found themselves in private facilities. In many cases, those who entered private nursing homes quickly encountered severe financial difficulties because regardless of their means on entry, if they outlived their savings, their families faced an exceptional burden to keep them in the nursing homes. That system is still in place and, until the Bill is enacted, that inequity will remain.

Every Member will be aware of cases of people facing severe financial hardship who, without the support and assistance of their families and not-for-profit nursing homes, would have nowhere to go and would have been turfed out on the street when unable to care for themselves. The State owes a great debt of gratitude to families who have succeeded in supporting loved ones through difficult financial times and to community hospitals, nursing homes and facilities run by voluntary organisations and religious orders which, despite their general charges, care for quite a number of people on a charitable basis.

The provisions of the legislation will give a clear understanding to those who require nursing home care about how to go about accessing services and it will ensure they will be treated in a fair and equitable way, primarily on the basis of need but also on the basis of financial capacity. That did not happen heretofore but it is important that happens into the future.

Medical need is critical because some people have not entered nursing homes on this basis. That will create strain for individuals in the future. It is important that dependency is assessed and it is not qualified on age grounds. In the past individuals who suffered a stroke when they were aged 62 or 63 were not considered eligible for subvention and other schemes because they had not reached retirement age and they were not facilitated in publicly funded care facilities run by the HSE. In other instances, people who suffered brain injuries and other illnesses at much younger ages and who required high dependency support were not covered. Thankfully, the Minister for Health and Children has decided to provide for such support in the legislation and that will provide great relief to the many families who support loved ones in their own homes or through their own financial resources but who are under great pressure.

In some cases I have dealt with, five or six family members clubbed together to support an elderly parent, even though some of them were in receipt of various social welfare payments, including the pension, and they were expected to contribute weekly to their parent's care in private nursing homes, which is extremely unfair. If a bed is not available in a publicly funded hospital or nursing home, the loved one must be cared for in a private facility, regardless of ability to pay or the support required. That is a phenomenal burden on families. Many families will welcome the implementation of the legislation as quickly as possible.

Good private and public facilities are provided in my constituency. St. Joseph's Hospital, Ennis, Raheen Community Hospital, Ennistymon Community Hospital and Regina House in Kilrush are publicly funded. A community hospital in Kilrush is operated by a voluntary, not-for-profit organisation, as is Cahercalla Community Hospital while Carrigoran House nursing home is operated by a religious order. They are supplemented by a necklace of private facilities, which have emerged in recent times following the provision of various incentives and which are welcome.

Increasingly, people are moving into what would be considered to be gradual care facilities. Some people are deciding to sell their homes and purchase apartments in retirement complexes, which is a worthwhile approach. While some people will need support as they grow older, they may not require the maximum level of support available in some of the publicly funded facilities. That pattern as it develops will provide a better capacity for elderly people to be cared for in a community environment where facilities are grouped together and adequate services are available.

I compliment the private service providers that are making imaginative proposals to potential patients starting with the basic living unit, to providing more assisted living units and ultimately full-scale nursing home care effectively within the same campus. That gives a great level of security to people advancing in years who do not want the burden of wondering where they will ultimately end up in the latter years of their lives. It is critical to provide that level of consistency, security, expectation and understanding to those people by providing a proper facility to assist them.

It would be wrong to discuss the fair deal and the attitude to providing services for older people without recognising the phenomenal service provided by the various day-care centres. I am particularly familiar with the ones located in Kilrush, Ennistymon, Raheen, Kilmaley, Clarecastle, Miltown Malbay and perhaps one or two more. These facilities provide an excellent daily service. I am sure the Acting Chairman knows of one in Tallaght. These facilities provide an exceptional service for people who have chosen to and are capable of living at home. Without that service many of these people would more quickly need to enter full-time long-term or maybe in some circumstances short-term care, occupying a bed. I recognise the exceptional amount of work the Minister of State has done in trying to keep people living at home. She has actively provided assistance in that regard and in her support for day-care centres, which is greatly welcome. The more people we can keep out of acute medical facilities and elderly care units, the better the chance of managing patients well.

Some people believe that nursing homes or hospitals represent the answer to all our ills, but they do not. In many cases it is a traumatic event for people to find themselves in a nursing home or a hospital. We have the issue of hospital-acquired infection, which is a fact of life. Regardless of how well run a facility might be it is clearly understood that one might interact with infection while in such a facility. If the patient's condition allows it, the best place to be is at home. Support for day-care centres is essential.

The Minister of State has worked with some groups in Clare dealing with elderly people with Alzheimer's disease. In that regard she has attempted to assist the Clarecastle day-care centre and I have no doubt she will continue her efforts to bring about a satisfactory outcome to deliver a much-needed service in that area and assist the real effort being made by a group of exceptional volunteers who have only the best interests of the patients at heart. There have been some complications there involving a number of different organisations all of which are well meaning. Unfortunately they do not share a common goal about delivering that service. I hope that through the good offices of the Minister of State we can continue that dialogue with a view to getting a service in the best interests of the patients in that region. It speaks volumes when people are at loggerheads about a particular service. It is not necessarily that anybody is being territorial. They are simply trying to deliver what they see to be the best services possible to the patients they seek to assist. It is important that an effort is made to bring consensus and a common focus to ensure that those who most need the service are given it in an appropriate and adequate environment. I hope that support will continue.

I also hope we can advance as best we can the development of our primary care facilities. Far too many people enter a hospital in circumstances where if the proper primary care service were available it would not be necessary. There are aspects of primary care for the elderly such as caring for their feet — ensuring their nails are cut and that they get the services of a chiropodist. If these things are not dealt with at the appropriate time it can create greater complications particularly for elderly people who may have circulation problems. We need to develop the kinds of models I have seen, particularly at the east Clare medical centre and also in north Clare in the Ballyvaughan area where a number of doctors have come together to deliver a very appropriate service under the primary care model. That model has been piloted by some great HSE people in County Clare. They have worked very hard to try to deliver a model which could be rolled out throughout the country. If we continue in that way we can ensure that people can continue to live a longer and more fulfilled life at home with the services available in a primary care community setting based around the doctor. That, linked with the day-care centres and day care support, represent the way forward.

It is also important to look towards the development of home-care packages as mentioned by the previous speaker. It is important to assist people in getting out of hospital. The figures have been referred to here on many occasions. The cost of keeping a person in an acute bed in one of our major centres — many of them centres of excellence — is considerably higher than having a patient in a step-down facility in a private nursing home or one of the publicly funded ones after which, hopefully, they can be moved back to their homes in the community. It would be very welcome to continue with the home care packages to help people to move from the main hospital back home through various steps. It would certainly ensure we got the best use of the beds available. There are great benefits in assisting people who are already in acute facilities and have no medical or nursing requirement to be there. For those people who are not able to go home and need some level of assistance, that assistance could be delivered either in a nursing home or even in an environment with fewer medical facilities. The sooner we can progress that the sooner we can assist in resolving the shortage of acute beds.

The Minister of State will be aware of the debate we had in this House last week on the Teamwork report on the transformation of the delivery of services in the mid-west region. Those changes are necessary to deliver a safer and better service to the people in the mid-west. One of the major stumbling blocks in rolling out that service will be the lack of availability of beds, particularly in the designated centre of excellence in Limerick. The only way we can help to release some of those beds is through the roll-out of the fair deal scheme so that more of the people, who do not need to be there and do not benefit from being in hospital, can get into nursing homes. Many of the nursing homes now available have bed capacity. It would be appropriate to expedite that.

I welcome the Bill, which is long overdue. It is a welcome outcome to a very difficult and sad situation where people sought to harangue or chase the State for a service delivered at a very meagre cost. This is how it was and we have to deal with it. This initiative must be financed to the point where the Department and the HSE are able to make beds available in acute facilities. This will be one of the positive effects. Most important, this initiative will give certainty to those people who require nursing home care and their families. It will give them a little bit of peace in the latter days of their lives and it is to be welcomed.

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