John Perry (Sligo-North Leitrim, Fine Gael)

I welcome the opportunity to speak on this Bill and have listened to Deputy Kathleen Lynch's contribution. As the Deputy who first brought to public attention the fact that old people in publicly funded long-term residential care were being forced to pay charges that had no legal basis, I welcome this new legislation.

I broadly support the proposal, but I am concerned that the delay in making repayments in respect of long-stay charges remains a major issue. It is important to point out that the body dealing with the issue will not be accountable to the Dáil. Many of those who made claims have since died. It is appalling that, five years on, people are still awaiting payment. Perhaps the Minister of State will account to the Dáil in this regard and request a report from the legal firm handling the matter, as it will not give information to any Deputy who makes representations in respect of delayed refunds. It is an issue of concern for those who are still alive and the next of kin who have claims on the estates of the deceased. We should examine this matter.

As Deputy Kathleen Lynch mentioned, the money has gone. When the Bill was initiated two years ago, people and the economy had a great deal of money. Many people who have been paying in excess of €1,000 per week to live independently in private nursing homes had large shareholdings in banks, sometimes worth as much as €300,000 or €400,000. Their shareholdings have devalued to €35,000 or €40,000. They are penniless. Numbering among the people who attended the Anglo Irish Bank shareholders' meeting were senior citizens who, despite owning blue chip stocks in major financial institutions, now find themselves without any money. They were not availing of subventions. I know of a number of cases in which people had their own money, did not depend on their families and had private investments. They were retired bankers and civil servants.

Such people, who perhaps were paying fees for private nursing home care, now find their long-term plan is affected. This has caused great anxiety and the concern engendered by seeing their financial well-being diminished will have an impact on their longevity on this planet. This is very serious, is of great concern and forms the backdrop to this so-called fair deal. I raise this point because of my concern for those who were given assurances and comfort, when advised by accountancy firms and financial managers, that the best place to put one's money was into blue-chip financial institutions within the State, which were making billions per year.

Those who bought shares in banks were guaranteed that their houses were safe and that they would have plenty of money, both for their lifetimes and to leave to their relatives on their departure. All this is gone. Last week, I met a lady who invested €200,000 into the Bank of Ireland and whose shareholding now is worth only €4,500. The lady, who is retired, was advised to so do two years ago. While obviously it was her decision to take such advice, her shareholding now is reduced to only €4,500, from an initial investment of her life savings of €200,000. To where can she go? Such developments will greatly affect the nursing homes support scheme and forms the backdrop to the present position. As Deputy Kathleen Lynch noted, matters were different two years ago.

I broadly support the proposal that elderly people should pay some of their nursing home costs, based on their means. A degree of co-payment must be central to any sustainable approach to financing long-term care. The Minister's proposals contain some positive elements, particularly in respect of the introduction of a standardised assessment system for patient eligibility and subvention between public and private nursing homes. This legislation is formally entitled the Nursing Homes Support Scheme Bill 2008. However, in her speeches and press releases, the Minister prefers to entitle it the fair deal Bill. This mixed description on the Minister's part reminds me of when a person prefaces a sentence with expressions such as, "To tell you the truth", "In my honest opinion" or words to that effect. This always raises alarm bells for me as why should someone tell me they do not intend to tell me the truth? Similarly, the Minister's use of the term, the fair deal Bill, also rings alarm bells. While we may have many political differences on a wide range of issues, I generally give the Government the benefit of the assumption that what it does is fair by the standards it normally uses. Consequently, when a Minister tells Members that this is a fair deal Bill, which will make residential nursing home care accessible, affordable and anxiety-free, my concern is they may find out in time that it is anything but a fair deal.

This proposed legislation will replace a system that is bureaucratic and inconsistent. The current subvention system also is inequitable, complex and unfair, as people who need care face greatly differing costs, depending on whether they are in private or public nursing homes. A huge anomaly exists whereby 90% of the costs of public nursing homes is subsidised, while the State only meets 40% of the costs of care in a private facility. This new legislation also brings its own complexity. I congratulate the parliamentary draftsmen on their work in taking a political agenda and party political proposals and turning them into robust legislation that hopefully will withstand the assault of the legal profession. It is not difficult to anticipate some challenges when the legal profession starts its microanalysis of the sentences, words and punctuation contained in the legislation, particularly regarding the deferred contribution from the estate of a person resident in a nursing home.

I have serious concerns about this issue. An issue has arisen in respect of the difficulty in selling property, in that this Bill is based on properties that were valued at €300,000 but which sell for €150,000 at present. In many ways, a massive sub-prime property problem obtains at present. It clearly is an issue about which Members must be highly concerned. Regardless of the proposals in respect of values of 15% or 5%, the obligations to have been living together for three years or the concerns it will raise among families or the next of kin, in certain cases this will bring huge pressure on people in respect of the transfer of property. In many instances, this must have taken place five years earlier. However, while it may be a consequence of past colonial exploitation, to this day people in Ireland appear to have a problem in recognising the genuine difference between long-term family occupancy rights and ownership rights. This constitutes a major issue for families who have lived in a home for generations.

As for those who already are residents in nursing homes but who, under the needs assessment criteria in this new Bill, are assessed as not meeting the criteria for long-stay admission to a nursing home, the Minister should clarify the position. As for those who currently are in nursing homes but who may not need to be there, the Minister should confirm that such residents will have guaranteed access to the nursing home after the Bill is introduced, regardless of their needs assessment. This is an important point and I note the Minister of State's adviser has indicated her agreement in this regard.

According to a submission by Age Action Ireland, a survey carried out by the Department of Health and Children in 2006 found that nearly 9% of long-stay residents were in residential care for social reasons. Older people who live in nursing homes at present should have their care needs assessed and should the community services exist, they should be facilitated in a move back to the community, if that is their wish. This also is a major concern. On the other hand, if their preference is to remain, this Bill should accommodate it. The Minister has promised that no one in care will be worse off under the new plan. The Minister of State should use this opportunity to confirm that statement, in so far as it applies to people currently living in nursing homes. According to the same Department of Health and Children survey, more than 29% of all long-stay unit residents had low to medium dependency. Consequently, if one takes those two figures together, a large number of nursing home residents should not be there, were the rigorous needs assessment criteria in this Bill to be employed. These figures clearly demonstrates care needs assessment services and the range of facilities being provided are inadequate at present.

The care needs assessment principles outlined in the legislation appear reasonable, in so far as they go. The outcome of a needs assessment process is a report, which will be used to make a determination that a person needs care services or otherwise. The important point is that in this context, care services mean long-term residential services. However, the options available for the care of older people are more varied than such a black and white scenario. At one end of the scale, there is self-care through support by family and informal carers, complemented by an element of formal care in the home. All recent reports on the needs of older people have stressed the importance of maintaining at least 90% of people aged 75 and over in their own homes. As people age at home, they may come to need the support of some home care services. Every older person should have adequate support to enable him or her to remain living independently in his or her own home for as long as possible. It is important that people are assisted and supported in living independently at home.

This pertains to the major issue of home care supports, home care packages and day centres, as does the point raised previously regarding the essential repair grant that is being administered by the HSE. It should be funded to a level that will ensure that people have an option to make a simple conversion costing €4,000 or €5,000 to their house. This would be a massive investment, were such a fund not available and one would have no choice but to seek a long-stay or a short stay bed. Consequently, that link would be broken. I am certain that the arrangement which provides for the best quality of life for the majority of older people is to be at home.

The Bill deals with only one aspect of care for the elderly, namely, the provision of nursing home and other long-stay care facilities. Regrettably, this issue is being addressed in the wrong direction and at a greater cost than necessary. The Bill fails to recognise that the majority of elderly people prefer to remain in their own homes. That is the fundamental misunderstanding underpinning the legislation. Most people wish to live independently. My father is in his 80s and would not move into a nursing home under any circumstances. A carer visits him in the morning and evening, thus allowing him to maintain his independence and remain at home.

In making this point, I do not mean to disparage the long-term residential care that is available. I am aware of several superb facilities in County Sligo, including St. John's Hospital and various private nursing homes. However, my father's choice is to remain at home. Elderly people wish to live in their own homes for as long as possible, where they are an integral part of family, social and civic life. People build their lives around their homes and have routines of social interaction with friends and family.

More supports must be available to elderly people who wish to maintain some degree of independent living in their own homes. The public health nurse has an important role to play in this regard. While carers are doing a fantastic job, there is insufficient funding to enable public health nurses to provide vital services that would be of benefit to many elderly people. The service provided by carers must be complemented by an improved provision in respect of public health nurses. More nurses must be appointed and criteria introduced whereby elderly people would receive a certain number of visits in their home from the local public health nurse.

Where elderly people are no longer able to remain in their own homes, the next stage should be to facilitate their transfer to sheltered accommodation, with on-site care facilities as necessary. In some cases, people may not qualify under the needs assessment test for a place in a residential unit even though they cannot continue to live independently in their own homes because of the need for formal assistance in areas such as meal preparation, housekeeping, shopping and increased security. Sheltered care, incorporating carer and public health nurse visits and the provision of day centre services, would be of great benefit to many such older people. Moreover, it provides good value for money when compared with the cost of nursing home care at €800 or €900 per week.

Independent living is critical. This valuable option is a means of bridging the gap between remaining in one's own home and having to move to a long-term residential facility. Long-term residential care must be the option of last resort and we must do everything to provide alternatives. This Bill is fundamentally deficient because it deals only with the end game. Sheltered care provision has been readily accepted in other countries as a mainstream solution that fits neatly between living at home and moving to a form of institutional care. It has become a central plank of community care policy for older people in several European Union member states.

Long-term residential care should be seen only as a solution of last resort and where the previous options have been exhausted or are inappropriate for the older person's needs. The Bill must include an explicit written commitment to the principle of resident choice to ensure residents and their families can choose the nursing home that most suits their needs. Persons who have been assessed and who are to benefit from the scheme must be given a list of all nursing homes from which to choose, including public, private and voluntary facilities. The Government gave a commitment to the principle of resident choice in its policy document, Quality and Fairness. This must be explicitly enshrined in the legislation. It is critical that care is provided in the community so that family and friends can have easy access for visitation. There is no point installing somebody in a nursing home 20 miles from their family, friends and community.

The Bill deals only with options for long-term residential care, as well as the related problem of a valid and equitable system of charging for it. This makes for a very black and white scenario; one is either in or out of long-term residential care. The Bill must be modified to make specific provision for a three-stage classification of needs outcome in the needs assessment process in place of the simple Yes or No outcome currently provided. We must have comprehensive and meaningful information on the full range of care need requirements of older people. This information is critical to future service planning in this area and will help the State put its resources into the service provision options that best meet the full range of needs of older people.

If incentives implicit in the provisions of this Bill are unbalanced, there will continue to be an unnecessary and unwarranted proportion of older people in long-term residential care when they could be at home or in sheltered accommodation. Will the Minister bring forward programmes for care of the elderly in their homes and in sheltered accommodation? In order to provide for certainty and transparency in the provision of care services, it is essential that there be greater clarity in regard to funding arrangements for these care options. If this is not done, the resulting gap in funding and services will lead to pressures to admit a disproportionate number of elderly people to long-term residential care. This is something we must avoid.

I urge the Minister to take on board the need to ensure that service provision and financial incentives attract older people and their families to the options of home care and sheltered housing facilities as the preferred option for elderly care. In particular, the financing model adopted for long-term residential care must not in any way discriminate against older people who wish to avoid such care. In this regard, I ask the Minister to consider the provision of income tax relief at the marginal rate for expenses directly incurred by families in the provision of home-based and sheltered accommodation care services.

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