John Cregan (Limerick West, Fianna Fail)

I welcome the opportunity to speak on this important legislation. The Bill has been before the House for quite a while and every Deputy who has welcomed it is anxious to see it finalised with a view to its implementation at the earliest possible date. I welcome the fact that the Government has made an initial allocation of €55 million for that implementation, funding the support scheme for the second half of this year.

The Bill would have been welcome during the country's boom period. Given the economic worldwide recession, it is now more important than ever that it be enacted. Many of my constituents who present to me, even those couples where both people are in employment, find supporting one or more elderly parents or relatives in private nursing homes difficult. We allowed this situation to develop despite the significant quantity of money that we were spending on subvention which, it has been stated, amounted to €300 million. While the spend was welcome, we must recognise the fact that the subvention only covered a small portion of the overall payment required to secure and maintain a nursing home bed for an elderly relative.

Even when times were good and there was full employment, many thousands of people were at the pin of their collars supporting their elderly relatives. We all know of families where some siblings care a great deal about the support they provide whereas others do not care as much. Many of those to whom I refer must live their own lives, meet their daily, weekly and monthly household bills and, in many instances, pay for their children's third level education. They are at the pin of their collars trying to make up the balance. Even with the elderly person's old age pension and the maximum subvention, there is a serious shortfall. Where only one family member is prepared to support his or her elderly relative, it is a considerable draw on his or her resources. Many people have found themselves heavily in debt as a result.

On the other side of the coin are the public residential care homes, of which there are two in my county, namely, St. Ita's Hospital in Newcastle West and St. Camillus's Hospital in Limerick city. Both are fine institutions that provide a top level of service, which is so good that everyone requiring residential care wants to be admitted to one or the other, depending on from where they come. Unfortunately, there are not enough beds to accommodate everyone and there is a significant dependence on the private sector to make up the missing complement. Most of the private nursing homes in my county with which I am familiar also provide a fine service.

While there may have been isolated instances of poor care, one is one too many. In the Leas Cross case, there was a shameful abuse of the elderly. This issue must be and is being addressed. I welcome that the elder abuse service is now in place. Unfortunately, it is necessary, given the remaining cases of elder abuse.

While I welcome the Bill, two buzz words that are being bandied about are "equality" and "equity". We have neither. One could develop the argument that there is discrimination, albeit unintentional. If two patients present to a public residential long-stay hospital, the good system in place assesses their financial means, social circumstances, dependency levels and ailments. Patient A is admitted to the facility and charged his or her pension minus a certain amount per week, which is rightly returned to the patient as spending money. It provides the family involved with a sense of consolation. As well as being guaranteed a top level of care, people are guaranteed that they will not need to put their hands in their pockets to come up with the balance, unlike in the case of patient B. Through no fault of the case conference but given the recession, the home must tell patient B that he or she cannot be accommodated.

As his or her dependency level is one, two or three, A, B or C or whatever, he or she must choose a private nursing home. While so doing for the level of care is fine, it places a huge financial burden on the family in question. I welcome the fair deal legislation under discussion today because it will bring about equity and a level of equality that is greatly desired by all. I understand the National Treatment Purchase Fund will act as the brokers that will agree on a price with such private nursing homes. I further understand that each elderly patient will pay the same amount, regardless of whether a public residential unit or private nursing home care is chosen, which will be highly welcome.

Much play was made of the clawback requirement in respect of a percentage being taken from a person's estate when he or she passes on to his eternal reward. I have discussed this issue with many constituents who have approached me with difficulties regarding subvention and shortfalls. While I have stated that the Government at present is in the process of introducing the fair deal system, most people wish to deal with the here and now. They want to ensure there is no serious draw on their financial resources arising from being obliged to support an elderly relative. Incidentally, the vast majority of people would love to keep their elderly relatives in their own homes with the support provided by the State and the help of their families and friends. However, as this is not always possible, unfortunately such people must be placed in long-stay care, which is a serious drain on people's resources. The clawback will be put in place and people will be well prepared to meet that demand if and when it arises. Their view is that if they are unable at present to afford to provide the requisite level of care and if an estate is bequeathed subsequently to their family, they then will repay the State in some fashion for what it paid for the care of their elderly relatives.

I have encountered another issue that I consider to be wrong. In respect of assessment for subvention, I meet many people whose elderly relative had been living alone in what was the family home but who suddenly required placement in a nursing home. It is difficult to ask one's mother, father, sister or brother to leave his or her home to enter long-stay care and it is completely unacceptable to penalise a family, were that home to remain empty. The HSE assesses the potential value of the income from that family home, were it to be let out as rented property. I certainly would not like to see an "For Sale" sign being erected beside my mother or father's house on the day after he or she entered a nursing home. However, in the event that such a family home is retained or not let out and no income accrues from it, a penalty is placed on the elderly relative because that asset and the potential income from it is taken into account. However, if a single family member still resides in that house, the same penalty does not apply. This is a difficult situation and while I consider it to be an anomaly that should have been addressed, obviously it was not and it is now too late to so do.

I welcome the opportunity afforded by this legislation to eliminate once and for all the discrimination that has taken place. I do not blame anyone as this is the way in which the system has worked. We have chosen to subvent private nursing homes at great cost. Obviously, this will stop and the State will have a system in place in which it will continue to pay for care in the main but in which those in private nursing home settings and public residential units will be asked to pay the same amount. This is welcome because I understand that approximately 8,000 people are in public long-stay care at present. I cannot praise such facilities sufficiently highly because I have experienced them in my own constituency. I also have had personal experience of them in respect of both my parents and the level of care and attention to detail given by those involved is second to none. Moreover, as I stated previously, in most instances the level of care in the vast majority of Ireland's private nursing homes is second to none. This also is to be welcomed because although one may criticise the Government for giving tax breaks to people to build such private nursing homes, the public system by itself would not be in a position to provide the requisite public bed capacity. As this would not have been possible, I greatly welcome that we now will be in a position to support all the people concerned. While the clawback will be in place, there must be some payback for the State's commitments.

This welcome legislation should pass through this House as quickly as possible to allow the Minister to enact this Bill and have the scheme up and running at the earliest possible date. I believe it will be broadly welcomed and will constitute a huge relief to many people, particularly in difficult economic circumstances in which there is significant demand on such people to pay for their elderly relatives. I am familiar with families in which one parent each of the husband and wife is in a nursing home. While having one elderly relative in a nursing home constitutes a major draw on resources, obviously having two relatives in nursing homes doubles that commitment. It is time to be honest and to note that regardless of whether one likes it, many siblings in many families either cannot or refuse to pay a fair share towards the support of their elderly relatives.

Deputy Deenihan made a valid point in his contribution when he referred to the occupancy of acute beds in some instances by elderly patients who cannot be moved from such beds because of the lack of step-down facilities. However, there is another reason. Were one obliged to make a decision today, tomorrow or next week about one's elderly relative, who is taking up an acute bed, and were one in a financial position in which one genuinely could not afford to pay for or support that relative in a private nursing home setting and furthermore, if one could not ensure the provision of a public bed in a public residential long-stay unit for one's relative, one would have a problem. In such cases, perhaps little blame should attach to those who walk away from the acute hospitals saying they could not take home their elderly relatives because they did not have the facilities or wherewithal to provide the requisite level of care. I refer to cases in which people cannot place their elderly relative in subvented nursing homes because they lack the wherewithal and financial resources to make up that gap of the additional resources required and who have been told that no long-stay beds are available in the public system. In some cases, the proposed new legislation should alleviate this problem to an extent and should free up some of those public beds. I believe it will and that this is a win-win situation.

While it still will constitute a massive draw on the State's resources, as I noted previously, most people would much rather keep their elderly relatives at home. In an effort to ensure this preference continues, the Government should at all times support in whatever way it can those families who are good enough to keep their elderly relatives in their own homes. I refer to measures such as home help and home care packages. This is being done at present and must continue because a massive saving accrues to the State in all such instances. Consequently, Members must ensure they do not simply pay lip service but continue to support and to increase support for all those who are good enough to do so, by way of the carer's allowance. The latter allowance is a payment of which many people can avail. While I accept it is means tested, it is available and acts as recognition for those who are good enough to care for their elderly mothers, fathers, uncles, aunts and other relatives, which is right and proper. This payment has been expanded and developed over a number of years and the excess amount that someone can earn has been increased continuously, which also is right and proper.

There are others who are good enough to care for elderly relatives in their own homes but do not avail of the carer's allowance. They take on these caring duties because they consider it their duty and obligation to do so. They are worthy of our admiration and gratitude. In the absence of their commitment and goodwill, the State coffers would face additional costs as a result of an even greater demand for long-term care beds.

I am glad to have had the opportunity to make a small contribution to the debate on this extremely important legislation. I welcome it warmly. In recent years I have made the point that the prevailing situation was not equitable and that people were facing serious financial difficulties because of it. I compliment the Minister of State, Deputy Hoctor, who has taken a particular interest in this legislation and has guided it through in recent months. I understand there were significant legal issues to deal with and that it was not a straightforward matter. I compliment the Minister of State on the introduction of the Bill in the House and I wish her well in bringing it to the Statute Book.

The public is crying out for a change in the system. We will undoubtedly take some criticism in regard to the claw-back. We can be sure there will be claims that Fianna Fáil is taking money from the dead. However, we must be realistic in these difficult economic times. This Bill seeks to ensure there is a fair and equitable system. I am confident that the public will ultimately thank us for putting this scheme in place.

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