Paul Kehoe (Wexford, Fine Gael)

I appreciate the opportunity to speak on this Bill, which I welcome. However, we will oppose it on a number of bases.

I checked the Citizens Information website regarding nursing homes and found informative web pages. Were every nursing home to be of the standard referred to on that website, every elderly person in a nursing home would be happy. Unfortunately, that is not the case. The Bill tries to set certain standards, but I will address this matter later.

The care of the elderly is important because they are the people who built the State. Unfortunately, some are not being cared for as they should be. In some homes, they are being neglected. The Minister of State is aware of a number of the homes in question. Deputy O'Dowd deserves praise for the due diligence he displayed in going about his business highlighting the Leas Cross issue and many other cases in which the elderly were not looked after.

Like every Deputy, I visit nursing homes frequently, albeit not regularly. The minute I walk through a home's door, I can judge whether people are being cared for correctly. It is obvious when people are happy. Other nursing homes do not have nice surroundings and the people therein could be cared for much better.

I will compare public and private facilities. Some of my colleagues from County Wexford have already mentioned care of the elderly in the public geriatric hospitals in our county. For example, when I was elected to the House in 2002, I campaigned for the new St. John's Hospital in Enniscorthy. Thanks to my work and that of my colleagues, construction on the hospital is at an advanced stage in phase three. Given the care and attention provided in a public nursing home, there is a considerable difference between the public and private sectors. The care and attention afforded to patients at St. John's Hospital, as the Leas-Cheann Comhairle will agree, are second to none. However, I criticise the other care centres and geriatric hospitals in my county. While doing so would be expensive, the Minister of State could use St. John's Hospital as a template for every major town.

For example, although the top floor of Ely House, Wexford, is used to provide care for elderly geriatric patients, it is completely unsuitable for such a purpose as it is up four storeys. Although the care and attention provided by its staff are second to none, it is not a suitable facility for the care of the elderly. Deputy D'Arcy also referred to Gorey in this regard and the Minister must consider the care centres, facilities and hospitals that are available to the elderly in those locations.

Since becoming a public representative following my election to this House in 2002, I hear of subvention cases in my constituency office that are an absolute mess on a weekly basis. Some previous speakers have noted that one person may receive a particular amount of money while someone else, who lives down the road or perhaps is a relative of the first person, receives a different amount. The variation in the sums of money that people receive as subventions is amazing. As Deputy D'Arcy noted this morning, the amount of subvention often depends on whom one happens on within the HSE while making a case for the person concerned. Although the proposed fair deal should make a great difference in this regard, I fear the Minister for Health and Children is being shortchanged, in that a sum of €110 million was to be put aside for this purpose but it has been reduced to €55 million. The elderly will suffer because of this shortfall and this is one reason people are highly annoyed. While they welcome the Bill, people become annoyed when promises are made by the Government but shortfalls arise months later. Ultimately, the elderly will be affected.

I wish to raise a number of issues pertaining to subvention and Deputy D'Arcy referred to loose wording in the legislation this morning. I refer to an elderly person who goes into care but who has a son or daughter living in the house who is less than 21 years of age. Will this 21 year old be kicked out of the house when the person passes away and when the HSE looks for 5% of the property? A 21 year old may not have a job, as he or she could be a student or whatever, and will not have the money or financial support to give 5% of the holding to the HSE. Similarly, what of a case in which a disabled person, who was in receipt of disability allowance of some kind, lived in the house? No straight language is being used and this will cause enormous problems in the future after this Bill has been enacted. All Members have raised delays in subvention for families and huge delays have occurred. I have dealt with people in nursing homes who were admitted months before any major decision was made on their subvention claims. I already have mentioned the varying amounts that are being awarded and the existing shortfalls, which ultimately will hit the elderly.

I refer to respite for families. Undoubtedly, all Members are familiar with families being given grants for respite care for two weeks annually. This is very little to any family who cares for either an elderly person or one with a significant disability. Throughout the economic boom and for many years, the Government neglected this issue and people have been left without proper respite facilities. In my native county, I fight and make representations on behalf of constituents to ensure their families are being looked after, especially those with serious disabilities rather than the elderly. Two weeks in the year is not much to offer to a parent or guardian who cares for a child or an adult with a disability and this issue is not being addressed properly within this Bill either.

I also wish to raise the issue of sheltered housing. My native town of Enniscorthy has an excellent facility for sheltered housing for the elderly, which is run by a voluntary group. In many cases, voluntary groups and organisations have come together to try to put in place a sheltered housing facility. Although they do their best, they happen upon a complete brick wall in respect of the amount of red tape through which they are obliged to go. This has not been made any easier for them although sheltered housing offers an alternative, whereby people can have their own independence while living in a small community village in which doctors, care assistants and care facilities are available to them.

This is an excellent facility for elderly people and 90% of such facilities are run by community organisations. If more sheltered housing in our communities is to be encouraged, matters must be simplified for the community groups and other applicants. In the main, these voluntary organisations meet at night because those involved are in full-time jobs but, for the good of the community and for the care of the elderly, give up their free time to try to get such facilities up and running. However, they are not encouraged to so do by the red tape through which they must go with the Department when trying to draw down different stages of funding. This process could be made considerably easier for such groups to facilitate sheltered housing in their localities.

Previously, I referred to Deputy O'Dowd's role in highlighting neglect in the care of the elderly in some nursing homes. Regrettably, I do not believe sufficient progress has been made in respect of checking nursing home standards. Sadly, some nursing homes are still in a similar position to that which obtained in Leas Cross and other nursing homes that have been highlighted in recent years. Undoubtedly, some nursing homes are perpetrating the same neglect in respect of the care of the elderly. While this issue has been highlighted in "Prime Time" and so on, it is sad to encounter cases in which the elderly are being completely neglected, even though cash-strapped families are paying for their elderly mothers, fathers, aunts, uncles or the elderly in their households to be cared for in such nursing homes. While the best display always is made for the benefit of visitors, major work is still outstanding in respect of standardisation of nursing home practice nationwide when no visitors are present, during night-time care and when nurses or care assistants are on duty. Undoubtedly, given the tax incentives that were made available for the building of nursing homes in recent years, the standards that should be in place are not.

The Minister of State's closing remarks should outline to the House how the shortfalls will affect the implementation of this Bill. As for the care of the elderly in some public hospitals, the Minister of State should examine care of the elderly in Wexford and Gorey towns in particular because excellent facilities exist in New Ross and Enniscorthy. However, the Leas-Cheann Comhairle will agree that the Minister must examine the existing facilities in Wexford town and in Gorey, because families from the southern end of County Wexford travel 30 or 40 miles to visit their elderly family members in St. John's Hospital, Enniscorthy and people from the north of the county travel south to Enniscorthy.

Distance may no longer be the obstacle it once was but it nevertheless presents a significant difficulty for some of the relatives of patients in St. John's Hospital. If such patients could avail of care facilities in Wexford or Enniscorthy, it would be of great benefit to them and their families. The current economic situation undoubtedly presents significant challenges. However, there are also opportunities through public private partnership and other means by which the Minister may be able to explore the possibility of providing these facilities. Such a facility is an absolute necessity for Wexford town, in particular. Its provision must be fast-tracked.

I referred to the prospect of family members being presented with demands from the Health Service Executive and the Department for their share of the family home when the elderly person passes away. There are major faults in the Bill in this regard which must be clarified. The language must be more straightforward so that it is clear what will happen in cases where a relative is living in the family home. These people may include persons with a disability or other type of dependency who are cared for in the family home. Will the Minister of State clarify this aspect?

There remains an issue in regard to the standardisation of care in residential facilities throughout the State. While some people receive excellent care in privately-owned nursing homes, other facilities are getting away with providing an inferior quality of care. The elderly are the most important people in this State. It is they who built the State and raised our living standards to the level we enjoy today. This is an issue about which I have strong views.

See this speech in context