Máire Hoctor (Tipperary North, Fianna Fail)

I thank Deputies for their contributions to the debate — more than 40 Deputies spoke, an indication of the interest in this Bill that addresses the care of older people in the future.

As mentioned at the outset, the purpose of the Bill is to establish a new scheme which will equalise State support for public and private nursing home residents, ensure that long-term care is affordable and anxiety-free and that no one has to sell his or her home during their lifetime to pay for their care.

The Bill addresses the reality that two thirds of all nursing home beds are in the private sector and puts in place for the first time a uniform system of financial support for individuals in public and private nursing home beds. We have worked hard to ensure that this system contains strong safeguards not only for the care recipient, but also for his or her spouse or partner.

The new nursing homes support scheme, however, is only one component of the overall Government commitment to ensuring access to quality nursing home care for all who need it. While the new scheme addresses the issues of access and affordability, the new draft standards will address the fundamental issue of quality; I know many Deputies alluded to the standards in their contributions.

A core principle of the health service reform programme is to put the users of health and personal social services at the centre of the services. We must ensure the protection of residents, safeguard and promote their health, welfare and quality of life, and ensure that there is a focus on the dignity and autonomy of older people. These are the core objectives behind the draft national quality standards for residential care settings which are currently under consideration within the Department of Health and Children. Regulations will be required to underpin the standards and the Minister plans to approve those standards and have the necessary regulations in place in 2009.

As is evident, this is a time of great change within the nursing home sector. In 2009, for the first time, there will be a single comprehensive system of registration and inspection for all nursing homes — public, private and voluntary — and a single comprehensive system of financial support covering all nursing homes. Moreover, both systems have the nursing home resident firmly at the heart of their service.

This is also a time of great change within our population; life expectancy in Ireland is increasing. This longevity is something to be celebrated, but it also presents policy challenges which we must recognise. The latest statistics tell us that today 11% of people living in Ireland are aged 65 years or over. It has been estimated that this figure will rise to 20% by 2036, and to 29% by 2056. Thus, over the years ahead, our nation's age profile will change. It is now, while our nation is still young, that we must consider the long-term care services needed to support us over the next half-century and the funding model that, by virtue of financial sustainability, might ensure the long-term provision of such supports.

The fair deal represents a response to the immediate situation faced by private nursing home residents. The Government is also committed to further analysis to identify a financially sustainable funding model which will support the future infrastructure of all long-term care services, both community and residential. This work is critical to all our futures, both as the recipients of care services and as taxpayers.

I would now like to respond to some of the points raised by Deputies in the course of the debate. Unfortunately, there is not sufficient time to address all the issues raised.

There appears to be some concern regarding the care needs assessment and people of medium dependency. I emphasise that all current residents in approved nursing homes on the commencement of the scheme will be eligible to apply for State support regardless of dependency. They will not have to qualify under the care needs assessment.

The nursing homes support scheme, in line with Government policy, is based on the premise that long-term residential care is not an older person's first choice and should only be considered as a last option. As such, the scheme encompasses a care needs assessment to determine whether a person needs to be in long-term residential care.

The care needs assessment is holistic in nature. In addition to medical needs, it provides for a person's family and community supports to be taken into account, thus allowing for social factors to be taken into consideration. For example, a person who historically may have been classed as being of medium dependency, but who lives in an isolated area, may be assessed as requiring long-term residential care.

I have been asked to clarify a number of points in regard to the treatment of assets. First, there seems to be a concern that the HSE will have sole authority for valuing assets. This is not the case. The Bill provides that a person will submit a valuation with his or her application form. The HSE also has the authority to undertake its own valuation at its own expense. If a person is subsequently concerned about changes in the value of his or her property, he or she can seek a financial review from the HSE at any time during his or her stay in care.

Second, where a property has multiple owners, the financial assessment will only relate to the actual interest of the applicant or applicants in the property. Third, I would like to clarify that foreign property is not excluded from the financial assessment. The assessment takes account of all relevant assets, including foreign properties. However, it is not possible for the State to offer ancillary State support in respect of foreign assets. Ancillary State support, or the loan element of the scheme, can only be availed of in respect of Irish land-based assets.

Fourth, the repayment of ancillary State support will be the responsibility of the Revenue Commissioners. Revenue will only seek to recover moneys actually paid by way of ancillary State support in respect of the cost of care. However, in order to take account of the time value of money, the amounts will be adjusted in accordance with the consumer price Index. This is what is meant by the references to interest in Schedule 2 of the Bill. Where repayment is overdue or problematic, Revenue will have the power to apply interest or to apply its existing care and management procedures. However, in line with the provisions of the Statute of Limitations Act, the power of recovery will expire 12 years after the debt falls due.

On the issue of quality of care, the Leas Cross Commission of Inquiry has been raised in the course of the debate. I can confirm that the commission is due to report to the Minister for Health and Children at the end of March and the report will be published after consideration by the Minister. I wish to confirm that an applicant to the scheme has recourse to the Ombudsman. The latter can examine complaints against the HSE under the Ombudsman Act, as amended.

I thank Deputies again for their contributions. I look forward to the further Stages of this legislation at which time the views put forward will be considered in detail. I, therefore, commend the Bill to the House.

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