Fergus O'Dowd (Louth, Fine Gael) | Oireachtas source

This is a very important debate. I welcome the developments taking place, particularly those relating to senior citizens and children under the age of six. As a result of what is proposed in the Bill, everybody who reaches the age of 70 will now be able to go to his or her doctor and will not be charged for the privilege.

I wish to comment on a number of cases with which I recently dealt in the course of my work as a Deputy. One such case involved a 95 year old man who previously had a medical card but who lost his entitlement to it. The trauma experienced by him and his family was both unbelievable and heartbreaking. Notwithstanding the fact that the individual in question has an income which is not small, he had a medical card for 25 years. It was absolutely unacceptable to his family that he, at 95 years of age, was informed he was going to lose the card. What happened had a significant and adverse impact on the man's health. He felt he was no longer needed or wanted. In particular, he was of the view that he was a burden to his family. The good news in this case is that earlier today I received a call from a member of his family to inform me that the card is to be restored until 2017. It was a major battle for the man's family to achieve this result. They were obliged to approach various doctors and consultants and expend enormous amounts of energy to have the card - to which the man, from his perspective, is entitled and which he had previously held for 25 years - restored. The amount of pressure exerted on the individual in question was unacceptable.

The Government should consider restoring medical cards to all of those who previously held them and who lost them when, from a financial perspective, times were very difficult. As matters improve, we should ensure that those who lost their cards will have them restored. In addition, cards should be restored without people having to do what the man to whom I refer was obliged to do. I must also refer to the case of a 77 year old man who came to my office recently and who was totally out of breath. That individual is on oxygen 18 hours a day and he lost his medical card, again for financial reasons. He clearly has a very difficult medical condition. The individual in question was successful in fighting to have his card restored but matters should never have reached that point.

The Minister, Deputy Varadkar, has done an excellent job since taking up his position. He is aware of the issues to which I refer and I ask him to address all of them either now or in the context of the forthcoming budget. If there is any leeway in the context of the public finances - it is clear that there is - and if we are intent on cutting taxes for people, which we should do, then we should cater for the needs of those who are oldest in our society and who need greater protection.

I wish to comment on issues raised by a number of previous speakers, particularly in the context of the fair deal scheme. There are many people in acute hospitals who are awaiting discharge. In that context, there are alternative care arrangements to which we should give consideration. In many instances, the community services that are in place are not as good as was previously the case. I am aware of increasing numbers of people who are seeking home help hours and home care packages and who cannot obtain them. I visited the home of an 80 year old woman and her 82 year old husband. He had just returned from a day centre at which he receives dementia care. The woman's problem is not that she cannot care for her husband - who, in addition to his dementia, has a serious medical condition and is doubly incontinent - because, by God, she is doing her very best in that regard. Rather, this very elderly lady's difficulty is that she was offered 18 minutes worth of home help per day. That is both appalling and unacceptable. I have raised this case with the HSE and I hope it will be dealt with properly. There are many people who are involved in caring in the community who could be given greater support. The provision of 18 minutes worth of home help per day to the lady in question is simply not good enough. I should point out that she is on the waiting list for further home care package support if and when money is made available.

Large numbers of people are being obliged to access fair deal scheme. These individuals do not want that to be the case and they would not be involved with the scheme if the relevant services were available in the community. It is far better to make services available in the community than it is to place people in long-term care, particularly if adequate supports can be provided to the families involved. The Alzheimer's facility in Dundalk, County Louth, is appealing for more funds because its budget has been cut by 5%. The Alzheimer's Society of Ireland branch in Drogheda is also seeking more money because it is not receiving the financial support it needs. I appreciate that the Government has one further budget to introduce. Regardless of that, we must consider how we support community services, particularly those relating to dementia care. The problem of dementia is going to increase in the years to come. As I understand it, every year a further 20,000 citizens are going to reach the age of 65. The total number of those above that age is due to increase by over 200,000, or 40%, by 2021. We must plan for that. While it works in many cases, the fair deal scheme is not the answer in a large number of others. There are significant alternatives which must be utilised. If we review both the scheme and the position regarding home care packages and home help hours and invest more money in the provision of support services, it will make a huge difference.

I wish to address a particular issue relating to home care. The role of migrant carers has been acknowledged and a policy relating to such carers must be formulated and implemented. As a recent report indicates:

The racial and cultural differences of care providers and recipients of care must be respected within domestic and long-stay care settings. Older residents, their families and the public need to be assisted in adapting to changes in the ethnic and cultural mix of care staff taking place within care organisations.

It also states that "Increased resources and support structures for education, training, orientation and integration should be introduced for migrant carers and Irish staff to cope with multicultural care environments". I came across a very sad case recently whereby the person involved insisted that their care should be provided by a person of a particular ethnicity. The cost of that care increased by over €2,000 per month in order that the demands of that individual, who is paying for the care privately, might be met. Clearly we need to examine the possibility of increasing the level of resources available in respect of integrating care providers.

Appropriate structures must be put in place for the reporting of racial abuse and labour exploitation at organisational, regional and national level. Better information should be provided on migrant rights and entitlements, particularly in respect of employment and equality regulations.

I congratulate the Minister on his successes to date, but in coming budgets we have to help that cohort of people over the age of 70 years who have reared their families and paid their dues. They want to live at home and their families want to support them. We must provide more resources to support community care, including home care and home help packages. The current system is almost like a factory. When patients are discharged from acute hospitals, their only option is a long-term care institution if adequate support is not available. It is far cheaper to support people at home than to put them into long-term institutions which are not necessarily the best place for them.

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