Tom Fleming (Kerry South, Independent) | Oireachtas source

I move:

“That Dáil Éireann:

calls on the Government to:

— implement a range of policies that are favourable to senior citizens to maintain independent living;

— provide the supports and services to assist people to continue to live in their own homes;

— in light of the upturn in the economy, prioritise the household benefits package including the electricity/gas allowance and the free television licence among other measures;

— continue to maintain the free travel scheme and the Christmas bonus;

— ensure that home help hours be maintained in line with demand so as older people can age in the community;

— invest in the Health Service Executive community care and community mental health services;

— ensure that:

— the living alone increase continues to reflect the cost of living; and

— the carer’s allowance and the half-rate carer’s allowance be maintained and recognise the value of the respite supports; and

— acknowledge the importance of:

— the household adaptation grant for people with a disability, housing aid for older persons scheme and home insulation and energy saving for older people living at home; and

— maintaining and enhancing rural community bus services.”

I propose to share time with Deputies John Halligan, Maureen O'Sullivan and Finian McGrath.

Over the past six years, changes in public services such as home help hours and community nursing units, reductions in the fuel allowance, cuts in the household benefit package, the abolition of the Christmas bonus and increases in prescription charges, as well as decreased front-line staff and services in the health care sector, have all adversely affected older people and have fallen very heavily on poorer groups without the income to compensate. In particular, the changes have affected poorer people with disabilities or illness. International experts have identified that spending on public health and on the over-65s will have fallen by approximately 32% between 2009 and 2016. Supports that enable people to live at home need to be part of a broader integrated approach that ensures appropriate access to and discharge from acute services when required. To achieve this, the specific deficits in infrastructure that exist across the country need to be addressed urgently. There should be an emphasis on replacement or refurbishment of facilities. If this is not done, the inappropriate admission of older people to acute care facilities will continue, along with the consequent negative effects on acute services and unnecessary stress on older people and their families.

A related issue is the shortage of appropriately resourced and staffed geriatric rehabilitation units. The National Clinical Programme for Older People 2012 recommends that every hospital receiving acutely ill older adults have a dedicated specialist geriatric ward and a designated multidisciplinary team as well as access to on-site and off-site rehabilitation beds delivering a structured rehabilitation programme for older people. This document recognises the fundamental right of an older person to receive an adequate period of rehabilitation before a decision on long-term care is made. Implementation of these recommendations is lacking and there continues to be a shortage of appropriately resourced and staffed geriatric rehabilitation units. The stated focus on the development of community-based services to support older people in their own homes and communities for as long as possible is welcome. However, an expert group described Ireland's under-resourced community health services as "perhaps the greatest deficiency in the current provision of health services in Ireland". A commitment to supporting people at home is only aspirational if funding is not provided for home help services, day care centres and home care packages, some of which have received serious and unwelcome cuts in recent budgets at a time when, on the contrary, they should have been the subject of investment to address population ageing.

Despite the steady growth in population, the public bed stock capacity has reduced significantly from a high of more than 10,000 beds in 2008 to a current capacity of 7,157 beds in 2014, which represents a 29% bed stock reduction since 2008. This is inclusive of a reduction in short-stay beds from a high of more than 2,000 to the current capacity of 1,868, an 11% reduction, and a reduction in long-stay beds from more than 8,000 to the current capacity of 5,289, a 35% reduction. In addition to the funding issues, HIQA requirements for the standards of long-stay accommodation have deemed certain facilities or parts of facilities to be unsuitable, and required reduced occupancy levels in others. This is a continuing issue for the sustainability of current levels of public bed provision. There has been some major and minor capital provision to address this issue, but not on a scale which would allow for the planned improvement or replacement of all facilities in need of upgrading.

Support for people to remain in their own homes is a key and appropriate policy objective, and coincides with the wish of most older people. However, this commitment does not appear to be supported in practice when we note the significant decrease in the provision of home help hours in recent years, especially at a time of population ageing. Approximately 8,300 fewer people were in receipt of home help support in 2014 than in 2008, a decrease of approximately 14.5%. There was a decrease of 2.34 million in the hours delivered, a decrease of 18.5%. In the years after 2008 there was a steady decrease in the number of hours delivered and people receiving hours, especially from 2011, and although there has been a slight increase in 2014, both the number of hours delivered and those served by the scheme are still considerably less than in 2008 or indeed in 2011. During the period between 2008 and 2014, the number of people in receipt of home care packages grew by 4,200, representing an increase of 47%, but the funding for this scheme has remained static. The 2015 Health Service Executive national service plan envisages additional spending in this area, including on home care packages for 600 people, but also acknowledges the risk that the overall amount allocated for older people is not sufficient to address the dramatically increasing demand.

The 2011 programme for Government committed to implementing the national positive ageing strategy in order that older people could be supported and enabled to live independent lives, enhancing and protecting people’s well-being and quality of life. Unfortunately, four years on, this strategy has been neglected and has not been implemented in any shape or form.

Four successive austerity budgets have greatly limited older people's ability to live full independent lives. Despite an 11% increase in the number of people aged 85 and over in the past three years, home help hours have not increased from the 2012 levels of 10.3 million hours and the present system is designed to see home help and home care as ways to meet the priority needs of supporting acute hospital discharges.

The failure to provide support to those in the community with low to medium needs has consequences in terms of demand for more intensive home care packages and long-term places for those with high dependency. More important, it denies older people the opportunity to live a full quality life. People are living longer with a growing population of people aged 80 and over and we need to plan to meet the increased demand for home help and home care services. These services give people, struggling at home, the skills to manage their daily lives, delaying the need for more intensive intervention and reducing the risk of admission to acute hospitals.

The Government should consider introducing a national re-ablement programme, a model that has proved very successful in the UK. Re-ablement or restorative care programmes improve and maintain an individual's physical strength and mental health. They enable greater independence, reducing ongoing home support needs. An evaluation of a re-able pilot programme in north Dublin and research from other countries show a reduction in the need for home care hours. Participants, the majority of whom were aged 80 or older, had a 21% reduction in their requirement for home help and a further 59% reduction in the number of hours required. Councils in Britain that are implementing this programme found a reduction in the number of people being admitted to long-stay care. For example, in central Bedfordshire, numbers admitted to long-stay care fell by more than 10% over three years. The percentage of the population entering long-stay care per year in Britain is 0.7% compared with Ireland, where the number of new clients supported by the national system in 2013 stood at 1.5%.

The demand for long-term care beds is influenced by the availability of resources within the community. If the Government reneges on its commitment to meet older people's preferences for care in their homes, the number of long-term care beds required to meet demand naturally has to increase. Investment in home help and home care services is a priority. If the Government does not invest in these services, the alternative scenario is a more costly investment in the nursing home support scheme. Based on the assumption that 4% of the projected population of people aged over 85 in 2016 will require long-term residential care, this means there will be a requirement for an additional 1,056 beds at an estimated cost of €43.8 million. This clearly underlines the need for a substantial increase in funding for the aforementioned home care and home help strategy.

Over the past ten years, there has been a 44.6% increase in long-stay residents categorised as low dependency and a 17.6% increase in residents with medium dependency. These figures indicate that the effect of Government policy for long-term care provision is driving up the numbers of older people in long-term care who do not need to be there. In many cases people have been prematurely put into long-term residential care totally against their will. It is affecting their mindset and outlook and is demoralising in many respects. They would be better off in the community amongst neighbours and friends where they could visit the local shop or post office or go for a sociable drink with their friends. There is need for a total change in strategy and policy.

Other countries take a home first approach. For example, in Ontario, Canada, patients are sent home with intensive case management and enhanced home care supports for several weeks. This frees up acute beds and ensures those with higher dependency care needs can get long-term care beds. This period of enhanced care supports also allows older people to see how well they manage at home, giving them the time and space to make a life altering decision about where they want to live long term, rather than making such a choice in a stressful and disorienting hospital environment. In the long term, this is a cost-neutral approach as the cost of the intensive case management approach used in Ontario is outweighed by the cost of acute hospital or nursing home beds.

For approximately 58% of people aged 65 and over, the State pension is their only source of income. Older people receiving nursing home care under the nursing home support scheme must contribute 80% of their income, even though the scheme only covers basic bed and board. This leaves those on a full State pension with a disposable income of €46 per week. This is completely insufficient to cover everyday living expenses such as clothes and toiletries, chiropody, social activities and prescription charges among many more little items.

I tabled this motion with a view to having a rational and logical debate to tease out many of the anomalies in the system. We could be much more cost effective: we have a lot of wastage and overspending. Instead, small amounts should be put into the right organisations and the State bodies which deliver community care. There are wonderful home help staff who are part of the jigsaw. Starting tonight, we should be more positive and enhance all the services. I hope we will have a fruitful discussion over the next two nights.

See this speech in context