Thomas Pringle (Donegal South West, Independent) | Oireachtas source

I thank Deputy Tom Fleming for introducing this Private Members' motion and dedicating the time to issues around elder care in Ireland. It is a timely issue, coinciding with yesterday's Dáil motion expanding the Ombudsman's remit to include private nursing homes. As I stated yesterday, our over reliance on private residential care and our approach to elder care has led to under investment in our home care sectors. The sector is reaching a critical stage as demand for home care increases with an aging population taking hold while people begin to prefer a more holistic approach to elder care needs. Predictions suggest that 75,000 people could seek to avail of home help services in 2021, compared to 48,000 in 2012.

There is a growing trend of people with low to medium support needs being admitted to residential homes such as nursing homes. ALONE's Home First campaign has tracked this trend, observing that 35.4% of people in the long-stay beds have low to medium support needs with an increase of 44.6% in the number of low dependency beds since 2004. The number of medium dependency beds has increased by 17.6% since 2004, while the number of high to maximum dependency beds are decreasing. High dependency beds are more likely to be kept in community hospitals, where there are nursing staff available to deal with patients. We can only imagine how many of these people are also located in hospital accident and emergency wards throughout country. This has become our policy for dealing with chronically ill elderly patients, leaving them physically on the margins of the health care service.

It is clear that nursing homes have a policy aimed at a lower level of needs for easier and more manageable environments, to reduce staff costs and in an effort to increase profits. Simultaneously, the Government has cut funding to vital home care supports for both carers and elderly patients, including supports to improve their housing environments. To further add to the disintegration of the home care model, the number of people aged over 65 is increasing and will reach nearly 1 million by 2031, an increase of more than 86% or an extra 20,000 people every year. Some 7% of people aged over 65 live in nursing homes in Ireland, compared to just 4% in the Six Counties. People want to age with dignity and respect and as thriving members within their communities, and home care should and can reflect this. These principles are even reflected in Government policy documents, such as the programme for Government, the national service plan and the national positive aging strategy. Unfortunately, home care continues to be underfunded, under-regulated and undervalued by the Government.

Home care can take place in a number of arrangements, informally through family members, friends and neighbours or professionally through the HSE home care packages either directly or outsourced to private care companies, which is a growing trend. This country does not appreciate respect the role of care and many family members care for an elderly relative and others provide informal care. The carer's allowance and respite care grant have been under constant attack and scrutiny in successive budgets. It is imperative, if we are to have an ounce of respect for the role of carer, that we invest in and protect our carers in the community by maintaining these supports and improving on them to fit within the home health model. The carer's allowance must be maintained alongside the half rate carer's allowance.

People could also be encouraged into employment by becoming carers if the Government had the imagination when it comes to labour activation measures.

Direct supports to elderly people are also under threat. The living alone allowance does not reflect the current standard of living while the over-70s GP card is too restrictive, allowing only free GP care without access to the services which come with the medical card. EUROSTAT data released this year showed the Government spent just 10% of social protection outlay on the elderly in 2013, almost 12% less than the eurozone standard. Countries like Bulgaria, Luxembourg, Austria and Romania all dedicate over 25% of their spend on the elderly. The State pension has not seen an increase since 2009. For many elderly people, their weekly incomes have been cut by over €14.

It is important the household benefits package, the free travel scheme, the Christmas bonus, the housing adaptation grant, the disability grant and other supports for the elderly are maintained in the forthcoming budget. A lack of financial investment in home help hours and home care packages, cuts to mobility aid and a lack of housing supports have meant elderly people have been forced away from the home care setting and into residential care. Up to 1.6 million hours of home help were removed from the sector over the past four years. Funding for home help services declined by almost by almost 12% since 2009. Overall, 72% of the older people’s services budget is spent on the nursing home support scheme, fair deal, while only 9% of the budget is allocated to home care packages. Housing supports, such as the housing adaptation grant, have seen a reduction from €79 million in 2011 to €50 million in 2015. As a result, home care provision is incredibly underinvested and is unevenly distributed across the country.

Thankfully, Donegal has one of the lowest proportions of elderly people living in nursing homes and has a culture of supporting the elderly in their homes. However, this too has been put under threat with cuts to home help hours, or rather home help minutes.

We also have a highly unregulated home care system. Many informal carers are not recognised and there are no set standards or legal obligations on home care provider companies to vet staff. HIQA is left with no remit to monitor or enforce the sector, even though we have heard time and time again of dreadful standards witnessed in some private home care settings. The HSE is paying millions of euro to home care providers but due to an unregulated market, thousands of elderly people are at risk of poor quality care, abuse and medication failures. This is against a backdrop of a majority of over 50 private providers in Ireland not having relevant external quality assurance certification. Certification is only reflective of their business practices and management systems, not the level and quality of care they provide for an elderly person.

The HSE claims the approved providers are selected through a tendering process, covering areas such as client focus service, appropriate complaints processes and training and supervision of staff. A new tendering process was meant to be completed in 2013 but here we are in 2015 and we still have not seen the roll-out of this. It is over four years since it was first promised and we do not have another four years to wait. It is needed to ensure a high quality of care for elderly people.

I acknowledge the incredible work done by voluntary organisations such as Alone and Age Action in the area of home care provision, independent advocacy and campaigning for the rights of elderly people and their needs. I only wish the Government could have such a strong record as many of these organisations have shown. We might otherwise be witnessing a more dignified approach to our most vulnerable in society.

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