Willie O'Dea (Limerick City, Fianna Fail) | Oireachtas source

I move: "That the Bill be now read a Second Time."

When talking about nursing home care and home care, we are talking about more than the elderly. Given that the elderly comprise such a large component of the people in receipt of such care, however, I will outline some statistics which demonstrate the magnitude of the problem we face. Ten years hence, it is estimated that there will be 908,000 people over 65 years of age in this country. That is one in six of the population. In the 20 years between 2006 and 2026, the number of people over the age of 75 years in the country will increase by a factor of 3.5. Every day for the next ten years, an additional seven older people in Ireland will require long-term residential care or care in the home.

The cost of caring for the elderly will increase exponentially. It will be up to approximately 2% of GDP by 2050. We are facing a spending tsunami in this regard, so it is incumbent on the Parliament and the Government to ensure the huge amount of money the taxpayer will be called upon to spend in this area is spent to best effect and that the taxpayer gets the best possible value for money, not to mention the individuals on whom the money will be spent. State policy, or at least State philosophy, is that elderly and infirm people should be cared for, in so far as possible, in the comfort and security of their own homes. However, as in so many other areas, philosophy and practice diverge. If somebody reaches a position where they are too old and infirm to take care of themselves or for their family to look after them without support, they have two choices - residential care or home care. We have legislated for residential care in nursing homes. Putting it on a statutory basis means that if somebody meets the criteria, the or she has a statutory entitlement to residential care. Of course, there is no such statutory entitlement to home care.

Another issue with home care is that it is geographically dependent, in that it depends on whether the various ingredients that comprise an appropriate home-care package are available in the locality where the patient resides. Local health officials may determine that if the necessary ingredients are not available in a locality the patient will have no choice but to opt for the fair deal scheme. Ironically, it costs the State more than three times as much, on average, to provide a fair deal package as it does to provide a home-care package.

Existing home care services are sporadic and inconsistent. They are not patient driven and there are significant geographical disparities in the availability of services. In other words, it always depends on where a person happens to live. Somebody recently described it as a postcode lottery. There is no transparency in eligible criteria and decision making. It is entirely at the discretion of the health service. In view of this, many elderly, infirm people have little choice but to opt for nursing home care at far greater cost to the Exchequer.

The ultimate solution is to have a home care system which is statutorily based, which the Minister of State is attempting to do. However, it will take time and as I said previously the elderly do not have time in abundance. In the meantime, I am proposing this as a temporary, stopgap measure. It has the capacity to assist some of those people. It will not give a general legal right to home care to everybody. However, it will give it to some, specifically those who qualify for nursing home subvention but who could be cared for at home if it would cost the State less and would not compromise the safety of the person being cared for. It would start the process of giving a universal legal right to home care. I accept the Minister of State's argument that it will take time to put in place a statutory system. If, in the meantime, we can extend it to even a small category of the population, why not do so? It would be a far better solution for the person requiring care and it would certainly be far better for the taxpayer.

The average net cost of a home care package is less than one third of the average cost of residential care and yet the HSE allocates 58% of the budget for older people to the 5% of people in nursing home care. Studies done by the Alone organisation and others show that in a clear majority of cases, older people awaiting transfer from hospital to long-term nursing home care wished to remain in their own homes. Up to 15% of older people were not involved in this decision at all. In the case of older people suffering from dementia, this figure was 45%. Ireland has 40% more people in nursing homes than the EU average and the average stay in a nursing home here, four years, is double the EU average of two years. A considerable number of these could be cared for at home.

Studies by a number of reputable organisations in this field show that 36% of people in long-stay nursing home beds have low to medium support needs. Low-dependency nursing home beds have increased by almost half in the 12 years since 2004. Medium dependency nursing home beds have increased by over one sixth in the past two years. The figure for low to medium dependency people in long-stay nursing home beds is increasing, while the figure for high to maximum dependency is decreasing. In other words, more of those in nursing homes could be adequately and more economically catered for in the home. Justin Moran of Age Action Ireland put it succinctly in a recent interview with the Irish Independentwhen he said there were more and more people in nursing homes in Ireland today who could be supported in the community.

When the recession kicked in, the resources for home care were slashed. Despite the fact that there has been a 25% increase in the population of over 65s since 2008, funding for community support has decreased. Expenditure is roughly at the level it was in 2008 and the number of home help hours has decreased by 18.5% or €2.3 million in the same period. While I realise home help is only one aspect of home care, the type of assistance the elderly can get from home helps has been pared back. Carers have been restricted from helping elderly people with domestic tasks such as taking out the bins, picking up shopping or cooking meals, not recognising that in many cases these domestic tasks are where the greatest need arises.

Interviewed by The Sunday Timesrecently, Dr. Sarah Donnelly, lecturer in social sciences at UCD, said the removal of these services was forcing people towards institutional care. "We can see there is a direct correlation between the removal of supervisory supports and the number of people with lower dependency having to go into nursing home care,” she said. The Minister of State's predecessor, former Deputy Kathleen Lynch, said in a recent interview, "It appeared to me that people expected my job was to put older people into institutions." She went on to say, "That really bothered me," which I do not doubt. This is precisely how the 2009 Act is being administered and interpreted. For every individual we can direct towards home care as opposed to into a nursing home, the taxpayer benefits in the normal course of events.

In the Bill, we have provided specifically that the option will be given only if home care will cost less. It will release resources, not to mention give people the joy, satisfaction and dignity of living at home with their families who in my experience are prepared to contribute to the care and support of their elderly relatives if there is some sort of decent home care package. I support the Minister of State in what she is doing. We need a statutory home care system. I would propose it myself but for the fact that as a humble non-Minister the rules of the House do not permit me to propose legislation which would incur a cost to the Exchequer. I will support the Minister of State in every way I can in her efforts.

The point has been made to me about the legislation opening new areas of expenditure. It does not. It will save money. If instead of going into nursing home care a person goes into home care at a lower cost to the State I do not see how it opens up avenues of expenditure. If the Bill were going to be a burden on the Exchequer I have no doubt the very resourceful people in the Bills Office would prevent our bringing it forward. The Minister has estimated that it may take two, three or more years to put a proper statutory system in place. The Minister of State can clarify this. We will all be delighted when that happens and there is no longer a need for something like this Bill. While we are waiting for nirvana, people are applying for the fair deal scheme today and in the future who could be catered for at home and would prefer to be at home. If we can bring something in which would facilitate this, would it not be the logical thing to do? I commend the Bill to the House.

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