Michael Harty (Clare, Independent) | Oireachtas source

I am very happy to speak on the Nursing Home Support Scheme (Amendment) Bill 2016. It is a matter very close to my heart. We must keep the frail, elderly members of our community living in their and our community. It is essential that we look after our frail, elderly people. Frail is the important word. We are facing huge demographic changes in this country. I will not give the House the statistics but the number of people reaching the age of 65 has surpassed any previous decade. The number of people who are reaching the age of 85 has surpassed any previous decade. Today we have children born who will live to be 100 such are the advances of medicine. We have a huge demographic deficit to deal with and make up. There are huge numbers of single, isolated elderly people living in our communities in both our rural and urban areas. They have to be supported to stay within their communities either in their own home or in supported accommodation within their communities. We must support day services and dementia services to keep people in their home. We must support the Alzheimer Society and give it funds and support home help and home care packages to keep our people at home. Our health service cannot afford to have people in hospital beds or nursing home beds who do not have to be there and who could, with support, live in their community. We have heard about delayed discharges and there are many people in nursing homes and hospitals today who could, with support, return to their community. That is exactly what they, their relatives and society wants. We must give our elderly people the quality of life, dignity and confidence to survive within their own community.

I have spoken about the difficulties in acute services in our accident and emergency departments in the Committee on the Future of Healthcare and the Joint Committee on Health. We have been grappling with these problems for the past number of months and we can see that the only future for our health service is to transfer hospital centred care to community centred care. We are not talking about transferring or taking away funds from our hospital service but we must put funds into our community based services.

There are many options which we can engage in to look after our elderly. If people cannot be looked after in their own homes, they can be looked after in low-support housing. A former Member of this House, Dr. Jerry Cowley, has a fantastic community service in his home town of Mulranny in County Mayo where he takes people in isolated communities who cannot live on their own. I do not like to use the phrase "congregated setting"; he brings them into a community, low-support setting where they can live out their lives independently but with huge levels of support. When they lose their independence they can move into a higher support setting within the same community. They can live out the end of their lives in a very secure and supported fashion. These incentives and supports should be encouraged throughout the country.

Inspired by what Jerry Cowley did, we have a similar, but perhaps not as advanced system in our own village in Kilmihil in County Clare. We have taken people out of nursing homes and hospitals and we have brought in homeless people. People look after each other. There is a huge community spirit. Communities are very receptive to looking after their elderly people if they are given support. We must face up to the challenge of looking after our elderly people because it makes no common sense to warehouse people in nursing homes. People must go in if it is a last resort but placing people in them unnecessarily is unacceptable and is also very costly.

If we are going to support our elderly people within their community, we cannot simply just put them in the community and leave them without any services. There must be a primary care team who can look after them. There must be occupational therapists, physiotherapists, adaptation to their homes and an increase in public health nurses, community intervention teams and GP services. All these components go to supporting our elderly people in our communities. It is important that if home help is put on a statutory footing, which I hope it will be when the consultative process is finished, we resource primary care and provide the services to assist people to live in their own communities. That is what we want.

Of course, people become acutely ill and there is no avoiding it. If somebody has a catastrophic illness and can be rehabilitated to a level of independence, they should be brought back into their communities and not be put into nursing homes.

In general terms there is a continuum of care and we must identify our frail elderly within the community to intervene very early. We cannot let them come to a stage where home help must be provided in an emergency. We must anticipate people becoming frail, giving them a limited amount of support and gradually increasing it to the maximum level to keep them living within their own communities. Early intervention in the decline of the frail elderly is very important. We must have more community geriatricians who can give expert advice on how people can be maintained medically in an independent fashion at home.

As I stated, part of the work of the Oireachtas Committee on Health and the Committee on the Future of Healthcare is to examine these issues. Yesterday we spent many hours examining how our accident and emergency departments are overcrowded, mainly with frail, elderly people who could be moved from those departments once their acute treatment is completed to bring them back to the community. The Committee on the Future of Healthcare hopes to produce a report at the end of April on a ten-year vision for our health service. The service needs to plan not year to year basis and from crisis to crisis but rather with a ten-year vision. There must be an apolitical plan that does not change every time a Government or Minister changes. It should be a framework for how we see a fair and equitable health service in future.

I commend the Minister of State on starting a consultative process on introducing a statutory home help scheme. I will certainly support her in that. However, that consultation must be finite and we must have a date for starting to trigger this change. It will be one of the fundamental changes in supporting our health service so it should not be put on the long finger or tied up in rationing or bureaucracy. The process must be fair and equitable. It is not common sense to do otherwise.

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