Róisín Shortall (Dublin North West, Social Democrats) | Oireachtas source

The Bill before us today provides for the extension of the three-year cap on assessable property to farms and businesses for not less than 50% of their normal working time for six years. This is an issue that has been long-recognised as something that needed to be addressed. To that extent, I have no difficulty with the Bill today and the Social Democrats will not be opposing it.

What is notable about the fact that we have legislation before us on the fair deal scheme, or the nursing home support scheme as it is called, is the number of issues that it does not address. It is beyond time that we took on those broader issues. Everybody’s talking about them today in the Chamber. We are all very conscious of the shortcomings in services for older people and we are dealing with them on a daily basis in our constituencies. It is incumbent on the Minister of State and the Government generally to address those issues which have been brought into stark relief over the past year or so, and I will refer to those later. This is a pressing area given our demographics and the growing number of people over the age of 65, which is going to continue to grow very rapidly over the coming years. We have to get services, our support systems and our accommodation sorted out to meet the needs of older people and we really must go much further than this simple measure.

The legislation is notable for those aspects of services for older people that are not contained in it. Primary among these is the failure to address the whole question of home care and the promise that has been there for a long time to introduce a statutory scheme for home care, similar to the statutory scheme for nursing home care. This issue was highlighted several years ago by Members in this House, and by Brendan Courtney who did a very good television series of programmes on his own circumstances with his late father and so on. He really brought this to prominence and showed how the current system, as it operates, makes no sense whatsoever. It limits people to arrangements that are not in their best interests and forces people into nursing home care when they are not ready for it, do not want it, where it may not be in their best interests, and is an expensive option for the State. On that basis, it makes no sense whatsoever.

The other things that are missing is that the Bill does nothing to address the over-reliance on private nursing home care, which I will talk about further in a moment, and the tendency to see nursing home care as an investment opportunity and a business rather than a critical element of the social care system in the country.

The Bill makes no effort to reorientate the social care system towards the community. We are supposed to be moving people away from institutional care to services in their community and the Bill makes no attempt to address that.

I refer also to the issue raised by Deputy O’Dea which I have been talking about for many years, which is that the Bill does not include any amendments to incentivise the rental of vacant residential properties when people have moved into a nursing home.

There are a whole range of more urgent and pressing issues, or at least equally pressing issues, that need to be addressed and it is very regrettable that these have not been brought before us today in a comprehensive piece of legislation.

Central to Sláintecare is the belief that care should be delivered as close as possible to people’s homes in their own communities. That is about the ethos of ensuring that we provide care at the lowest level of complexity as close to a person’s home as is possible and recognising what his or her desires and needs are. Our population is ageing very rapidly which means more people than ever will enjoy their older years well into their 80s and 90s, which is a fantastic thing. They should be able to age independently and for as long as possible in their own homes where that suits their needs. It falls to Government to ensure that they have the care and housing options which older people rightly deserve.

When we look at the health outcomes, we know people do best when they are in their own homes. No matter what age one is, wherever one is away, be that on holidays or elsewhere, one always wants to get back to one’s own home because that is where one feels best, most comfortable and secure. We ignore those feelings when it comes to older people in the main.

Understandably, most people want to stay at home in their communities for as long as possible and it is also the best option for many different reasons. Many, however, have been essentially forced into nursing homes because of the Government’s focus on only this one narrow aspect of social care.

I will read an excerpt from the nursing home expert panel review that came out last year, after Covid-19 forced this Government to look at what was happening in our nursing homes. That review states:

In the past 20 years significant financial incentives ... were given toward meeting the costs of new private nursing homes. This major policy shift effectively handed future responsibility for the residential care needs of an increasing number of frail older vulnerable members of society to the private sector. Thirty years ago, 80% of residents in long-term residential care were in publicly-funded [nursing homes].Today the exact reverse applies with 80% in private nursing homes.

This over-reliance on the private sector has clearly failed our older people in many respects. It has led to a situation where nursing homes are largely unregulated.

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They have been like that for many years and were essentially left to their own devices when the dangerous virus arrived on our shores. It is not acceptable to have care institutions that are not properly regulated. This thing of keeping nursing homes at arm's length, which is what the current system amounts to, is dangerous and irresponsible of the Government and it is unfair to the residents. We know, of course, how that arm's length relationship worked out through the past year or 15 months in the context of to the impact of Covid. HIQA has been very clear in its call for regulatory reform for many years. Mr. Phelim Quinn, its chief executive officer, appeared before the health committee in March and at that meeting he stated, "It is important to note that Covid-19 has not in itself signalled the need for regulatory reform; rather, it has shone a spotlight on an issue that was already in need of urgent consideration."

The 2015 review of the nursing home support scheme looked at the need to reorientate the social care system and highlighted that home or community based care can be a cost-effective alternative to nursing home care for many older people. It states, "Admission to long-term residential care should be seen as the last resort and should only be availed of when it is no longer feasible for people to remain in their own communities with appropriate support." It further states, "Reducing the proportion of older people in residential care will require the expansion of community and home based services and perhaps, the development of alternative models of care."

The same conclusion was drawn last year by the nursing home expert panel review, which clearly calls for a revised model of social care. The review states, "There is increasing evidence to show that highly dependent persons can live safely and more happily in domestic settings, provided their required home care supports are in place." It clearly states, "Nursing homes should be part of a continuous spectrum of care of the older person in the wider healthcare system, with provision of multidisciplinary support." However, there is still no statutory right to home care in this country and the pilot scheme for it has been pushed out yet again. Having a statutory scheme for nursing home care without the same provision for home care forces people into nursing homes even if that is not what they want or the best option for them.

One of the key issues raised during the pre-legislative scrutiny of the Bill related to incentivising the rental of vacant properties. The way rental income is treated under the current operation of the scheme does nothing to encourage people to let out their homes while they are in nursing homes. All Deputies, as public representatives who have been involved in election campaigns and going door to door, see clearly the extent of this issue and the vast number of houses that are lying idle and are clearly the homes of older people. One can see all the signs such as handrails, ramps and so on, but the houses are vacant and there is nobody on the register. Those are clear signs that, in the main, these are the homes of people who have gone into nursing homes and which are lying idle. At a time when we have a serious housing crisis, it makes no sense whatsoever to have thousands and thousands of homes lying idle. Of course, it makes no sense from a financial perspective either. There should be a way of addressing this issue which ensures that people do not lose, euro for euro, any income they get from letting their homes. Many Deputies have been talking about this for years. There is a real urgency about that. The Minister of State should raise this with her colleagues in government, particularly the Minister for Health, Deputy Donnelly, but also the Minister for Housing, Local Government and Heritage, Deputy Darragh O'Brien. It should not be beyond them to come up with a scheme that addresses this issue and is better in terms of the costs involved in nursing home care, but also ensures that those homes are brought into use.

Right now, there are more than 13,000 homeowners on the scheme but only approximately 740 of them lease their home. Some properties are occupied by partners or family, and that is quite understandable, but that still leaves many thousands of vacant homes. More often than not, the homes are left empty because rental income is assessed. In light of the major housing crisis, the Bill should have taken note of that issue and addressed it. Legislation is needed urgently to change how rental income is assessed. This could instantly help people in nursing homes to generate extra income while also dealing with the housing crisis.

The responsibility for creating better options for older people as they age does not fall only under the remit of the Department of Health. Sage Advocacy, which provides advocacy and support for older people, has been very vocal on this. We need to listen to older people regarding what they want, what their wishes are, what is in their best interest and how they can be best supported into their older and frailer years.

It is extremely important that the Minister for Housing, Local Government and Heritage takes action on the issues of supported housing as well. The 2015 review of the nursing home support scheme recommended that sheltered housing and assisted housing models should be considered to provide more options for people as they age and to ensure that greater overall capacity is created in supported living. There are many different models of that with which Members are familiar. There is no standard model. There are various such models but there is not anything like enough capacity to meet the significant need that is there. If older people had better housing options that enabled them to live independently for longer in local communities, many would choose to do so rather than maintaining and heating costly homes that are larger than needed or paying property tax, for example, on a home in which not all of the rooms are used.

All Members are familiar with constituents such as an elderly couple, an elderly single person or a widowed person living in a three-bedroom or four-bedroom house. They really struggle to maintain the house as they are on a fixed and usually low income and they are faced with many maintenance and energy bills and property tax but their options are so limited in terms of what they can do. I regularly get queries from constituents asking whether there are any options for them to move to designated older people's supported housing so that they can continue to live independently and live full lives but not have the burden of trying to maintain a bigger property. Even a two-bedroom or three-bedroom property can be very difficult for an older person to maintain. If there were better options available, we could cater much better for older people. I do not know why that is not being done; it just does not seem to make sense.

I am very familiar with what is done in other countries. In Germany, for example, 10% of units in every housing estate are designed for older people so that when a couple or an elderly person is left with an empty nest, they do not have to move out of their community or struggle to try to maintain their home. Rather, they can move down the road, into a more appropriate housing unit within the estate.

One obvious and important part of the response is to designate housing for older people and to enable purpose-built accommodation, but the current housing strategy of the Government largely overlooks this. There are examples of such housing in London, where there are flat complexes or apartment blocks that are designated for over-55s or over-60s. They are very suitable for people who want to downsize. We do not have any equivalent here in the private sector and that makes no sense whatsoever. We should have that designation because at the moment the only option for an older person is to move into an apartment and, as Members are aware, there are no apartments for sale at the moment because the funds are gobbling them up.

There must be designated housing for older people where they can have that kind of security. Older people do no want to move into a mixed apartment block where a gang of students or otherwise could be living next door to them and where it would not be suitable for their needs.

I ask the Minister of State to consider designated developments for older people, which could be built on many of the small infill sites in our cities and new estates could include a mix of older people's homes as well as family homes. This would enable people to move to more appropriate accommodation as they age. There are some models of dedicated housing schemes in Ireland, but there is no standard consistent model in place. This is happening in many other countries and we should be doing the same. There are also sheltered housing schemes run by local authorities and they have proved to be very successful. When people are getting older, they need easier to maintain and more accessible housing. Local authorities had been providing that on a widespread basis, but they have largely stopped doing that. We need local authorities to get back into that area, not only for the sake of older people, because that is what they want, but also to address the wider housing issue.

The financial contribution scheme is a very good one. I do not know if the Minister of State has come across it. It was used widely in my constituency and in other Dublin areas during the 1990s. People sold their homes back to the council, they kept a portion of the proceeds and in return they were offered supported sheltered housing units that were accessible, easy to maintain and well insulated, with supports around them. That was the ideal arrangement. From the local authority's point of view, it got back family homes which it could re-let. They were pepper-potted around the area rather than all in the one place. That is something which must be restarted. Different levels of support can be provided. There are some good models in existence. There is a very good one in Clareville in Glasnevin, which has been there for about 20 years. Different services are brought in. As a security measure, there is somebody on site who drops into people. All the other services, such as public health nursing, can be brought in. Meals on wheels can provide meals everyday if people require them and if not, that is fine. We must be much more ambitious in relation to the kind of support services older people need.

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