Fergus O'Dowd (Louth, Fine Gael) | Oireachtas source

I welcome this debate and the Minister of State, Deputy Butler. Anytime I have raised issues in relation to the care of older people, she has always listened and she is very attentive to the excellent debate we are having this afternoon. I have every confidence, having discussed it with her in this House and in private, that statutory home care packages for all families who want to receive them is the way forward. That is absolutely critical and essential. It is an essential promise in the programme for Government. There is universal support from those of us in this House who articulate that demand.

I agree with what this Bill seeks to achieve. I congratulate the IFA and business groups for ensuring that all family members, no matter what their income or background, are treated fairly and appropriately under the fair deal system. There are many good things about the fair deal system. This is an additional support which will be very welcome.

I am concerned about the deaths in nursing homes during the past year as a result of Covid. There is an urgent need for an independent inquiry into these deaths. Through my investigations, queries and freedom of information requests, I believe there must be an independent inquiry into what happened in the Dealgan nursing home in Dundalk. I discovered two precedents recently under a freedom on information request. There are inquires-audits-investigations ongoing into two nursing homes, namely, the Tara Winthrop private clinic in Swords and the Phoenix Park community nursing unit. I do not know the reasons this is happening but I welcome them. It is absolutely critical that the Dealgan nursing home is independently investigated. It is the only nursing home in the State that the HSE went into and, with the consent of the owner, took over the running of it and in which more than 22 people died.

I agree with the point that a nursing home should be the last option. With all due respect to the people currently in one, I believe a nursing home is the last place, medically and physically, one should be in. Support should be provided in one's home or in sheltered housing and through the many good ideas Deputy Shortall outlined.

One issue that has arisen because of Covid is the inability of survivors to meet repayments after a person who had benefited from the fair deal scheme has passed away. There is a difficulty in meeting the 12-month requirement. The Revenue Commissioners want their income back within a 12-month period after the passing of the person. I think the time period should be extended and the interest should not be demanded for a further six to nine months, or even a year, while maintaining adequate precautions. People cannot get houses repaired at the moment, as we all know. One could not bring in a builder until recently. If a person has to sell a home, we should not penalise him or her because of Covid.

I want to express my deep concern about the potential for elder abuse if we insist older people living in their homes must go into nursing homes, or other care institutions, before their time. I am very reluctant to make any change to the right of an individual to live in his or her home for as long as he or she possibly can. I oppose absolutely family pressure, financial pressure and other pressures on older vulnerable people living in a home they have lived in all their lives, for 70, 80, 90 years, and pushing them into a nursing home as quickly as possible. That is wrong and is absolutely morally unacceptable. We must examine that proposal in greater detail.

Some 70% of people who are in nursing homes suffer from dementia. Dementia is not like the flu - here today and gone tomorrow - it gets progressively worse. I know of many people who are broken-hearted looking after a family member at home as the dementia proceeds and increasingly disables the individual cared for. We need due and proper recognition of any pressure which may be inadvertently put on such individuals to get out of their homes. Their quality of life and their familiarity with their bedroom or kitchen is hugely important to them. The only knowledge they may have of their very existence may be something as small and as simple as a favourite teapot, cup or chair. Before we go down that road, we must look at the decision-making process we would make if we were be put in that situation. Consent is the most important thing. How can one give his or her consent in advance to such a decision? The protocols put in place should be clear and absolute. I am very concerned about it. We should be looking at research on it from other countries.

I support the Minister of State's reluctance to introduce this without due and proper thought. Older people have given their lives to society and their families. They do not want to be placed in a situation where there is conflict between family members, with children saying to parents who suffer from dementia that it is time for them to get out because they cannot pay for their care without doing this. The fair deal scheme is there to protect that individual. That is what it is there for. The asset is not disposed of until the person has passed on and there are no other survivors who are entitled to live in the home. I am reluctant in respect of that.

I have no doubt this Bill is very important and I look forward to contributing on Committee Stage. I advise proceeding really slowly on the other proposal and the Minister of State has my full support on that.

I welcome this amendment to the nursing homes support scheme. I am happy to support it and it is long overdue. For years, many families with small farms or businesses have been charged 7.5% of the value of the farm or business to pay for nursing home care. It is draining those farms and businesses and making them unviable. I am happy to see the 7.5% will be capped to three years. However, I believe it will not be retrospective, which is quite unfair because of the length of time it has taken this Bill to come to the Houses of the Oireachtas. Many families have been waiting for this, as has been discussed, over a number of years but nothing was done. It is better late than never but some repayment or reduction in fees should be considered for those who have been paying since 2018.

There is an overemphasis by the HSE on nursing home care for elderly people. There are other options. The HSE has indicated that under Sláintecare it will invest more in providing home-based supported living for elderly people. I welcome that but at the moment not enough is being done in that quarter. I know of several people who would be able to live in their own homes and be much happier there but the home support packages are not available. There would be a saving for the State and, more importantly, people would be able to continue living in and contributing to their community.

Recently I raised as a Topical Issue the upgrading of boarding out regulations. I also raised that issue with the Minister personally and with the Department. It is a much more cost-effective form of care for elderly people based in the community. It suits people who cannot or do not want to live alone but do not require nursing home care. It and other options need to be looked at as there is far too much emphasis on nursing home care. Many people being discharged from hospital are directed towards living in a nursing home instead of looking at what other options might suit them. It may be the most suitable option for many, but it is not for all.

The programme for Government contains a commitment to reform the nursing homes support scheme to incentivise renting out vacant properties and encouraging vacant accommodation to be brought back into active use. It is disappointing it is not being followed through in this Bill. There was potential to free up approximately 9,000 properties if it had been included in the Bill. We are in the middle of a housing emergency and that would have been a most welcome move. That is unfortunate but I welcome the amendment as it is.

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