Éamon Ó Cuív (Galway West, Fianna Fail) | Oireachtas source

I welcome this Bill. I did not get a chance today to count all the parliamentary questions I submitted over the years concerning when this Bill would be introduced. It was promised and promised, and yet, like many things, it never happened. The Minister of State is less than a year in government and she has already brought this Bill before the House. I congratulate her on doing that. Promises never fed anybody or solved a problem. Action is what was needed here, and action is what we are getting.

In this State, we need to look holistically at our care of the elderly. We have not done that for many years. Many policies impact on care provision. Covid-19 made one thing very clear in that regard. It was interesting that a statement made at the height of the pandemic crisis by then Taoiseach, and now the Tánaiste and Minister for Enterprise, Trade and Employment, Deputy Varadkar, remarked that it was not a great policy to put people into nursing homes who, if better arrangements were put in place by the State, communities and society, could have lived independently or with intensive support within the community.

In looking at this, the issue of physical planning has to be taken into account. Looking at our rural areas, all of the plans and designs of the great experts in planning seem to be designed to stop people living in the area from which they come and near their parents, particularly in rural Ireland. I have argued repeatedly that the free choice of people to live in the community from which they come and to live near their parents should be facilitated. There are two very obvious human consequences from that, which professional planners and academics, in particular, seem to overlook. The first is that in the earlier years, parents often become grandparents and become a very big support within the family network in terms of babysitting, nurturing, supporting and educating, doing all the things that grandparents can do and can do in a special way. As the years go by, the grandparents are often looked after and cared for by the next generation. In those situations it is often possible to continue living in one's own home, which I believe is the wish of most older people.

Therefore, we should think this out again post Covid. It does not matter what mistakes we have made in the past. Just because we may have got it wrong, there is no need to avoid putting our hands up and admitting that is the case. We can admit that we did not think about a particular element and revise our thoughts on the matter.

The second option is the provision of dedicated housing for the elderly in small clusters. There is a perfect example of the provision of such housing in my parish. It is a community-operated social housing scheme. It is built around an old convent which is now a day care centre and a health centre. It is located beside the church, the shops and the post office. There are eight houses in the development. In my parish, the vast majority of older people choose to stay in their own homes, but there is a minority for whom that is not a viable option. They move into these houses where the services are all near-by. There should be one such scheme in every parish, so that support and meals can be provided easily. However, meals-on-wheels should be available pervasively throughout the community.

There are also models which provide even higher levels of support that are not nursing home care. Therefore, in many cases nursing home care should be the last option. However, it is one that is absolutely vital and for which there will always be a demand. Some people choose to go into a nursing home for reasons that are good to themselves. For others, there is no choice because of the level of disability and the support that they need. All of these must be facilitated.

When we look at our model for nursing home care, the one good thing is that I can always reassure people that those of very little means will go into the same nursing home as those of significant means. They will get the same care and they will only pay according to their ability to pay. According to the scheme, 80% of the person's income is assessed, and he or she gets to keep 20%. However, assets are taken into account. That is the issue that we are addressing.

Normally, a couple's assets are divided into two in the means test. In the case of a single person, all the assets are taken into account. There is a disregard of €36,000 for a single person and €72,000 in the case of a couple. The house or principal residency is taken into account and 7.5% of that value is included in the assessment each year for three years. Therefore, the maximum amount that is taken out of the estate by means of a charge is €22,500, because the collection of this money can be deferred. However, there was a problem with the scheme. The value of family farms and small businesses could be assessed continuously, with no cap, at a rate of 7.5% per annum.

The average stay in a nursing home is less than three years, but there are many people in respect of whom it is longer. I recall the case of a neighbour of mine, who went into a nursing home. I visited that neighbour two years later. I did not think that person would survive as long. It was a great thing that the person did survive for years as a single person who had been living alone in the nursing home. If that person had a farm or a business, the amount included in the assessment would have increased until virtually the whole farm or business would be taken away. For many families, a family business or farm is something that they have effectively inherited on trust, which they pass on to the next generation. They hope to pass it on intact.

The other rule that catches people out is illustrated by the following example. If an elderly parent had a son or daughter working on the farm with him or her, unless he or she transferred the farm to the son or daughter five years or more before going into the nursing home, except in exceptional circumstances, the assessment would include the total value of the farm. So, if he or she transferred it three years before going into the nursing home and did not own the farm on going into the nursing home, he or she would still be assessed as owning the farm. Of course, that rule has placed a huge burden on people. I have often pointed to what I refer to as the double lock system in rural Ireland, whereby parents are reluctant to hand over the ownership of their property at times and they will it to their children. For one reason or another, they keep their name on the deeds of the property as they get older.

There are many reasons, which I do not need to into, why this might happen. By introducing the rule whereby if the successor has worked on the farm in three of the previous five years and undertakes to continue to devote a reasonable amount of time to the farm in the following years - I believe it is six years - the value of the property will only be included in the assessment for three and a half years. This means it will be treated on the same basis as the family home. What that means is that if the person lives in the nursing home for three years, 22.5% of the asset will have a burden on it that will have to be repaid to the State. That is a far cry from what can happen if somebody lives, for one reason or another, in a nursing home for ten years. The inclusion of 7.5% of value of the property in the assessment would amount to 75% of its value. That does happen in some cases involving various conditions that we can fully understand and that we have all come across.

There are many other issues, but I will run out of time before I can cover all the issues I would like to cover. I would like to raise an issue that I think needs addressing. I refer to the example in which a couple or a single person goes into a nursing home and they have a private principal residence which is empty.

They are in the nursing home for one, two, three, four years and so forth. After three years the clock stops, but the house is empty. However, if at any time one liquidates the asset and ensures that somebody can occupy the house, in other words, one sells the house, one then becomes liable for the cash one received on a continuous basis in the fourth, fifth, sixth and seventh years. There is no doubt that at a time of huge housing shortage there are houses in this country that are owned by people in nursing homes. They are either afraid that if they cash out now that after the third year, if the people in the nursing home survive, they will keep having to pay, or where they have already spent the three years in the nursing home, they would certainly be levied indefinitely on the capital they would realise. Therefore they do not sell and make the house available. This is a pity because, as I said, housing is in short supply. We should consider a provision whereby if a vacant house belonging to somebody in a nursing home is sold after the person goes into the nursing home, the proceeds of that sale, whether it happened within the three-year period or afterwards, would be treated as if they were the house. If we made that change, we could do away with the scandal of vacant houses around the country at a time so many people are screaming out for housing.

Reference was made to the model of private versus public nursing home care. First, HIQA does a very thorough job. One of the good decisions was to bring HIQA into the equation. The authority was set up during the Taoiseach's time as Minister for Health. It certainly was proposed at that time. It is very important that such a service exists to monitor, on our behalf, the human and physical standards adhered to in the many health facilities, particularly in the nursing home sector, because ultimately we do not know which service, be it private or public, might leave a little or a lot to be desired in how it operates.

The argument regarding the private and public sectors is old, and one I do not find easy to resolve. Public care is very good and there is a number of the facilities in my constituency. They earn universal praise. Most of the private nursing homes in my constituency appear to be owner-run. They, too, provide top-class services. If we had relied on the public service to provide all the nursing homes we needed with a burgeoning older population, I am not sure that we would have met the demand in time in the way the private sector did. There were flaws and difficulties with that, but in the greater scheme of things, the private sector delivered in great measure to meet a rapidly increasing demand, brought capital into the process and delivered projects. As I said, there is a very strict regime in terms of scrutiny by HIQA. The other issue is that because people have a choice in nursing homes, it is fair to say that there is fairly fast migration away from the nursing homes that are not providing a high standard of care.

That said, as in so many facets of life, I do not like the corporatisation of businesses by big players. I would much prefer the small operator dedicated to the task. I do not know if there is any way to try to incentivise that approach, particularly in line with EU rules that can often be a barrier by favouring one thing rather than another. I would prefer that because personal attention is very good. I recall reading a document about the 1940s when the question was asked of Fianna Fáil as to what its policy was on private property. A very interesting answer was given. It was that Fianna Fáil was in favour of private property, but, and this was vital, in as diffuse an ownership of private property as possible. The party was making it quite clear that many people owning a little was a great deal better than the few owning a lot. Unfortunately, modern trends are going the other way and it appears that small operators of every type in social and commercial services and in so many facets of life are being swallowed up by the might of the euro, and those who have a large number of them. Whether it is private housing, social care, nursing home care or ordinary private business, I am not sure that this is a good model. It is not just confined to this sector, and it is something on which we need a wider debate on another day.

See this speech in context