Michael Moynihan (Cork North West, Fianna Fail) | Oireachtas source

I welcome the opportunity to contribute to this much promised debate. I congratulate the Minister of State, Deputy Butler, on steering this through the Department and the Government. I know the tenacious way she applied herself to the job, to ensure the Bill was brought to the Dáil and, hopefully, through the Seanad and onto the Statute Book as soon as possible. I wish to ensure that it be done as soon as possible. It is a very important legislative measure. No constituency office, rural or urban, unaffected by this or is not having discussions with family members about small businesses and farms, trying to do the right thing for them and trying to ensure the future viability of small businesses and family farms into the next generation. It has been a discussion for many years between farming organisations, business organisations and the Department. However, it took the Minister of State to ensure that this came through, and I congratulate her on the way she did it. She should keep up the good work she is doing in the Department.

Before I discuss the substance of the Bill, I should point out that nursing home care is a massively important part of the care of the elderly in our society. For decades, community hospitals provided nursing home care.

It was, by and large, done in the public sector and in community hospitals up to 20 or 25 years ago. Going back decades, the acute services in those hospitals, of which there may have been some, were withdrawn and they became hospitals providing care for the elderly. The debate on refurbishment enters at that point. I am glad to say that the Department of Health and the HSE are moving to advance the refurbishment of Macroom, Kanturk and Millstreet community hospitals. Those hospitals have provided vital services over the years. The staff and management of those hospitals must be commended for the excellent way in which they have cared for the people, particularly in the Kanturk and Millstreet hospitals. They have cared for the people of Duhallow in their most vulnerable time of need. There is not a family within our communities that has not had a loved one in those hospitals for some time. Many have spent their final days in either Millstreet or Kanturk hospital. The workmanship and standard of care provided by the nurses, care assistants and all who are inside those hospitals need to be applauded and they should be thanked for their dedication and work. Any time that one goes into those hospitals, one can see the commitment of the staff and the compassion they have for those whose care they are charged with. It is important that we acknowledge and accept that, and applaud it in every way we can.

Over the past number of years, HIQA has come on board. HIQA was initiated approximately 20 years ago and it has done various reports into the community hospitals and residential settings and has been critical of the antiquated buildings. The Department and the HSE have worked at a slow pace to bring those community hospitals up to standard. It was clearly evident many years ago that these hospitals would not meet the correct standard required today. The bed numbers were reduced because of HIQA reports. The capacity was reduced. While nursing homes would take up the long-term care, many people would require acute hospital and medical care. Such people were predominantly being cared for in the community hospitals. It is important that the HSE and the Department of Health come up with the money to ensure that any community hospitals which receive a critical report, stating they are not up to standard, are brought up to standard and their capacity is maintained. I am glad that the hospitals are working at pace to get the foundations laid and work started. Tenders, documents and so forth are in place. It is important that we keep an eye on it and ensure that the work on those hospitals starts. It is long-awaited and long-promised but it will happen at last.

An amount of work is being done by the private nursing homes. In some past instances, families have started nursing homes. There is regulation in respect of nursing homes nowadays, guidance for care and instruction as to what is needed and expected of someone who starts up a nursing home. In some of the instances where nursing homes were started, the dedicated people involved understood people's care needs and built nursing homes with little or no help or guidance. We must applaud them. They have continued to maintain those nursing homes. The people who work in those institutions have committed their lives to caring and are dedicated.

It would be remiss of me while speaking on this topic not to refer to the recent report of the Ombudsman about young people who require long-term care, whether they have a capacity issue, in terms of disability, or have been the victims of a road traffic accident or any other issue. Such people are sometimes committed to long-term nursing homes because no other residential setting is available for them. We as a country need to take that head-on. It is vital that we ensure it is no longer acceptable that nursing homes or community hospitals are settings for young people with long-term care needs. Some people in their 30s or 40s, or younger in some instances, with care needs have been left without alternatives. We as a State need to be mindful of that. We need to take head-on the report that was published a couple of weeks ago. We need to try to challenge what is in that report and ensure it is corrected in the shortest possible period of time.

This Bill is predominantly to ensure a fairer deal for people with small businesses and farms, and to ensure a nursing home set-up is there for them. I know that the Minister of State has been a champion of keeping people at home and in their own communities as long as possible. That must be an extremely strong arm of the State. It must be strong in the context of public health nurses, home help co-ordinators, the people who provide help at home and home care assistants, who were once called "home help". They have been doing invaluable work. Our family has benefited enormously from the professionalism of the public health nurses and the home care team and we are deeply indebted to what they did for our family when we needed them. We will be indebted to them for the rest of our lives for the work they did in our setting. Many other families are in the same position and understand this too.

We must further empower the sector and ensure that it is stronger, better and more robust. Some people are looking for extra hours of home help and, depending on a family's circumstance, they may need help in the evening to get an elderly person to bed and so forth. We need to accommodate the needs of people, including the families and the people who require care. People will try to manage for as long as they possibly can but when they go looking for help, we need to be more robust in ensuring help is out there. Much of the time, the challenges relate to getting home help professionals and people to do the work in different parts of the country. We need to take a fundamental look at the whole home care package to ensure that people are kept in their homes as long as possible. It is far more beneficial for society, whatever way you look at it, to have people in their homes for as long as is humanly possible. It benefits everybody, including the patient, the family and the State. We should be looking at it in a critical way and examining how we can improve the position as we go forward. Those services have been invaluable to many families but there are gaps that need to be addressed and we need to be mindful of that. We must be at the forefront in ensuring the continuation of those services.

I pay the utmost tribute to those who are on the front line and providing those services in people's homes on a daily basis. They have showed professionalism, particularly over the past 12 months. They dealt with the situation and stepped up to the plate, showing courage and commitment in everything they did. I am referring to public health nurses and care assistants, and I say "well done" to everybody for what they have done over the past while.

Some nursing homes have added different services and extra charges. That is unfair. A family with somebody in a nursing home are depending on their means and circumstances. They are paying so much towards nursing home care that we need to be mindful there is not much more that family can give.

Some people have paid extraordinary fees over the years, in particular, as I said, the family farm units. They do not have very big farms but because it is on paper, it is valued for a huge amount of money, which causes an awful lot of difficulty.

As we are debating it, the discussion must acknowledge that our population will grow older over the next number of years. We have to be mindful that the policies being discussed by the HSE, the Department of Health and the Government, which we should discuss on a regular basis, will impact on society for the next 25 years.

We must recognise the direction in which the demographics are going and what is coming down the tracks in terms of what we need regarding care. We also need to make sure we are not just doing it the cost-effective way. The State is always looking at the cost-effective way and how much it will cost but what is best for the greater good of society?

The previous speaker, Deputy Ó Cuív, spoke about the role of planning. It might be very far away from this Bill but it is fundamentally right. If one can ensure the support is intergenerational, then a couple of generations of people who live in close communities will support themselves. The older families would support the younger families in the first instance and, as time goes by, the younger families would support the older families. That has always been the case going back over the decades.

There was this notion that we should urbanise the entire country and have nothing in rural communities. Covid-19 has shown without any shadow doubt that this was a wrong policy. We need to reverse that and recognise the greater good in terms of providing the intergenerational support that was there in decades past. It can be recreated if we have the mind to challenge some of the rhetoric or policies.

There is much we could talk about. I welcome the Bill and congratulate the Minister of State on the way she has brought it forward. It is important this Bill becomes law as soon as possible. Will the Minister of State in her closing remarks give us an idea of when she envisages that it will be on the Statute Book? Will it accommodate people who are going into nursing homes today and tomorrow? Will it ensure the family farms or small businesses will not be affected if people are going into nursing homes on the last week of May 2021. The Minister of State might refer to that issue.

I also pay an enormous tribute to all those who worked on the front line during the last 14 months in community hospitals and nursing homes given the challenges they faced and the suffering and heartache they saw among the elderly people who died as a result of Covid-19. As a result of that pain and suffering, it will be two or three generations before the heartache those workers saw in the families who lost loved ones to Covid will be erased from memory. The way they had to part with their loved ones, particularly in the earlier part of the pandemic, will resonate for a long time.

I thank all those who have put their lives on hold for their professionalism in how they deal with people who are at the end of their days. It is important we treat the elderly with respect.

I also want to ensure the Minister of State takes on board the Ombudsman's report on people with intellectual and physical disabilities who are in long-term nursing homes or community hospitals. It is not a setting for them, certainly not in 21st century Ireland, and it needs to be looked at.

We must bear planning in mind in every discussion we have with regard to the next generation and the ageing of our population. We have to bear in mind that a huge swathe of the countryside needs to be repopulated, where people have family support. That feeds into a whole raft of other issues in terms of housing and everything else. That is a scéal eile.

The other issue is sheltered houses and the sheltered housing model in terms of people who are moving into towns or villages. The sheltered housing model that was in place comprised the small community groups, which were set up as section 39 housing organisations, did such great work right throughout the country. We should be encouraging this more, and encouraging those who have it done it in the past to perhaps add another number of units onto their facility, because they are doing excellent work.

As the Minister of State will be aware, there is a huge appetite for daycare centres, which provided massive services to elderly people in their own homes, and to reopen them as soon as possible. Sage Advocacy has issued statements over the last few days in that regard and I support what it is doing. I thank the Ceann Comhairle very much for the opportunity to contribute to the debate this evening.

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