Michael McNamara (Clare, Independent) | Oireachtas source

Like previous speakers I commend the Minister of State for bringing this legislation before the House. Sometimes one marvels at how resistant the system is to change and how long it takes to achieve change. When someone does bring a measure before the Dáil that changes the system, albeit long argued for and long promised, they are to be commended. I commend the Minister of State, Deputy Butler, on that. As Deputy Cahill has pointed out, it removes a potential unfairness from the fair deal scheme. The scheme is excellent and is availed of by many.

This Bill removes a potential unfairness in the scheme. Where there is an asset, and where people have to pay something towards the support of their family member, it is not unfair. It is unfair, however, if the entire asset is dissipated, especially in circumstances where it is a working asset and where a family member is willing to take it on to farm it or work in the business. Just because a person became unwell or aged more rapidly than he or she had anticipated and did not have time to transfer their assets, it should not be a reason the entire asset is dissipated or that the person should somehow be disadvantaged.

The five-year rule, by which anything that has transferred within the previous five years is looked at, does seem a little unfair. I can, however, appreciate why it is there. We do not want somebody on the eve of going into a nursing home dissipating all of his or her assets and somehow frustrating any attempt to have to pay. I understand why the five-year rule is there but it does seem a little bit unfair. I am aware that the Minister of State has officials in the Chamber who would say that the line has to be drawn somewhere. I accept that a line must be drawn somewhere and I will come back to this drawing of the line towards the end of my contribution.

Like many previous speakers I wish to talk about the need to resource home care packages adequately. In fairness, the Minister of State is well aware of this and I know it is something she intends to move towards. I do not want to seem churlish in any way by pointing to that or to diminish the achievements of the Bill. They are an achievement of this Government and of the Government I have at times been highly critical of. It is a particular achievement of the Minister of State, Deputy Butler. I would take the credit when it comes because, as she well knows, it does not come very often in politics.

The Minister of State was a member of the committee for Covid-19. Deputy Shanahan said there was a bias in the committee against private nursing homes. I am not entirely sure I agree with that. There was certainly a strong bias by some members of the committee against private nursing homes, but I am not entirely sure that this was a bias of the committee as a whole. I rather think it was not. Many committee members realised that private nursing homes exist to fill a lack of capacity by the State, which the State has not managed to fill. The State certainly should provide more nursing home care.

A new site, St. Joseph's, is one of the things that have been pledged and I look forward to it being delivered. I was delighted that Raheen District Hospital, which was effectively slated for closure when I was first elected to the Dáil in 2011, is certainly flourishing now. It is a huge asset to the community and one that is very close to my own heart. It means a lot to people to know that their family members are looked after. One cannot put a financial value on that.

This is equally true of private nursing homes as it is of State nursing homes. The one my family member was in is a public home. I have been critical of the visiting regime and I endorse what Deputy Shanahan said about antigen testing and anything that enables visiting to take place safely. I am not saying that we should abandon our duty of care to the residents because it is their home and it has to be protected but anything that can make it safe should be looked at.

I very much agree with what Deputy Shanahan had to say in respect of vitamin D. NPHET's attitude to antigen testing and vitamin D is inexplicable. I have spoken to doctors who are respected in their profession and communities and who hold very senior positions of responsibility in our hospitals. I am not a doctor, and I do not ever wish to pretend I have any medical expertise. However, these doctors convinced me that there is a correlation between vitamin D inadequacy and the ill-effects suffered when people contract Covid-19. This attitude to vitamin D and antigen testing is inexplicable and is almost dogmatic. Of course, dogma is the polar opposite to empirical science. We are told we are being led by science in this regard. I digress slightly and I will return to the issue.

The Oireachtas Committee on Covid-19 made a number of recommendations. I see Deputy Durkan, who was also a member of the committee, in the Chamber. The report of the committee stated:

The State is over reliant on institutional care for our vulnerable population. This issue was starkly highlighted by the Expert Panel report and was also a central theme of the Committee's Interim Report on Covid-19 in Nursing Homes in July 2020. The Committee is grateful to Professor Kelleher and the Expert Panel for providing a blueprint for the further care of the elderly and will make recommendations accordingly. The Committee is of the strong view that future moves to support the older people at home must have, as a priority, a publicly funded and publicly provided model of care that is underpinned by community intervention teams from the HSE.

I know this is not something the Minister of State has forgotten about but I fear it has the potential to be forgotten. The committee recommended that an implementation plan be drawn up in respect of the recommendations contained in the report of the Covid-19 nursing home expert panel, which was the panel chaired by Professor Kelleher, with a requirement to provide six-monthly progress reports to the Houses of the Oireachtas. The committee also recommended that standards regarding staffing and staff ratios in nursing homes be developed by HIQA.

This goes back to the idea of home care. I am not unique in believing that the latter is essential. I was not here for all of the debate, and I appreciate the fact the Minister of State is here to listen to all of it. That shows a certain attitude to the Parliament and it is one I respect and I am grateful for it. I heard Deputies Cahill, Calleary, Moynihan and Ó Cuív referring to this idea. This view is broadly held across the House and it is something that I hope we will see some movement towards in due course.

While we are all grateful for the fact nursing homes exist, I do not know how I would react if and when I am put in one. I would say the same of the Minister of State. It may become an inevitability some day but if it is an inevitability, it is one we all want to put off for as long as possible in the context of ourselves and our loved ones. I have seen that our loved ones will put it off for as long as possible, and understandably so. We need to move towards care in the home and in the community even from a humane and societal perspective. If the past 12 months have taught us anything from a disease control and infection control perspective, it is that we have a further reason to move towards care in the community. I want to draw the attention of the Minister of State to this because it needs to be highlighted.

The alternative to care in the home is a risk of institutionalisation, and I appreciate that some nursing homes are far more institutionalised than others. Two very recent HIQA reports happen to pertain. One, in respect of an unannounced visit to Cahercalla Community Hospital and Hospice, was published on 9 April 2021. The visit took place on 20 January 2021. It has to be said it was in the midst of the Covid outbreak and in fairness to Cahercalla this has to be borne in mind. HIQA stated:

A system of communication was in place throughout the centre that included loud speakers on every unit. This was used to call members of staff to different areas of the centre. Inspectors found this system to be intrusive distracting and incongruent with an environment that is meant to be a residents home.

Inspectors observed some residents watching television or listening to the radio to pass the day. However, over the three days of inspection there was limited social engagement observed between residents and staff. One resident explained that she had not had access to a newspaper for a couple of weeks and that while she had a radio and access to television, a read of the newspaper everyday kept her going. Limited access to meaningful activities and little opportunity for social engagement are repeat findings from the inspection last September.

These are the two passages I wish to highlight from the report in respect of Cahercalla. A report on St. Joseph's Hospital was published on 11 May, the unannounced inspection having taken place on 10 March. Again, this was during a Covid outbreak, in fairness to the staff and management of St. Joseph's Hospital, and it should be borne in mind.

During conversations inspectors were told by residents that they were not allowed to have showers as a result of the COVID-19 outbreak. Residents spoken with were of the understanding that if assistance was required this meant that the option of a shower was not available for them. Inspectors reviewed the care records and spoke with care staff. Records evidenced that there were periods of months where residents did not have a shower. This was discussed with the nursing management who took immediate action and on day two of the inspection all residents that chose to have a shower were facilitated to have one.

I do not draw this to the attention of the Minister of State to beat her up over it or to beat up the HSE or the management teams at Cahercalla or St. Joseph's. All of us, the Minister of State included, would accept it is not acceptable as, I am sure, would the management of St. Joseph's and Cahercalla. We need to move away from this. It is not enough to accept that it is unacceptable. We need to move forward. We need to move towards care in the home and in the community. If anything, not being able to choose when to eat or what to watch on television, or whether to watch television, and not being able to choose what newspaper, if any to read, shows how important this is. There was a time in my house the Irish Presshad to be read every day, and it had to be the Irish Press. To some younger Members of the House, this is of no consequence but Deputy Durkan has a certain understanding. I am making the point that autonomy is hugely important. It is part of what gives us dignity as human beings. It is better served by care in the community if and when possible. I urge the Minister of State to move, if possible, in this direction.

Another point I want to bring to the attention of the Minister of State is a slight unfairness that has emerged in the existing system. As the Minister of State is aware, the nursing home support scheme, which she is reforming - I congratulate her on doing so - essentially means that a person who is a resident of a nursing home is able to borrow money that pays for his or her care against an asset. He or she borrows this money from the HSE and it is repayable to the HSE. It is against an asset and is capped at 7% a year and now will be capped at three years. All of this is excellent. Rightly, this money has to be repaid and it is set out in the primary legislation that the interest shall start to accrue following the person's death.

That is all dealt with by way of statutory instrument and it could be changed at the stroke of a pen. The way it is set out is as follows. There is an interest rate set out. It is 0.02% per day payable on the overall amount until it is repaid. That is entirely fair. The rate is 8% a year. I suppose 8% a year seems high because interest rates are so low. When the statutory instrument was introduced in 2009, however, interest rates were probably a bit higher, and were certainly a higher than they are now. When the nursing homes support scheme was introduced way back, interest rates were much higher. As a result, 8% a year seems low. Interest is not payable where the money is repaid within a year of the person's death. If they do not pay, however, it all becomes payable thereafter and payable from the moment of death.

The point I would make, and I think the Minister of State will agree, is that this has not been an ordinary year for regulating affairs in terms, for example, of selling part of a farm - if it is a farm that is involved - if that is what is required. Obviously, the vast majority of people will do a lot rather than sell a piece of a farm. To repay the money, they will try to refinance and get a loan, as Deputy Cahill said, in order to keep the farm together and pass it on to the next generation. It has not been an ordinary year in terms of going to solicitors, banks and, where necessary, auctioneers. The statutory instrument states: "Interest shall not be payable on a repayable amount which arises from a relevant event or a deferred relevant event where the repayable amount is paid within the period of time specified in Regulation 3(2)(a) or (b), as the case may be." It also refers to "the period of 12 months from the date of the relevant event or deferred relevant event, as the case may be ... ." What I would urge the Minister of State to do, by way of a further statutory instrument, is merely to say, "the period of 12 months from which can be deducted any time that we were in a level 5 lockdown." That is not unfair. I am not suggesting that people should not have to repay the money. Of course, they should have to repay it. I am not saying that there should not be an interest rate. Of course, there should. It is merely the period of 12 months about which I am concerned. Interest does not start to accrue after the 12-month period; it starts to accrue from the moment of death. It is quite punitive in that regard. I urge the Minister of State, in light of the year that we have had and given the unfairness to which this can give rise for some people, to look at whether that period could be extended by, for example, including the wording, "In the context of Covid-19, periods of level 5 restrictions shall not be taken into account." It is a few of words but it would bring a great deal of fairness to bear.

I appreciate that this is not something the Minister of State can decide here and now, but it is something I would urge her to look at in the interests of fairness. Like Deputy Cahill, I who was brought up on a farm family. Deputy Cahill, unlike me, was chairman of a national farming association. Fair is fair. If one has an asset, one has to repay the money. However, the timeline that is provided for in the relevant statutory instrument is something that I would urge the Minister of State to look at in the context of the year we have had. In terms of contacting professional people, I think the Minister of State will agree that it was all quite difficult. Even contacting the Department was quite difficult. People were working from home. That was, of course, true of any of the professionals that one would need to go to in order to regulate affairs after somebody's death.

I commend the Minister of State on bringing this Bill before the House. It introduces a degree of fairness. If a person has an asset and he or she is availing of a service, that asset should be used to pay for the service but there should be a cap on that where it is something like a family business or a farm that is being farmed by the next generation. I am aware that the idea of a designated successor is slightly controversial and has the potential to be unfair. The Minister of State has agreed to look into that to see what can be done. I again congratulate the Minister of State for having brought some small bit of change to an institution that sometimes looks completely impervious to change.

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