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

I move amendment No. 1:

To insert the following after "the Commission on Care":

"further calls on the Government to: — act on Recommendation 2 of the Final Report of the Oireachtas Special Committee on Covid-19 Response, by carrying out a review into the impact of nursing home privatisation; and

— urgently bring forward legislation to provide for a statutory right to home care.".

I welcome this debate. It is long past time that we had a debate on the care of older people. It will be a short debate and we need to have a much more extensive one. I stress that to the Minister and the Minister of State, Deputy Butler, who are both present. Such a debate should not only involve people providing services and Members of these Houses; it should also fundamentally entail hearing from older people and their advocates with regard to what they are seeking. I would like a proper debate to take place with organisations such as Sage Advocacy, Age Action and the Irish Senior Citizens Parliament. They have a lot to say on behalf of their members and older people regarding what older people want. We need to stop talking about what we think older people want and, instead, listen to what they want and design services that are in their best interests.

There is no denying that many nursing homes are in serious financial difficulty. In the past three years, 31 private and voluntary nursing homes closed. As a result, 915 beds were lost. For many years, there have been calls for reform of the fair deal pricing mechanism. It is clear that is now needed, given inflationary pressures. The aim of any such reform, however, must be to improve facilities, make them patient-centred, ensure the workers are paid a living wage and address the challenges faced by small nursing homes, rather than the big chains.

The financial difficulties facing small nursing homes and those facing large operators should not be conflated. The latter is still viewed as a lucrative investment opportunity, especially for overseas operators and investors.

I note the comments made by the Minister in that regard.

In recent years, we have seen a significant consolidation of nursing homes, with 15 operators now controlling almost 40% of private nursing homes and almost 50% of all nursing-home beds. Only seven of the top 15 are Irish-owned. Four are French-owned while the rest are owned by German, Spanish, Dutch and Chinese operators. A Global Commercial Real Estate Services, CBRE, report into the Irish nursing home market found there were 18 nursing home deals last year worth €440 million. This was the second strongest year after 2021, when there were 25 deals worth approximately €600 million. Although activity is expected to drop to 14 deals this year, the CBRE director told the Business Post that she expects continued investor interest in this sector. It is clear from these figures that large nursing homes are still a very attractive investment opportunity despite inflation. That is why any reform of the fair deal scheme must not fall into the trap of incentivising or encouraging the larger nursing home model. The problems with accommodating older people in these large congregated settings were laid bare during Covid-19 and we were told that lessons would be learned. On 14 May 2020, the Taoiseach said that we needed to consider alternatives, for example, more and better home care. He went on to say that we needed to consider a move away from large, modern, newly-built, 150 to 200-bed, single-room nursing homes towards smaller units, as we have done in the disability sector.

However, the Taoiseach was not alone in this sentiment. A month earlier, the then Minister for Health, Deputy Harris, said in response to issues which I raised:

At the outset I just want to say that we will need to have a very serious conversation about the way we care for older people at the end of this pandemic. The Deputy is 100% correct that the current model is not fit for purpose.

Yet here we are, three years on with a further 16 medium to large nursing homes under construction, including a 146-bed in Clondalkin and a 151-bed in Portmarnock. I ask the Minister what has happened to alternative models of elder care. Why has this Government continued with an arm's-length approach? How are we still in a situation where elder care is viewed as a business opportunity best left to the private market? The Special Committee on Covid-19 Response recommended a review into the impact of nursing home privatisation but there has been no movement at all on that. That report was published in October 2020, almost three years ago. In February, I raised this issue at the Joint Committee on Health with the Secretary General of the Department of Health regarding that committee's report and the report of the expert group. He was not aware of the recommendations. Has anything at all happened in the Department of Health in terms of learning lessons from the appalling experience during the pandemic? Is anybody in the Department listening to what is being recommended in terms of new models of care? Clearly, all of the talk of doing things differently post pandemic was just that; it was just talk.

If we are to fundamentally change the way we care for older people and support them in their own self-care, then we need to resource and expand alternatives to nursing homes such as home care in particular. In 2018, a statutory right to home care was first promised by Government, with 2021 identified for the delivery date. Here we are five years later and there is still no statutory scheme or even regulations. What is what the hold up? I raise this matter with the Minister on a regular basis and there never seems to be any progress.

Another aspect of elder care policy which has been entirely sidelined by successive Governments is proper accommodation and sheltered housing for older people. We know most older people wish to stay in their own community. However, there often comes a point when their homes are no longer suitable for their needs. In these instances, people should have the choice to downsize but there is rarely an alternative option in most communities. However, to address this, we do not need to reinvent the wheel. There are two existing local authority schemes which have been under-utilised since the economic crash and should be scaled back up. The first of these is for older people who are local authority tenants who want to surrender larger accommodation and move into purpose-built older people's accommodation that is accessible, properly insulated and that is in a group setting but allows them to maintain a high level of independence themselves. Another scheme which was used very successfully was the financial contribution scheme where an older person could sell back their home to a local authority and in exchange be able to rent one of the new purpose-built, high-quality senior citizen units. Both of these schemes were extremely successful. We used them extensively in the north west area of Dublin and they could have been filled many times over.

It is also worth looking at the model the Iveagh Trust has, for example. It has really good quality group sheltered housing schemes and employs nurses to come in and to check on the needs of residents on a regular basis. That is an ideal kind of set-up. We need local authorities and the HSE working together to provide that kind of range of choice for people. We know that staying in their own homes with supports is what older people want. We know that this is how we get the best health outcomes. We have the fastest ageing population in Europe and we need to prepare for that. However, we need to prepare for it in a way that addresses what older people want to do and what is in their best interests. We should know what that is at this stage.

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