Kieran O'Donnell (Limerick City, Fine Gael)

I welcome the opportunity to discuss nursing homes and the care of older people. To begin, I want to acknowledge the "RTÉ Investigates" programme that was broadcast on 4 June. This was a very hard-hitting and harrowing programme which highlighted a litany of poor care standards in two nursing homes, showing clear neglect and abuse of older people, namely, the Residence, Portlaoise, and Beneavin Manor in Glasnevin.

The welfare of the residents and their families was obviously at the forefront of my concerns following the RTÉ programme. I am very conscious of the impact this programme will have had on the residents, their families and the staff in the nursing homes featured in the broadcast. I am also conscious of the impact the programme will have had on the nursing home sector more generally. It is important to acknowledge the committed, compassionate and dedicated providers and care staff operating in nursing homes across the country. Like everyone else watching the programme, I was shocked and deeply concerned at the level of non-compliance with care standards in evidence from the distressing footage that was aired. In a subsequent RTÉ "Prime Time" programme broadcast this week, we also heard personal testimony from Paul Guy on behalf of the family of Audeon Guy, regarding the poor ongoing care that their father has been receiving in Beneavin Manor.

As Minister of State with responsibility for older people, I want to state categorically that poor care, mistreatment, neglect or any other form of abuse of any person living in a long-term residential care centre is completely unacceptable. I expect the highest standards of care to be upheld for every resident in every nursing home across the country, and anything less than this standard will simply not be tolerated. The distressing footage aired during the "RTÉ Investigates" programme highlighted serious issues of non-compliance within these nursing homes.

As the national independent regulator of nursing homes in Ireland, I expect HIQA and the office of the chief inspector to utilise all powers available to them to ensure rigorous oversight and accountability in nursing home care. I met with HIQA on Wednesday, 4 June to discuss regulatory activity relating to the nursing homes featured in the "RTÉ Investigates" programme. At this meeting, HIQA’s chief inspector confirmed its continuous intensive engagements with the two nursing homes in question and committed to providing me with an update on progress this week. I assure the Members of the House that I, the Minister for Health and the Department of Health continue to closely monitor developments regarding both nursing homes. The welfare of residents and their families will remain our highest priority. The Minister will be meeting with HIQA shortly.

I have formally requested that HIQA furnish me with a comprehensive overview report of all of the nursing homes in the Emeis group. The chief inspector has committed to providing an interim report by the end of this week and a full report by the end of next week, providing an overview of regulatory history, including but not limited to regulatory compliance, escalating enforcement actions and any additional conditions of registration. HIQA has publicly acknowledged the importance of examining its processes and methodology. It is essential that these are continually being looked at for ways to improve the inspection and regulation of nursing homes.

On Tuesday of this week, I had a constructive engagement with representative bodies and stakeholders from the nursing home sector, with an immediate focus on delivering the highest quality care to the residents of nursing homes in Ireland. I want to be very clear that every nursing home resident deserves and should expect the highest standard of care at all times. To achieve this, it is paramount that registered providers of nursing homes adequately support their staff. Having effective governance and management arrangements in place ensures staff are equipped to deliver person-centred care to residents. That includes training and staffing.

I met with the HSE chief social worker and HSE staff and management from the two nursing regions where the two nursing homes are located yesterday. The HSE confirmed the directors of nursing from both local community support teams have been onsite in both nursing homes and continue to engage with them. A review of safeguarding concerns raised in respect of the two nursing homes is also ongoing. The HSE has confirmed it will be engaging with all nursing homes in the Emeis group over the coming week. With Department of Health officials, I also met HSE senior staff and management from the six health regions yesterday. This engagement was constructive and centred on supporting residents and staff in community nursing units across the country to deliver the highest quality of care.

I turn to adult safeguarding. I know there have been many calls since the "RTÉ Investigates" and "Prime Time" programmes aired for the introduction of adult safeguarding legislation. I also know that many Deputies have been calling for this legislation for much longer. I am on record as stating that the introduction of safeguarding legislation for the health and social care sector is a priority for me and the Minister for Health. The Department of Health, in collaboration with the Department of Children, Disability and Equality, is finalising an adult safeguarding policy for the health and social care sector. Our intention is to bring it to Government before the summer recess. This policy has been informed by research, stakeholder engagement and an extensive public consultation carried out last year. It has also been informed by the Law Reform Commission report from 2024 and the Mcllroy review of adult safeguarding in the HSE, also published last year. The policy will provide a framework for strengthening adult safeguarding structures, processes and supports across our health and social care services, inclusive of the public, voluntary and private sectors. Importantly, it will commit to the introduction of safeguarding legislation in the sector and will set out, at a high level, proposed legislative provisions. The Government has included a health (adult safeguarding) Bill in its legislative programme to facilitate this and it is recognised that this will be an important development in protecting vulnerable adults from abuse. We look forward to engaging with Deputies on this important legislation over the coming period.

I want to be clear that legislation on its own cannot and will not address the failings in care we have witnessed in these two nursing homes. We must remember that we already have safeguarding requirements in legislation for nursing homes. The 2013 care and welfare regulations contain specific requirements in respect of adult safeguarding, including the following: the provider must have a safeguarding policy and must take all reasonable measures to protect residents from abuse; all incidents or allegations of abuse must be investigated by the person in charge and notified to the chief inspector and records kept; and staff must be trained in the detection and prevention of and responses to abuse. We also have national standards for safeguarding, which were developed jointly by HIQA and the Mental Health Commission.

This is not to say we do not need further legislative provisions. We will be bringing this legislation forward as a matter of priority. However, the distressing images we saw on "RTÉ Investigates" and "Prime Time" demand a fundamental change in culture, one in which poor care, poor practice and abusive and inappropriate behaviour are not tolerated, and one in which staff feel empowered and supported to call out poor practice and know exactly how to do this. The forthcoming policy on adult safeguarding for the sector will not only provide the framework for legislative change, but also for a wide-ranging reform programme across the sector to ensure that a culture of safeguarding and of intolerance for poor care is fostered and embedded at all levels.

Safeguarding in its widest interpretation is about safe services. We all have a fundamental right to feel safe, especially in the case of residents of nursing homes, in what is their home. As Minister of State with responsibility for older people I remain fully committed, working with the Minister for Health, to introducing this robust national policy on adult safeguarding for the health and social care sector, strengthening Ireland’s existing legal, policy, and operational safeguarding framework and driving necessary reforms to enhance protections within the health and social care sector.

Although engagement with our older population clearly indicates their preference to age in their own homes for as long as possible, it is recognised that care provided in long-term residential care settings will continue to be an important part of the continuum of care for older people. Across the country, nursing homes in the public, private and voluntary sectors play a vital role in the provision of long-term care and other services.

It is acknowledged that the nursing home sector has evolved in Ireland over the past 30 years from a predominantly State-led service to a situation today where approximately 80% of nursing home services are provided by the private sector. I am fully aware of the investment trends in the long-term residential care market, the growing consolidation of the sector and the complex investment and ownership structures that now exist. It is therefore important that all aspects of the nursing home sector are scrutinised over the coming period to ensure service delivery and configuration meet the needs of service users in a sustainable and safe manner.

For those people who require long-term residential care, it is imperative we ensure they have access to safe, high-quality and regulated care services in a timely manner. Most people avail of this care through the nursing home support scheme, commonly known as fair deal. Fair deal was designed to protect and support vulnerable older people, to give them a home and to ensure equal access to nursing home care. It has given people the opportunity to live in a safe environment in a sector that holds to the highest standards of care. For those who avail of long-term residential care, it is critical this high standard of care continues to be provided in settings that meet their needs. The fair deal scheme will receive Government funding in excess of €1.2 billion this year.

The Government is also committed to continued investment in healthcare infrastructure which supports the highest quality care for our older population and to utilising planning and resource allocation measures as a lever to reduce regional inequalities in long-term residential care supply. This investment includes the ongoing community nursing unit programme, a major capital infrastructure programme which was launched to ensure that up to 90 of our public community nursing units and community hospitals would be refurbished or replaced in order to provide the best quality environments for our older people and to meet HIQA standards. A sum of €4 million was allocated in budget 2025 to staff and open 615 public community beds this year in capital projects that are coming to fruition through this programme.

The programme for Government commits to building more public nursing home beds and this is an absolute priority for me, the Minister for Health and the Government. The Department of Health, alongside the HSE, is developing a new public long-term residential care additional capacity plan, which will be published in 2025.

This plan will be informed by an update of the 2018 health service capacity review, currently being undertaken by the Economic and Social Research Institute, which will identify future capacity needs in the sector. The ESRI report on older people’s care will be published this month. It is also of paramount importance that the built environment and location of long-term residential care settings support high-quality care and positive experiences for our older population. The Department of Health is therefore committed to creating new design standards for long-term residential care settings for older people across all sectors.

The aim of the design guide is to describe and illustrate what good building design looks like for long-term residential care settings for older people, and to provide a common benchmark against which the standard of these settings can be measured. In December 2023, a public consultation on the draft design guide for long-term residential care settings for older people was launched, and a report on the public consultation reflecting the feedback received was published in January 2025. This is a matter I am working with my Department officials to progress as quickly as possible.

Earlier this year, I launched the nursing home residential premises upgrade scheme. This is a €10 million scheme that will support nursing homes to carry out structural works to improve compliance with standards published by HIQA under regulation 17, which concerns the nursing home premises itself. The maximum that can be claimed by an individual nursing home under this scheme is €25,000.

I am aware that while our commitments in the programme for Government are ambitious and achievable, the scale of the demographic challenge ahead is significant. In this context, in March 2024, the Government established an independent commission on care for older people. The commission is charged with examining the provision of health and social care services and supports for older people and with making recommendations to the Government for their strategic development. Subsequently, a cross-departmental group will be established under the auspices of the commission to consider whether the supports for positive ageing across the life course are fit-for-purpose and to develop a costed implementation plan for options to optimise and implement these supports. The commission on care is due to publish its first report shortly.

The programme for Government 2025 pledges to publish, resource and implement a national action plan that will take account of the work of the commission on care to ensure that long-term care is timely, comprehensive, and affordable, and examine and enhance the mix of professional care options, including homecare, community-based care, independent living options and long-term residential care facilities.

As all Members of this House will be aware, the Irish population is growing across all regions and age groups, with the most significant growth seen in the older age groups. The number of people aged 65 years and over is estimated to have risen by more than 40% between 2013 and 2023 and is expected to double again to 1.6 million by 2051. In 2020, it was also estimated that there were approximately 64,000 people living with dementia in Ireland. This number is expected to rise to 150,000 by 2045.

The improved health outcomes and extended life expectancy that have been achieved in recent decades must be acknowledged and celebrated. We all clearly recognise the benefits that our older population offers to society. Ageing populations will, however, present many healthcare, social, and economic challenges in the coming decades. Thoughtful preparation combining policy and institutional reforms, investment in capital infrastructure and technological innovation can enable this country to meet this challenge and take advantage of the real opportunities presented by demographic change.

Investing in services for older people has been a governmental priority over recent years. There has been an increase of approximately €1 billion in funding for services for older people since 2020. This year alone has seen an increase of approximately €350 million on the amount secured under budget 2024, bringing the total figure to approximately €3 billion in budget 2025.

Sláintecare is the most significant reform programme in Ireland’s health sector and Sláintecare reforms are changing how health and social care services are provided. Sláintecare is focused on providing the right care, in the right place, and at the right time. Instead of relying on hospitals as the primary location of care, the focus is on providing more care in the community, or at home. This is also accompanied by a strong emphasis on prevention, which will help people stay healthier for longer, and reduce the number of people who would otherwise need medical care in an acute setting. The recently published Sláintecare 2025+ plan sets out an integrated and whole-of-system reform programme to be implemented over the period 2025-27 and is designed to respond to the demographic challenges that Ireland is facing. The plan builds on the progress made in implementing successive programme for Government and Sláintecare implementation strategies between 2018 and 2024. It is an ambitious and multifaceted programme designed to move Ireland towards a universal healthcare service. The 2025 programme for Government is dedicated, among other things, to the vision of creating a caring society, and commits to a range of actions that will advance a social care model which supports older people to live full and independent lives in their own homes and communities, with the appropriate wraparound supports. It is incumbent on all of us to work collaboratively to realise this vision.

Home support is an essential service for thousands of people each day across the country and is highly valued by service users and their families. Since 2020, the Government has increased the budget for home support by more than 70%, from €487 million to €838 million in budget 2025. The delivery of home support hours is increasing year on year and will continue to do so as demand is expected to increase due to an ageing demographic and older people’s wish to stay at home for as long as possible. The programme for Government commits to the design of a statutory home care scheme, which is an absolute key priority for me as Minister of State for older people. In the time I have been in this post, this is something I very much want to progress.

The Department of Health is progressing the development of a regulatory framework for providers of home support services to support this commitment. The new system of regulation for home support will ensure the public can be confident that the services provided are of a high standard and bring Ireland in line with best international practice. The legislation to be developed will regulate home support services in Ireland by establishing a system for registering providers of these services, under which it will be an offence to operate a service without being registered. Alongside this, HIQA is currently finalising draft national quality standards for submission to the Minister. The first step we must take in statutory homecare is to bring in legislation to regulate homecare providers. We then need to define what statutory homecare is and look at a funding model. This is something I am absolutely committed to but the first step is to legislate for homecare providers.

The programme for Government has a strong focus on community supports for older people, including day centres and meals on wheels. Day centres are a crucial part of social care provision in our communities that provide invaluable support for people who may, for any number of reasons, experience isolation and loneliness. Currently, day care services are provided across the country by private, voluntary and HSE-funded day care centres. Since its establishment, the meals on wheels service has also been an invaluable resource in helping older people in our communities to maintain their health and independence through the provision of healthy meals.

In line with Sláintecare priorities, the enhanced community care programme is a major reform programme. The objective of the programme is to deliver increased levels of healthcare, with service delivery reoriented towards general practice, primary care, and community-based services. The focus is on implementing end-to-end care pathways that will care for people at home and over time prevent referrals and admissions to acute hospitals where it is safe and appropriate to do so, enabling a "home first" approach. As part of the enhanced community care programme, the integrated care programme for older persons model aims to improve the quality of life for older people by providing access to integrated care and support that is planned around their needs and choices. These interventions support older people to live well in their own homes and communities without the need to access acute care settings. The integrated care programme for older persons seeks to ensure older people with complex care needs can access care quickly, at or near home, through care pathways specifically designed for them and targeting fragility, fall prevention, and dementia. The Department of Health and the HSE also support a number of complementary support co-ordination models which help our older population to age in place for as long as possible and reduce the rate of older people transferring to long-term residential care.

The healthy age friendly homes programme is an innovative partnership between the local government sector through Age Friendly Ireland and Sláintecare. The programme commenced in 2021 and saw the introduction of a new person-centric, robust, support-co-ordination service that will enable older people to continue to live in their homes or in a home more suited to their needs and will help older people to live with a sense of independence, autonomy, and to feel part of their communities.

The HSE has also partnered with ALONE as part of the roll-out of the enhanced community care programme to develop a support co-ordination service. The focus of the service is to support older people to live independently at home for as long as possible by facilitating access to services including befriending, social prescribing and assistive technologies and by co-ordinating linkages to local community groups. These services support the enhanced community care model and facilitate the HSE to deliver a co-ordinated system of care, integrated around older people's needs.

The programme for Government 2025 also commits to a new all-of-government national housing plan to follow Housing for All. In my dual role as Minister of State with responsibilities for older people and housing, I am committed to a focus on housing options and choices for our older population in the context of the new housing plan. It is vital that we continue to increase the housing options available to older people and to facilitate the integration of supports in a more coherent way between the housing and health sectors. To this end, the Department of Health and the HSE, alongside the Department of Housing, Local Government and Heritage, are supporting a housing with support demonstrator project in Inchicore, Dublin. This is a collaborative, cross-sectoral and cross-departmental project that recognises the need for a joined-up approach to addressing the critical issue of creating housing choice for our ageing population, enabling people with lower care needs to live independently for longer. It is the hope that this project will act as a pathfinder project for the future mainstreaming of this form of housing. I was pleased that this innovative housing project reached a milestone recently, with the first tenants receiving the keys to their new homes.

As I have stated, an ageing population means that the prevalence of dementia is increasing. I am committed to improving services for people with dementia and their families, and just over two years ago, in May 2023, the HSE published its new Model of Care for Dementia. The model of care sets out care pathways to advance timely diagnosis and post-diagnostic support and care for people living with dementia in Ireland and sets targets to achieve this goal. To support the implementation of this model of care, the Government has funded new specialist diagnostic memory services in locations around the country. Establishing these essential services will ensure there is timely access to both diagnosis and post-diagnostic supports and a reduction in waiting times. There has also been €19 million in new recurring investment in dementia services over the past five budgets and the Government is committed to continuing to invest in improving services for people with dementia.

This Government has also made specific commitments to improving dementia services in the 2025 programme for Government, and since my appointment as Minister of State with responsibility for older people, I have been working in earnest towards their implementation. In May, I was pleased to announce the implementation of one of the programme for Government commitments, the development of a national dementia registry for Ireland. The national dementia registry will provide us with vital data on many aspects of the care of people with dementia. This was a top priority for representative groups and people with dementia. I am pleased we have been able to initiate the creation of that register, which will be hugely beneficial in addressing the needs of people with dementia. The Government will continue to build on the already substantive investment in dementia over the next five years.

My absolute focus over the lifetime of this Government will be on ensuring Ireland can genuinely call itself a great country in which to grow old. As Minister of State with responsibility for older people, I want to ensure our older population feel valued and respected and when health or social care services are required, that our older citizens receive the best care possible, whether in their own homes and communities or in long-term residential care settings. I also firmly reiterate that poor care, mistreatment or any other form of abuse of any person living in long-term residential care centres is wholly unacceptable and will not be tolerated. Every resident of a nursing home deserves dignity, respect and the highest standards of care. As Minister of State with responsibility for older people, I, the Minister, Deputy Carroll MacNeill, and the Government are absolutely committed to ensuring everything possible is done to ensure the distressing scenes we witnessed in the recent "RTÉ Investigates" programme do not happen again in any nursing home in the country. We saw clear neglect, abuse and violations of basic human rights for older people. I want to restate and be clear that every nursing home resident deserves, and should expect, the highest standards of care. I cannot repeat that enough.

When this issue broke, like everyone else I watched the programme. My immediate reaction on seeing the wanton neglect was to reassure older people and to deal with the issue for the older people in the two nursing homes, namely, the Residence and Beneavin Manor. I rang Bernard Gloster after the programme was aired to ask that the HSE would put in safeguarding teams and direct its nurses into the two nursing homes. I had met representatives from HIQA earlier that day. The names of the two nursing homes had been released by RTÉ, so I immediately sought a meeting to ask the HIQA to continue with intensive engagement, provide a report by the end of this week, an interim report on the Emeis group overall and a final report next week. I had follow-up meetings with the nursing home sector to ensure it was reaching out to its members on the provision of safe care through nursing homes. I then met with representatives from the HSE and its community nursing home units and asked that they would do likewise in terms of reaching out to nursing homes and residents and regarding what is happening as we speak. I met with the HSE safeguarding teams and with the directors of nursing. I had meetings with them yesterday regarding their interaction.

What happened should not have happened. The issues in Portlaoise were identified in the two HIQA reports. The Beneavin report did not highlight that fact. These are questions I have put to HIQA, such as how this happened and why the compliance plans were not implemented. This is a basic process. Like everyone else, I have one concern above everything else - politics aside; I have been at this 20 years - and that is the care of older people. What we witnessed in the two nursing homes was unforgivable. No one should be treated in that way. We have to do whatever is required here. We have to get a system that provides reassurance to residents and their families regarding the delivery of safe healthcare the length and breadth of Ireland. We all know there are nursing homes delivering great care. There are great staff delivering great care. Once again, however, I go back to the key point. Older persons in nursing homes must be respected and cared for. What we saw in the "RTÉ Investigates" programme, and I commend the team on its work, was neglect and abuse of older people of such a magnitude that it can never happen again. In my role as Minister of State, working with my colleague the Minister, Deputy Carroll MacNeill, and with the Government, I will be working night and day to ensure this is rectified and never happens again.

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