Martin Daly (Roscommon-Galway, Fianna Fail)

Like the Minister of State and every Member in this House, I was deeply disturbed by the scenes broadcast on the recent "RTÉ Investigates" programme. While immediate and decisive action is required in those specific cases in Glasnevin and Portlaoise - and I fully support the Government's commitment to that - this must also be a catalyst for wider reflection. How are we going to care for a growing population of older people, many of whom will require some level of support to live with dignity and independence? Our population is ageing rapidly. That is a mark of progress in public health, but it presents serious challenges. We must ensure that our care system is prepared, not just for immediate pressures, but for the longer term demands that will come with demographic change.

Many of our older people are living longer, more healthy, independent and productive lives, which is to be welcomed. However, when their living needs change, it must not be a binary choice of home or a nursing home. There are people in nursing homes today who would be better served by sheltered or supervised living in the community. It is essential that we get the regulatory framework right. I welcome that the Minister of State has met the chief inspector of HIQA and that he plans to appear before the health committee shortly. I also welcome the Government's commitment to progressing safeguarding legislation while recognising existing protective legislation, policies and protocols.

While regulation is vital, it is only one part of the solution. Culture within care organisations is equally important; culture ultimately determines the quality of care experienced by patients. We know culture comes from the top down. What we saw in those recent reports was not simply individual misconduct, although such behaviour is inexcusable, but the product of a deeply healthy organisational culture, where management is driven primarily by profit, and staff are clearly undervalued, undermanaged and deprived of the most basic tools to do their job. In such an environment, it is inevitable that standards would degrade and that staff would become demoralised, demotivated and disconnected. Culture is more difficult to measure, but we must find a way to do that.

We must find a way to financially sanction those private companies that do not manage those nursing homes properly. As a GP who has worked closely with more than ten nursing homes over the last three decades, including excellent, small, community-based homes such as Nightingale in Ahascragh, Oakwood in Roscommon, St. Francis in Kilkerrin and Mountbellew Nursing Home, I have seen the difference that a positive personal culture can make. Older people are living in their communities in those homes, often with contemporaries whom they know, and are cared for by staff whom they also know. Unfortunately, many of these smaller homes are now struggling to remain viable. I am told it takes a congregation of 70 people in a nursing home to make it profitable for private operators. In my area, two excellent homes closed, namely, Ballygar Nursing Home and Brideswell Nursing Home in Athlone. My own grandmother lived for two years and died in Ballygar Nursing Home. She was given excellent care. One of the most natural things in the world was that my children would wander in to visit and chat to her on their way home from school over those two years.

We have become too reliant on large, corporate and congregated settings, where that sense of community and personal connection is lost. I know the Minister of State and the Government are committed to increasing the provision of public nursing home places, especially for people living with dementia and Alzheimer's. However, we must look beyond institutional models. We need to build a continuum of care that enables older people to live in their homes and communities for as long as possible. We must also use smart technology to enable them to do so. Nursing home care should be the last resort, not the default option. That means being more ambitious about innovative care models, such as retirement villages, where independence is preserved and intermediate levels of support are provided. It also means addressing the current barriers to home care. Too often, where home care packages are approved, they cannot be delivered due to workforce shortages. We must look seriously at the terms and conditions for home care workers, and invest to make this a sustainable and respected career pathway.

I also urge that we examine closely the comparative cost of long-term institutional care with community-based and home care. In many cases, keeping a person at home is better for their well-being and is more cost-effective for the State. The older people we are speaking about today have contributed immensely to the life of this country. The least we owe them is a system of care that honours their dignity, respects their humanity and allows them to live with purpose and autonomy for as long as possible. I support the direction the Government is taking, but we must think more boldly and build a modern model of care that truly meets the needs of a changing Ireland.

See this speech in context