Dáil debates

Thursday, 1 June 2006

Health (Nursing Homes) (Amendment) Bill 2006 [Seanad]: Second Stage (Resumed).


Question again proposed: "That the Bill be now read a Second Time."

1:00 pm

Jerry Cowley (Mayo, Independent)
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I am grateful for the opportunity to speak further on this Bill.

There is a major problem with the subvention system. While the Bill addresses the situation regarding subvention for nursing homes, that is only part of the equation. One cannot discuss this Bill without talking more generally about what is happening to older people in this country. We must ask whom the system is serving. When one considers that only 5% of older people will require long-term care, one has to ask why the system is so much biased in favour of private nursing homes. That is the fundamental question. The answer lies in a complete fiasco and abdication by this State of its very onerous responsibilities to look after its older citizens. We are all getting older and will all require some type of support in our old age. The question is whether that support extends to the subset of care, but 5% of us will require long-term care, many in private nursing homes.

The Bill deals with the subvention system and regularising the position etc. It is an understatement to say the current situation is irregular. It is a total mismatch, a patchwork quilt of eligibility or ineligibility, whatever one may call it. There is total uncertainty. Nobody knows exactly what is the situation. Older people like certainty in their lives, but there is no certainty in this area. I blame successive Governments for their gross and utter neglect and incompetence in dealing with support for older people.

Old age is just the other end of young age. Just because one is old, that does not mean one needs to be in a nursing home, with doctors, nurses and so on. There is a great need for us to look beyond the medical model. I have talked of that for many years, and as someone working in the community as a general practitioner, I saw at first hand the sad silent migration of older people to institutions because there was nothing else for them. The people who needed our help most did not get it. Instead of getting help to stay in communities in which they lived all their lives, where all that they knew was — some had never even travelled outside those areas in their lives — they had to spend their sunset years in faraway places where they knew nobody. Just like the old Red Indians, they simply lost heart and died, because they were not in their homes and communities.

Nowadays, everyone is on the conveyor belt of life and all are very busy. Quite often, older people in institutions are left to their own devices, which I see all the time. I am not criticising those who look after older people in nursing homes or other public institutions. There are some very dedicated people who do a good job. There are, however, notable exceptions, such as Leas Cross. The Government has placed its emphasis on the wrong area. Considering that only 5% of the population will require long-term care at some point, why is the emphasis on care through nursing homes?

The Minister of State at the Department of Health and Children, Deputy Seán Power, is a fine and committed man. He stated Government policy was to support "older people to live in dignity and independence in their own homes and communities for as long as possible". That is fantastic, but he further added the Government supports:

long-term care where it is no longer possible. It was for this reason that the nursing home subvention scheme was introduced in 1993.

When an older person cannot live at home any longer or in his or her community, he or she is placed in a nursing home. Therein lies the rot and what is wrong with the system.

Who does the system serve? It does not serve older people. How is it that, long after independence, we have a system that does not serve the citizen? The citizen is supposed to come first in the republic. Does the system serve the person trying to make the shilling or does it serve the older person? The emphasis seems to be on the profit-driven sector.

I am not criticising the dedicated staff of private nursing homes but there is another way to provide care for older people by supporting them in their communities. Such a system of support, however, has never been in place. The report, Care of the Aged, spells out clearly that an older person should be able to stay at home. When that is no longer possible, the person should then be supported in the community through social housing. This has not happened. The choice is either stay at home or end up in a private nursing home, if one can afford it.

The State has abdicated its legal obligation to provide further nursing care. Every citizen has the right to a public nursing home bed. However, they are as rare as hen's teeth. That is why people do their damnedest to get their relatives into them. It is an unequal system. As the report, Care of the Aged, states, care at home is the best option. It is Government policy but the Government seems to have forgotten that. Various reports on the issue, such as Tom O'Malley's, refer to supporting older people at home and that many in public nursing home beds may well not deserve them. Every older person I know does not want to be a burden on his or her family, although it can be a labour of love for the family. The system does not help the older person to have the certainty he or she needs by giving him or her the necessary supports.

I was involved in establishing St. Brendan's village in County Mayo which supports older people in the community. It has support ranging from its day centre to low support sheltered housing, from medium support to high support. No matter how old or disabled the person is, he or she can stay in the community. It is very difficult for communities to establish such schemes because it is impossible to compete against the private nursing home sector.

Who does the system serve? Who does the Government serve? I am not only blaming this Government but also former ones. They have not served the citizen. The citizen, who should come first, is second class. Every facet of social life is given over to supporting the person making the profit. The Government has forgotten that it is the people who must be served. That was evidenced with the legislation on statutory rape. When parties get into Government, they instantly forget what it is all about, namely, people.

Recently I raised the matter of community care with the Taoiseach. He said the Government was considering introducing community zoning. The main difficulty for community care groups is securing land for schemes such as St. Brendan's village. I have seen many fine projects fail because a private developer bought up the site first. I have gone to banks and to Government seeking funds for such site purchases, yet I have seen suitable sites slip through the fingers of community groups because they could not raise the money. Many landowners are altruistic and would like to sell their site to a support scheme for older people in the community. However, they cannot wait forever for the money to be raised because they want to sell the land.

Although the Government's emphasis is on supporting private nursing homes, it must be remembered community matters too. If the Government is to follow its own policy, which is contradicted in the speech of the Minister of State, it needs to give community care schemes a chance. There should be a level playing field for them. Communities have proved it can be done. Group water schemes are one example. In rural Ireland, traditionally there was a cailleach in the corner for an elderly relative because the older person was always valued and looked after. However, where is the flat in Ballymun that can hold an older person? With increased urbanisation and smaller dwellings, there is no opportunity to keep a grandparent in the cailleach, the warmest place in the house.

I am encouraged by the Taoiseach's comments on community zoning. He stated Des Geraghty's social policy group has discussed it. It is an idea from the United Kingdom where open space land is used specifically for community purposes. I hope this is more than talk. Sheltered housing has fantastic benefits. Up to 20% of people in nursing homes should not be there. If there were adequate sheltered housing for them, they could be taken out of the nursing homes. However, it is difficult to secure sites for and funding to run such schemes. If the private nursing sector can do it, why not community groups? It is now estimated that only 5% of older people will require long-term care at some point in their lives. Why is the emphasis on keeping people in non-community, profit-driven nursing homes?

Photo of Damien EnglishDamien English (Meath, Fine Gael)
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It was interesting to read the speech of the Minister of State at the Department of Health and Children, Deputy Seán Power. He claimed the Government's policy is to help older people stay at home. He spoke, both at the beginning and end of his speech, of how great the Government is and how much it is doing. This is in a week when I have received 15 telephone calls from people because their fuel allowance has been stopped in one of the worst months of May for weather in my memory. I am 28 years of age but perhaps it was worse before I came along. It has been the coldest and wettest May in my memory, and still there are people whose fuel allowance has disappeared and who have no help towards the cost of fuel. The predictions are that the weather in June will not be great either. I hope the weather in July and August will be better, but the predictions are bad. If the Government is so helpful to older people, it would not be cutting their fuel allowance which does not break the bank. A little help towards the cost of keeping themselves warm and comfortable in their homes would be a good example of how committed the Government is to keeping elderly people in their homes. Incidentally, the fuel allowance is not large enough and does not reflect the cost of fuel. It does not help these people. The Government should look at that matter as another option to help people remain at home.

Before addressing the substance of the Bill and the area of nursing homes and subvention, we must realise that the Government has not increased the rates of subvention in the past five years. As I recall, the Government has not looked at or increased the subvention rates since 2000 or 2001. Even when it did change them, there was not much of an increase.

The cost of nursing home care, compared to that pertaining ten or 15 years ago, even five years ago, has increased dramatically. I am not familiar with any nursing home, in my county or any neighbouring county, whose charges are below €800 a week. Most of them charge €1,000 or €1,200 a week, and that is before account is taken of all the extra services and the cost of visiting specialists etc. While such care costs a minimum of €800, the maximum subvention is €190, although I am open to correction.

There are people of all ages in families struggling to raise such sums to try to make ends meet for the cost of a nursing home. I encountered one woman whose husband is a retired bank manager. He has been retired for 15 or 20 years and his pension income is not as high as one might think, just because he is a retired bank manager, it might be. She has forked out over €70,000 in the past three years on nursing home bills for her husband, who she would prefer to have at home. If she had savings of approximately €30,000, under this new proposal they would be assessed as income and she would be penalised in the context of the rate of subvention, and yet one could see €20,000 or €30,000 disappear on nursing home costs in a year. The Government needs a dose of reality in discussing subvention and the area of nursing home costs and care for the elderly because it is not in touch. I acknowledge it is improving the subvention rates a little as it goes along, but they are not matching the costs and the Government must face that fact. I am afraid no back-clapping should be allowed or considered until the Government matches the costs involved.

Family members are under immense pressure to come up with the cost of nursing home care. It might not be so difficult to cover these costs in the case of families of seven or eight such as those of years ago, but nowadays the average family consists of two or three earners who can contribute towards their parents' nursing home costs and due to today's society many persons do not have the option to keep their parents or their ill family member at home. Although many might like to, it is just not possible and they are forced to turn to the nursing home, which causes a serious drain on resources. With trying to fund their children's college fees, or their children's first homes because the price of houses are also so expensive, and trying to pay for their parents' care, family members are caught in the middle. They have their own expenses, their children's education and accommodation needs to look forward to, and their parents' care. We are asking the people in the middle to do too much and it is not possible. When we wonder about stress and mental illness and people having strokes and heart attacks at a young age, the answer lies in all the pressures of life on them from a range of sources. The Government cannot clap itself on the back or state that it is doing everything possible, and cannot state it is doing a great job for the elderly because it is not. It is as simple as that.

There is a need to clarify who takes on the responsibility when an elderly person becomes ill or cannot manage to stay at home and needs to go into a nursing home. Attempting to get answers about who is in charge or accountable from the health authorities would break one's heart or about to whom one must turn. Must one make 20 telephone calls to find out who pays the subvention. It is especially difficult where this involves different counties or health service areas. For example, if the children live in Kildare but grew up in Dublin, the parent decides to live with one of the children for six months and it becomes too difficult to the point that they cannot manage and must seek nursing home care, when one telephones the authorities to discover which of the areas, Dublin, Kildare or Meath, covers the subvention one is told one has reached the wrong person and to telephone somebody else. That happens regularly and I have dealt with that on many occasions because I live in the greater Dublin region and represent people in County Meath, many of whose parents are from Dublin, although the parents may have moved for a couple of years, their home is still in Dublin. Such cases are causing considerable problems. As the subvention comes out of one pot and is taxpayers' money provided by the Government, it should not matter who takes on the responsibility of paying it. It is not good enough that people spend a year trying to figure out who is responsible for paying subvention, with everyone concerned running away from it.

A one-stop shop for services for the elderly would be useful, where one could telephone one person in the HSE stating the needs of an elderly parent and asking that he or she take on the case and respond in a week outlining the entitlements and what can be done, rather than trying to chase up and get answers from across the board which is impossible. A one-stop shop where one could get the answers and where the health authorities would say that they will do what they can to help the caller. While one cannot give them everything, at least give answers, take on the responsibility to help and do this. They should state that the elderly relative has done his or her duty to this country and the health service is here to look after the case. That does not happen.

If there was enough support to keep one at home in the first place, the subvention rates and the cost of nursing home care would not be a problem. In my experience, the person needing nursing home care and family or friends would prefer if the person was able to stay at home, but it is not really an option. I will outline the different areas which would help. Our public health and community nurses in most areas, especially in the greater Dublin region, are under immense pressure and cannot do their job. They have a list of criteria which they are supposed to fulfil. They have a list of people who they are supposed to visit, which includes drop-in calls to the elderly to keep an eye on them. They cannot do that anymore. They can barely cope with the people coming out of hospitals, new-born babies etc. They are under immense pressure and they cannot cover the areas requested, in terms of keeping an eye on people, providing a back-up service and being there to help out.

The Minister must look at such primary care because that is where it starts. These people are unable to do that and we are asking too much of many of the nurses, who are doing immense work but cannot do everything. One will always deal with what comes to the door first. As public representatives will be aware, people are being passed over. There are people, especially the elderly, who are in need of help and who are not found in time. The difficulties are exacerbated because the health service does not have the staff to cope with the routine calls to check up on these people.

The Minister also needs to rearrange the geographical areas covered by public health nurses and other nurses assigned to the health authorities because they vary greatly from those covered by general practitioners. There is no co-ordination with the general practitioner services. There is a need for a system to align the nurses to the general practitioners on the basis of a group of patients rather than a geographical area. The current system does not work well and people fall between two stools.

I am fed up hearing from the Tánaiste and Minister for Health and Children, Deputy Harney, that she has increased the home help hours and the funding involved. The funding might have increased but the hours have not, and most people in the area I represent in County Meath have had their home help hours cut in the past few years. Last year and the year before the home help hours were slashed by half.

Photo of Bernard DurkanBernard Durkan (Kildare North, Fine Gael)
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Hear, hear.

2:00 pm

Photo of Damien EnglishDamien English (Meath, Fine Gael)
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I encountered someone who has been battling for the past three months to get two hours of home help per week, not per day, after coming out of hospital. She received a letter stating she could have home help only for the first three weeks after leaving hospital. It was not that they would reassess it, but that it would end and she would have no help. This woman is in her 80s and it has been deemed that she can manage without home help.

We are all aware that home help is not just about providing the necessary service, it is about providing company and a little support — the friendly, happy face who visits. That is good for one's mental health. Even if a person is in good physical condition, he or she needs somebody to visit and say hello. The Minister should recognise that in the provision of home help. She needs to increase the home help hours available to people, especially those who are entitled to one hour a day but would be able to manage if they got three.

Apart from the social aspect, significant economies of scale are possible if we support people so they can remain in their homes, such as home help hours or different care packages. Elderly people want to stay in their homes but there is a gap in the services provided to them. More nurses in the community and a greater availability of carers would make a significant difference. The current system of means tests for carers and the assessment of people who want to take time off work to help look after their loved ones must be examined. The current situation is inadequate. People who take time off work to provide a caring service at home should receive an income to help towards paying the bills. Currently, they get nothing as people are penalised for the income of other family members. We should look at the overall family budget in terms of income and expenditure. It is insufficient to say one wage provides enough money and nothing extra will be provided. The means test should be abolished, which will not happen under the Government. However, we should at least examine the system and make it more flexible in terms of assisting people to stay at home.

Disabled person's grants, DPGs, and emergency repair grants, ERGs, are provided to people to make their homes suitable for a person with either an infirmity or a disability. The rate at which it is paid is outdated. As we are all aware, construction costs have increased at 11% per year for the past seven or eight years.

Photo of Bernard DurkanBernard Durkan (Kildare North, Fine Gael)
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Hear, hear.

Photo of Damien EnglishDamien English (Meath, Fine Gael)
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However, the grants have not increased in line with inflation. Most councils have, in fact, cut the grants available. In 2002 and 2003 letters were sent to applicants informing them no funding was available for the provision of grants.

Photo of Bernard DurkanBernard Durkan (Kildare North, Fine Gael)
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It is crazy.

Photo of Damien EnglishDamien English (Meath, Fine Gael)
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It is totally crazy. I accept there has been a slight improvement in the situation, in that some funding has been made available, but that will not be adequate to deal with the backlog of applications.

Photo of Bernard DurkanBernard Durkan (Kildare North, Fine Gael)
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We are coming near an election.

Photo of Damien EnglishDamien English (Meath, Fine Gael)
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Exactly, we are coming near an election and the provision of an extra €2 million here and there will make nice headlines. It sounds good but does not make a big impact on the ground. The average cost of building work, such as putting in a bathroom, is €40,000. The cost is no longer €20,000, it is at least €40,000 or €50,000. I am being conservative with the figures. We must examine this matter. I question the administration of disabled person's grants. In many cases, by the time a decision is made, it is too late.

Photo of Bernard DurkanBernard Durkan (Kildare North, Fine Gael)
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That is correct. It takes two or three years.

Photo of Damien EnglishDamien English (Meath, Fine Gael)
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It can take two or three years to get a decision on an application. If somebody has had an accident or stroke and wants to live at home again or with relatives when he or she leaves hospital, he or she should not have to wait two years to be told a grant of €20,000 will be provided. If there is a delay in processing applications, surely people can be allowed to carry out the building work and claim back the grant funding. It is rare for this to happen. It took me eight months to get money back for someone who did not realise the grant application had to be made in advance of the building work. Luckily, due to common sense on the part of the council authorities, the individual in question was awarded a grant for the work that had already been completed. However, according to the rules set down by the Government, it is not possible to do that. It is not good enough for people to have to wait two years to get an answer in the first place. People should be allowed to have the work carried out and then be able to claim the money back but currently that is not possible.

Essential repairs grants cover small building jobs such as having a window or roof fixed to better insulate a house and make it more comfortable. I object to the five-year rule governing this scheme. It is the greatest load of crap I have ever come across. It is ridiculous to write to an elderly person to inform him or her that because he or she got a grant four and a half years ago to fix a window or a door, for example, another application cannot be considered until five years have elapsed. That is absolute rubbish. If someone needs a grant for a certain purpose the application should be assessed on its merits and should not be subject to a four-year or five-year rule. That is absolutely ridiculous. It does not support people to live at home or care for the elderly in the community, far from it.

The provision of home improvement grants, home help hours or other local nursing services are important for elderly people but many of them cannot afford home maintenance or to do the little odd jobs that occur around the house from time to time. People generally have a sense of pride about their area and like to have their house looking well, properly painted and with gates and fences in good order but it is difficult to get anyone to do these small maintenance jobs. It is all very well for people who have relatives or friends who can help, but in many cases elderly people do not have anyone to help them, especially those who have moved to new areas.

Services for the elderly should be provided at an affordable rate. In County Meath, among other counties, a programme of works provides services for the elderly and although it operates on a not-for-profit basis, the charge is still €10 or €15 per hour which can amount to €50 or €60 as most jobs such as repairing a gutter or doing a painting job can take four or five hours. Elderly people cannot afford to pay these amounts. The Government must establish schemes in communities, be they voluntary or otherwise, to help elderly people who need odd jobs done. This will help people remain in their homes for longer and help them feel happy and proud to be there. People sometimes opt to leave home to go into a nursing home because they are no longer able to manage the small jobs it is necessary to do from time to time. In many cases, a little help would go a long way in terms of keeping people at home where they want to be, in their communities with their friends and neighbours. We must endeavour to do this.

Photo of Bernard DurkanBernard Durkan (Kildare North, Fine Gael)
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Hear, hear.

Photo of Damien EnglishDamien English (Meath, Fine Gael)
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Provision has been made in the planning legislation for child care facilities, community facilities, green spaces, open spaces and so on, yet there is no obligation to provide facilities for the elderly. Planning has moved on from the stage of one application per field to local area plans and the development of 100 acres at a time — strategic development zones or SDZs. These involve comprehensive planning for an area to provide all the services required for community use, child care and so on, yet no reference is made in the planning laws to providing facilities such as nursing homes for elderly people. We must examine this issue so that when areas are first being developed we can provide facilities for the elderly. It is more affordable to provide such facilities when it is done at the planning stage.

The Government should also encourage people who are building houses to allow for a granny flat or some accommodation to the side of their house. A small grant could be provided for this purpose. If the work is done at this stage it will save €60,000 or €70,000 in ten or 15 years' time if people then have a need to modify their homes to cater for an elderly or disabled family member who can no longer live alone. People should be advised that it would be wise to lay out their house in such as way as to make it easy to modify at a later stage should that be necessary. In certain areas, building regulations now specify that doors must be a certain width to ensure homes are suitable for disabled people or those in need of a wheelchair. Some regulations also specify the inclusion of ramps.

People should be encouraged to take these things into consideration without putting a great financial burden on them. We should all be mindful that we may have to take in an elderly relative some day and that houses should be designed in such as way as to require minimal modification. This will reduce the costs to homeowners and the State in the future. It is not rocket science. A little encouragement is all that is required. We, in the House, are all aware of the situation as we deal with it regularly but, in general, people may not think of such things when they plan their new house.

Sufficient support is not available for people in the home and they are begging for help. In some cases they require very little to allow them to stay in the home. Sometimes it may only be the loan of special equipment that is difficult to get but is available from the local Health Service Executive office. We should jump at the opportunity when a family member tells us he or she wants to keep his or her elderly relative at home. We should do all in our power to facilitate them but we do not.

We must provide more community nursing home beds. The only one in my area is St. Joseph's in Trim. It provides an excellent service. People are queuing up to get into it. The waiting list is long due to demand on the service. I am sure there is such a centre in every county but there is a need for three or four of them. Community nursing homes should be available in every town. Even if the cost of this service were to increase it would still be more affordable than private nursing homes. The standard of care in the nursing homes under the ownership of the health authorities is second to none. They are brilliant and we need more of them. It is as simple as that. There is no other way around it. Tax breaks should be given to people to help build them cheaply without the involvement of the private sector. Most nursing homes provide a very high standard of care but some do not and try to take advantage of elderly people in their care. Such practices must be checked and examined but we are failing to do so properly at the moment.

Subvention rates are deplorable and do not meet even 20% of the cost of nursing home care. Assessing someone's needs involves assessing his or her savings and how much of them could be used to pay for a year's worth of nursing home care. Some wise individual has decided that a home worth over €300,000 should be assessed differently in certain areas. People now pay €300,000 for a cottage, which they then bulldoze and replace with a new house. The average bungalow probably costs over €500,000 in Wicklow, Kildare and Dublin.

Photo of Bernard DurkanBernard Durkan (Kildare North, Fine Gael)
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It is €600,000.

Photo of Damien EnglishDamien English (Meath, Fine Gael)
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Many elderly people live in houses in the country which are worth over €300,000 and yet we have decided that anything above this figure should be assessed. Where did these figures come from? Can we not produce figures which reflect reality? The sum of €300,000 is sufficient to purchase a site in most areas. I accept that prices are different in other areas of the country, such as the west, but prices should be adjusted to match different areas. An allowance of €500,000 is made for Dublin but this figure would not buy a person much in the city, particularly in light of the fact that many elderly people live in homes worth over €500,000 in inner Dublin. We should be realistic when we address this issue. Perhaps when a Bill comes before the House, its framers might tell us the truth and address real life because this would go down better and save us from being forced to constantly argue with them. The public wonders what planet Members live on when they read about some of our debates, the figures we quote and the way in which we congratulate ourselves on the great work we do for elderly people. We do not carry out great work for elderly people. Most elderly people do not have the option of remaining in their own homes and we are failing those who wish to do so.

Photo of Bernard DurkanBernard Durkan (Kildare North, Fine Gael)
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I congratulate Deputy English for his excellent speech which addressed all the major issues in this debate on care for retired or elderly people. He encompassed the words of many of us who have served in this House for far longer than him. One issue he addressed concerned disabled person's housing grants.

I had the privilege of processing the first disabled person's housing grant in the local authority in my area in 1976 or 1977. I cannot remember how much the grant was but it was sufficient to make a major contribution to an extension to a house to facilitate an amputee. The first inquiry was made in August and the work was finished by November. This was in the days before computers and all the developments which are supposed to have been so beneficial to us since then. It was before the introduction of a slick assessment of planning applications in local authorities and before the same degree of care and attention was given to elderly people. Yet, everything was put in place in the space of three months. This included planning permission; it was not even an exempt development.

It could take three or more years to achieve such an outcome for elderly people today. If we discuss nursing homes and nursing care and attention, we must also weigh up the alternatives and whether they are made available. In the past two days, I was asked to visit a family whose home is in a serious state of disrepair. The household includes a person with special needs who uses a wheelchair and attends a day care centre and another person who acts as a carer. Buckets are used to catch water leaking from the roof, water is running down the walls, the house has rising damp and birds are building nests in the rafters. The house is dilapidated to an embarrassing degree.

After some investigation, I discovered the local authority had, as my colleague noted, made the two people an offer, an offer they cannot refuse. It offered them a new house which was between ten and 20 miles away. People who have lived all their lives in one place do not want to move away from it. They wish to stay among their friends who they have known all their lives and in a place where they have ready support and where they know and can talk to, rely on or argue with their neighbours. To shift them 20 miles away from their original home is unfair on them because it changes their entire lifestyle.

The local authority's next offer was, to use that famous phrase, a demountable dwelling; the answer to the Lord's Prayer. I queried whether it might not be better to issue the maximum rate of disabled person's grant and use it to refurbish the house as much as possible, re-roof it, make it comfortable for its occupants and then leave them alone. I was told by the relevant officer that the local authority did not plan to do this because it had decided on the two options to which I have referred. I queried whether such a decision was democratic and stated that a little care and compassion for the people concerned would not go astray but to no avail. I asked which person had made the decision and was told that such information could not be divulged because it was confidential. This attitude is becoming more prevalent in public services. We are told the information we seek is confidential.

The reality is that, in the 21st century, we care less for the elderly than before. We pretend to care more but we actually care less and are prepared to do less to accommodate people with particular needs at particular points in their lives, which is disgraceful. At some stage, our society will be judged by all and sundry on the way in which it treats people who are in need at any given time. We have spoken about this issue in this House on several occasions in the past and I do not know why it has not sunk in. I am aware that every Minister has the best intentions and hopes to wake people in the public services but a serious wake-up call is required because some schemes are being operated solely on an economic basis. The tap is turned off at a certain point and certain people lose out. What happened to concern and care for the individual? What about the individual's needs? Do they take precedence or are they considered?

I ask the Minister of State, who is a caring and compassionate individual, to make a few phone calls to local authorities and the Health Service Executive and not allow local Deputies to be fobbed off with copies of replies to constituents. Such replies merely tell the constituent that the relevant individual is not prepared to authorise a payment or service. These replies are glib, concise, abrupt, callous, cold and uncaring. We, as public representatives, should not be forced to write back to these people and inform them that they are not the sole arbiters of these issues and that other people have views that are as valid as their views. We should not be forced to do this and revisit the same issues.

Some members of staff in local authorities and the Health Service Executive instruct constituents not to talk to their local Deputy or other politicians because they apparently know nothing about such issues. These are not isolated incidents. I can quote chapter and verse in respect of such incidents which take place around the country. This type of conduct will not continue indefinitely because a change will take place at some point. The people who hide behind what they now see as safety will not hide forever. There are serious problems which must be addressed in either the short or long term because there will be fun in the future if they are not addressed.

Deputy English addressed the adequacy of nursing home subventions, an issue which has been debated for many years but not resolved. I do not know whether we will resolve it because problems will arise as long as a person's home is assessed as means in the process of identifying his or her entitlement to subvention. As Deputy English said, the value of a humble home is sufficient to put people outside the qualifying income limits and, consequently, they get nothing.

I have spoken about a sad situation in the context of another Bill, that is, a family member who lives with one of his or her parents and may have joint ownership of the family home, which is included in the arbitrary assessment. The junior member of the family will inherit the home, but to ensure he or she does not inherit easily, a bureaucrat somewhere has decided to assess the person on half the value of the family home, which could be €250,000 or €300,000 depending on its location. As a result, that person is burdened.

What can he or she do? Such people talk to us, we make representations, bureaucrats decide to give responses, if "response" is the proper description, and the situation continues. Sometimes, representatives only receive replies to queries a year later. Ministers must accept responsibility for these matters. Were I a Minister in a Department that treated people in this way, I would go mad, as would anyone in the House. The time has come to put care, feeling and humanity into how some applications are dealt with. A little bit would go a long way.

Caring at home has been mentioned. Times and the economy have changed considerably and it is not always as easy to care for people at home as it used to be. However, there are people who are willing to do so where it is possible. I welcome the improvement in respect of the carer's allowance, but it could be improved further because many people do not qualify for various reasons.

Building an adjacent structure to a house can be helpful in some cases. I can cite a classic example of how daft bureaucracy can be. A man decided to build an extension to his home when his mother-in-law arrived to live with his family, who was a young woman at the time. The extension was an upstairs conversion above a garage or something similar. After some time, the woman was not as mobile as she used to be and it was decided to apply for planning permission for a downstairs extension. The family applied to the local authority and was refused five times. Why? Planning permission was bad enough in the past, so why do people adopt and stand over such stances? The case was made that the woman was not as mobile as she used to be, the circumstances had changed and no law would have been broken if permission had been granted.

On disabled persons' grants and nursing homes, one must weigh the alternatives. There was a tendency, and some evidence indicates it remains the case, that to qualify for the disabled persons' grant, such modifications would need to be made to the house as to make it impossible for a reconversion after the disabled person left without razing it to the ground.

For example, a ramp would stretch diagonally across a garden from the front gate to the front door. I cannot understand why anyone would design this, as it is wrong in two ways. First, it gives a signal to potential burglars that a disabled person lives in the house. Second, it is dangerous because it is a diagonal construction across a rectangular plot. Anyone who knows about health and safety matters would know what this means. Imagine what it would be like for an abled person to walk in the front gate after drinking two or three jars in the local pub. It is crazy. It would be simple to do a good job without decimating the house. A straight run could be built to a garage or somewhere nearby, a ramp could be enclosed in the garage and no one would see anything.

Another tendency was to tear out the inside of the house or modify it to the extent that to qualify for the grant, it would not be possible to reconvert the house. For example, two walls would be demolished, load-bearing girders would be installed and so on. It was nonsense. Why not simply build an extension to the side of the house?

My last example is as true as I am standing here. In the past four years, a widow applied for a grant to build a downstairs extension because she was suffering from a terminal illness. The usual assessment was carried out by the usual bureaucrats and a port-a-loo was bolted onto her house's gable because it was decided that such would be sufficient to meet her lifetime's requirements. I do not want to shock people, but if any Deputy were to be treated in this way at any stage of his or her life, it would be a sad stage in the country's development. Caring and compassion do not go hand in hand with this attitude. I am referring to these matters to identify the difficult issues facing people who may have the option to be cared for in the community or may be forced into residential care.

My constituency is lucky to have a number of nursing homes, all of which are of high quality and standard and are providing a good service. From time to time, there is an odd glitch. While I am never one to shirk when it comes to telling a person my views on his or her operation and never will be, we should give credit where it is due. Generally, the nursing homes provide a good service. The subventions to date must be examined carefully, but they must keep pace with nursing home charges.

In some quarters, there is a perception that elderly people are a burden on society, that they have worked, earned money and stashed it somewhere and, consequently, their money should be extracted from them by fair means or foul. Deputy English referred to a bank official. I view the matter in another way. For example, persons from a part of the income scale may have worked for their lifetimes, given their best to society, reared their families, built their houses, got and repaid their mortgages and, in many cases, are attempting to repay their children's mortgages, including by remortgaging their own homes. Having done all of this, there may come a time when a bureaucrat must make a decision on whether they will get support, but the qualifying income limits will be a barrier.

These people have paid society, which has not been taken into account in any way. They have carried their burdens, moved along, done their jobs and should not be punished as a consequence. If they had sat idly by and done nothing during their lives, they would be better rewarded. We must respect their lifetime contributions. Instead of evaluating their eligibility for something on the basis of the few euro they have in the bank by the time they reach 80 years or 90 years of age, they should be judged on their contributions to society. Were this factor taken into account, their entitlements to nursing home subventions would be more fairly based. My experiences are similar to those of other people. We come into this House and talk about those experiences, the Minister thinks about what we have said and his officials take notes and discuss what they hear. When the notes are written, the experiences related on all sides of the House are well rounded in the best Irish tradition. They should be taken on board so that reality dawns on those dispensing and administering in this area.

Paddy McHugh (Galway East, Independent)
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There is a basic inequity in the making of assessments and a disparity in nursing home subventions in different parts of the country. Unfortunately in the western region, the subvention is lower than in other areas. I have raised this with the Tánaiste but she has given the standard answer that the HSE is the body responsible etc. It is not good enough for the Tánaiste to wash her hands of this disparity by saying the scheme is administered by the HSE, thereby attempting to distance herself from any blame for this unacceptable method of dealing with elderly people. When those elderly people were paying tax, there were no graduated contributions, they paid the full amount regardless of their capacity. People in the west paid the same tax as those in east. When it comes to care in their twilight years, there should be no discrimination and every senior citizen in this country requiring nursing home care should be treated equally.

It is no defence for the Tánaiste to hide behind the HSE. She is the Minister for Health and Children and the buck stops with her. She should immediately take the necessary steps to rectify this situation. As a democrat she should ensure all citizens are treated equally and fairly. Senior citizens are depending on her for protection.

It is no coincidence that elderly people in the west are treated as second class citizens. The Government thinks that second rate treatment is acceptable for those in the west, as we see from the absence of the BreastCheck programme. Why are we being treated like this? For women in the region, it will be 2009 at the earliest before the first cycle of BreastCheck will be completed. It is unacceptable that such discrimination should occur. All women should be treated equally.

I welcome this Bill. It sets an existing scheme on a sound footing. It is important that we place it in the context of the problems surrounding nursing homes in the State. The regulatory regime has been found wanting, with tragic consequences for many older people. Most of those providing private nursing home care do so efficiently but there are also many institutions where standards are poor. The State has still not invested resources to regulate this sector properly. It must act now before there are more scandals like that in Leas Cross nursing home.

The Bill makes provision for the assessment of older people's means when they apply for subvention but there is no provision for accountability on the part of the proprietors of nursing homes and no check to establish if they are providing the range and quality of care needed by the older people who will benefit from the HSE subvention. An ongoing assessment must be put in place. The current lack of regulation and an independent nursing homes inspectorate is intolerable. It is incredible that in a modern society, care for the elderly is being overlooked in this fashion. Many of the elderly currently in nursing homes are responsible for the success this country is now experiencing, they have worked hard all their lives and have made the Irish State what it is today and we owe them a debt of gratitude. At a minimum, we owe it to them to ensure they have a proper lifestyle and are treated with dignity and respect.

To be sure this happens in our nursing homes there must be proper regulation. The inspectorate should be for public, private and voluntary nursing homes and should have the resources and powers to allow it to carry out its functions. It is vital that the inspectorate is made up of the appropriate professionals to inspect all aspects of the service. The reports of all inspections must be available to the public free of charge so there will be transparency about standards in nursing homes. People cannot be put away in substandard conditions. The elderly are vulnerable and we cannot ignore issues about the standards of care in nursing homes.

The lack of funding for special housing aid for the elderly, specifically in east Galway, is a scandal. The failure of the Government to make adequate funding available to elderly people to enable essential repair work in their homes is deplorable.

The special housing aid scheme for the elderly funds essential work on houses owned by people over 65 years of age who live in unfit or unsanitary conditions. The works that can be funded are basic and essential, such as providing indoor toilet facilities or fixing leaking roofs in houses where the elderly resident cannot afford to carry out the work. There is no more money, however, to carry out work in east Galway for the remainder of the year. The authorities are advising people not to apply and that is deplorable. It is a terrible way to treat senior citizens who have made a contribution to society and who find themselves living in substandard conditions. By not providing these funds, the Government is creating a problem whereby more nursing home beds will be needed because people cannot be expected to live in houses that have leaking roofs or no indoor toilet facilities. It is sad that our elderly citizens who have worked hard and helped make this country what it is are being treated so badly by our Government. I appeal to the Minister, if nothing else, to take up that issue with his Government colleagues to ensure this scandal is addressed immediately.

Photo of Paul GogartyPaul Gogarty (Dublin Mid West, Green Party)
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I thank the Chair for allowing me to speak following the mix up in slots. We have been waiting for this Bill for almost a year and a half and we are still on Second Stage. I realise there is other important legislation to be dealt with, particularly that to be taken tomorrow which should supersede everything else, but this Bill is dragging on and is unlikely to be approved until the autumn, which is regrettable. That may be bad but what is even worse is the scandalous delay, to paraphrase Deputy Joe Higgins, in introducing the legislation on an independent inspectorate for nursing homes. That is even more urgently needed given the reports on Leas Cross and other facilities published in the past 12 months or so.

It appears that all important legislation debated in this House is forced upon the legislators as a result of events, to use that unfortunate term, or court decisions. We have only to witness the sorry situation regarding the release of the child rapist dubbed Mr. A and the possibility that in an hour's time Mr. B might also be released to realise that the Government was caught napping and had to react. In that respect I welcome the legislation to be debated tomorrow on the age of consent and the rape of children, which is crucial. I refer to it in case I do not get a chance to do so tomorrow.

Similarly, this legislation is being debated as a result of events, namely, the revelations about conditions in Leas Cross nursing home and also, to a lesser degree, the fall-out from the payments issue and the illegality that arose around the same time. The appalling treatment of a few individuals in one facility brought on a media investigation which highlighted other cases throughout the country and brought the mistreatment of the elderly to widespread public attention. That is one of the reasons this legislation comes before us now.

This legislation is flawed in respect of one issue, namely, the implementation factor. I will deal with some of the issues in the Bill in due course but the conditions surrounding this at the moment are chaotic. It is a time of chaos in the health service. We have no new public nursing home places, despite a commitment made by the Government that 2,000 would be provided. We have no new strategy for the care of older people and, as I said at the outset, no independent inspectorate.

This Bill appears to be a charter for the rich and a slap in the face for every other older person who has contributed to society over many years. Social welfare recipients are being told they can pay for a private nursing home when no public ones are available. Although the Supreme Court upheld their rights, their rights continue to be trampled on because subventions, about which there is much reference in this legislation, mean nothing in terms of private nursing care if one does not have the money to top up one's social welfare payment. Enhanced subventions, which other Members spoke about, might be available in some cases but eventually, under the current funding arrangements, people will be drawing lots or told, as one speaker said some weeks ago, that they have to wait for someone to die. That is not good enough and it will do nothing to help take out of the public hospital system the elderly who cannot afford private care. It will mean people will continue to live in poor or unsuitable conditions for many years until someone dies and a public space becomes available.

There is only so much outrage one can spout in this Chamber without sounding like one is playing to the gallery but this is one issue — and I have said it in regard to nursing home charges and repeat now — that is an absolute outrage in terms of our older people. It is an outrage and a scandal that the people who paid the highest taxes and contributed to the birth of the Celtic tiger are now being mistreated in this appalling fashion.

While we have some amendments to the legislation to introduce a system of approving those who may qualify for public and possibly private nursing home care, we still have not tackled the fundamental issue of paying for it. That is the problem. The legislation only ensures that the sorry situation that currently exists has some form of legal protection, rules and regulations. I have examined some of those in terms of what constitutes a person's ability to get different types of funding in various scenarios and the worst case condition is where a person does not have a top-up pension and is on the lowest social welfare payments available. This does not do anything to facilitate people entitled to public nursing home places to get into private nursing homes. That is just one issue.

My colleague, Deputy Gormley, who is health spokesperson for the Green Party, related to the other factor in the equation in terms of the lucky few who get into private nursing homes. That is a lottery, however, in that people cannot tell whether they will find a facility that will care for them. We know only a minority of establishments have been shown to be seriously lacking but in many cases because of cost and geographical factors, one cannot necessarily choose where to go. The issue of choice is a real one. We can say people can look around or the sons or daughters of the people in question, or they can visit a few places, be sold a few platitudes and in they go. It is very difficult to get out of a situation like that when one has committed oneself financially. That is for the people who can afford to commit themselves financially. For those who cannot afford it, we are talking about people who are left in their homes in a condition where they cannot look after themselves and where there is no community care, even though community care is supposed to be provided.

I will quote from a letter written by a health care worker who, for obvious reasons, wishes to remain anonymous but it outlines some of the concerns being expressed. The letter was written to Deputy Gormley following his comments on radio about the poor care in nursing homes. This individual states:

I too have very major concerns that the HSE and the Department of Health are not taking the issue seriously enough . . . [That is the issue of nursing home care] . . . and in particular that the HSE are more defensive of themselves than of the care and well-being of the vulnerable people who are supposed to be protected by them. Your report [that is Deputy Gormley's report] of staff concerns effectively being stymied by insisting that they are formal complaints has a ring of truth.

Sadly, this attitude is all too evident in their approach to Professor O'Neill's report on Leas Cross, which has been with them since February (first draft) and a relatively unchanged second draft . . .

According to this person it appears that the attitude is more about concern for the impact of the report on senior HSE staff and recently retired staff who have returned on contract rather than patient care. The person finally states:

It would be of great service to the public if the report were released promptly as it outlines a series of system failures which require urgent attention, and which are likely to mean that poor care is widespread and unchecked in the nursing home system.

I deeply dislike writing anonymous letters — this is the first in my life — but you are aware of the culture, and it is good to hear a sympathetic and firm approach.

Yours sincerely,

A concerned HSE healthcare worker.

It has got to the stage where members of staff are writing anonymous letters even though Deputies and Senators do not make names available under the Data Protection Act but this person was so afraid that their name would get out as having criticised the malaise in the health care service they would not give it.

The point that person made was valid. Members of staff are afraid to raise issues until they turn into major issues with formal complaints, de facto identification of those involved and the risk of intimidation. Why can the system not be made easier? The establishment of an independent inspectorate for public nursing homes would help so why the delay? Deputy Gormley and others have tabled questions to the Tánaiste and Minister for Health and Children about this matter and on his behalf I intend to ask her whether the Government has lost all credibility on the issue. Is the Government trying to drag it out because an inspectorate might identify problems which exist, both in terms of the care provided and in terms of the substandard accommodation which still plagues our system?

In contributions, Deputy Gormley and others referred to the long list of inadequacies which were identified, but it seems nothing will be done about them. The Government has reneged on its commitment to provide public nursing homes, and it is not training sufficient specialists, or even those who are not specialists but who require a modicum of training to carry out duties effectively.

The issue of community and public care units is not being looked at. Lip service is being paid to the matter, but I do not see them on the ground. Other Deputies have spoken on the issue of community care. It should be remembered that only a small minority of older and vulnerable people require full-time or part-time care. If possible, such care needs to be carried out at local level within the community.

In my constituency, the St. Loman's Hospital lands were sold for €31.5 million, and it is worth noting that some of that funding is going towards community care. I welcome that, although I realise it is for mental health issues, though some of it is for elderly people. The money should be spent within the area rather than being dispersed for hospitals for elderly people.

In ten years, hospital beds will still be taken up by older people unless investment is made to open 2,000 community care places. These are meant to be separate beds for older people. Not having a background in health, I sometimes get confused by the use of the word "beds" for elderly people. These are separate to beds for people who have medical conditions. There should be no place for an older person in hospital unless they have a medical condition, even if it is in an annex. These people belong in the community, be it in a properly inspected public nursing home or a private nursing home if the person can afford it.

Deputy Gormley also referred to the wider issue of people not necessarily having to go into nursing homes because they may be living longer, be independent and healthy. There is an issue regarding the overall treatment of older people and Government policy on health care. For example, this relates to tax incentives for matters such as gym membership, active retirement associations or even mixing in adult education and subventions for VECs, which have diminished in recent times. It is now more expensive to do an adult education course.

These might seem distant or unrelated to the issue we are discussing, but the more people are kept active and involved both mentally and physically, the less likely they are to be dependent. For a relatively small investment for many people now, one would not have to worry about the nursing home issue, hopefully not ever and definitely not for a considerable period. The related holistic community-wide measures can also be looked at in parallel to the immediate emergency situation. The Government should be planning for both of these simultaneously so that in a few years, we do not have more people who could have been active and engaged in the community but who are on the scrap heap because of a lack of foresight in Government policy.

That is a serious indictment of the way we value our older people. Government policy must reflect respect for people who put me in my current position, gave me an education and made me as articulate as any other Member of this House in representing their views. Without the efforts of people like that, we would not have the calibre of Deputies and Senators which we have today, or the calibre of business people or teachers, for example.

The people who made our State the economic powerhouse it is today are those who we are trying to thank, but we are doing it very badly. We must recognise and respect what these people have done for us and give them the dignity and courtesy of a proper retirement with appropriate medical care and support. That is not happening. Without financial input accompanying the Bill, it will not happen. It seems to be a list of reasons why money will not be received as opposed to a list of guarantees. Under the Constitution one is entitled to health care, and the Government should back this up with money. There is very little in terms of additional financial investment.

We know there is a problem, and various Ministers with responsibility for health have acknowledged it. The Tánaiste and Minister for Health and Children, Deputy Harney, has also acknowledged that a problem exists. If a problem is recognised and nothing is done, it is a bigger sin than what has happened this week, where the Government indicated it could not foresee the Supreme Court decision. We foresaw the issue of elderly care and we have seen that we are not properly inspecting our nursing homes. We have seen this matter coming and we can do something about it this year.

Why are we not doing this? We should be able to see the problem, resource the solution and give our elderly the respect they deserve. At the next election there will be some new Deputies whose education was funded by people who are now in need of State care and who will be saying the same thing I am. They will argue that we need to respect our elderly. In five years I do not want to be saying I warned people but I was talking to a blank wall.

3:00 pm

Photo of Tom HayesTom Hayes (Tipperary South, Fine Gael)
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This is a great opportunity for us to have our say on a Bill for many elderly people we represent in our communities. When this Bill was published, I was looking forward to the many areas it could cover. On reading it, I was disappointed. The contents of the Bill show more of what is not there than what it contains. A glorious opportunity to address the huge issues concerning elderly people in our community was missed.

Everybody who represents people or carries out work for the elderly in the community knows only too well the large amount of issues which concern the elderly people in our communities. The population is growing older, and we are all keeping ourselves fit because of better health care. People are living longer, and as a result, much pressure is being put on the system.

Report after report has been published with regard to the elderly in our community. The Ombudsman has looked at nursing home subventions. The national health information strategy was published in November 2001, and following its publication the Government published its national health strategy, in which it promised to clarify and define eligibility for health and personal social services.

That was never acted on. With the Sustaining Progress special care initiative, the Government gave a commitment to publish the study and examine the future of long-term care. What has happened to this? The Ombudsman also considered the issue. The O'Shea report contained significant issues, findings and recommendations. It pointed out, in one document, problems which exist for the elderly in our communities and what needs to be done.

One could go right across the board, even to simple issues such as housing aid for the elderly, which was mentioned. The lack of funding for housing aid for the elderly is a disgrace. In every area across the country, it is seen as one of the finest schemes devised, if it is funded. However, it is not. Every May, June or July the funding runs out — in some areas it has already run out for this year. At a time when huge resources are available to Government and we boast about how strong the economy is, simple projects that would make life much easier for the elderly in our community cannot be delivered.

The aim must be to allow people to live in their communities. Most of our elderly want to stay where they have become accustomed to live, with their families, and do not want to be put into long-stay care, though some obviously must. Grandchildren want their grandparents to live with them but we have not seriously addressed the issue. Last weekend I attended a funeral in my constituency where three grandchildren of a 95 year old lady, though sad at her death, expressed pride at the fact that they had looked after her in their home. A 95 year old lady was sent from Tipperary to Waterford Regional Hospital, where she was kept waiting for a full day for a small problem with her eyesight to be attended to. She is now deceased. Such treatment is unfair in a State such as this.

Many families have been waiting a long time for subvention, which is an onerous burden. All of us, as public representatives, deal with the issue in our communities on a regular basis. Only last week I attended another funeral of a person aged 87 who had been seeking the subvention from the health board and then the HSE in the county. He paid his taxes all his life and had worked very hard. He had one leg amputated a year and a half ago and was fighting with the health services for three years to resolve an issue. A week ago last Monday he was informed he would get the subvention but he only lived until the following Friday. It is unacceptable that such a situation should develop. I do not wish to frighten anybody but these are examples of how we, a supposedly Christian, caring country, treat our elderly people.

I do not enjoy citing those examples but they are facts. We must bring legislation before this House as soon as possible to address the plight of the elderly and improve their quality of life. The Bill deals only with a small aspect of the problem. Support services for the many people who wish to remain in their community are dismal. Public health nurses——

Photo of Michael D HigginsMichael D Higgins (Galway West, Labour)
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Home helps.

Photo of Tom HayesTom Hayes (Tipperary South, Fine Gael)
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Home helps — we could mention the whole range of services.

Photo of Michael D HigginsMichael D Higgins (Galway West, Labour)
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They have all been cut.

Photo of Tom HayesTom Hayes (Tipperary South, Fine Gael)
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They have all been cut, which creates problems for those trying to care for the older people who live with them. The country needs more public health nurses because they would reduce the cost of care to the State but, as Deputy Michael D. Higgins said, home help has been cut.

The quality of care has been discussed. Reports have surfaced about private nursing homes which failed to provide adequate care and found themselves in trouble with the authorities, which is as it should be. One half of St. Patrick's Hospital in Cashel, where there are 150 patients, is closed. We have lobbied for years for funding to open the other half because people live longer in such hospitals. I have visited it regularly and seen at first hand the care being provided. There are more people on the waiting list for St. Patrick's Hospital in Cashel than there are patients in it. The hospital is based on a model which works so the State should give people the chance to stay in such institutions and fund them accordingly. I beg the Government and the Minister of State to treat as models the many institutions around the country that have given great service over the years but have suffered cutbacks for various reasons. Every county should have one such hospital, if not two. It is vital that those owned by the HSE are developed and that more Exchequer funding is made available because they offer professional care.

Many people have difficulty with subvention rates. The rates do not seem to keep pace with the cost of a nursing home and it is a real problem. Hospitals should be graded to allow consistency of charges and a degree of control. People constantly petition us to review subvention rates because they find it difficult to maintain their elderly relatives in the community. The O'Shea report dealt with concerns about subvention rates, elderly people being forced into schemes and the lack of long-stay public beds in some areas of the country, which resulted in the inappropriate placement of some people and severe financial hardship for others paying for expensive private care. That needs to be addressed.

The report states that a significant number of elderly people in the subvention scheme are unable to maintain their payments and something must be done about it. Significant time costs are associated with the operation of the nursing home subvention schemes. Assessing people requires a great deal of administrative work and staff often have to ask the applicant for additional information, and to have recourse to other agencies for details in connection with an application. An application must go through a number of stages before a final decision can be taken. Simple cases can take four to six weeks to process. However, if additional information is required, the process can take longer. It should be a requirement that such decisions be made within a certain timeframe, as is the case with decisions on planning applications. I outlined a case in which a health board took nearly three years to make a decision on the subvention rate for one of my constituents.

I am disappointed the Bill does not address the wide range of issues affecting elderly people in our communities. Major issues have been addressed during the lifetime of this and other Dáileanna. I hope future legislation will address the full range of issues associated with care of the elderly in the community. We need to enable elderly people to remain at home by providing them with supports which enhance their quality of life. All of us, regardless of whether we like the idea, must face old age. We hear day in and day out how rich our economy is and how well-off we are. We need to implement existing plans which would make life easier for the elderly and tackle the hardship and drudgery experienced by those who provide care in the community.

Photo of Michael D HigginsMichael D Higgins (Galway West, Labour)
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I welcome the opportunity of saying a few words on the Bill. Any legislation that addresses the issue of care for the elderly, particularly those who are dependent in any way, is welcome. However, when one considers what is required I must agree with Deputies who have suggested that the Bill takes only a small step.

In assessing what is required it is important to define the perspective from which one departs. It is clear the approach taken in the drafting of this legislation is not rights based because the Bill does not incorporate any principle of universalism. I will spend a moment clarifying what is meant by universalism. Universal provision arises from a view of citizenship which is based on the idea that certain rights are granted to citizens at all ages and that the rights one might expect in citizenship at a certain age, particularly in old age, are specified. In some respects, one of the legal confusion about nursing home care arises in this area.

This Government and other Governments have rescued themselves from the requirements of the Constitution by suggesting that the existence of a scheme of nursing home bed provision, for example, for those with medical cards, satisfies the constitutional obligation to citizens. It is only a matter of time before this assumption is tested and it should be correctly found to be unconstitutional. In a previous case it was found that when a bed in the public system is not available to a person, for example, a medical card holder who is entitled to a bed in a nursing home, he or she is entitled to require that the relevant body — at that time this was the former health boards — provide a bed in a private nursing home. This court ruling is probably one of the most clouded of all decisions on administrative policy because some of those who administer the system would like to believe it does not exist and no attempt has been made either to draw attention to it or legislate for its extension and implications.

To move from this legal constitutional point to another obvious point related to health policy, it has not been to the benefit of the elderly, their spokespersons or public representatives that accountability for their care and responsibility for the legislation that addresses their care has been transferred from the Houses of the Oireachtas to the Health Service Executive. This move has made it very difficulty to obtain specific answers.

To make my position perfectly clear, my first point is that a rights-based approach to the provision of care for the elderly is the only one which will answer current needs. My second point is that the proposal to allow private hospitals to develop on public hospital grounds is outrageous, given that voluntary groups, including active retirement associations and other voluntary associations dealing with the care of the elderly, have for years sought opportunities to have facilities provided, including on public hospital grounds, in which care of the elderly would be available.

In another life I was a sociologist by training. About 35 or 40 years ago, as part of my only experience in the United States, I worked with the late Professor John T. Liell of Indiana University, the author of a book entitled Links to Life which dealt with care of the elderly. An advanced study in its time, the book suggested that maximising the number of links people have to community allows them to lead longer and more full and active lives. This approach is clearly the way forward.

Public nursing homes, by reason of their responsibility to the public, provide greater assurance about standards. The day facilities available in some of them include laundry and day care facilities and opportunities for those outside who wish to maintain links to residents, in other words, they offer a full range of activities.

The argument in all our life cycles is that we begin with few links to life but acquire many more as we move from childhood into family life and the world of work. Thereafter, the curve shifts downwards and we depart, as it were, linkless just as we arrived. The main point, however, is that the more links that are available, the better. All this means that there is immense benefit in enabling people to spend as much of their life as possible in their own homes, which are positive and reassuring.

To be fair, I note this principle is partially acknowledged in the proportion of funding allocated for the forthcoming year. It is singularly misleading to the public, however, to give gross figures in all discussions on health matters. While it is politically attractive to be able to indicate that the gross figure for the current or forthcoming year has increased substantially when compared with a few years previously, what matters is the amount of time available to provide care, the degree to which services will be extended and the quality of care available to the older person. It is not interesting, apart from being satisfactory politically, to project what will be the gross expenditure on services and care for the elderly either this year or next.

People want to know what has happened to the home help service; whether they will have more or less access to services and whether more or less hours will be available; whether a particular service is better integrated in the public health service and whether the amount of time available to public health nurses to care for elderly people has increased.

It is appalling in the city I represent that a woman who relies on dialysis treatment will have her taxi service to Merlin Park Hospital discontinued because the HSE has taken the extraordinary position that, with demand increasing, it must achieve economies by stopping its taxi service for dialysis patients. I became a Member of this House more than 20 years ago. At one time, if this had happened, I would be able to ask a question of the Minister for Health and Children and get an answer but I cannot get an answer now. Therefore, I began the laborious process of writing letters to the western section of the HSE and waiting for a reply. I was told the same information as was contained in the Minister of State's speech on this matter. The process is neither transparent nor accountable. It is appalling to suggest we should cut off a service like this in a country with such high income levels, however they are measured.

It is disappointing the promised public nursing home beds have not arrived. There is no justification for that. I invite the public to express their outrage as strongly as they can if a site notice for a private hospital is erected on the grounds of a public hospital, while at the same time these public beds have not been provided. It is an incredible indictment of the policy decision that simultaneously stands over the theft of public assets and the neglect of the elderly.

The failure to legislate properly for the inspectorate is equally unacceptable. From time to time, much has been said about the public and private health sectors. It is to the great credit of the public health system that it is accountable. It has built-in norms of accountability concerning new facilities that have been provided. I am thinking, for example, about one such facility in Kildare. The regime that operates in that public nursing home facility provides an excellent model for medical care and the overall delivery of facilities for older people, including chiropody and hairdressing. I cannot understand, however, why we are not assuring the same standard across the system. It is one thing to create through the Finance Act incredible advantages for private nursing home developments but if there is to be a net transfer — which there was of approximately €56 million — taxpayers are entitled to ask that an inspectorate will ensure private services will be of the same standard as those achieved in the public sector. It is deeply disappointing, however, that that is not so.

While I am critical of certain aspects of the Bill, I wish to translate such criticisms into positive proposals. Part of my criticism concerns the absence of a policy based on rights of the elderly, citizenship and the principle of universalism. Means testing is costly, fallible and administratively difficult to deliver. There are two forms of qualification in the Bill, one of which concerns dependency. I read the Bill with a certain amount of concern because the qualification is defined in terms of physical dependency. I refer to Part 2, section 7B(2)(a) on page 6, which states:

the applicant's ability to carry out the activities of daily living, including the applicant's—

(i) degree of mobility,

(ii) ability to dress unaided,

(iii) ability to feed unaided,

(iv) ability to communicate,

(v) extent of orientation,

(vi) cognitive ability,

(vii) ability to bathe unaided, and

(viii) degree of continence.

While I do not have an argument with that list, there are other items one could add to it.

Part 2, section 7B(2)(b) refers to "the family and community support available to the applicant". In that regard, there is a straight, hard fact concerning Ireland, which is how willing families are to look after the elderly. A cultural change has occurred here, which is not necessarily good, in that there has been a decline in the willingness, ability or amount of time a family has to be able to look after an elderly relative. We should be careful about this. One can answer the question by looking at the number of people aged over 60 or 65 in the labour force. Increasingly, one finds the economy is gobbling up all the available social hours in a person's lifetime. The Tánaiste has lectured all those aged under 70 that they are in danger of betraying the economy unless they last until 75 and drop dead. Given the nature of the economy and our views on social time and working time, fewer people will be left to take care of the elderly. If that is to be the case, let us hear about the State's responsibilities to the elderly in rights-based legislation.

The second set of qualifications concerns income. Section 7B also refers to the applicant's principal residence for purposes of valuation, unless a person has disposed of it "within the five years immediately preceding the date on which the application is made". Exclusions apply when the applicant's principal residence is continuously occupied by the applicant's spouse, a child under 21 years of age, or a child in full-time education, and so on. The valuation is not only made on the home but also on its contents. For example, if one inherited a painting or other valuables they must be listed also for purposes of valuation. This valuation system is against everything we know about the social orientation of old people and the importance of that which is proximate and valuable to them. We must take the family home out of consideration when assessing attributable income.

We also need to examine seriously the subvention system and make it available on the basis of equality to a person relying on any form of social welfare or even on the minimum wage. If a person qualifies on the basis of disability and income level, they are then categorised on the basis of extreme, medium or simple dependence. How can the weekly allocation of approximately €195 enable a person to enter a private nursing home in any part of the country, even though they are entitled to do so under the terms of this legislation? A person may reach the maximum dependency and qualify under the income criteria but they are still limited to an allocation of €195 per week so where will the rest of the money come from? Which nursing homes will accept such a person? They do not exist. We are retreating all the time from a rights-based approach to planning for the elderly.

I could argue about why such an approach should be adopted. For example, during one's working life the levy for future pension provision applies. One could argue that the right way to go about it is to make compulsory provision for pensions in future, if necessary. The State could construct a rights-based system governed on universal principles. If Irish law could fit easily into European legislation or international law generally, it would be moving towards granting rights to the elderly. That is the way the legislation is going and it is the way future legislation will be forced to go as elderly people seek to vindicate their rights beyond the framework of Irish law. It would be wise to see this as a limited Bill. We need to resource our planning for the elderly and to do so by having a far wider legislative base.

Debate adjourned.