Dáil debates

Thursday, 20 November 2008

Nursing Homes Support Scheme Bill 2008: Second Stage (Resumed)


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

11:00 am

Photo of Arthur MorganArthur Morgan (Louth, Sinn Fein)
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I welcome the opportunity to complete the slot commenced by my colleague, Deputy Caoimghín Ó Caoláin. A number of questions remain to be answered. How long a delay can we expect in the commencement of the Bill? Will we see the creation of a massive waiting list for nursing home care? Thousands of people may be assessed as being in need of such care, but will the places be available for them. Age Action Ireland has asked how a waiting list might work. Would it be on the basis of first come first served, or on grounds of need, with those most urgently requiring care being accommodated first? Has this actually been worked out yet?

Another key question asked by Age Action Ireland is if the Bill is enacted, whether this means an older person assessed as being in need of full-time medical and nursing care who refuses to sign up to the new charging arrangement, whereby he or she will pay up to 80% of the valuation of the home and up to 15% of his or her estate, will be refused essential care by the State. Other concerns include the fact the Bill does not recognise the situation of siblings who share the same house although it does recognise married, cohabiting and same sex couples.

People could be charged twice in their lifetime. A person could pay a 7.5% share of the home on behalf of a partner who is in care and if he or she sold the home and later needed nursing home care himself or herself, he or she could face a 15% charge on the new home. Another vital issue is the need for a draft national quality standard for residential care settings to be approved and in place before the scheme commences. There are many more serious issues and questions raised by the detail of the Bill which need to be teased out on Committee Stage.

Sinn Féin cannot support this Bill. It is a move from universal entitlement and is not rights-based or comprehensive in providing the wide range of care older people require.

Photo of Joanna TuffyJoanna Tuffy (Dublin Mid West, Labour)
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This legislation is called a fair deal but it is the opposite of fair. By saying something is fair, everyone accepts it is so even when it is not. There has been little analysis, particularly by the media to whom the public will look, as to whether the scheme is fair. Our duty as politicians is to hold the Government to account and convey the information to those affected so they can make a judgment on whether the legislation is fair. I will set out why I think this legislation is fundamentally unfair.

The operation of this legislation in terms of people's payments involves a redistribution of wealth from the less well-off to the better off. That is how it is being funded. Money is taken from the less well-off so that people who are better-off can come out better under the new scheme. The better-off will pay less under the scheme while those who are less well-off have to pay more. Another reason the scheme is unfair is that is involves a transfer of State subsidy currently paid to public nursing homes to private sector nursing homes. It privatises public nursing home care and long-term care for the elderly. It discriminates against older people, a point made by many Deputies, including Deputy O'Sullivan, Labour Party spokesperson on health.

On the redistribution of wealth, when the scheme was announced in 2006 the Minister for Health and Children, Deputy Mary Harney published a guide to the scheme in which she gave an example of how payments would work. She published examples of before and after scenarios; she set out what people might pay under the current provisions and what they would pay under the so-called fair deal scheme. One example is of a "Mrs. Fitzgerald" who pays a maximum of €120 per week towards the cost of her care, and under the new scheme as a new entrant to a nursing home she would pay a combination of €145.60 and a deferred contribution of €157.69, which is more than €300 per week. She would pay almost €200 more per month under the proposed scheme than she was paying previously.

When the Minister published the details some months ago she gave examples of co-payments under the Nursing Homes Support Scheme Bill 2008 but she did not give before and after examples, and only published what people would pay under the new scheme. I did my own calculations of the figures for before and after. I am making the same assumptions as the Department of Health and Children and the Minister in the document "Examples of Co-Payment under the Nursing Home Support Scheme October 2008" that the cost of a private nursing home bed is €800 and the current maximum payment in a public nursing home is €120.

One fictional example which represents many people in nursing home beds is "Mr. Doyle". He is a widower who lives alone in his home in Kildare and has a house valued at €200,000 which he may have bought from the council under the tenant purchase scheme. His sole income is the contributory pension of €230 per week. If he went to a public nursing home today all he would pay is €120 per week to HSE.

Under the new scheme, if it is passed, if he were to go to a public nursing home, he will pay €341.69 per week, which is €221.69 more than under the current system. The figure of €341.69 is made up of €184 which is 80% of his assessable income which is his pension, and €157.69 which is 5% of relevant assets and is made up of the value of his home minus a €36,000 disregard and divided by 52 weeks. He can pay it now or it can be taken out of this estate after his death, but he will pay €341.69 under the new scheme compared to €120 under the current system. He will pay €221.69 per week more. How is that system fair for him?

People who currently enter a private nursing home bed and receive no subvention from the HSE are treated unfairly under the present system and they will benefit under the fair deal scheme. One example is "Mrs. Smith", a widower who lives alone in a house in Dublin with a market value of €400,000 and has savings of €42,000 and an income of €260 per week. If she went to a private nursing home now she would pay €800 per week, and if she went to one when the new legislation is passed she would pay €598.39, coming out approximately €200 better off under the new scheme. She is much better off than Mr. Doyle. She has a house with a value of €200,000 more, savings of €42,000 and receives €30 per week in income more than him. She benefits under this scheme at his expense and he is subsidising her under the new scheme.

The scheme benefits those in the middle who have a fairly good value on their house and a modest income, but they are benefiting because money is taken from the less well-off who have no other income than the State pension and a modestly valued house. Many people like Mr. Doyle are currently in public nursing homes. According to statistics from the Department of Health and Children from 2006, 40% of nursing home beds are public. Therefore, there will be a substantial redistribution of wealth because many of those people own their houses. They are not well off and have only a State pension, but they will now have to pay much more and that money will go to pay for people in private nursing homes.

This brings me to another issue. The scheme provides for a transfer of State subsidy from the public to the private sector. When the Minister drew up the provisions in 2006, she gave examples of both private and public nursing homes. Her example of co-payments under the nursing homes support scheme October 2008 basically assumes that everybody will go into a private nursing home, including a Mr. Jones mentioned in her document. Mr. Jones is single with no assets who lives in a local authority house on an income of €212 per week. He pays rent to the local authority and does not own his house. The assumption is that he will go into a private nursing home where he will pay €49.60 more under the new scheme.

The scheme is unfair. It is a redistribution of wealth. It cost the State €34 million to provide tax relief for the development of private nursing homes from the year 2004 to 2006. Substantial amounts of money have been provided to private nursing homes and this will provide more. The Bill will bankroll private nursing homes that the Government has allowed under the tax reliefs to private nursing home builders and developers. The provisions in the Bill will give them a secure income. It does this at the expense of those who are less well off. The Bill privatises nursing home care and discriminates against older people because it assumes their nursing home care is a luxury that should be paid for and provided by the private sector. That is wrong and unfair.

Photo of Chris AndrewsChris Andrews (Dublin South East, Fianna Fail)
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I am pleased to get the opportunity to speak on the Bill which is a milestone in terms of how older people are dealt with by the State and will have a significant impact on them.

As we get older, our health becomes more important to us and we begin to appreciate what we had. I notice a group of young people in the Visitors Gallery today. Many of us look enviously at the health and fitness of those younger than us. Health is important to everybody, but as one gets older it becomes more important and it is a concern when the body starts to fray and health deteriorates. This does not always happen gradually, but can occur quickly and can cause deep anxiety. This happens at a time when the older person's children have grown up and are now setting up their own families and living their own lives, but with their own stresses, concerns and challenges about their children. Older people may be concerned they see their children less because they are so engaged with their own children. This increases their anxiety.

This Bill will have an impact on this. The current system is unclear and in many ways unfair. The measures taken by the Government in the Bill will help to make things fairer. Fairness is what people want. As well as deteriorating health, older people often face increased social isolation. Although we have become more prosperous, notwithstanding the current downturn, people have become more isolated from mainstream society, particularly older people who feel cut off.

This is particularly true for older men. Older men do not seem to engage as much as women with community facilities and activities. I have noticed when active retirement associations have visited the Houses that they usually contain only approximately two out of 50 who are men and they are inclined to remain quiet. The women are significantly more active. The sense of isolation among older people is particularly acute among older men. This must be addressed. There are attempts being made to address it, but there is no magic wand. Older women deal better with ageing than older men and engage with community groups and activities to a larger extent.

Growing old is a traumatic and terrifying experience for many, particularly if they have no family or if, for whatever reasons, they find themselves isolated in a community in which they were not brought up. It is very difficult for these people to re-engage and become involved unless they have a strong personality. It is difficult to muster the strength needed to become involved at this time of life.

Many elderly people do not have families on which they can rely. Various circumstances have led to them finding themselves isolated without family. When people have families, the family usually does everything it can to lessen the difficulties of the older person. However, there often comes a point when there is no option but to say the family can no longer deal with the older person. I heard of the sad experience of a family, where the mother was experiencing some form of dementia. The family was concerned about her, but given the family circumstances they were not able to stay with her as much as they would like. It was when it came to the point of having to lock her into a room one night that they realised the situation was unacceptable and they could not carry on any longer. In the interest of the mother, whom they loved deeply, they had to give in and decide to let her go into a home. Such people feel a sense of failure when they have to let their mother or father or relative leave their home and their roots and put them into a nursing home.

Most experiences in public nursing homes are positive and families speak highly of the care provided. The difficulties that have been highlighted have been mainly in private nursing homes. This Bill will address such difficulties and ensure an equitable standard in these homes. It will ensure that what has been unclear will be clear. People will be able to understand and see how the system will work and how they will fit into it. They will understand how they will be able to care for their parents for the long term.

Given our economic difficulties, the simplest thing for the Government would have been to put this legislation on the long finger. While that could have been done, this Bill demonstrates the commitment of the Government to older people. The manner in which the issue pertaining to medical cards was communicated and handled was disappointing. Nonetheless, older people subsequently have told me that over the past 11 years, Fianna Fáil and the Government in many ways have acted as the trade union for older people. This legislation will reinforce such a view, will demonstrate the Government's commitment to protecting the elderly, who are the most vulnerable people in society, and will clarify matters that were unclear.

Furthermore, it will bring about change by allowing people to plan for and predict the future to a degree. Older people and families with older people who are reaching the age at which they will be obliged to enter nursing homes seek such an opportunity. They consider it to be comforting to know they can plan and predict what will happen into the future. It has been and continues to be unfair that assessments and financial supports vary so markedly across health board areas. It gives rise to scenarios in which close neighbours, who could be living across the road from each other, each must comply with different assessments, guidelines and payments. This is difficult to understand for the person who perceives him or herself to have been treated more harshly by a particular health board and is highly frustrating for the families concerned.

The pressure to secure adequate nursing home facilities is such that families may have no other option but to sell their family home. Moreover, this can take place although a child or son still lives there. The cost of meeting such charges is such that even large or well-off families find it a huge strain on their financial resources to be able to pay for nursing home care. Consequently, they find themselves being obliged to sell their home. Deciding that one's parent or loved one must enter a nursing home is one matter. However, when it is reinforced by being obliged to sell that home, it gives rise a great sense of failure, disappointment and sadness among family members. This also can vary, depending on the health board area in which one is living.

I refer to the doubt and lack of clarity on how one pays for public nursing home places, when one will be obliged to pay for it and who qualifies to get into them. Given the current economic climate, a great deal of uncertainty exists and this Bill will provide a degree of certainty to families, inasmuch as the State can. While the State will do whatever it can, ultimate responsibility comes down to families, which must take responsibility for their ageing loved ones and members.

As for the proposals, I found a newspaper report to be interesting. It stated the new proposals offer to take the value of the resident's home at the time of his or her application to enter nursing home care and to link this value to the consumer price index, not the housing market, which has changed. However, if the house prices should fall, as they clearly are at present, the resident or his or her care representative can apply to have the resident's financial assessment reassessed. This is a very positive measure.

Over the years there has been a blurring of the lines between the public and private sectors, which has had a great impact on the manner in which patients take their places in particular homes. A major difficulty has arisen in respect of the number of nursing homes and hopefully this Bill will clear the ground to ensure there are more nursing homes, particularly in the Dublin area. Recent reports have demonstrated that the number of nursing homes in south Dublin does not meet the demand. In effect, people living in south Dublin are obliged to travel significant distances to access public or private nursing homes. This gives rise to considerable inconvenience. For example, when one lives in the inner city or in Terenure, Rathgar or Rathmines and one's loved one, be it a mother, father, aunt or grandmother, is in a home in counties Wicklow or Kildare, visits will entail considerable journeys. Moreover, such distance will give rise to a sense of isolation and unhappiness with the service provided, irrespective of the micro-delivery of the service in the nursing home in question.

It is traumatic for families who are obliged to travel down the country to visit relatives. The family member may be notified of the visit but will then have to wait if there are delays, or even if the visit has to be cancelled due to traffic or other factors. The consequent sense of disappointment felt by person affected is hard for the family to take.

More nursing homes are required in the south Dublin area. While its population is both ageing and changing, a significant number of older people live there. I recently visited a service provider for older people in Rathmines, which two or three years ago used to cater for approximately 20 clients in the form of older people who visited for lunch, dinner and daytime activities. That number has more than doubled. While the general population is ageing, south Dublin is ageing significantly.

The infrastructure for older people is insufficient and this Bill will bring clarity, consistency and reassurance to them. It will allow people to plan and to predict what will happen. Moreover, it will enable them to plan their finances, which must be a good thing. The measure is designed to make the service provision for older people in nursing homes much more sustainable. The State will continue to meet almost 70% of the total cost of long-term care for the population. I welcome the Government's introduction of this measure during a difficult economic downturn. A recent NESC report on the developmental welfare state claimed the Bill will be tailored universalism. In the past few months, universal payments and their long-term impact during downturns have been debated. The Bill will not leave other people picking up the tab. Rather, recipients will pay for services on delivery. They will not be thrown out of their homes onto the streets, which would be traumatic, and they will get better care in public——

Photo of John O'DonoghueJohn O'Donoghue (Ceann Comhairle; Kerry South, Ceann Comhairle)
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The Deputy has one minute remaining.

Photo of Chris AndrewsChris Andrews (Dublin South East, Fianna Fail)
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The Minister, Deputy Harney, stated:

We are making fair what has been unfair. We are making consistent what has been haphazard. We are making sure what has been in doubt. What has been unsettling will be reassuring. What has been unclear will be clear.

I commend the Bill to the Dáil.

12:00 pm

Photo of Denis NaughtenDenis Naughten (Roscommon-South Leitrim, Fine Gael)
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I welcome the opportunity to discuss the Bill. The majority of Deputies will contribute, as we all must address the issue daily. Each of us has familial and constituency experience of it. As valuable contributions are being made, I hope the Minister of State and her colleagues and officials will take note of points made by all sides of the House.

In December 2006, the Minister for Health and Children, Deputy Harney, announced this proposal. It was just before an election. However, the proposals will not be in place until at least 2010. It is complex legislation and a number of issues must be addressed. The assessment of need and financial assessments are of concern.

As a public representative, I am galled by something flagged by Deputy Chris Andrews, namely, the theory that the HSE is responsible for the entire country. There are greater discrepancies in terms of entitlements than there ever were under the old health board system. The HSE has been an unmitigated disaster and the Ministers in charge should put their heads on the block for their incompetent implementation of the HSE's establishment.

I will cite two examples of care of the elderly, one of which concerns two sides of the same road in south County Roscommon. In Athlone, a white line in the middle of a road marks the county and provincial boundaries and the boundary between HSE, western area, and HSE, Dublin-north Leinster area. The eligibility for an enhanced subvention differs depending on what side of the white line one lives on. At the edge of Ballinasloe ten miles away in HSE, western area, there is a discrepancy between sides of the road despite being in the same region. An elderly person from the County Roscommon side attending hospital is not entitled to step-down care in a nursing home after his or her release, but an elderly person from the other side of the road is entitled to that care because he or she lives in County Galway.

The same pertains to access to the Alzheimer's disease unit in Ballinasloe, which is a stone's throw from my constituents in County Roscommon. However, since they have addresses in that county and live on the wrong side of the road, they are not entitled to admission to the facility whereas patients from 50 or 60 miles away in County Galway are entitled. Greater discrepancies have come about since the HSE's establishment.

To be eligible for a bed, one must need care for a 12-month period. However, the Department of Social and Family Affairs, which is ruthless in its assessment of need, requires that someone seeking a respite care grant must be providing care for a six-month period. There is a discrepancy between the interpretations made by the Departments of Health and Children and Social and Family Affairs. The assessments will be carried out by the HSE and, according to legislation, provisions will depend on available funding. As the year progresses and demand for nursing home beds increases, the HSE will need to curtail its provision by increasing the medical thresholds for eligibility. Someone applying on 1 January will need to meet a lower threshold than someone applying on 31 December. This is what the HSE does. It is dependent on the level of funding, but there is no commitment to long-term funding to meet demand. This provision in the Bill is a significant problem.

The Bill is unclear in respect of the assessment of social need. In my constituency, isolation is a considerable issue because families, relatives, friends and even neighbours may not be available to provide support and care. The most galling provisions relate to assessments of community and home care supports. In County Roscommon, eligibility for home help support requires someone to be, according to the HSE, "actively dying". People who are "actively dying" have their families and friends around them. Likewise, people are not entitled to community supports unless they are "actively dying". Unless someone requires full-time care for a period of at least 12 months, he or she will not be eligible for nursing home care.

The Bill has some winners, namely, those with large capital assets in the form of houses and who may not have been eligible for public beds. The cap has been placed at 15% of a home's value. Nursing homes running on a low cost model will also benefit. However, a significant number of people will lose out. In my constituency, elderly brothers and sisters who have resided in family homes for generations will be rendered more vulnerable. They could have spent 70 or 75 years together. In many cases, one brother owns a farm while another brother maintains the house. The Bill does not make adequate provision for them. They are not considered a married couple for the means assessment because they are not having sex. Were they having sex, they would be eligible for assessment. In many cases of two brothers, a brother and sister, two sisters or so on residing in family homes, one is dependent on the other and does not have his or her own income or has a limited income. Such people will be penalised by the legislation.

The legislation's provision on clawback in respect of property handed over during the previous five years will put another group under serious pressure.

There is a major loophole in the legislation in respect of family-run businesses and family farms. The capital assets relating to such concerns are excluded from the cap set down under the Bill. As a result of this loophole, young family members will hound their elderly parents to sign over property or land well in advance of the age at which they will require care. These individuals will inform their parents that if they do not transfer ownership now or if they contract Alzheimer's or dementia, the property, land or whatever will go to the HSE or the highest bidder, namely, a neighbour, the bank or someone else. Major pressure will be placed on elderly couples throughout the country to sign over their property to younger relatives at a much earlier stage. This will have a damaging effect in many areas, including my constituency.

Part 7 deals with reviews and appeals. I hope the HSE makes a better fist of these matters than it did of those relating to medical cards. When a decision is made in respect of a medical card at present, the HSE does not believe it worthwhile to explain to the applicant how it arrived at a particular calculation. I have been approached by such applicants and I have been obliged to apply to the HSE on their behalf for a breakdown in respect of said calculation. This increases the level of bureaucracy and paperwork involved. When assessments are carried out under the terms of the Bill before us, I hope applicants will be provided with all the relevant details regarding the result of their assessments. They will then at least be in a position to make an appeal rather than being obliged to approach the HSE in search of information regarding how a calculation was arrived at before doing so.

An applicant's means will be assessed at 50% of a couple's combined income and assets. While that is fine in many cases, it does not take into account the real costs incurred by couples on low incomes. The cost of running a house will not be reduced by 50% because one member of a couple goes into a nursing home. While I accept that the costs relating to food will decrease, those for heating and electricity will remain the same. The figure of 50% in this regard is not accurate.

A significant number of people will lose out as a result of the implementation of the provisions of this legislation. At present, those in public nursing homes only pay 80% of their assessable income. These people will lose out under the new scheme.

Would it be possible for someone to investigate what I believe to be a financial scandal, namely, the lack of accountability and transparency regarding the massive nest egg relating to patient accounts that is being stored in Tullamore, County Offaly, by the HSE? For the next of kin or families of, for example, Alzheimer's or dementia patients, trying to discover how much money is stored in one of these accounts is similar to attempting to uncover the third secret of Fatima. It is not possible to access such information. It would be an improvement if statements were issued to families or next of kin regarding the amount held in patient accounts by the HSE at present. Everyone is aware that a new stealth tax is being introduced in the context of the service charge. However, there must be transparency regarding the contents of patients' accounts.

Among those who will also lose out are people who enter nursing homes but who may not be regarded as being highly dependent in medical terms. These individuals will lose out in respect of the tax relief available to them. The average cost to stay in a nursing home is approximately €50,000 per annum. This means that the tax relief proposed in the budget — I presume it will be underpinned by the provisions in the Finance Bill to be published later today — will be slashed from €20,000 to €10,000. For many families, €10,000 is a significant amount of money.

Nursing homes with a higher cost base will also lose out under the Bill because the resources available to fund this scheme will be capped. The National Treatment Purchase Fund, NTPF, will negotiate on behalf of the State in respect of the new contract beds and will seek the cheapest possible beds. The standards relating to nursing homes have still not been placed on a statutory footing. I refer here to the standards for residential care settings that were drafted by HIQA. We must ensure that such standards are put in place. If proper standards in respect of the care of the elderly are put in place, we can then proceed to examine the position with regard to the costs relating to nursing homes. Some nursing homes will not be able to continue to charge the rates they are charging at present and meet the standards laid down by HIQA. If the NTPF is exerting pressure in that direction, standards will drop and there will be a race to the bottom. In such circumstances, it will not be a case of trying to obtain quality care for the elderly in facilities that are as close as possible to their own homes.

There are those who provide care on a private basis in the community. I refer to facilities that are not funded by the HSE but rather by the fund-raising efforts of local community organisations. Such facilities are excluded from the legislation. The fair deal does not refer to care in the community. There is a gaping hole in the legislation in this regard. While there will be assessments in respect of the care that is available, the reality is that care in the community varies from month to month and year to year and is dependent on the level of funding that can be accessed.

As soon as the HSE begins to tighten its belt, care in the community will be the first area to be affected. As a result, elderly people will become ill and will be obliged to enter hospital. They will then not be able to re-enter the community because resources will not be available to allow for the provision of home-care packages. As stated earlier, they will not be able to access home help services either. Funding will not be available for these individuals to enter private nursing homes, except in circumstances where they require care for 12 months.

Let us consider the case of an elderly person who has a hip replacement operation and who, with intensive support, can return to his or her home and live independently. Due to the fact that there are no community physiotherapy services — posts have been created but appointments have not been made as a result of the ban on recruitment — and because home-care packages and the necessary home help structures are not in place, persons such as the individual to whom I refer are obliged to remain in acute hospital settings or enter nursing homes.

What happens to elderly patients who only require care for a number of weeks in order to recuperate and who do not require it for a 12-month period? At present, they can apply for a nursing home subvention and if they are eligible under the thresholds, they will receive it. Under the new scheme, however, they will not be eligible for the fair deal. As a result, there will be a significant increase in pressure on acute hospital settings.

There is an extremely high dependency ratio in my constituency because of the large elderly population living there. The county hospital in the area is the only facility of its kind between Roscommon and Galway which does not have a step-down facility to allow patients to move from acute hospital settings to nursing homes. I refer here to the beds provided under the winter initiative. A person admitted to Portiuncula Hospital or to University College Hospital Galway will receive two to three weeks' extra care. It is in the interests of family members not to send their elderly relatives to the local hospital, namely, the Roscommon County Hospital, but to send him or her to one of the most congested hospitals in the country, namely, University College Hospital, Galway, because a person admitted to that hospital can avail of up to one month's care in a private nursing home following their release from hospital. A person admitted to the local hospital will not get even one hour of respite care once they leave that setting. This causes an incentive to be put in place that will put further pressures on the acute hospitals setting.

The theory behind this legislation is good. I welcome that we are at last having this debate on the fair deal. While I acknowledge many will gain from it, there will also be many who will lose as a result. In the future, vulnerable elderly people and siblings in family homes will be left high and dry as a result of this legislation. Also, elderly people will be brow-beaten into signing over their assets at a much earlier stage than they intended.

What chance will an elderly person willing to sign over, say, a corner store, to a son or daughter wishing to expand or develop the business, have of raising loans with the banks if the State has a claw-back on that asset for five years? Banks will not release money and this will cause stagnation in regard to the development of small businesses in rural communities.

Photo of Peter KellyPeter Kelly (Longford-Westmeath, Fianna Fail)
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This Bill seeks to put first and above all else the best interests of each person needing care. We should not lose sight of this. Foremost in everybody's mind must be our duty and responsibility to care for elderly and vulnerable people who require nursing home care. We must remember that above all else, each person needing care must receive priority. It is the interests of these people we should be looking after.

I am pleased to speak on this Bill which provides the legislative base for the new nursing homes support scheme, a fair deal. Going into a nursing home or long term care facility can be a source of anxiety and upset for older people and their families. This legislation includes comprehensive, clear and coherent measures in regard to the provision of financial support for people who need long term care.

Under the current nursing home subvention scheme, many older people and their families suffer real financial hardship in meeting the cost of care, including having to sell or remortgage their homes. It has also put families under huge financial and emotional strain as they seek the funds to pay for an elderly person's care. Under the new fair deal, people will be asked to contribute to the cost of their care according to their means. This system is right and equitable. Furthermore, no one will be disadvantaged, whether in public or private nursing homes.

Under the new arrangements, people requiring residential care will be assessed in regard to their ability to contribute to care. People who require long-term residential care will contribute 80% of their assessable income, for example, their pensions, whether for public or private nursing home care. Where a person's assessable income is deemed insufficient to meet the cost of care, he or she may be required to contribute up to 5% of his or her assets.

The system allows for flexibility as payment can be deferred until after settlement of the person's estate. This system is equitable as no one will pay more than the cost of their care. Furthermore, people will have the freedom to choose from any approved private or public nursing home. A national campaign was held a few weeks ago to highlight elder abuse. Age Action Ireland informed us that this often goes unnoticed and that, to my surprise, it is often relatives who abuse elderly people. It appears the care of older people cannot be easily policed when they are living independently or with family members.

There is no excuse for poor standards of care in our nursing homes. While the HSE inspects private nursing homes on the basis of current standards, public homes are not inspected. The Health Act 2007 provides for the registration and inspection of all nursing homes, public, private and voluntary. Further inspections will be carried out by the Office of the Chief Inspector of Social Services which is part of the Health Information and Quality Authority, HIQA.

I am pleased to note that existing inspection and registration systems for residential services will be replaced by a strengthened and expanded scheme. We were all horrified a couple of years ago by the "Prime Time Investigates" programme which showed older people living in appalling conditions. This derogation of our duty can never be allowed to happen again.

Photo of Seymour CrawfordSeymour Crawford (Cavan-Monaghan, Fine Gael)
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It is still happening.

Photo of Peter KellyPeter Kelly (Longford-Westmeath, Fianna Fail)
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I accept that HIQA is still in the process of recruiting staff and building up its operational capacity. I have been informed that it will be well resourced with a budget of €16.8 million in 2008 to meet the estimated cost of its planned worked programme, including the commencement of nursing home inspections. Budget 2009 provides €55 million for the implementation of the fair deal scheme next year. This brings to €900 million total funding for long-term residential care.

I commend the Minister for Health and Children and her officials on the introduction of this complex legislation. The introduction of the scheme will mean that all but those with the highest incomes should receive financial support from the State towards nursing home care. Furthermore, no one currently in a nursing home, public or private, will be disadvantaged by the introduction of the fair deal.

In my constituency, I commend two nursing homes, one private and one public, in the town of Longford. The facilities in the St. Joseph's-Mount Carmel Care Centre, a public nursing home on the Dublin Road in Longford, are as good as anything one would find in the world. Anybody who visits friends or relatives in the home will agree the matron and staff provide a caring service that is second to none. The patients are well cared for, and deservedly so. It is heartening for elderly people to know that such a facility is available. The Laurel Lodge on the Ballinalee Road in Longford is a magnificent state-of-the-art private nursing home staffed by tremendous and caring people who provide a 24-hour, seven day per week service. It operates to the highest standards. People have nothing but the height of praise for these facilities. It is great to know that conscientious and compassionate people work in the private nursing home sector. They are not just in it for the money. I have heard about outrageous charges being imposed in private nursing homes but that does not happen in County Longford. These people are certainly not in the business to become wealthy because the services they provide and the standards they adhere to indicate they do not run a money making operation. One could not make money by providing the best of everything for everybody in this home.

The HSE receives a lot of criticism, some of which is justified, but who is the HSE? In my county, I deal with the staff who work on the ground. I defy anybody to tell me the people who work in the county clinic and the health centre on the Dublin Road in Longford are not doing a good job. They are more than helpful in terms of assessing entitlements and facilities for patients. At present, they are diligently seeking nursing home places for people. The help is available and those who work in this profession are caring people. When commentators are critical of the HSE in the future, I ask that they be more specific in regard to whether they are criticising the administrators or the people at the top. One cannot be critical of the staff who are working on the ground to the best of their abilities. They are humans who do what they can to the highest standard.

It is important we look after older people. In recent times, we have experienced an unprecedented expansion of services for older people. Prior to the introduction of home care packages, very few older people received nursing or therapeutic care at home. This year, more than 10,000 people will benefit from the package. People want peace of mind rather than worrying where they will sleep tomorrow night. This Bill is fair from the point of view of short and long-term care for the elderly. In addition to home care packages, we have expanded home help by more than 500,000 hours. In 2007, 53,000 people received home help services and more than 11.75 million home help hours were provided. The Minister for Health and Children, Deputy Harney, introduced home care packages to provide nursing and therapy at home. This year, 11,000 people will benefit. Approximately 2,500 additional places in day and respite centres have been created since 2005. Since 2004, the Government has increased the budget for services for older people by €540 million. In this year's budget, €55 million is being provided to implement the fair deal, while home help and home care services have been protected.

Life expectancy in Ireland is now above the EU average, having exceeded it for the first time in 2002. The rapid increase in life expectancy we have experienced since 1999 is unmatched by any other EU country. At 79.6 years, Ireland's life expectancy is now more than one year longer than the EU average. Since 1996, life expectancy has increased by approximately four years. The fact that our life expectancy is nearly 80 years must say something for the people, the country and the Government. People have a will to live and, by living a happy and healthy life, they will last longer.

More than 50,000 elderly people were removed from the tax net between 2003 and 2007. Income exemptions for those aged 65 and older currently stand at €20,000 for single people and €40,000 for married couples. This is more than double the 1997 level. These were not increased in the budget. The social welfare pension has been increased from €147.30 per week in 2002 to €223 per week in 2008 and the weekly non-contributory pension has increased from €134 to €212 over the same period.

People will not have a problem with the 5% levy on property over three years. I commend the Minister of State at the Department of Health and Children, Deputy Hoctor, on her caring approach to looking after the elderly. She is the right person for the job because she does her best and means well. Elderly people have a friend in the Minister of State.

Debate adjourned.