John O'Donoghue (Kerry South, Ceann Comhairle)
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Is that agreed? Agreed.

Seán Ó Fearghaíl (Kildare South, Fianna Fail)
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I thank Deputy Michael Fitzpatrick for sharing time.

I am pleased to have this opportunity to speak on this important and long-awaited Bill. The Minister and the Government have been correct in taking their time to ensure that any legal or other impediments have been dealt with.

This debate may highlight other issues that might require changes to the legislation. I trust that the Minister and her colleague, the Minister of State, Deputy Máire Hoctor, will closely follow the debate and take on board positive proposals from all sides of the House. There is great interest in this measure among Members of all parties who all have, as public representatives, dealt with the various issues raised in the legislation, and in many cases have had to confront them within their family circumstances.

The care of our ageing population is one of the most important issues that we will face in this century and is a political and societal challenge. The issues involved vary from pension provision to medical care and residential care. The residential care element is probably the most important because it has such a significant impact on the person as well as on his or her partner and on their extended family. The system of nursing home subvention clearly needs reforming. A scheme that covers only 40% of the cost of private nursing home care is not sustainable and is thankfully being replaced by this much more workable and supportive alternative.

We can all list examples in our own constituencies of families who have had to borrow heavily or sell the family home to offset the cost of care for an elderly relative. This Bill will negate the need to do this and I warmly welcome this initiative by the Government.

In assessing the need for this legislative change, we must reflect on the numbers of elderly people being cared for within the system. There are approximately 7,700 people in public long-term residential care and just over 15,000 people in private nursing homes. To cater for them, the HSE has over 10,000 public beds in residential care centres for older people across the country. In addition, the HSE partially finances 9,000 beds, "subvented beds", 3,000 of which are fully financed contract beds. These were secured between 2005 and 2008. Last year, the HSE indicated a strong commitment to providing over 800 public fast-track beds before the end of this year — more than half of which were to be in place at or before the end of 2008. This six-fold increase in Government spending clearly signifies its strong commitment to providing for the care of elderly people in society.

The provision of funding is not in itself an adequate response to the needs of the aged, and it has been clear for some considerable time that the State needs to reorganise the way in which it supports long-term residential elder care. It is deeply unfair that people were faced with hugely varying costs for nursing home care, depending on where they lived, or whether the nursing home was in public or private ownership. Under this new measure, families will have a certainty and consistency, something that is definitely not available to them under the current arrangement. This security is something which older people and their families require. The enactment of this Bill will bring with it a new peace of mind to many elderly people up and down the country, a peace of mind which will ultimately be beneficial for their personal health and well being. At the moment, nobody is charged more than 80% of the non-contributory pension for care in a public nursing home, regardless of income. However, the costs were quite substantial in the private nursing home sector, even allowing for subvention. This anomaly had to be put right and the Government will thankfully bring equity to the situation with this Bill. The pressures placed on family members to provide care for a dependent relative were extremely difficult and at times overwhelming, leading to financial hardship in many cases.

I commend the Minister on bringing forward this Bill, the benefits of which will be felt for decades to come. There was a clear need to address the situation and we are now in a position to deal with the matter effectively and decisively. The requirement to reform the manner in which nursing home provision is subvented has been apparent for a considerable time, but the manner in which nursing homes are managed and regulated was highlighted by the RTE exposé on the Leas Cross nursing home in north county Dublin. I pay tribute to Deputy Fergus O'Dowd for the work he has done in highlighting the inadequacy of the service in many nursing homes around the country.

This Bill requires all nursing homes to be registered. The Health Information and Quality Authority will be responsible for the monitoring and inspection of nursing homes, based on the provisions of the Health Act 2007, and taking into account the recent draft report on quality standards presented to the Minister. The combined objective of all those involved in this process must be to ensure that we provide residential conditions that are nurturing and supportive, and where the care available to elderly and dependent people is verifiably of the highest possible standards. These standards will apply to both public and private nursing homes and will address the safety and financial concerns of many families in caring for their loved ones in long-term dependency situations.

In the period since the Leas Cross revelations, significant progress has been made by the HSE in the development of its elder abuse programme. The initiatives rolled out include the appointment of 29 senior case workers nationwide; the establishment of a national steering committee to oversee the provision of HSE elder abuse services in detection, reporting and response; improved training for staff; and the development of a public awareness campaign aimed at informing people on the risks and realties of elder abuse. These initiatives will ensure the prevention of elder abuse in public and private care facilities, but the care and attention of families and the wider community must also be a factor in tackling such horrendous abuse.

One of the key decisions we have to make in the provision of long-term care facilities is on their location, to which Deputy Fitzpatrick referred. A number of homes have been built or are proposed to be built in rural locations around County Kildare. This has led to some controversy as to the merits of such proposals. In its recently published annual report, An Bord Pleanála stated:

A number of large scale nursing homes have been proposed in isolated greenfield sites remote from towns or villages, shops or services of any description. Invariably, these have been refused by the board, as it is considered that such facilities are best located within existing settlements where public services are available and where the occupants have some degree of access to shops and other amenities, or can walk up the street and encounter members of the local community.

Like Deputy Fitzpatrick, I do not entirely share the board's views on this matter. We should not be too prescriptive in this area. I feel that, as in many areas of life, variety is key. Many people who have lived in the countryside all their lives would much prefer to look out onto a green field than on an urban scene. Alternatively, many people would still like to be able to access the local shops, post office, pub or betting shop if they are fortunate enough to enjoy relatively good health in later life.

Therefore, quality and variety of location are very important. Placing someone who has lived in Dublin, or in any of the other large urban centres, in a nursing home in a rural location can cause huge difficulties for the person and his or her family, who may find it difficult to access such a location. Planners, developers, advocates for older people and the HSE need to work more closely to ensure that a full range of facilities are available to our aging population.

Much more needs to be done by those working in the planning system to provide trading down opportunities for older people and in particular, to encourage the provision of retirement complexes in which independent or supported living conditions are available. Kildare County Council has undertaken a study, through its strategic policy committee on economic planning and development, on the provision and location of elderly care facilities within the county. The Minister should conduct a national review on the same issues.

This Bill will have wide ranging effects on so many people in the coming years that it is one of the most important Bills to come before this Dáil. Therefore, it is vitally important that we frame it by taking as many points of view on board as possible. The title "fair deal" indicates this will be fair to the elderly, fair to their families and fair to the taxpayer.

I thank the Minister, the Minister of State and their officials for the work they have done in bringing the Bill before us, and I commend it to the House.

Fergus O'Dowd (Louth, Fine Gael)
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This is a very important debate, which deals with the future of those people currently in nursing homes, as well as with our own future. It is about where we and our families will end up, not just those fine people — some 30,000 of them — who currently reside in nursing homes.

Sickness comes to us all, and none of us will live forever. The Department estimates that 4.6% of the current population over 65 are in nursing home care. The total proportion of those who ultimately end up in nursing homes is comparatively quite small. By trying to keep our people out of nursing home care and by having effective, efficient, committed and dedicated community teams to look after our senior citizens, we will keep that number as low as possible. Nobody willingly wants to go into nursing home care, while two thirds of those in such care are deemed to be highly dependent.

The fatal flaw in this Bill is that it does not deal with the fundamental issue of sharing the cost burden of the nursing home. The penalty for being sick when elderly falls on the individual who happens to get ill. It does not respect such a person's income, qualifications or family background. Everybody who ends up in a nursing home must pay the costs, or else their family pays them. This Bill makes sure that if somebody is not lucky enough to have the money to pay for nursing home care, then 15% of the sale of that person's house plus a proportion of the person's assets per annum will go towards paying for his or her care. That is fundamentally wrong and unjust.

How we treat people in our society, especially the very young and the very old, indicates the value we place on the most vulnerable. Nobody is arguing that the cost of a long-term stay of a child in hospital should come out of the family income. Nobody is arguing that a women having a child in a hospital should pay for the child birth if she does not have health insurance. The State picks up the bill in that instance. Why should we victimise elderly people and insist that they must pay for their care, and if they cannot pay for it, insist that payment come from the sale of their homes? Not only must people sell their homes, but they must sell those assets at 15% of their value when they went into the home. People spend three and a half years, on average, in nursing homes. When a house is sold in line with this measure, 15% of its end value will be much more than 15% of its value when they went in. When this Bill was introduced, house prices were much higher than they are now. As this measure is fundamentally wrong and unjust, we must decide how to deal with it. I suggest that we should revisit the 2002 Mercer report on the care of the elderly, which included a number of recommendations. We should consider the introduction of an insurance scheme, for example, whereby a specific contribution is made as people age. That money should be ring-fenced and ultimately used to meet the cost of future care. As people go through their working lives, every single individual, rich or poor, should know that if and when he or she gets sick and needs to go into a home, all of us will share his or her pain. In such circumstances, everyone should make a contribution to the cost.

Nobody should have to sell his or her home. That is a fundamental and important aspect of this issue. People value their homes more than anything else. As we know, the Government is introducing legislation to try to ensure the banks will allow people to stay in their homes when they cannot afford to pay their mortgages. Everybody recognises the need for social justice in this regard. A deeper form of justice is at play when it comes to making sure that those who happen to end up in nursing homes do not have to sell their homes and bear the cost of it. I urge the Government to think again about this aspect of the legislation, which is fundamentally flawed. The proposed system is totally unacceptable to me.

Approximately two thirds of people in nursing homes are in high dependency categories. They may not be able to get out of bed, for example. Many of those who have Alzheimer's disease cannot speak or walk. In many cases, people in nursing homes have no means of expressing what is happening to them. They are extremely vulnerable. The HSE website provides evidence that time and time again, private nursing homes are unable to care for such people. They do not have enough staff on duty, particularly at night, to look after them.

I would like to refer to a HSE evaluation of 25 of the 26 complaints that were made about nursing homes in the Cork-Kerry region in 2007. The complaints related to non-accidental injuries, including trips, falls, fractures and bruising; dehydration; problems relating to pressure sores and wound care; lack of attention to residents' personal hygiene; poor standards of hygiene; inadequate care; an assault by a resident on another resident; absconding or leaving a nursing home; staffing levels; rough handling of residents; issues relating to contracts of care, including finances; poor communication between those in charge of nursing homes and families; and failure to summon medical care or to seek medical opinion. One of the evaluation's recurring themes is the care of residents with dementia or mental health problems.

I would like to mention some incidents in a specific nursing home in Cork. They are by no means unusual in Cork or anywhere else in the country, sadly. A patient with dementia suffered a fracture while in bed. Another patient, who had high levels of dependency, was allowed to rest on a broken bed. No explanation was given for the discharge of a patient, following respite care, who had an infected leg wound. In other cases, individual patients at the home were found to have an infestation of head lice, an untreated leg wound, to be suffering from dehydration, to have new and discoloured pressure ulcers and bruising on the body, to have a swollen and bruised right foot, to have scratches on the genitalia and a tear on the perineal area. A patient aged 94 with poor hygiene was admitted to Cork University Hospital. Cases were reported of rooms not being cleaned for new patients, soiled sheets being discovered and confused patients being allowed to enter rooms and rummage through other patients' clothes. Bells were not answered at night. In cases of falls, family members were sometimes expected to take patients to the local accident and emergency department. It was found that some clinical procedures at the nursing home were carried out in a rough manner or without the permission of the relevant families. That is a sample of what is going on.

I invite the Minister of State, Deputy Hoctor, to take the time to visit the website to get evidence of what is happening in many nursing homes. I wish to make it clear, in the interests of fairness and objectiveness, that a significant number of nursing homes provide an excellent and first-class service. However, an equally significant number of nursing homes are bad and some of them are absolutely appalling. If one was depending for one's evidence on the facts in the Leas Cross documentation that I obtained under the Freedom of Information Acts, one would not think there was anything wrong with the place at all. There was just one hint of a problem at the home. Many other nursing homes are just as bad as Leas Cross, if not worse. Despite what those on the other side of the House might say, nothing has changed. In my view, things have got worse. The only good thing that has happened is that the HSE is providing for out-of-hours inspections in some cases. Inspectors discovered some appalling things in a nursing home in County Cavan at 4.30 a.m.

The law has not changed. One of the key points I would like to make is that the law should impose a statutory duty and obligation on people, particularly those who work in nursing homes, who have evidence of elder abuse. They should be obliged to report such evidence to the relevant authorities. There is no such obligation at present. It should be a criminal offence for them not to report what they know to the HSE or the competent authorities. The problem at the moment is that we do not know about these things because they are not being reported.

The HSE's lack of accountability also needs to be considered. The HSE has a statutory duty of care to ensure that every nursing home in the State is inspected at least twice per annum. In previous years, I used to get those details when I tabled a parliamentary question on the matter to the Minister. Last year, however, the HSE responded by saying that it did not keep the information I was seeking, or that it did not have time to give it. In other words, it could not care less. It is appalling that there is such a lack of accountability or concern at administrative level within the HSE.

I have made a complaint to the Irish Human Rights Commission about the abuse of people's human rights that is taking place in nursing home care institutions. I received an answer from the commission today. I was sent a letter to the effect that a member of staff from the commission had spoken to the senior inspector of nursing homes within the Health Information and Quality Authority, whose name I do not immediately have to hand. As I understand it, the senior inspector informed the commission that the Minister for Health and Children has not yet signed the order to allow the authority to inspect private and public nursing homes. That is a disgrace. It was supposed to be signed in January, but it has not happened yet. I urge the Minister to sign it immediately. I have faith in the totally independent inspectorate that the Health Information and Quality Authority will put in place. The inspectorate does not have any statutory powers at the moment. It is not acceptable that we are continuing to rely on the structures that have been in place over recent years.

I would like to speak about the merits of public and private nursing homes in the context of a contribution made earlier by a Deputy, whose comments I respect. The Deputy in question suggested that the State now takes a neutral stance on the question of whether people should opt for public or private care. In other words, if somebody has to go into a nursing home, the State does not mind whether he or she goes to a State institution or to a private institution. That is unacceptable. It is an abrogation of the State's responsibility and accountability when it comes to the care of senior citizens. It is part of the ongoing policy of the Minister, Deputy Harney, to privatise the health services. There is absolutely convincing international evidence to suggest that private nursing home care is not as good as State nursing home care. The best care of all is not-for-profit care.

There is a way around all of this. The State has encouraged builders, etc., to invest in nursing homes. When such people build the infrastructure for a nursing home, they do not have the capacity to run it. That is what happened in the case of Leas Cross. The State needs to continue to encourage people to invest in the physical buildings, but it should run them. In the absence of the State, voluntary not-for-profit organisations should be encouraged to get involved. They should provide services in buildings that have been developed by others. While each nursing home would have to be run as a business, obviously, the money that would be made should be reinvested in the home's patients and clients. If there is a problem with the person who made the investment, he or she should be entitled to get an income from the home.

The present system, which has failed miserably and appallingly, is unacceptable. I ask the Minister of State, in her speech at the conclusion of this debate, whenever that is, to give the House a commitment that the final report from the Leas Cross inquiry will be debated in this Chamber. As the report has now been delayed by six months, I am sure it will include many recommendations, all of which should be brought into effect. That is critically important.

Other issues pertaining to nursing home care have been brought to my attention. One such issue is that the economic and social status of siblings living together, as many do throughout the country, is not recognised under the Bill. They are not classed as couples and are, therefore, charged individually, which may leave the sibling in the home particularly worse off. He or she cannot apply for financial hardship due to the conditions requiring him or her to be made part of a couple. That issue must be addressed.

Those involved in the care of the aged in our community have brought a number of other issues to my attention. A key point is whether people will be better off under this Bill than they were heretofore. The case has been made that the quality of care is not improving and I accept that is the factual position. The majority of clients who will be cared for in nursing homes under the provisions of this Bill will have high levels of dependency. A key point is that nursing homes do not have sufficient staff with the necessary qualifications to care for these people. Nursing home staff will not have the capacity to look after these very ill patients and the necessary facilities will not be in place. A key issue in the case of Leas Cross Nursing Home was that, while it was evident from television coverage or if one walked around it that it was a state-of- the-art building, patients with high levels of dependency who resided there were not properly looked after.

There is evidence that some people in the State system are being abused, namely, some people in some State-run or in HSE nursing homes. Cases of such abuse in Donegal have been brought to the attention of the Minister of State. A case is under investigation in an institution in Roscrea. I have not been able to obtain any further facts on it. Perhaps the Minister of State can advise what happened in that case, as the HSE was not in a position to advise me, other than to indicate that a serious investigation was carried out there. I would like to know its outcome.

The response I received from the HSE in one area was shameful and disgraceful. I inquired as to the reason a facility in Dundalk was not taking in any more respite patients during the summer. Under a freedom of information inquiry, I discovered the reason for this. It transpired that approximately a year ago when some agency nurses in a unit did not turn up for work and no nursing staff were available to look after the patients, domestic staff took on nursing duties. That happened over a period of time and it is well documented. The HSE decided it could not allow that situation to continue. It decided that it would not take in any more respite patients in order to reduce the exposure of patients to a lack of care arising as a result of agency nurses not turning up for work.

I was shocked to read about that. While I appreciate that the staff there tried to help out, they were not qualified or able to do the work. I submitted a question to HSE areas throughout the country seeking information on whether there is evidence of such practice occurring elsewhere and I have yet to receive a response from some. The HSE in Cork kindly replied to the effect that the processing of my freedom of information request would cost €50,000. That represents an obstruction in my trying to ascertain the facts. The Minister of State has responsibility for this area. I ask that she take up this issue with the HSE and inquire what other evidence, if any, there is of agency nurses not turning up for work resulting in patients, in some cases, in State institutions not being looked after properly. If domestic cleaning and caring staff are doing the work of nursing staff, that is not acceptable.

The situation is serious. The Government has not acted adequately or properly in this respect. If this Bill is enacted, I would be particularly concerned about provision for those people who may not have any income, other than their State pension, of whom there are thousands. I refer to people, in the main, currently in our State institutions. They are there mainly because their only income is their State pension, they do not have private insurance and cannot afford to go into a nursing home.

The sale of such a person's home, the only asset he or she has, will impact heavily on that person's family. Mary Murphy or Johnny Maguire, on going into a nursing home, will be told she or he will have to sell her or his home. That may be the only asset that person has to hand on to his or her family or relatives. It is a measure of the lack of respect we have for these people, if we do not say that should not happen. We would not ask such a person to sell his or her home if his or her child was sick in hospital. Neither would we ask such a person to do so to pay for his or her care if he or she was under the age of 65 and had been in hospital for a long time. However, once a person goes into State care or nursing home care, that person is told he or she must sell his or her home. There is a basic inhumanity in that process. I ask the Minister of State to reflect on those issues.

Under this legislation, the Minister of State is delivering these people into the hands of a negotiating team, the National Treatment Purchase Fund, who will negotiate with the nursing home owners the price of care. My evidence is that nursing home costs are increasing. People cannot afford to pay such costs. The HSE is not increasing subventions. Will the basic cost of care include cost of physiotherapy, speech therapy, patients' laundry, all those services the provision of which involves extra costs under the current system? Whatever amount the Minister will fix and whatever cost is negotiated, it will not be sufficient because the nursing homes will seek more and more money. My basic point is that they cannot provide adequate and proper care. Poor helpless people will find themselves in a worse situation than they are in at present.

Mary White (Carlow-Kilkenny, Green Party)
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I welcome the Bill before the House. It has been a long time coming. We know that rushed legislation often is poor legislation. The patience in bringing forward this detailed Bill hopefully will result in a good Bill that is in the best interests of people who need to access nursing home care.

We all know that an issue such as the provision of care for the elderly is an emotive and important one. I have met many families in my constituency of Carlow-Kilkenny who were desperately trying to support a loved one in a nursing home, perhaps struggling to cover the cost of case with a subvention or the lack of it, paupering themselves in many instances to ensure that a much loved relative could have comfort and care at the end of his or her days. This Bill addresses that worry. I have no doubt there was a temptation to bring forward this Bill at an earlier stage so that the Government could provide the country with a new framework for nursing home care, but I believe this legislation will make sound investment for the future and remove much of the worry experienced by the families to whom I have spoken.

Having a relative in a nursing home is a tremendous wrench for a family, the move often deeply upsetting, the feelings of guilt uppermost in people's minds, even though we know with our minds, if not our hearts, that care is needed. That, added to the financial worry, results in a family being deeply stressed at such a time.

We knew that we had to have a new framework for care for the elderly in Ireland. It was much needed. With an aging population the demand for nursing home spaces has increased immensely, as has the provision of care. Currently, as the Ceann Comhairle probably knows, there are more than 18,000 private beds and approximately 9,000 public beds in the country, but huge regional disparities underlie these figures. Big shortages are to be found on the east coast and in other parts of the country such as in the north east and even with State subvention, beds are often 50% more expensive than the nursing home spaces, many of which are in the south west.

The current framework of nursing home subvention had to be replaced. The State is currently subsidising much of private nursing home care — 50% of private nursing home funding comes from the nursing home subvention scheme — caused in part by insufficient public nursing home beds. The regulatory impact analysis for this Bill stated that under the current system an individual who gets a public long-term care bed may be charged a maximum of up to 80% of the non-contributory pension; while every resident in public care has to pay the charges, which are capped regardless of means. The person availing of long-term private care, however, is subject to a rigorous means test. Some may be deemed ineligible for subvention, hence the anomalies in care to date. Problems also arise in our hospitals because of this framework. Many patients are kept in hospitals longer than necessary because there is a shortage of beds in nursing homes. This gave rise to that awful term, "bed-blockers", an obscene and degrading term which should not have been coined in the first place.

The new scheme, as outlined in this Bill, will provide for an accessible and far more equitable system. At the outset, professionals from the HSE will be required to conduct a comprehensive evaluation of people's care needs. This is vital if we are to ensure that care is targeted, appropriate and given to those who really need long-term residential care.

The principles underlying the financial assessment of people, and the State funding of care, as contained in this Bill, are that co-payment is calculated in accordance with ability to pay; that no one will pay more than the cost of care; that an initial amount of income will be disregarded; and that there will be capping of charge on people's principal private residence. These are all sound and will give us better care for our elderly. The principle that the State will guarantee the costs of nursing home care over and above 80% of a person's assessable income is something we can support.

The present inequitable and unsustainable system is addressed by the Nursing Home Support Scheme Bill. Long-term residents in nursing homes, who are on similar incomes, are unlikely to end up paying vastly different care costs as a result of this Bill. I commend the Bill to the House.

Seymour Crawford (Cavan-Monaghan, Fine Gael)
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I welcome the opportunity to speak on this very important legislation which has been awaited for some time. It was known originally as the "Fair Deal Bill" and is now known as the Nursing Homes Support Scheme Bill 2008. Why was there a change of name? One must ask many questions about the nature of this Bill.

Deputy White spoke about the difficulty in getting patients moved from hospitals to nursing homes and that, as a result, individuals are being called "bed-blockers". This is an awful name and is completely unfair. Very often, such people are not able to move because of the difficulty with the present subvention system. It is possible that I know more about that than anybody else in the country because of the situation in Cavan-Monaghan. I say that without fear of contradiction because during the last election I talked to both my party leader and to the then leader of the Labour Party, Deputy Pat Rabbitte, about the situation in other constituencies to which they travelled. There did not appear to be the same pressure in other areas as there was in my immediate area. I have further proof of that because when people moved out of my immediate area, while remaining the responsibility of the Cavan-Monaghan grouping, nursing homes in Sligo could not believe the greater difficulty they had in dealing with the assessment office in Cavan. This was no fault of the people there who were just doing what they could with the money available to them. However, it was a different situation. I was glad the Minister of State referred to this in her speech. She admitted there was inconsistency between different areas. This is completely wrong and must be rectified. I hope the situation will be different.

However, after a cursory glance at this Bill, one must question how it might be. The initial budget for the fair deal Bill was €110 million but only approximately €50 million is to be allowed for this year. I imagine it was expected the Bill would take a long time to go through the system and that the money might not be needed. A ceiling will be put upon it and, if that is to be the case, we will return to a situation where somebody decides who will get a nursing home bed and who will not. That is a major worry to me.

Assessment is another issue that worries me. Assessment will be made by individuals in the health services and I have a serious anxiety about that. Assessments are made concerning home help that raise major questions. Who decides who will get two or four hours, or one hour, per week?

I will mention another issue in passing before giving more detail. I refer to the different groups that are allowed to benefit from the Bill. Section 4 defines a couple, for the purpose of the scheme, as a married couple, a heterosexual or a same sex couple, who have been co-habiting as husband and wife for at least three years. As somebody who lives in a rural area where there are a few other people like me who never married, I know several situations where there are brothers, or brothers and sisters, or sisters living together, perhaps for 30, 70 or 80 years, rather than for a mere three years. However, they are not entitled to be treated in the same way as those heterosexual couples and others mentioned in the Minister of State's speech. Same sex couples will get preference over family members who live together. There are all sorts of implications in this. There could be a situation where somebody retires early to look after a loved one. However, because that person is not the dependant of the loved one, he or she will not be treated in the same manner as same sex couples. That is a major issue.

There has been much talk over a long period in this House concerning legislation for the inspection of nursing homes and the need for independent inspection. That must be equal across all nursing homes, whether private or public. The majority of nursing homes I deal with are good and of high quality, for example, St. Mary's Nursing Home in Castleblayney. That home is absolutely brilliant. There are other private nursing homes that are of an equal standard, and almost as good as St. Mary's. However, when we come across other situations, and the subsequent investigations into those situations, we must raise major questions. I have an e-mail from a daughter about a loved one. This person did not die in the nursing home in question because friends of the family got her moved to Our Lady of Lourdes Hospital in Drogheda where she subsequently died. An inquiry was held but, although names, addresses and telephone numbers were supplied of people who had attended that nursing home and seen what had happened, they were never contacted. What sort of inquiry was that? It was totally unrealistic and irrelevant and gave only the account of the staff in the nursing home. It is a home which I normally have much time for because it usually does good work. A situation such as the one to which I refer is unacceptable and raises many questions about how investigations are carried out.

The Bill, and the length of time it has taken to get through the House are causes of much worry. People have been expecting it for a long time. A family approached me about 18 months ago. They had literature from a farming organisation of which I am a member, the IFA, stating that this great Bill would sort out everything. They had two loved ones going into a high dependency ward in a nursing home at significant cost to them. They thought this Bill would sort out everything. Although, thankfully, matters sorted themselves out reasonably well, in that context the situation was untenable and unfair to many people.

I am greatly concerned about some details in this Bill. Making fair what has been unfair and making consistent what has been haphazard is not good enough if it does not solve the problem completely. The capping of the money is very serious. This is a needs-led situation and nobody can tell how many people will need this type of support on any given day. The capping of the money is not on and must be examined. We can find €7 billion for banks that run riot, whereas only €50 million is allowed for the remainder of this year. How much will be allowed for next year? We have to live and see. Will the Bill operate on the basis that a finite sum is available? Will high dependency define up to the point of the ability of the State to pay? There will be differences in the ideas of HSE staff who will decide who will get a bed and when. That is unacceptable.

Nursing homes have different costs. While an ordinary dependency person can get a nursing home at €800, somebody who needs a high-dependency unit, for example an Alzheimer's disease patient, could pay up to €1,000 or €1,100, even in my home area. Will that be allowed for under this Bill? It is equally important. Many people in very poor circumstances are being asked to pay the difference between what a nursing home cost in 2007 and what it costs today, and they cannot afford it. It is putting tremendous pressure on them. I know an elderly person on an old age pension who lives just outside Monaghan town who is being asked to pay the difference out of his social welfare yet is expected to keep a car on the road to travel to and from that nursing home daily. This is unjust and I hope this Bill will rectify such situations, but I am not sure because the devil is in the detail.

The other issue about which I am worried is property, specifically farm holdings. A farmer may live a normal length of life and decide to hand over the farm holding to the son or daughter. If the holding is out of that person's name for five years it is no longer taken into account. On my way up the road this morning I was told of a situation where a young man's father dropped dead suddenly a couple of years ago. The man's mother had been in a bad accident 15 years ago, and while the father could cope, the family could not and she is in a nursing home at a very early age. I will not quote her age because I do not want to embarrass any family. As the property was transferred less than five years before the father's death, there are all sorts of complications. This Bill does not clarify how that family will cope. I hope through the detailed study of the Bill afterwards situations such as that can be clarified. Not everything is clear cut and goes the way the clerks expect it to, and that is just another example of serious difficulty.

I was glad that in the budget the Minister for Finance, Deputy Brian Lenihan, referred to the tax benefit for anybody staying at home and that is some relief. Some might argue that one house might be worth €1 million while another house is worth only €100,000; that is not fair. However I am much more concerned about the property issue. If a person is unfortunate enough to go into a nursing home at an early age as a result of disease or a stroke, the 5% comes off for every year that person is in a nursing home. This is very unfair and could create major problems. Taking a farming situation, if that went on for seven years it would take 35% of a farm holding. No son or daughter could raise that sort of money.

If the bank gets to know that the loved one who holds a title is in a nursing home, will it lend money to the young person running that property, shop or whatever other business? Some of these matters may be constitutional and raise questions. I appreciate that the Bill went through a long gestation period because of many of these issues, but there is still much concern. A few months ago one of my colleagues mentioned in a speech that he was worried about shares. Shares are not a major problem now, especially if they are in banks.

I want to return to the medical assessment, a serious issue about which I am very concerned. A person living alone in an isolated area may want to go into a nursing home earlier than somebody in a family situation with plenty of support and help. Will those circumstances be taken into account as part of the assessment? If not, we have a major problem. These issues must be clarified. Another issue was brought to my attention in recent days, that of somebody who has recently returned home from the US, the UK or anywhere else. Deputy Connaughton has dealt more than anybody else with the people who went away years ago, had to come home or wanted to come home and may not have any family. What is their situation? Will they be treated in the same way as a non-national who has been in this country only a few years? Will the fact that they were born and reared in this country and their wish to come home be taken into account? The person about whom I am talking, whom I met in the past few days, had two brothers in the US, both of whom are deceased. None of the three married and they have no families, yet all his family circle are in the region to which he has returned. He does not want a nursing home now, but if he wants one in the future what will be his situation? He would still carry the pension from the US, the UK or wherever he worked, but alone it would be insufficient and he is unlikely to have any property. That is an interesting question. There is another issue. If any person, including the Minister of State, has a second home here — I am not sure whether the Minister of State does or not — it is taken into account, but if a person has a home outside this country it is not taken into account. This is a strange situation and one over which there are major question marks. I hope I am wrong. Am I?

Máire Hoctor (Tipperary North, Fianna Fail)
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It is taken into account.

Seymour Crawford (Cavan-Monaghan, Fine Gael)
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That is important, because it did not seem clear in the Bill. I hope it is definite, because it would be totally wrong if that were not the case.

At the start of this debate the Minister 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. What has been unpredictable will be predictable.

I wish I could get that same certainty from this Bill. I say this with all due respect, and I will come back to the points with which I started. There is a problem if there is a ceiling on the money concerned. That is not possible. There are many other schemes in this country which have no ceiling. How can the Minister put a ceiling on what is available to the elderly? Those people gave their lives for the State when things were more difficult even than they are today. My other concern relates to the issue of inspection of homes. More important, however, is the issue of who will decide who gets into a home. If there is a limited budget, who decides who will get the money that is available? That is the most serious issue of all. Political structures and pressures will be in place which will not be to the overall benefit of the elderly, whom we all want to see cared for.

My late mother died in a nursing home. I appreciate what the Sacred Heart home in Clones did for her. It was a sudden call because she deteriorated so quickly. That is the situation that many families are up against. I genuinely did not believe she would last more than weeks, but she lasted 15 months in the home because of the excellent care she got. Nobody should decide what the ceiling is and nobody should decide who can get the subvention and who cannot. It should be available for all who need it.

Ciarán Lynch (Cork South Central, Labour)
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I wish to share my time with Deputy Sherlock.

Johnny Brady (Meath West, Fianna Fail)
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The Deputies have ten minutes each.

Ciarán Lynch (Cork South Central, Labour)
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This Bill marks a significant change in how health care is delivered in Ireland, as it removes the right to free health care enshrined in the Health Act 1970 and singles out a particular sector of society — the elderly — as a group requiring institutional care and paying institutional costs. No other section of our society will be hit by this Bill. Children are born in maternity hospitals provided by the State. When they cut their knees in the schoolyard they go to the emergency unit of a public hospital. Those of us who do not have private health insurance will live our lives in the public health care sector until we get old. The Minister has not discriminated between private and public sector by specifying in which sector this care will take place. Is there a preference as to where the Minister sees this care being delivered? Or will we see with the roll-out of this scheme something similar to collocated hospitals, with collocated long term nursing beds?

If we are to take the fair deal scheme as a good idea, we must admit there is a world of difference between a good idea and good implementation. This scheme was launched in 2006 with an expectation that it would be in place on 1 January 2008. After two years in the making, it was not launched. Deputy White stated earlier that the Government needed to take its time thinking it over. There were two years to think it over. In the absence of thinking it over, when 1 January 2008 came there was no contingency plan. Nothing was in place for subvention that year, and chaos was created. People were left in limbo.

In 2008, Age Action Ireland pointed out that €110 million was set aside for the roll-out of this programme, and €85 million returned as savings to the HSE during that time. There are approximately 30,000 people in long-term care at this time, whether in the public or the private sector, and the cost of the delay for the extended families of those people ran into thousands upon thousands of euro. The Minister, Deputy Harney, when speaking about the fair deal scheme in one interview, mentioned a cost of €40,000, which is €6,000 more than the average industrial wage, to keep a person in care because of the failure to implement the scheme, which was on the shelf for two years.

One could make a study of the Government's version of chaos theory. The principle underpinning this theory is that one creates so much chaos that people will accept anything. There has been so much chaos out there, and people have been paying so much, that they will accept any deal except what they have at the moment. They cannot get subvention as it is not available or it is capped at whatever it was before 2008. In the absence of this legislation, they are being bled on a week-to-week basis of massive sums of money. I will give just one example of a case I dealt with in my own constituency of Cork South-Central. The family of an elderly woman was paying her nursing home fees, which were recently increased by €50 per week to more than €2,600 per month. At the same time the subvention from the HSE towards the woman's nursing home costs was dramatically cut, leaving her family to shoulder costs of more than €400 per week. This happened in June of last year. At first she was receiving a weekly subvention of €472.70, but when her house was taken into consideration these payments were reduced to €182 per week, leaving the family to shoulder the remaining charges of €400 per week. There is a great deal of nonsense in this. How, in the name of God, could the HSE give a notional value for an income based on the value of a house when the fair deal scheme was not even in place? I cannot get my head around it. How was this elderly women concluded to be earning an income from this property when the fair deal scheme was not in place, she had family still living in the house and it was generating no income? The calculations do not add up.

The numbers in nursing homes and nursing costs will increase. Deputy O'Dowd referred to the current number of 30,000 people in nursing homes. That number will rise significantly in forthcoming decades. The reason this will happen is that the demography of the Irish population has changed significantly. When I was a child, and I am not that old, there were six to eight children in the average household on Connolly Road, Ballyphehane. That was an extended family that could provide care for their parents when they got elderly. Thankfully, in my case my parents live at home. However, we have now moved to a position where the normal size of a family in this country is two children. The extended family support, and one should bear in mind the age profile of the people currently in nursing home care, will not be available in the future. That support cannot be sustained in the way it has been to date with smaller family sizes.

One issue that has arisen, between the cock-up on the subvention scheme and the two year delay, is the overall sum of money that is to be calculated. I do not believe this issue has been raised in any of the earlier debates. Property values have dropped significantly in the past 12 months. A 15% calculation has been made to pay for these costs. Given that the value of property is to drop further in the next three or four years according to all expert opinion, there will be a falling income under the fair deal scheme for the system as it is currently presented. In fact, it would make sense for somebody to opt into the fair deal scheme in the next year and a half when property values are at their lowest. Will the Minister clarify when the property value is set? Is it at the time the contract is signed, the time of the person's death or at some point between the two? After all, the value of property in Cork South-Central two years ago is quite different from its current value. This matter must be clarified.

I wish to mention a situation, one of many, I have encountered in my constituency. Every Member of this House has heard their constituents discussing this situation. Where an elderly person bequeaths a house to a child, who subsequently marries, but the elderly person retains a proportion of the house — perhaps one third and the husband and wife would have two thirds, how will that be calculated in the future?

How will the nursing home beds be provided? Does the Government envisage the State being the main provider of the beds or will it be the private sector, where costs and standards may vary from one location to another? Another critical point is that if the calculation will be based on a falling property market, I cannot see how daily costs will be met. I would be grateful if the Minister would respond on these issues.

Seán Sherlock (Cork East, Labour)
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Will the Minister tell us whether it is envisaged that the Health Act 1970, which guaranteed the right to a bed, will be revoked and whether that right will be enshrined in the new legislation? If that right is not to be revoked and in the event of somebody deciding not to sign up to and be a willing stakeholder in this scheme but it is decided medically that the person requires a bed, will he or she have an automatic right to a bed in a public or private facility?

On the resourcing of the scheme, if somebody goes into a private facility, will the charges accruing for the provision of that bed be capped by the State? Will the State legislate for or regulate the charges of nursing homes for the provision of that bed? I can envisage a situation where the private sphere, because of the economies of scale in that sector and the dramatic reduction in the provision of public beds for elderly people, will see an opportunity, when the budget is outlined each year in the annual Estimates passed by this House, to get together, pool their resources and calculate what the charging regime could be for a bed. That will present untold problems for many families. Can the Minister comment specifically on this issue?

If a person has a property and a son or daughter has been bequeathed that property or if a son or daughter who is not married has been given that property legally and if there is a legal arrangement whereby the person has an automatic right to residence in the home, what is the legal provision in the event of that person going into a nursing home? The regime at present is such that even though the son or daughter is residing within the family home and there is a legal arrangement to that effect, there is still a calculation of 15% rental income in arriving at the nursing home subvention. That is unfair. I consider it so unfair that I have referred the specific case to the Ombudsman, as an independent source, to ascertain her determination on such a provision. What will the legal provision be in the new arrangement, after the legislation is passed?

We are shoring up many problems but in seeking to deal with one set of problems the House and the Government will create a new set. I still cannot get my head around the proposals in the legislation regarding ancillary State support. I refer Members to the Citizens Information Board which produced a paper in December 2008 that referred specifically to ancillary State support in the context of this Bill. The paper says the Bill distinguishes between State support and ancillary State support. We are aware of the provisions relating to State support but, according to the paper one must apply separately for ancillary State support; one can apply even if one does not qualify for State support; ancillary State support can be based on relevant assets only, not cash assets; and there must be a property over which a charge can be taken.

If somebody applies for ancillary State support, a charge is levelled against the property. What is the repayment schedule on that? If I need to go to a nursing home tomorrow, for example, and I apply for ancillary State support, what agency will pay the money to the nursing home in terms of the support that is given? Will it be the HSE or another such agency as determined by the Minister for Health and Children? If this will be a resource-based scheme and if we are now living in times of economic turmoil, I can see a situation where there will be hundreds of people queuing up for nursing home beds who will not be able to get one as they will not be able to benefit from the ancillary State support because there will not be such funding. How that will work its way out through the system needs to be teased out.

We are reaching a stage in this country where the community beds that once provided wonderful nursing home care are being whittled away by a process of stealth. We are moving so far into the private sector that by the time it comes for me to be cared for in a nursing home, the costs accruing will be so astronomical it will place such a burden on the State as to be untenable. At this stage of the process I would put forward a theory that there needs to be a greater degree of analysis about how we can provide beds within the public sector. For example, there is a 42-bed facility in north Cork which is about to be closed. It is neither a geriatric nor a psychiatric unit; it has no designation. It is a wonderful facility in a wonderful setting. If, instead of being closed, it received the right amount of investment, it could provide a wonderful facility for the provision of care for the elderly within its catchment area as a community facility. Those same people would happily pay their pension or a proportion of the cost of getting their bed within that facility and they would gladly welcome whatever subvention or State support that would arise.

However, there is no foresight and no planning. I see nothing in this legislation that would give me any grounds for hope — I must be honest about it — that the Minister will ensure we will move seamlessly from the current regime into a new regime and that this will be a panacea for the elderly. I can see a situation where the number of people, family members of persons who are in nursing homes, who come to my clinics will increase as a result of this ill thought-out legislation.

I heard the Taoiseach describe himself here as an egalitarian republican. If we are speaking of egalitarianism, older people should be able to come to their autumn or winter years with a certain peace of mind knowing that they or their families will not be left with an undue financial burden when it comes to caring for them. I cannot see anything in this legislation that will give solace to those people.

I reiterate the point that if we are to have a proper system in this country, it must be with the proviso that the cost of care in nursing homes must be capped. Deputy O'Dowd made the point earlier. There is the bare cost of provision for the bed for the week but there are also the extra costs that now seem to be accruing, which are not accounted for. I refer to chiropody, hairdressing and other such services which seem to be added on week in, week out.

I am not against the private sector because I visit nursing homes on a regular basis and I see the good work that is being done there, but there must be a good mix. This comes back to the point I made about the 1970 Act. I am asking that the 1970 Act not be rescinded and that everybody would have a right to a bed, whether in the public or private sector.

Paul Connaughton Snr (Galway East, Fine Gael)
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I am delighted to get this long awaited opportunity to speak on this Bill in which I have a great interest.

I suppose all one could say at the outset is that this legislation is like the curate's egg in that it is good in spots, but I have serious reservations about part of it. The Minister of State, Deputy Hoctor, and her senior Minister are selling this as being accessible, affordable and anxiety free. It is all three for a certain category of person. It is surely that for someone who does not own a house, who has less then €36,000 in personal belongings and who owns no land. By and large, the person to whom I refer has no means other than his or her old age pension. I must admit it is a good scheme for such a person.

If one scrutinises the next category, then the scheme becomes extraordinarily involved and difficult. I do not want to see legislation going through the House that will have the effect of splitting up families. The Minister of State, Deputy Hoctor, comes from a rural constituency, as I do. I do not want to see the slightest possibility of a family having a row about an asset they thought was theirs until the State gets its hands on it and proves that it was not. I will try to explain what I mean.

No doubt the system had to be changed. There was terrible trouble about the inconsistencies in and the unfairness of the subventions as applied right across the country. Those, like me, who came from the old Western Health Board area felt that others were getting a much higher subvention than we could get. This scheme treats public and private patients equally and from that point of view, it is to be welcomed.

The old scheme had to be changed. One aspect I noted — on this issue I have considerable experience, as much as anybody else in this House — is that in so far as keeping elderly people in a nursing home was concerned we had reached a point where there were only two or three fundamental points to be addressed. Deputy Hoctor will know this better than most. We are speaking about people who had the maximum old age contributory or non-contributory pension. That is what they had in their hand every Friday, approximately €200. In our case the subvention was €300 making a total of €500 under most conditions. That was all right when the bed in the nursing home was €550 or €600. If they had relatives or family members, they might be able to come up with the balance. Over the past couple of years, however, as the House will be aware, we found that the figure of €600 rose to €700 and €800, and by and large there was no such increase in the pension or the subvention. The wedge that then came in between was so great that many families just could not afford it. That was a real issue, as the Minister of State well knows from all the representations I am sure have been made to her and to all Members. Obviously, there was a need to change that.

The new scheme will work well for certain categories of people but the Government is creating havoc with regard to people who own property. I want to bring the Minister of State back for a moment to these deferred contributions. I hope I have scrutinised the Bill fairly well. We hope that every person in the country is entitled to his or her own home. That is a concept in which I always believed. That is enormously important in everybody's life, especially as people grow older. What is happening is that there is a 5% surcharge for the first three years, but it is all dependent on how the sums are calculated. The Minister of State is saying, in effect, that the maximum will be three years on the house, even if the person is in a nursing home for ten. However, that does not seem to apply to other assets, such as land. The rural constituency I represent is very similar to the Minister of State's. There have been multiple cases of people who own a house and, perhaps, 40 acres of land. The family might be gone, in the professions and so on and perhaps it might not have suited them to come back, so the land was never transferred, for whatever reason. In the back of their minds, however, the elderly folk would have somebody in mind to continue the family name, which is enormously important in rural Ireland.

However, 40 acres at the moment, even at the depressed values of €10,000 an acre are worth €400,000. The holding would have been worth a good deal more a few years ago, but that is today's value, with the average price per acre at around €8,000 to €10,000. A person might be charged €800 a week in a nursing home, which is not exorbitant. Even bottom league prices, so to speak, are coming close to this and as many colleagues have said, some have gone way over that. In the event, that works out at €40,000 per annum, and if the person spends ten years in the nursing home, it is €400,000, equivalent to the value of the land at today's prices. In other words if the patient remains in the establishment for ten years, there is no land left. The Government has said the patient will only be charged for the cost of the care, or €800 a week. However, it ultimately means that there is no land left to be transferred to anyone else. I do not know whether that was what the Government had intended, but it will happen. There have been several cases of that, already.

I want to talk about the house for a minute, the family home. People talk glibly about the 5% deferred payments on the house. A house might be worth, say, €75,000. Until recently one could get nothing for €75,000, although one might, perhaps, be able to buy a small Land Commission-type house for that figure now. Over the three years, €11,250 will be taken off that. In other words somebody must come up with that amount. I shall deal, in a minute, with how it is taken off.

Deputy Sherlock mentioned this a few moments ago, and I understand that this will come about by means of the ancillary State support. I understand the Revenue Commissioners are involved in this. If one takes the mythical 40-acre farm I was talking about, I assume that at the end of the ten years the State will expect to get its money back. At that stage the Revenue Commissioners will apply to the Land Registry to say, in effect: "As far as we are concerned the burden of debt is so great on that particular folio that we now own it." At that point, when the State or the HSE seeks to realise the assets, will the Minister of State say whether the property will be sold on the open market? The family at that stage will be in no position to come up with the money and according to the legislation, it appears to me that the Revenue Commissioners have an asset on behalf of the State and in order to realise it, I assume the land will be sold.

I shall be obliged if the Minister of State will specifically deal with this when replying to the debate. In the event, I assume that the Revenue Commissioners will sell to the highest bidder. If land values appreciate to where they were two years ago, will this mean that the estate of the elderly person would benefit by the difference between the sale price and the asset value? There is a reference to interest being applied, in the legislation. Will the Minister of State say where that interest is? Does it mean, in effect, that not alone are we talking about the €10,000 per acre but interest on it every year as well? What will the interest rate be? Suddenly one finds that the Revenue Commissioners will be seeking a great deal more money than anyone had anticipated at the beginning.

That brings me back to what Deputy Sherlock mentioned. Will we reach a stage where it will become extremely difficult for the Exchequer to keep on paying? Remember, there may not be much of an appetite in rural Ireland for some of those sales by public auction. Some family members, for instance, might object on the grounds that this was where they had been born, not wanting to see the Revenue Commissioners selling the whole place over their heads. I hope somebody has thought this through because it is a real issue in rural Ireland. I wanted to have the opportunity to put that before the Dáil this evening. I hope this has been well thought out but I do not believe it has.

I wanted to mention another matter. As regards the assets, as such, when a person is going into the nursing home, will this involve a legal commitment, and will he or she have access to his or her own solicitor, in the event? Will each person or family be allowed to have their own legal representative present, beside that of the HSE, and who will pay for the cost of such legal proceedings? It would be very unfair if only the HSE legal representative was present in processing the deal. As the Minister of State knows, it is very important to have a balanced legal approach in matters such as this. Most parties have solicitors to work on their behalf.

In so far as nursing homes are concerned, by and large they are doing an excellent job, and fulfil an enormously important role. It is not the only role, as we know. We talk of primary care and helping the elderly to stay in their own homes. If I live to be 100, I hope I shall die in my own home, not that I have anything against the nursing homes. We understand that they exist for a particular purpose, but from my viewpoint, I hope to finish up at home, and I believe a great many people think as I do.

I was misrepresented here some time ago when talking about the checks on nursing homes, which I entirely agree with. I pointed out that none of the nursing homes in Galway with which I am familiar was anything other than perfectly run but for some strange reason the news was reported in a slightly different manner. I have no evidence that any nursing home in Galway with which I am familiar is anything but properly run. I base that statement on the advice of the relatives of patients in these nursing homes.

In so far as this scheme is concerned, the inspectorate will be important. I hope inspections will take place without advance warning and at any time. That is important in regard to every person who depends on medical care, whether in nursing homes or hospitals. I like what I hear in regard to the inspectorate, provided the funding is in place to ensure it is strong enough to act. It is easy to determine how a nursing home is being run at 3 p.m. but it is another story at 3 a.m. The people who run great homes will have no problem with inspections but if another Leas Cross exists, it has to be discovered. A nursing home is no place for an elderly or vulnerable person unless he or she is receiving the best of care and attention.

This legislation has had a very long gestation period. I have seen few other Bills hang around as long as this one. When it is finally passed and the Minister of State has responded to the issues raised by Deputies on all sides, I hope there will be no more false dawns. I do not want to hear in six months time that the money has disappeared. Legislation is no use if a cap is put on its provisions. Deputies will be aware of the trouble farmers are experiencing in regard to the farm waste management scheme. If something is promised, the resources should be made available for it even in these difficult times. Whatever else we do, let us avoid playing around with the elderly because that would not be fair.

I do not have time to address the issue of medical eligibility other than to speak about rural bachelors in their late 50s and 60s who have nobody to care for them and may be living a bit rough. There may be nothing physically wrong with them but they can be lonely and are often unable to access activities. It would be a disaster if these people are made ineligible for places in nursing homes because where else will they spend the remainder of their lives? A case could be made for their eligibility on mental health grounds alone.

David Stanton (Cork East, Fine Gael)
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I am pleased to contribute to the debate on this important Bill. However, I get a sense from the Bill and its accompanying documents that old people are viewed as a growing problem. The number of people aged over 65 has increased by 7.3% since 2002 and is expected to increase to more than 800,000 by 2025 and triple by 2050. Life expectancy is increasing. I would like to see this Bill put in the context of an overall philosophy of care for older people.

The Bill defines "long-term residential care services" as "a facility predominantly for the care of older people, which designation shall specify the health or personal care services to be provided at that facility" but nowhere is the definition of "older people" set out. Are they over the age of 60, 70 or 80? The provisions are vague in that regard. I remind the House that nursing home patients also includes chronically ill young people, many of whom are inappropriately placed.

In general, older people want to stay in their own homes for as long as possible. Home care packages are available but I would like to see an increased provision of sheltered housing and day care facilities. Nursing homes should be the place of last resort. People should be provided care in their own homes and day care for as long as possible, followed by sheltered housing. However, there is a dearth of sheltered housing around the country. Many people in public and private nursing homes would happily live in sheltered housing if they had the choice. We need to develop a continuum of care for older people.

Clearly, when somebody's health deteriorates to the point at which he or she can no longer continue to live alone, nursing home care has to be provided. However, an issue arises in regard to a patient's level of incapacity. Section 7(6) states:

A care needs assessment of a person shall comprise an evaluation of—

(a) the person's ability to carry out the activities of daily living, including—

(i) the cognitive ability,

(ii) the extent of orientation,

(iii) the degree of mobility,

(iv) the ability to dress unaided,

(v) the ability to feed unaided,

(vi) the ability to communicate,

(vii) the ability to bathe unaided, and

(viii) the degree of continence,

of the person,

These factors require several decisions to be made by multidisciplinary teams.

Section 7(11) states:

Where a care needs assessment is carried out, this shall not be construed as meaning that the Executive will provide or will arrange for the provision of any service identified in the assessment as being appropriate to meet the needs of the person or that the Executive has an obligation to provide or arrange for the provision of any such service.

I am not sure what that provision means. Is it an opt-out clause? It suggests that care does not have to be provided even if an assessment points to the need for it.

I am aware this is resource capped and I am interested to hear at what point these caps kick in. Section 10 deals with appeals. It is important such appeals are carried out by independent people. As pointed out by other speakers, the Bill provides that the Executive does not have to take into account a valuation provided by a property owner. I suggest that independent mediation should be provided for in this instance as in others where a dispute arises in respect of a valuation.

Section 10(7) refers to requests for information and states that 28 days be provided in that regard, which is a relatively short timeframe. The section states that the Executive may refuse to further consider an application if such information is not provided. I believe more flexibility is required and that the section should, perhaps, be reworded as often it can be difficult for a person to obtain the information being sought.

More clarification is required in respect of interest on land outside the State. Many people own property outside the State nowadays. I do not believe the Bill is clear in terms of how this issue will be dealt with. This section needs to be tidied up. The appointment of a care representative is important. The Bill states such person may be a member of a couple, a parent, child, brother, sister, nephew, niece, aunt or uncle of a relevant person. Often, elderly people who live on their own are cared for by a cousin or neighbour. The Minister of State might take another look at this provision. I know of elderly people, living on their own, who have no such relatives. I accept a care representative may also be a registered medical practitioner. However, an elderly person may have a cousin who is close to and good to them. Perhaps the Minister of State will consider taking into account such a person.

I believe there is a typographical error on page 28 wherein it is stated that the court shall not appoint a person to be a care representative unless it has before it a report. There appears to be something wrong there. I cannot make sense of it. The Bill makes reference to the Revenue Commissioners and states that they cannot act after 12 years. As far as I am aware the Statute of Limitations is six years. Perhaps the Minister of State will explain the reason for the provision of 12 years in this regard.

The Ombudsman is not mentioned in the Bill. Could the Ombudsman have a role here in the event of a dispute? I am aware the Health Service Executive comes within the remit of the Ombudsman so it might be useful to include somewhere in the Bill a reference to this. I did not come across such a reference although I may have missed it. Perhaps such reference is not necessary as the matter is covered by other legislation. The Minister of State, when replying, might state on the record whether the Ombudsman can be called upon to adjudicate or give an opinion on some aspects of the Bill if a dispute were to arise. It is not clear from the Bill whether that is possible although I believe it may be.

On ancillary supports and property, elderly people, having sought legal advice, may opt to transfer their property to a son or a daughter when they reach their early sixties, thus taking the gamble that five years will elapse following which the asset, having been transferred, cannot be touched by the State. Not everybody will have the wherewithal or legal advice to do that. People who do this may also include in the transfer a clause which provides that they may reside in the house for as long as they live. It could well happen that many houses belonging to older people will be transferred at an early stage to sons or daughters with a condition attached that they may reside in the house for as long as they want. However, ownership of the house will then lie with the son or daughter. Could this type of transfer get around this legislation? From my reading of it, I think it could. I am not sure how this issue can be addressed but it is important it is addressed.

I was told a number of years ago that construction of nursing homes in Denmark ceased in 1997. They may have built a great deal of them prior to then. Going back to my original point, their philosophy is to care for people in their own homes, sheltered housing, day-care and so on for as long as possible. Also, they have a national rehabilitation service which we do not have. Often, people here, many of them stroke victims, end up in nursing homes owing to a lack of rehabilitation. The philosophy on the Continent is that a person first be stabilised in an acute hospital and then moved to a rehabilitation unit. I have visited some of these units, which are amazing and provide all the services required. While we have an excellent rehabilitation centre in Dún Laoghaire there is a lengthy waiting list for admission to that facility. We all know stroke victims go downhill very quickly without early rehabilitation. I was amazed by the intensity of the service provided at the rehabilitation centre in Denmark and in other parts of Europe. The philosophy is to assist a patient to be as good as he or she can be and to return him or her, where possible, to the home or sheltered housing. A person here who suffers a stroke is taken to an acute hospital and usually ends up in a nursing home. In many cases, there is no need for this.

The National Treatment Purchase Fund will be involved in negotiating prices. I am aware that in some places commissions have been established to set maximum prices to ensure there are sufficient resources to run an operation, that standards are not impacted upon and that investors obtain a reasonable profit. The setting of prices may be an issue worth examining. It is important assessments are carried out quickly. There are two types of assessment involved, namely, the financial assessment and the medical assessment. It may be possible for a person to arrange for a financial assessment to be undertaken at an early stage. For example, a family who is aware a person will require nursing home care might require that such an assessment be undertaken, say, six or 12 months earlier. This would help to speed up the process. Often, people get ill quickly, a family cannot cope and a delay occurs in getting them into a nursing home. This is when the real stress builds up. I say that bearing in mind all of the services we need to put in place, including rehabilitation services etc.

We must be careful. There is a great deal happening in the property market. There have been massive changes in a short period and the value of property has fallen dramatically. The current situation is an awful mess. The system needs to be tightened up and clarified.

I look forward to the rest of the debate.