Seymour Crawford (Cavan-Monaghan, Fine Gael)
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I thank the Ceann Comhairle for the opportunity to raise this important issue on the Adjournment.

A number of cases have recently been brought to my attention. In one case, the carer for a 93 year old woman who is almost blind had to go into hospital. Initially, it was not certain how long the hospital stay would last and an application was made for the provision of care to the woman in the meantime. It was refused. Fortunately, her carer only had to go on two individual days so the situation was not as serious as it might have been. This 93 year old woman has to have her food liquidised three times a day and the only support she was given while her carer was absent was one visit in the morning. This person has no living relatives. Her sister in law, who is in her 70s, lives eight miles away. She visited at lunch time and another neighbour helped in the evening. This is a typical situation where no cover is provided by the HSE and it is unacceptable.

Another case was that of an 86 year old woman who has had two strokes and is confined to a wheelchair. Her daughter, who lives with her and cares for her with the help of other carers, has been seriously ill following a difficult child birth. She wants to go for a week's holiday in June and when she asked for that, she was told it was not possible and that the family would have to look after her mother.

This is not acceptable. Money can be found for all sorts of issues but those are two cases from many. Another lady on the far side of Cavan is unable to walk. She was checked a year ago but has not been reviewed since. When she was checked, it was estimated that she did not need too much help. She must use a walking aid and she cannot get to the toilet in time. We all know the result of that. Any female would have an understanding of the dire needs of that person but she cannot get a carer when her own carer is absent.

I spoke to someone in charge of an outside agency. She spelled out the difficulties that occur in Cavan-Monaghan. She no longer wants to do business there because regulations are so lacking in understanding, sympathy or care for the elderly. She works in other counties where the situation is totally different.

This comes down to one thing. In the north-eastern area, which consists of four counties, there has been a massive increase in population. The budget for the region, however, was never increased and, as a result, there is penny pinching everywhere. I beg that this not be taken out on the elderly, the most vulnerable in the country. When millions can be found for other issues, as happened in the past few days in our own area, the few euro it would take to employ a carer or an agency worker to carry on for the few days in question must be provided. It is not so bad if there is a family who can help out but some of these people have no living relatives and it is desperately unfair on them. I spoke to this lady on the phone and she is a lovely person who does not deserve such treatment.

I urge the Minister to ensure, no matter what it takes, that people like her get the care they deserve in their later years. These people are saving the country a mint by staying at home but they are being penny-pinched.

Áine Brady (Kildare North, Fianna Fail)
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I thank the Deputy for raising this issue as it provides me with an opportunity to reaffirm the Government's continued commitment to services for older people generally and, in particular, to the important area of home care services.

The development of these services nationally reflects the prioritisation and significant investment by the Government in recent years with, for example, just over €200 million in additional funding provided to develop or expand such services over the period 2006-08. This additional funding related to a range of services such as home care packages, home help, meals-on-wheels, and day and respite care.

Home care services are delivered either directly by the Health Service Executive or on behalf of the executive in partnership as appropriate with the voluntary sector or through private providers. The position in the home help programme shows for expected expenditure this year by the HSE of around €210 million, including just over €55 million development funding provided since 2006; an increase from 10.8 million home help hours in 2006 to nearly 12 million hours this year; and an increase in the number of clients benefiting from around 41,500 in 2006 to 54,500 this year.

Home care packages are a relatively new initiative introduced by the HSE in 2006 and developed nationally in the meantime through phased investment of €120 million new funding made available by the Government. A package comprises a variety of community-based services and supports, including a significant home help element in many cases, to best meet the needs of an older person. Clients may have significant medical, nursing and-or therapy requirements and may be recently discharged from hospital, or at risk of admission to hospital, if such needs are not met in a planned way. The HSE service plan envisages around 8,700 people benefiting from packages at any one time, or over 11,000 people benefiting over the course of this year.

I wish to highlight that, notwithstanding the current financial pressures generally across the health system, the Government has made every effort to protect home-care services for older people. This year, the HSE aims to deliver the same quantity and quality of home help and home care packages nationally in line with 2008. If the Deputy can supply details of the individual cases raised today to the HSE, or to me personally, the executive will arrange to urgently review these and report back direct to the Deputy.

The capacity of the HSE to provide approved levels of home help services continues to be reviewed in the context of overall available resources. It is incumbent on each local health manager to ensure home help services are delivered within allocated budgets. This requires a stringent ongoing review of the application of the resources.

As with every service, a limitless resource is not available for the provision of home help services and while the resources available are substantial, they are finite. Levels of services provided are reviewed regularly and, as a result, this in individual cases may increase, decrease or remain constant based on the assessed need in each case. Professional staff on the front line, who are aware of local circumstances, undertake the individual client assessments. Services are targeted at clients with a high level of dependency, and in accordance with their assessed need.

An example would be a person discharged from an acute hospital who may require home help assistance for a period following discharge, until he or she has regained independence. In this case, the level of service provided on discharge would be kept under review. When the person is in a position to live more independently, the home help hours may be reduced or withdrawn in line with the re-assessed care needs.

The Government has made considerable improvements in recent years to enhance home care provision throughout the country. Demand can at times exceed service resources, especially in cases involving the need for temporary cover. I am satisfied, however, that the HSE will continue to deliver the home help service in the best manner possible, taking account of evolving circumstances at national and local level.

Seymour Crawford (Cavan-Monaghan, Fine Gael)
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I gave the names and addresses of the people concerned so the Department knew the exact situation.

Johnny Brady (Meath West, Fianna Fail)
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I cannot let Deputy Crawford speak again.