Peter Fitzpatrick (Louth, Fine Gael)
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I welcome the opportunity to raise this very important topic. I attended a meeting with the Louth Respite Working Group this week. Members of the group outlined in great detail the current situation regarding the provision of respite care in County Louth. In addition to the facilities already available, Louth currently requires respite care for an extra 60 families. The current situation is that seven beds are provided by St. John of God in Drumcar, with 42 adults and nine children having access. In addition to this, there is a three-bed facility in a small bungalow in Ardee, which allows 81 adults access respite care on a basis of one weekend and one five-day week annually. We have the Maria Goretti facility in Lordship which gives access to respite care for 80 families. On top of this, six young adults will leave children's respite this year and a further 12 next year but none of these will have access to adult respite care.

It has been clearly identified in County Louth that additional adult respite care services are urgently required for older adults with a disability living at home with older parents, for younger adults with challenging behaviour, and for emergency or crisis situations. These needs were agreed by the HSE but it stated that it had no funds in its existing service plan. I do not accept this and ask that funding be made available as a matter of urgency. Also, a very serious situation arose in the summer months when respite care services were cancelled in St. John of God in Drumcar, which resulted in a number of families being left in limbo and without respite care services at very short notice. This is not acceptable and we, as a Government, should be doing more for these families, not only in County Louth but throughout the country.

I will give the example of a case involving a 17 year old boy with severe autism spectrum disorder, ASD, and intellectual disability, ID, who experiences random meltdowns along with physically challenging behaviour. These events have escalated over time. There have also been a number of serious assaults on his mother and other family members. An incident happened while he was in respite care which resulted in no respite care for a period of months. At this stage there was no other respite care available to the family. The family applied for a three-month residential assessment. Their business case was supported by the local HSE staff but was refused by senior management. This decision is typical in these circumstances. This child will be 18 years of age soon at which stage there will be no respite care available to the family. This is not acceptable and it is a disgrace that this is still allowed to happen.

Another situation that must be considered is the needs of older families with adult dependants with a disability. Many parents of these children are now in their sixties and seventies and in many cases they are suffering from ill health. They would previously have received respite care services but now this is unavailable due to the age of the child. These are people who probably need respite services more than others, yet these are the people who have the most difficulty accessing respite services. We must remember that respite does not end when a child reaches the age of 18.

I ask the Minister to examine the situation urgently in respect of respite care in County Louth and to find a proper solution to this very serious matter.

There must be a ring-fenced revenue stream allocated to the Louth HSE to provide appropriate, regular and planned respite for families with adult children with a disability in Louth.

Marcella Corcoran Kennedy (Offaly, Fine Gael)
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I thank Deputy Fitzpatrick for raising this important issue and for giving me the opportunity to address the House on this matter. A key objective of the Government’s health policy is to support people to live in dignity and independence in their own homes and communities for as long as possible. Respite services are a key element of achieving this, both to improve the quality of life of patients and to provide support to carers who are the backbone of the provision of care services in Ireland.

Respite care is provided in a number of different ways and settings. It may be provided via an enhanced home care package for the period of respite or in public or private nursing home beds. Respite beds are also contracted by the HSE in private nursing homes where it is used to boost the availability of such beds to meet demand within the resources available in the local health office or integrated services area. In addition, there are 2,000 short stay public beds within our health system which include step-up-step-down care, intermediate care and rehab and respite care, which are used in a flexible manner to meet local needs at any given time. These are interchangeable for use depending on demand in the units so the number of respite beds in any one month can fluctuate depending on demand for the short stay beds.

Louth County Hospital is an 89-bed hospital including 28 day beds and 61 inpatient beds that provide palliative, step-down and rehabilitation care. Efforts to expand capacity in Louth County Hospital and Our Lady of Lourdes Hospital, Drogheda include the opening of 24 new beds in a modular build at Our Lady of Lourdes Hospital, Drogheda within the last six months. The purpose of the new capacity is to improve patient flow from the emergency department and assist in early admission decisions. In addition, as part of the winter initiative 2015-16, ten new beds were provided in February 2016. The new capacity includes the elderly medical rehabilitation service, the purpose of which is to facilitate discharges from Our Lady of Lourdes, Drogheda. As the Deputy rightly highlighted, there are currently no specifically designated respite beds in Louth County Hospital. However, inpatient beds can be used flexibly to meet patients' needs. Respite services are provided in a range of other settings in the community, in nursing homes or as appropriate in specific residential centres, for example, the St. Oliver Plunkett Hospital, which is designed to provide respite care for older people, and the children’s respite centre in Lordship which opened in 2014. These services can be accessed via the local public health nurse or GP.

Our Lady of Lourdes Hospital is one of nine hospitals targeted under the winter initiative 2016-17 to reduce overcrowding and improve winter preparedness. This will include the expansion of community intervention teams in the Louth-Meath region and an increase in home care packages to support the discharge of patients at the hospital.

Peter Fitzpatrick (Louth, Fine Gael)
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I thank the Minister of State for her reply. We spoke to the Ceann Comhairle's office this morning and explained that this Topical Issue matter was not on respite services in Louth County Hospital but in County Louth as a whole. It is a very serious concern for the families affected. The situation is such that more funding is needed urgently. At a meeting with the Louth respite working group the amount of funding required in Louth to support respite for an additional 60 families was identified. With funding of approximately €800,000, additional respite could be provided for 30 families. This would amount to seven week's respite per family per annum. If this was to be spread further to provide three to four weeks of respite per family, we could have a situation whereby 60 families could be supported with respite for the same amount. These figures are based on providing a four-bed respite service seven nights a week, 52 weeks a year, in other words a full-time service. An alternative service could be provided on a part-time basis, for example from Thursday to Monday. The cost of such a service would be in the region of €500,000. While the part-time option is cheaper, in the long run the full-time option is much better value for money and provides a better service to families. There are many companies and organisations capable of providing this service and which have the knowledge and experience to do so. One company that also attended a meeting this week with the Louth respite working group provided the figures I have mentioned and also stated that any property or vehicles required would be purchased and maintained by them. We must not forget that families are the real losers here. Sometimes we get caught up in the figures and statistics. The families going through this at the moment are the ones in the real crisis. We must do all we can to support these families. I urge the Minister of State to ring fence funding for respite services in County Louth.

Marcella Corcoran Kennedy (Offaly, Fine Gael)
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I thank the Deputy for the clarification. The information sought was on Louth County Hospital so I will seek the information the Deputy requires on the county of Louth. I will ensure the Deputy's requests are submitted to the Department and the HSE, which is responsible for funding. The Deputy is concerned about specific issues that arose and I see no reason why we could not get some response in a confidential capacity on how those situations arose and why. I could not comment on them publicly but I will certainly seek the information for the Deputy.

Respite is a cornerstone of public health policy in terms of encouraging people to remain at home, which is where they want to be. It will become and increasing challenge for the Health Service Executive because we are all living longer. It is something we will have to focus on and while the Deputy's focus will have to be on Louth it is something that will resonate with Deputies across the country as these issues arise. I thank the Deputy for raising the issue and I will get him the specific information on County Louth as he requested.