Seán Crowe (Dublin South West, Sinn Fein)
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I raise this Topical Issue because I am greatly concerned about the lack of provision of respite care and home packages by the Department of Health. I realise it is not the Department of the Minister of State present. I will give an example of how this issue came to a head. A 93 year old constituent of mine was in hospital after a recent illness and the social worker said that 21 hours of home care would be awarded to this family. The difficulty is that the family has been told there is no funding available for the 21 hours. I put questions down to the Minister and he said it was a matter for the HSE but the HSE is not in a position to give the information on these 21 hours. I realise this is an issue affecting people throughout the State. Some counties have been left behind. There are nearly 700 people waiting in Galway, 600 in north Dublin, 578 in Wexford, and 200 in Dublin South-West. They are all impacted by this.

The crisis this family is facing is that the mother was getting very distressed where she was and they took her home. She is getting 24-hour care now. One can realise this cost of this by a simple calculation in one's head. It could be anyone's relation. This is just one example. Unfortunately for the family, they have taken on this burden. Surely if it is indicated that there are hours available, the family should get some support. Unfortunately, up to now, that has not happened.

I am aware that this is not the responsibility of the Minister of State present but there is the notion of collective responsibility. I ask the Minister of State to go to the Minister of State in charge to try to find out when this funding may become available. The Minister of State may recall that during the week I asked the Taoiseach about this particular area. Nobody at Cabinet level seems to be able to answer the question on these hours. The Taoiseach stated that the budget had been increased for next year which is great. When will this be seen on the ground and, in particular, in these people's homes?

It does not make economic sense to leave people in respite care beds if the family wants to take them home. It is distressing for the patients themselves. It also probably puts the patient at risk from infections and so on that can be picked up in hospitals, unfortunately. This woman, and perhaps many other people who are elderly, want to spend their remaining time in their home. That is where their happy memories are. They do not want to be in a bed in a ward with strangers even though they are being well looked after. At the end of the day, this woman wants to be at home with those who love her around her. She has good neighbours as well. Surely we should be able to come up with some sort of package or supports to help people remain in their home.

I do not know how the Minister of State feels about this but I feel sick to my stomach that someone is left in this situation where the family are left helpless. This woman is on oxygen and she is blind but her brain is absolutely perfect and she knows exactly what is going on. She knows her own mind and wants to stay in her own home. This is not a Third World country. With all the wealth that is floating round and the money we can spend and misuse on different things, surely we can come up with some sort of supports for families like this one.

John Paul Phelan (Carlow-Kilkenny, Fine Gael)
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I thank Deputy Crowe. I am taking this Topical Issue on behalf of my colleague, Minister of State, Deputy Jim Daly. In the case outlined by the Deputy, where 21 hours of home help is required, one could not but wish to see a person of that age and who still has her faculties in her family home situation.

The Government's core stated objective is to promote care in the community so that people can continue to live with confidence, security and dignity in their own homes and communities for as long as possible. A wide range of services are provided, including home supports, day care and residential care, through direct service provision and through voluntary and private providers. Respite care is an essential component to ensuring older people with care needs in the home, including those with dementia, can be cared for in their community and close to their carers. The service offers additional assistance to families and carers, thus helping to alleviate the ongoing stress associated with providing care. Respite can often assist with avoidable acute hospital admissions. Respite is provided in several different ways and settings across the health system. It is provided through designated respite beds in public residential centres and contracted by the HSE in private nursing homes – where it is used to increase the availability of such beds to meet demand – within the resources available in the local area.

There are over 1,800 short stay beds in public long stay units. These may be used interchangeably for respite, rehabilitation, convalescence or other uses, depending on current demand in the centres. Therefore, the number of respite beds in any one month can fluctuate up and down depending on demand for that bed.

Planned respite can be provided, allowing carers to have planned breaks throughout the year. Respite may be provided as part of an enhanced home support package, where the funding can be used to procure a period of respite. Respite can also be provided on an emergency basis for unforeseen circumstances, for example, due to bereavement or illness of carers, or emergency environmental changes to the residence of the client. The provision of respite beds is part of an integrated model of care and the HSE strongly advocates and supports the system of respite care nationally. The HSE is currently considering the role of the respite services and how these can contribute to the provision of a streamlined pathway of care for older persons. Respite services are also an important part of the range of services supporting people with disabilities and their families. Short breaks can also provide an opportunity for individuals to meet and engage with other people socially. This year, the HSE will provide over 182,500 respite nights and 32,500 day respite sessions.

Home care is an increasingly important part of the supports for enabling older people to remain in their homes and communities for as long as possible and for facilitating their discharge from acute hospitals. Last year, a single funding stream for home support services brought together the funding for home help and standard home care packages which now operate as a single home support service. In excess of 53,000 people will receive more than 18 million home support hours this year. This will assist older people to live independently in their homes and enable large numbers of people to return home following acute hospital admission.

Despite this significant level of service provision, demand continues to rise and there is considerable variation in access to services in different parts of the country. While the existing home support service is delivering crucial support to many people, it needs to be improved to better meet the changing needs of our citizens. That is why we propose to establish a statutory scheme for home support services which will improve access to the service on an affordable and sustainable basis while also introducing a system of regulation that will ensure public confidence.

Seán Crowe (Dublin South West, Sinn Fein)
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While I understand the Minister of State is reading a script, on a personal note, what does he say to families who are left in this situation and who are clearly facing a crisis? I do not know of any family who would be able to pay €20 an hour, 24 hours a day, seven days a week for a package that, in this case, would allow a woman to stay in her home. A huge burden is being put on such families and we are a bit light in our response to those in that situation. Can anything be done? Will additional funding be made available to community healthcare organisation, CHO, 7, the area where this woman is located? If it will, when will it be released?

During the week, the Taoiseach said additional funding was coming down the line. While that would be one way to help, we need to look at the bigger picture if we are serious about our ageing population and about supporting those who will clearly have support needs. If our overall policy is to try to keep people in their homes for as long as possible, we need supports. This family are in crisis and there are no real answers for them here today. I am awaiting a reply from the Minister but I know he will kick it back to the HSE, which does not have the answers.

It sounds like a whinge but I do not know where to go with this. The family have come to me thinking I have the answers. I am coming here today asking the Minister of State whether he has the answers, but it is clear that, collectively, we do not. I am sure the Minister of State will go back to the Minister. We need an answer specifically in regard to those who are getting on in age but who are distressed by the idea of having to stay in hospital. Even where there is a loving family who want to take such people home, they need some sort of support. If we can do that and come up with some sort of solution for families like this, it will be a good day's work for us. While I am concentrating on one family, I realise there are probably thousands of families in the same situation.

John Paul Phelan (Carlow-Kilkenny, Fine Gael)
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There are certainly many families in this situation. Although it is no consolation, I deal with similar issues in my CHO area and it is often down to resources in different areas. On the bigger picture issue raised by the Deputy, the Department is engaged in the process of setting up a statutory, stand-alone scheme along the lines, I would expect, of the fair deal scheme that exists for residential nursing home care, which can be slow to access but seems to deliver for the people concerned. In this whole area of home care and home support, given the fact many more people are seeking it and, with the demographics, we know many more will be seeking it, it makes sense to have a statutory scheme. On the bigger picture, I will ask the Minister specifically when he thinks those measures for that scheme will be announced. I will also ask him in regard to CHO 7 and the case raised by the Deputy. I know the Deputy is awaiting a response from the Minister and perhaps something can be done in that case. The bigger picture is that we are going to have a statutory scheme. I fully agree with the Deputy that we should have it as soon as possible.