Dáil debates

Wednesday, 19 May 2021

Nursing Homes Support Scheme (Amendment) Bill 2021: Second Stage (Resumed)

 

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

2:17 pm

Photo of David CullinaneDavid Cullinane (Waterford, Sinn Fein)
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I am sharing time with Deputies Patricia Ryan, Martin Kenny and Martin Browne.

Yesterday, I outlined what the various sections of the Bill did and my views on those. I now wish to deal with some of the recommendations of the review of the fair deal scheme. The Government needs to consider these. The review made 32 administrative recommendations, but there has been no update on their implementation. Thirteen pricing recommendations were made and we need a report on their implementation. Twelve recommendations were made on a future model of social care. There should be a report on their implementation. A great amount of work must be done on a new model of social care.

The pandemic has shown up many failings in clinical governance and oversight, the lack of integrated systems and, in some cases, a lack of knowledge about the sector on the part on the HSE. At a meeting of the Oireachtas Committee on Health a number of weeks ago, HIQA stated that, in its opinion, the HSE did not have knowledge of the private sector from which it was purchasing services. HIQA was referring to nursing homes among other elements. That is a problem.

There are poor standards and a lack of authority for safeguarding. The Government says that it is committed to ensuring the latter and putting safeguarding on a statutory basis. That must be a priority. We must also consider strengthening HIQA's powers over public and private nursing homes. HIQA has stated that its powers are a blunt instrument and do not provide enough flexibility to work with nursing homes and approved centres for older people and people with disabilities on making necessary improvements. Similar to the Health and Safety Authority, HIQA wants the power to issue what are called improvement notices. That would be important.

Young people with disabilities, including some children, have been placed in centres for older people. This matter was the subject of an "RTÉ Investigates" programme some time ago and needs to be addressed.

We must deliver a high-standard and fully public model of care for older people. The statutory home care scheme needs to be expedited. It was reported at the end of last year that the scheme had been pushed to 2022 because the IT system and a new assessment process had yet to be developed. Once again, IT systems were a problem. Thankfully, the problem was not one of cybersecurity in this instance. Rather, our healthcare system does not have a modern IT infrastructure, which impacts on the State's ability to respond to new systems, policies and processes when it needs to.

I support the Bill insofar as it goes. The welcome development in the Bill is the three-year cap on assessments of transferred assets to protect the viability of family farms and businesses. The Minister of State, Deputy Butler, and I share the same constituency and we have attended many meetings of the Irish Farmers Association and other farming representative groups down the years, often at election time when we are in the cut and thrust of debate. This was one of the issues that arose time and again and what the Bill intends to do will help to resolve it. I commend the Minister of State on introducing the Bill.

Photo of Patricia RyanPatricia Ryan (Kildare South, Sinn Fein)
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I welcome the move to address a long-standing issue affecting business owners and farming families under the fair deal scheme. This issue has been raised many times by my constituents. Unfortunately, the move will come too late for many families who will not be able to claw back thousands of euro in fees already paid.

While the Bill is a welcome move, we need to do more to facilitate a greater number of older people in ageing in place. We need to increase funding for the home help scheme to deliver for all older people. Our older people have been an afterthought for successive Governments but were to the fore when cuts were made, as in the case of Fine Gael and the Labour Party during the austerity years.

Sinn Féin in government will introduce a statutory home care scheme. We will increase the role of the public and not-for-profit sectors in the provision of home supports. For too long, our older people have been commodified like our early childhood education, housing and health services and many other public services. I do not mean the small family-run nursing homes that provide a modest income for owners and much-needed employment in rural areas. Rather, I mean companies like Orpea, which recently became the largest provider of nursing home places in the country with almost 2,000 places, and Bartra, which has a number of large nursing homes, including a 146-bed facility that is under construction in Clondalkin and apparently includes co-living staff accommodation. Profit should not be the primary motivation for the provision of older persons' care. We in Sinn Féin favour public nursing homes and, until there are sufficient public places available, a strongly regulated private nursing home sector.

We have learned many lessons during the pandemic. One is that concentrated care of our older people is far from ideal. They should be supported in living in their own homes for as long as possible, if that is what they want. The Minister of State and I have discussed this at several meetings. There are many examples of international best practice, such as the Green House model and the Eden Alternative. These favour ageing in place or in small congregations of purpose-built or redesigned homes, with appropriate supports.

I commend the book by Mr. Pat O'Mahony from Newbridge, entitled Rethinking Housing Options for Senior Citizens. It makes some interesting proposals and international comparisons as regards retirement villages. We need to accelerate our provision of housing for older people before demographics overtake us and we end up in the same place as we are with schools, where some students still do not know if they will have places in their local schools in just over three months' time.

I wish to raise an issue that was brought to the attention of the Committee of Public Accounts recently by my colleague, Deputy Munster. She raised the matter of residents in private nursing homes having to pay for items that they were entitled to free of charge under their medical cards and the practice of applying increases to residents' bills as a result of a change in their medical needs despite this being prohibited by the legislation for scheme-supported residents. By law, nursing homes should not be charging patients for items such as incontinence pads, wound dressings, sore creams and medications that residents are entitled to free of charge under their medical cards. This smacks of profiteering on the part of nursing home operators. It is not acceptable and anyone found responsible must be held accountable. People in nursing homes can be vulnerable.

We must ensure that those who are tasked with looking after them are not taking advantage. They certainly are taking advantage if they are doing the things I mentioned. We need to put a stop to those disgraceful practices. The treating of our older people as cash cows must stop immediately.

2:27 pm

Photo of Martin KennyMartin Kenny (Sligo-Leitrim, Sinn Fein)
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We welcome this long-awaited legislation. As colleagues have stated, the IFA, other farming organisations and business organisations have been campaigning for changes to the nursing home support scheme for many years. Their campaign pointed out that people who had built up assets from nothing over a lifetime are having those assets held against them when they try to get care in their old age. Many people have said to me that they worked hard and paid taxes all their lives but when they needed a service at the end of their life, they had to take out a chequebook and pay for it. That is how people feel about the scheme that has been in place for many years. It was christened the fair deal scheme but, for many, it was not very fair at all. The essence of what we need to address in this legislation is ensuring we bring fair play back into the system.

I welcome the three-year rule that will apply in respect of farmland and other assets. Up to now, such assets were subject to a 7.5% per annum charge for as long as their owner was in a nursing home. Of course, the issues with nursing homes do not stop there. There is a great deal of work to be done in this regard and the Minister of State, Deputy Butler, is aware of that. We need a review of how the system works. Clearly, it does not work properly for many people and there are issues that need to be addressed. Many owners of smaller nursing homes have long been saying that there needs to be a round-table discussion on how we can resolve the issues and try to create a fair deal for everyone involved. That must include the providers, particularly in areas where they are under stress.

The issue of home help and home care provision is linked to all of this. Many people have difficulty getting proper home care packages in place for elderly loved ones and people who are returning from hospital. It is an issue that has devastated people across the country, when they are on waiting lists and cannot get the level of service they require. Sometimes, people have a level of provision, perhaps for a couple of hours a week, but if they deteriorate and need more, the family is told help will have to be hired privately. That is simply not appropriate. People work hard, pay taxes and are loyal to the State throughout their lives. The least they should expect when they come to the end of their days is that the State is there to provide for them.

The work the Minister of State has done on this legislation is welcome. It represents an advance on the current situation and is something that has been lobbied for at length. However, there is much more to be done. I encourage her to look at all the remaining issues and to address, with speed, as many of them as possible.

Photo of Martin BrowneMartin Browne (Tipperary, Sinn Fein)
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One thing we can say about this Bill is that it is welcome, but it is also a long time coming. For too long, our farming communities and small business owners had their futures put at risk by the Government despite their being vital contributors to our economy, exports market and reputation. It is welcome that sense has finally prevailed and the way in which these sectors have been overlooked in the past is being addressed to some extent.

Family farms have been under increasing pressure for years. Their owners have been taken for granted and advantage has been taken of them repeatedly. They seem to be the last in line for attention but the first in line for criticism, as we saw in recent debates. Unfortunately, farmers have become used to being taken for granted. We see that in the manner in which the meat processing industry has been handled with kid gloves over the years. Family farmers are responsible for producing the high-quality, premium product that is renowned globally and which we are, rightly, only too proud to promote. Yet, despite the 24-7 effort farmers put into producing a quality product, their endeavours are underappreciated in financial terms. They find themselves on a low rung of the ladder of beneficiaries when it comes to the food supply chain. Today, we are finally discussing a Bill that addresses how these enterprises have been subject to rules that put many businesses and farms at risk.

How was it ever right that in order to avail of the nursing home support scheme, farmers and small business owners had to pay a proportion of their capital value for as long as they availed of the scheme, with no cap on the number of years of contributions? Do the Ministers for Agriculture, Food and the Marine, Enterprise, Trade and Employment, and Health, as well as the Minister of State with responsibility for older people, have any idea of the damage that was done to many farms and businesses over the years this scheme has been in operation? Given the challenges that have faced family farmers, why did it take so long to make the changes we are discussing today? Given that the Government depends on small businesses to keep the unemployment figures down and give our produce a particular identity, it is hard to believe it has taken so long to get to where we are today.

These are the big questions but the Minister of State, Deputy Butler, will also be acutely aware of the need to deal with a particular issue on which she has spoken before. When a loved ones gets ill and needs the care provided by a nursing home, it is an incredibly emotional time in the life of a family. To date, that situation has been made worse for many by the rules that governed the fair deal scheme in respect of farms and businesses. When families find themselves having to make a decision about their loved one's welfare, they do not want to have to worry about anything else. The fair deal scheme, as it was designed, meant that the families of farmers and small business owners had the additional concern of how their livelihood would be affected. I do not know how the Minister of State feels about having to deal with the legacy of previous Governments but she must have questioned how such a situation was ever devised under the governance of her colleagues.

The time it has taken to arrive at where we are today is concerning but I am thankful we got here. The IFA has been campaigning for changes to the scheme since not long after it started. In 2016, it made a presentation to a working group on the fair deal scheme. Now, in 2021, progress is eventually being made. The provisions in the Bill will leave many farmers and business owners scratching their heads and asking whether there are to be retrospective payments to those who paid out under the current rules. Will the Minister of State clarify her stance in this regard? Will she speak to the farmers and business owners who have those questions? If she is resistant to do so, she will have to take it up with the previous Fianna Fáil and Fine Gael Governments that put the families of farmers and small business owners in this situation. I welcome that there is finally movement on this issue. It is crucial that no questions are left unanswered and the new system is put in place as quickly as possible.

Photo of Seán SherlockSeán Sherlock (Cork East, Labour)
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The Labour Party is supporting this Bill and we thank the Minister of State for bringing it forward. It will provide a considerable amount of alleviation for farm families. Who among us has not had a person from a farm family on the telephone telling us about how a loved one is filling out the forms for the nursing home support scheme and expressing deep doubt about the process? Some of that doubt is because it is the end of the road in terms of being able to care for somebody at home. It is often the last resort for a spouse in respect of his or her loved one. It is always with deep reluctance that people agree that it is in a loved one's best interest to go into a residential unit or nursing home.

On top of that is the added pressure of not knowing where people will stand financially as a result of taking that decision to sign up to the nursing home support scheme. People too often tell us of their concern about what the charge will be on their X amount in assets and where will it leave them and their family in terms of their future financial security. There is no question that this Bill goes some way towards addressing this and, for that reason, it must be supported. Who among us has not dealt with a family whose savings, which were built up with bare hands working the land, have been whittled down to nothing? In many cases, people started with nothing or with a very meagre holding and built it up through years and years of hard work, only to find it is to be scattered like grains on infertile ground. Although their loved one is being cared for, there is often nothing left in reserve.

That seems to me to be an awful waste and an awful shame for all those years of work people put into building up these people's holdings. The Bill alleviates that. As I understand it, it does not apply retrospectively, so we spare a thought for the people who have gone through the double hardship of having savings whittled down and having had to make the decision on a loved one's nursing home care.

We have to acknowledge the role of the IFA in this issue. It is interesting to read some of the debates and the submissions that were brought forward by the IFA in respect of the pre-legislative scrutiny in 2019. I note in particular the association's submission through its then president, Mr. Joe Healy, in which he encapsulates the matter very well:

[Significant] uncertainty and anxiety has been created for family farms, with fear that the viability of the farm will be undermined or lost while attempting to meet the costs of care. This has led to the introduction of a three-year cap on farm business assets in circumstances of sudden illness.

It is also important to note that assets transferred for less than five years are included in the assessment of means. As ... [you] can imagine, this has proven to be a barrier to the next generation taking over the family farm due to the debt owing on the farm business asset.

To be fair to the Minister of State and the Government, they have sought to address this imbalance in the system, and that is absolutely to be welcomed.

It is important for us to look as a society at the entirety of care for older people, given our demographics whereby people are living longer than historically was the case. There was a very interesting debate in the Seanad on 10 May, at which the Minister of State may have been in attendance. My colleague, Senator Bacik, participated, stating:

Despite there being half a million carers in Ireland, the issue of care and the immense challenges faced both by carers and the people for whom they care are often neglected. Ireland's population is ageing and people with disabilities comprise a significant portion of the people living in our communities. However, the State remains reluctant to address the fact that most of us will either require care ourselves, or will have to give care to another, and that the infrastructure currently in place is seriously lacking.

She further stated:

[T]he State's default preference for institutional care is archaic and highly problematic. Not to mention that this preference is not in the spirit of the UN Convention on the Rights of Persons with Disabilities, UNCRPD, which Ireland ratified in 2018, it causes havoc in the real lives of the thousands of people living in this country who cannot do so independently. We have become all too used to hearing horror stories about our broken care model, whether that concerns the scandalous practice of inappropriately housing young people in nursing homes, or the tragic loss of life in institutional care settings that we have seen over the past year due to Covid-19.

Again, to be fair to the Minister, she is seeking in her approach to fix one element of that, and this legislative proposal before us does that. However, we in the Houses of the Oireachtas should have regard to the issue of our ageing population such that we can put in place a housing infrastructure that allows people to downsize and live independently or to create communities across this land that allow people to live independently but in a sheltered environment such that they retain their independence but there are shared services. In the context of today's debates on housing and the motion on waste water treatment services tabled by the Regional Group, I believe strongly that if we are to have serious regard to the fact that we are all ageing and that some of us will be able to live very independent lives until we shake off this mortal coil, even if we will require some level of care, and in the context of the nursing home element of this, with residential care another element of it, where there are levels of dependency from low to high, then a housing mix that allows people to downsize into communities needs to be inculcated into political debate. It needs to be further inculcated into how we devise national planning frameworks in order that we talk not only about younger people getting on the housing ladder but also about how older people will be housed into the future and what our communities will look like in respect of the third or fourth age, when people reach the autumn or the winter of their lives. Nursing homes are a part of that narrative but not the only part. I acknowledge the Minister of State is very conscious of this because she has spoken of this previously. I know she is very cognisant of the need to ensure we start inculcating new language into the debate on care for older people.

As I have said, we in the Labour Party support this legislation. We hope it will bring peace of mind to many farm families. It is important we note again that IFA submission on the pre-legislative scrutiny of the Bill, in which Mr. Joe Healy quoted from the 2018 Teagasc national farm survey, which showed that 30% of farmers were aged 65 years or older while only 7% were under the age of 35. The survey also showed that average farm incomes declined by 21% in 2018, dropping from approximately €30,000 in 2017 to €23,500 in 2018. His submission stated:

This steady erosion of farm incomes threatens both the viability and sustainability of the family farm and the sector's growth prospects. This can be clearly seen in the survey findings with only 34% or 47,000 of farms classified as viable.

We can interrogate those figures more closely, and some will say that the natural result of there not being intergenerational solidarity between fathers and sons or fathers and mothers and daughters going into family farming is that people flee the land, which then allows other people to consolidate farm holdings. What we want to see is a system that ensures that as many people who want to stay on the farm as possible are incentivised to do so. We do not want to see another Mansholt plan, a famous European Commission plan dating back to the 1970s whereby an attempt was made to create massive industrial-type holdings. There needs to be a mix that includes the small, sustainable, intergenerational, father-to-son or father-or-mother-to-daughter farm. I do not mean to be gendered in my language in any way. I do not think people will take me up the wrong way on the point I am making. This mix should allow for the passing of the farm from one generation to another and ensure that no disincentive is put in place. This legislation seeks to provide that type of alleviation at least. It takes out one worry for farmers who find themselves in that unfortunate position whereby a loved one has to go to a nursing home.

We support the legislation. We send our sympathies to people who find themselves faced with very difficult decisions of filling out the form and making the life-changing decision to send a loved one to a nursing home. In dealing with the financial element of this, they are concerned about whether their financial legacy will be whittled down to nothing. We hope this legislation will at least provide some alleviation for them at this time. I am talking about small farmers, people who have built up farm holdings from nothing, from mere blades of grass to fields of green. We must be mindful of those people who are the backbone of the co-operative movement and who continue to be a vital part of our life on this island.

2:47 pm

Photo of Willie O'DeaWillie O'Dea (Limerick City, Fianna Fail)
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I welcome the Bill. As a member of the Government that introduced the home care system initially, I recognise that we obviously did not get it completely right. It is very hard to get it exactly right the first time around. Several deficiencies emerged which are being effectively dealt with by the Minister of State in today's legislation, which I welcome.

I am slightly concerned that it has taken so long. I remember the fourth last Minister of State in that Department actually speaking about this particular reform. Since then we have had three different Ministers of State and now Deputy Butler is the Minister of State. Thankfully she has been able to introduce it. It is quite a complex Bill, containing several points of detail that I would like to discuss, but that will be a matter for Committee Stage.

We have always recognised that social care does not come cheap. It is very expensive system. This year the fair deal scheme will cost in excess of €1 billion to the Irish taxpayer in net terms, after taking into account the contribution from the nursing home occupants. The elephant in the room here is the absence of a system of statutory home care.

The policy of parties on all sides of the House is that people who can be cared for in their own homes should be cared for in their own homes insofar as that is possible. They should be left to live out their declining years in the comfort and security of their own homes. Only people who cannot be cared for in the family home should be taking up nursing home beds. Of course, as in many other cases, policy and practice diverge. Everybody on all sides of the political divide is in favour of people being cared for at home. Whereas the law states that if a person meets certain criteria, they have a statutory legal right to be accommodated in a nursing home under the fair deal scheme, they have no statutory legal right to home care which, apparently, is what everybody wants.

I know the Minister of State intends to introduce a system of statutory home care. I understand she is working very hard on that and it will be her next project after this Bill has been passed. However, I am concerned over how long it has taken us to get to this point. This is a significant improvement on the current system, but it has been spoken about for several years. How long will it take us to have a system of statutory home care?

First, it is recognised as being more desirable for people to be able to live out their lives in the comfort and security of their own homes if that is possible. Second, it is much less costly for the State. I have seen various figures, and while it is hard to average these things because conditions vary so much, on average maintaining somebody at home costs one third of what it costs the State to prop up the fair deal scheme for people in nursing homes. This means there is a double benefit. If people feel they can stay in their own home and can be catered for in their own home, and their family are willing to have them at home, they would prefer to be in their own home. It is much better for them. All studies tell us that it is much better for their mental health. The added bonus is it only costs the State about one third of the cost. It makes no sense that we have not moved further in providing a statutory home care system even as things stand. The home care system in the country is sporadic and inconsistent. It depends on where people live; there is a certain postcode lottery.

In the last Dáil, I introduced a stopgap measure to allow people to access home care on a statutory basis while we were waiting to put in place a statutory home care system, which needs to be carefully worked out. That legislation was passed by a large majority in the Dáil. I believe everybody in the House, bar Fine Gael Members, voted for it. It passed Second Stage. The Minister of State at the time promised me that she would hold Committee Stage within six months, but that six months has come and gone. It was about three years ago when I was promised that it would be back in six months.

Having drafted the Bill - the temporary measure I just referred to - myself, I recently sent another Bill to the Minister of State. I must give the credit for drafting the second Bill to Community Law Limerick, which comprises many learned legal people, including experienced senior counsel. Given that there are about 5,000 houses vacant whose last remaining occupant has gone into a nursing home, the Bill provides that in such cases there should be discretion to hand the house over to an approved housing body, which would then select somebody from the list of homeless to put into that house.

The arrangement between the owner and the approved housing body would be a licence arrangement so that the approved housing body did not have to act as a landlord with all the attendant rights, duties and obligations. It would operate from year to year. It would be entirely at the discretion of both sides. The central tenet is that people from the list of people who are officially categorised as homeless would be put in there, which is far preferable to the hubs and other places where they are accommodated at present. This would also be a financial benefit to the State because in 2019 the average cost to the State of providing emergency accommodation for a homeless person was €36,000, which has probably risen quite significantly since then. While I know that rents vary significantly in different parts of the country, the average rent is about €14,500 per annum. At €14,500 per annum as opposed to approximately €40,000, it would be cheaper for the State.

I have sent a copy of that Bill to the Minister of State and I know she is studying it. If she cannot incorporate it into this legislation, I hope some version of it makes its way onto the Statute Book soon.

Photo of Thomas GouldThomas Gould (Cork North Central, Sinn Fein)
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I welcome and support the Bill because for many, the fair deal scheme has not been fair or equal and the Bill finally provides recognition of that. We could go further and introduce a publicly funded residential care model because the Government is relying too heavily on the private sector to provide residential care.

Older people must be treated with dignity and respect and they must be confident they will get the care they deserve.

Statutory home care should be provided. Where possible, people should be supported to stay at home when they are able and where they want to be, but for many families because the support is not there, they have no option. That is something this Government needs to look at and put in place because if people want to they should have the right to stay at home with supports.

Five years ago, I asked the then Minister with responsibility for housing, Deputy Coveney, to meet with groups and to look at the possibility of renting out the homes of people who are on the fair deal scheme. This would provide a rental income for the people in the nursing homes. As far as I am aware and I stand to be corrected on this point, the HSE requires 80% of rental income for people in nursing homes. This is not viable for most families and where I live in Gurranabraher in Cork there are three houses within 100 yd of mine where people are in nursing homes and the houses are empty, with trip switches to turn the lights on at night. This is shocking because the people in the nursing homes could do with an income from these properties. There are thousands of families in Cork who are crying out for these beautiful homes.

We are in the middle of the worst housing crisis in the history this State. Many promises were made that this Government will deliver on housing. As mentioned, I raised this issue with the then Minister, Deputy Coveney. Here we are now, three housing Ministers later, and the Government is still looking at this. The Minister of State needs to engage with Age Action Ireland to get its insight into rolling out a scheme like this. According to theIrish Examiner, there are 25,000 homes tied up in this scheme right across the State.

I will finish with the comment that people are also waiting too long to get into nursing homes in that it can be four to six weeks and perhaps longer. Many of these people who need a nursing home place have been in hospitals but because of issues they have to wait. There should be no waiting list for people who need to go into nursing homes. Places should be available. I ask that the Minister of State puts the supports in place to deliver on the fair deal scheme for everyone.

2:57 pm

Photo of Róisín ShortallRóisín Shortall (Dublin North West, Social Democrats)
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The Bill before us today provides for the extension of the three-year cap on assessable property to farms and businesses for not less than 50% of their normal working time for six years. This is an issue that has been long-recognised as something that needed to be addressed. To that extent, I have no difficulty with the Bill today and the Social Democrats will not be opposing it.

What is notable about the fact that we have legislation before us on the fair deal scheme, or the nursing home support scheme as it is called, is the number of issues that it does not address. It is beyond time that we took on those broader issues. Everybody’s talking about them today in the Chamber. We are all very conscious of the shortcomings in services for older people and we are dealing with them on a daily basis in our constituencies. It is incumbent on the Minister of State and the Government generally to address those issues which have been brought into stark relief over the past year or so, and I will refer to those later. This is a pressing area given our demographics and the growing number of people over the age of 65, which is going to continue to grow very rapidly over the coming years. We have to get services, our support systems and our accommodation sorted out to meet the needs of older people and we really must go much further than this simple measure.

The legislation is notable for those aspects of services for older people that are not contained in it. Primary among these is the failure to address the whole question of home care and the promise that has been there for a long time to introduce a statutory scheme for home care, similar to the statutory scheme for nursing home care. This issue was highlighted several years ago by Members in this House, and by Brendan Courtney who did a very good television series of programmes on his own circumstances with his late father and so on. He really brought this to prominence and showed how the current system, as it operates, makes no sense whatsoever. It limits people to arrangements that are not in their best interests and forces people into nursing home care when they are not ready for it, do not want it, where it may not be in their best interests, and is an expensive option for the State. On that basis, it makes no sense whatsoever.

The other things that are missing is that the Bill does nothing to address the over-reliance on private nursing home care, which I will talk about further in a moment, and the tendency to see nursing home care as an investment opportunity and a business rather than a critical element of the social care system in the country.

The Bill makes no effort to reorientate the social care system towards the community. We are supposed to be moving people away from institutional care to services in their community and the Bill makes no attempt to address that.

I refer also to the issue raised by Deputy O’Dea which I have been talking about for many years, which is that the Bill does not include any amendments to incentivise the rental of vacant residential properties when people have moved into a nursing home.

There are a whole range of more urgent and pressing issues, or at least equally pressing issues, that need to be addressed and it is very regrettable that these have not been brought before us today in a comprehensive piece of legislation.

Central to Sláintecare is the belief that care should be delivered as close as possible to people’s homes in their own communities. That is about the ethos of ensuring that we provide care at the lowest level of complexity as close to a person’s home as is possible and recognising what his or her desires and needs are. Our population is ageing very rapidly which means more people than ever will enjoy their older years well into their 80s and 90s, which is a fantastic thing. They should be able to age independently and for as long as possible in their own homes where that suits their needs. It falls to Government to ensure that they have the care and housing options which older people rightly deserve.

When we look at the health outcomes, we know people do best when they are in their own homes. No matter what age one is, wherever one is away, be that on holidays or elsewhere, one always wants to get back to one’s own home because that is where one feels best, most comfortable and secure. We ignore those feelings when it comes to older people in the main.

Understandably, most people want to stay at home in their communities for as long as possible and it is also the best option for many different reasons. Many, however, have been essentially forced into nursing homes because of the Government’s focus on only this one narrow aspect of social care.

I will read an excerpt from the nursing home expert panel review that came out last year, after Covid-19 forced this Government to look at what was happening in our nursing homes. That review states:

In the past 20 years significant financial incentives ... were given toward meeting the costs of new private nursing homes. This major policy shift effectively handed future responsibility for the residential care needs of an increasing number of frail older vulnerable members of society to the private sector. Thirty years ago, 80% of residents in long-term residential care were in publicly-funded [nursing homes].Today the exact reverse applies with 80% in private nursing homes.

This over-reliance on the private sector has clearly failed our older people in many respects. It has led to a situation where nursing homes are largely unregulated.

4 o’clock

They have been like that for many years and were essentially left to their own devices when the dangerous virus arrived on our shores. It is not acceptable to have care institutions that are not properly regulated. This thing of keeping nursing homes at arm's length, which is what the current system amounts to, is dangerous and irresponsible of the Government and it is unfair to the residents. We know, of course, how that arm's length relationship worked out through the past year or 15 months in the context of to the impact of Covid. HIQA has been very clear in its call for regulatory reform for many years. Mr. Phelim Quinn, its chief executive officer, appeared before the health committee in March and at that meeting he stated, "It is important to note that Covid-19 has not in itself signalled the need for regulatory reform; rather, it has shone a spotlight on an issue that was already in need of urgent consideration."

The 2015 review of the nursing home support scheme looked at the need to reorientate the social care system and highlighted that home or community based care can be a cost-effective alternative to nursing home care for many older people. It states, "Admission to long-term residential care should be seen as the last resort and should only be availed of when it is no longer feasible for people to remain in their own communities with appropriate support." It further states, "Reducing the proportion of older people in residential care will require the expansion of community and home based services and perhaps, the development of alternative models of care."

The same conclusion was drawn last year by the nursing home expert panel review, which clearly calls for a revised model of social care. The review states, "There is increasing evidence to show that highly dependent persons can live safely and more happily in domestic settings, provided their required home care supports are in place." It clearly states, "Nursing homes should be part of a continuous spectrum of care of the older person in the wider healthcare system, with provision of multidisciplinary support." However, there is still no statutory right to home care in this country and the pilot scheme for it has been pushed out yet again. Having a statutory scheme for nursing home care without the same provision for home care forces people into nursing homes even if that is not what they want or the best option for them.

One of the key issues raised during the pre-legislative scrutiny of the Bill related to incentivising the rental of vacant properties. The way rental income is treated under the current operation of the scheme does nothing to encourage people to let out their homes while they are in nursing homes. All Deputies, as public representatives who have been involved in election campaigns and going door to door, see clearly the extent of this issue and the vast number of houses that are lying idle and are clearly the homes of older people. One can see all the signs such as handrails, ramps and so on, but the houses are vacant and there is nobody on the register. Those are clear signs that, in the main, these are the homes of people who have gone into nursing homes and which are lying idle. At a time when we have a serious housing crisis, it makes no sense whatsoever to have thousands and thousands of homes lying idle. Of course, it makes no sense from a financial perspective either. There should be a way of addressing this issue which ensures that people do not lose, euro for euro, any income they get from letting their homes. Many Deputies have been talking about this for years. There is a real urgency about that. The Minister of State should raise this with her colleagues in government, particularly the Minister for Health, Deputy Donnelly, but also the Minister for Housing, Local Government and Heritage, Deputy Darragh O'Brien. It should not be beyond them to come up with a scheme that addresses this issue and is better in terms of the costs involved in nursing home care, but also ensures that those homes are brought into use.

Right now, there are more than 13,000 homeowners on the scheme but only approximately 740 of them lease their home. Some properties are occupied by partners or family, and that is quite understandable, but that still leaves many thousands of vacant homes. More often than not, the homes are left empty because rental income is assessed. In light of the major housing crisis, the Bill should have taken note of that issue and addressed it. Legislation is needed urgently to change how rental income is assessed. This could instantly help people in nursing homes to generate extra income while also dealing with the housing crisis.

The responsibility for creating better options for older people as they age does not fall only under the remit of the Department of Health. Sage Advocacy, which provides advocacy and support for older people, has been very vocal on this. We need to listen to older people regarding what they want, what their wishes are, what is in their best interest and how they can be best supported into their older and frailer years.

It is extremely important that the Minister for Housing, Local Government and Heritage takes action on the issues of supported housing as well. The 2015 review of the nursing home support scheme recommended that sheltered housing and assisted housing models should be considered to provide more options for people as they age and to ensure that greater overall capacity is created in supported living. There are many different models of that with which Members are familiar. There is no standard model. There are various such models but there is not anything like enough capacity to meet the significant need that is there. If older people had better housing options that enabled them to live independently for longer in local communities, many would choose to do so rather than maintaining and heating costly homes that are larger than needed or paying property tax, for example, on a home in which not all of the rooms are used.

All Members are familiar with constituents such as an elderly couple, an elderly single person or a widowed person living in a three-bedroom or four-bedroom house. They really struggle to maintain the house as they are on a fixed and usually low income and they are faced with many maintenance and energy bills and property tax but their options are so limited in terms of what they can do. I regularly get queries from constituents asking whether there are any options for them to move to designated older people's supported housing so that they can continue to live independently and live full lives but not have the burden of trying to maintain a bigger property. Even a two-bedroom or three-bedroom property can be very difficult for an older person to maintain. If there were better options available, we could cater much better for older people. I do not know why that is not being done; it just does not seem to make sense.

I am very familiar with what is done in other countries. In Germany, for example, 10% of units in every housing estate are designed for older people so that when a couple or an elderly person is left with an empty nest, they do not have to move out of their community or struggle to try to maintain their home. Rather, they can move down the road, into a more appropriate housing unit within the estate.

One obvious and important part of the response is to designate housing for older people and to enable purpose-built accommodation, but the current housing strategy of the Government largely overlooks this. There are examples of such housing in London, where there are flat complexes or apartment blocks that are designated for over-55s or over-60s. They are very suitable for people who want to downsize. We do not have any equivalent here in the private sector and that makes no sense whatsoever. We should have that designation because at the moment the only option for an older person is to move into an apartment and, as Members are aware, there are no apartments for sale at the moment because the funds are gobbling them up.

There must be designated housing for older people where they can have that kind of security. Older people do no want to move into a mixed apartment block where a gang of students or otherwise could be living next door to them and where it would not be suitable for their needs.

I ask the Minister of State to consider designated developments for older people, which could be built on many of the small infill sites in our cities and new estates could include a mix of older people's homes as well as family homes. This would enable people to move to more appropriate accommodation as they age. There are some models of dedicated housing schemes in Ireland, but there is no standard consistent model in place. This is happening in many other countries and we should be doing the same. There are also sheltered housing schemes run by local authorities and they have proved to be very successful. When people are getting older, they need easier to maintain and more accessible housing. Local authorities had been providing that on a widespread basis, but they have largely stopped doing that. We need local authorities to get back into that area, not only for the sake of older people, because that is what they want, but also to address the wider housing issue.

The financial contribution scheme is a very good one. I do not know if the Minister of State has come across it. It was used widely in my constituency and in other Dublin areas during the 1990s. People sold their homes back to the council, they kept a portion of the proceeds and in return they were offered supported sheltered housing units that were accessible, easy to maintain and well insulated, with supports around them. That was the ideal arrangement. From the local authority's point of view, it got back family homes which it could re-let. They were pepper-potted around the area rather than all in the one place. That is something which must be restarted. Different levels of support can be provided. There are some good models in existence. There is a very good one in Clareville in Glasnevin, which has been there for about 20 years. Different services are brought in. As a security measure, there is somebody on site who drops into people. All the other services, such as public health nursing, can be brought in. Meals on wheels can provide meals everyday if people require them and if not, that is fine. We must be much more ambitious in relation to the kind of support services older people need.

3:17 pm

Photo of Fergus O'DowdFergus O'Dowd (Louth, Fine Gael)
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I welcome this debate and the Minister of State, Deputy Butler. Anytime I have raised issues in relation to the care of older people, she has always listened and she is very attentive to the excellent debate we are having this afternoon. I have every confidence, having discussed it with her in this House and in private, that statutory home care packages for all families who want to receive them is the way forward. That is absolutely critical and essential. It is an essential promise in the programme for Government. There is universal support from those of us in this House who articulate that demand.

I agree with what this Bill seeks to achieve. I congratulate the IFA and business groups for ensuring that all family members, no matter what their income or background, are treated fairly and appropriately under the fair deal system. There are many good things about the fair deal system. This is an additional support which will be very welcome.

I am concerned about the deaths in nursing homes during the past year as a result of Covid. There is an urgent need for an independent inquiry into these deaths. Through my investigations, queries and freedom of information requests, I believe there must be an independent inquiry into what happened in the Dealgan nursing home in Dundalk. I discovered two precedents recently under a freedom on information request. There are inquires-audits-investigations ongoing into two nursing homes, namely, the Tara Winthrop private clinic in Swords and the Phoenix Park community nursing unit. I do not know the reasons this is happening but I welcome them. It is absolutely critical that the Dealgan nursing home is independently investigated. It is the only nursing home in the State that the HSE went into and, with the consent of the owner, took over the running of it and in which more than 22 people died.

I agree with the point that a nursing home should be the last option. With all due respect to the people currently in one, I believe a nursing home is the last place, medically and physically, one should be in. Support should be provided in one's home or in sheltered housing and through the many good ideas Deputy Shortall outlined.

One issue that has arisen because of Covid is the inability of survivors to meet repayments after a person who had benefited from the fair deal scheme has passed away. There is a difficulty in meeting the 12-month requirement. The Revenue Commissioners want their income back within a 12-month period after the passing of the person. I think the time period should be extended and the interest should not be demanded for a further six to nine months, or even a year, while maintaining adequate precautions. People cannot get houses repaired at the moment, as we all know. One could not bring in a builder until recently. If a person has to sell a home, we should not penalise him or her because of Covid.

I want to express my deep concern about the potential for elder abuse if we insist older people living in their homes must go into nursing homes, or other care institutions, before their time. I am very reluctant to make any change to the right of an individual to live in his or her home for as long as he or she possibly can. I oppose absolutely family pressure, financial pressure and other pressures on older vulnerable people living in a home they have lived in all their lives, for 70, 80, 90 years, and pushing them into a nursing home as quickly as possible. That is wrong and is absolutely morally unacceptable. We must examine that proposal in greater detail.

Some 70% of people who are in nursing homes suffer from dementia. Dementia is not like the flu - here today and gone tomorrow - it gets progressively worse. I know of many people who are broken-hearted looking after a family member at home as the dementia proceeds and increasingly disables the individual cared for. We need due and proper recognition of any pressure which may be inadvertently put on such individuals to get out of their homes. Their quality of life and their familiarity with their bedroom or kitchen is hugely important to them. The only knowledge they may have of their very existence may be something as small and as simple as a favourite teapot, cup or chair. Before we go down that road, we must look at the decision-making process we would make if we were be put in that situation. Consent is the most important thing. How can one give his or her consent in advance to such a decision? The protocols put in place should be clear and absolute. I am very concerned about it. We should be looking at research on it from other countries.

I support the Minister of State's reluctance to introduce this without due and proper thought. Older people have given their lives to society and their families. They do not want to be placed in a situation where there is conflict between family members, with children saying to parents who suffer from dementia that it is time for them to get out because they cannot pay for their care without doing this. The fair deal scheme is there to protect that individual. That is what it is there for. The asset is not disposed of until the person has passed on and there are no other survivors who are entitled to live in the home. I am reluctant in respect of that.

I have no doubt this Bill is very important and I look forward to contributing on Committee Stage. I advise proceeding really slowly on the other proposal and the Minister of State has my full support on that.

I welcome this amendment to the nursing homes support scheme. I am happy to support it and it is long overdue. For years, many families with small farms or businesses have been charged 7.5% of the value of the farm or business to pay for nursing home care. It is draining those farms and businesses and making them unviable. I am happy to see the 7.5% will be capped to three years. However, I believe it will not be retrospective, which is quite unfair because of the length of time it has taken this Bill to come to the Houses of the Oireachtas. Many families have been waiting for this, as has been discussed, over a number of years but nothing was done. It is better late than never but some repayment or reduction in fees should be considered for those who have been paying since 2018.

There is an overemphasis by the HSE on nursing home care for elderly people. There are other options. The HSE has indicated that under Sláintecare it will invest more in providing home-based supported living for elderly people. I welcome that but at the moment not enough is being done in that quarter. I know of several people who would be able to live in their own homes and be much happier there but the home support packages are not available. There would be a saving for the State and, more importantly, people would be able to continue living in and contributing to their community.

Recently I raised as a Topical Issue the upgrading of boarding out regulations. I also raised that issue with the Minister personally and with the Department. It is a much more cost-effective form of care for elderly people based in the community. It suits people who cannot or do not want to live alone but do not require nursing home care. It and other options need to be looked at as there is far too much emphasis on nursing home care. Many people being discharged from hospital are directed towards living in a nursing home instead of looking at what other options might suit them. It may be the most suitable option for many, but it is not for all.

The programme for Government contains a commitment to reform the nursing homes support scheme to incentivise renting out vacant properties and encouraging vacant accommodation to be brought back into active use. It is disappointing it is not being followed through in this Bill. There was potential to free up approximately 9,000 properties if it had been included in the Bill. We are in the middle of a housing emergency and that would have been a most welcome move. That is unfortunate but I welcome the amendment as it is.

3:27 pm

Photo of Gino KennyGino Kenny (Dublin Mid West, People Before Profit Alliance)
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I want to say this Bill addresses enormous problems in the care of older people in Ireland but it does not really address the profound problems we have in that provision. The past 15 months have exposed the inadequacies of the model of residential and long-term elderly care in Ireland, particularly around staffing levels, medical expertise, resources including personal protective equipment and payment and treatment of staff. There are limitations in the model we have. As Deputy Shortall said, 20 years ago the ratio of nursing homes was 80% public and 20% private. Now that has reversed completely and it has been Government policy over the last 25 years to incentivise tax breaks for wealthy individuals and companies to invest in large-scale private residential nursing homes. In Clondalkin, two multi-bed nursing homes are being built at the moment. The model has compromised care of the elderly. I would like to see it reversed and a model in which 80% of nursing homes or all of them are publicly run for the good of our elderly citizens. That is the way I ideologically see it. It even makes economic sense, rather than giving it to the private sector.

A number of Deputies have mentioned the fair deal scheme, which has been quite controversial since its inception over a decade ago. Some people have huge difficulties with it but, in some ways, it shifts the onus onto families where the cost has shifted to the private sector. There are huge gaps in the fair deal scheme in relation to those who can or cannot pay and the money going to the private sector. Alarm bells always ring when the private sector sees this as a model to make profits, while the State has given up its obligation to care for older people. There are very good, well-run nursing homes in the private sector but I do not think any healthcare should be in private hands, especially the way we have it now. During the pandemic, there were gross inadequacies around private healthcare.

As Deputy O'Dowd has stipulated, there is an onus on the Government to call a public inquiry into all deaths in nursing homes. Just over half of those who have died in the South of Ireland have been in nursing homes. They were extremely difficult circumstances for all the people working in that setting. There were times when people did not get to say goodbye to their loved ones. It is profoundly difficult. The least we and the Government can do is have a public inquiry into what happened in the last 15 or 16 months during the pandemic. It is important that families and loved ones have some closure about what happened to their loved ones and that this never happens to anybody in those circumstances again.

Photo of Niamh SmythNiamh Smyth (Cavan-Monaghan, Fianna Fail)
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I congratulate the Minister of State. I do not want to underestimate the work she has done and what she has achieved in delivering this. As Fianna Fáil's Opposition spokesperson for older people, she often spoke about the unfairness of this and how it was debilitating in terms of allowing people to go forward for the fair deal scheme. Not only has she spoken about it and, as Deputy O'Dowd said, listened, but she has delivered on it in a short time in office.

This change to the scheme that Fianna Fáil has long sought will mean that, after a period of three years, the value of the family-owned farm will no longer be taken into account when calculating the cost of a person's nursing home care. This will happen where a family successor commits to working the farm or business. We often talk to young farmers who feel it is difficult to find a future in farming and all of that plays into what the Minister of State is trying to do. This change is essential to the viability and sustainability of family firms and allowing them to pass down to the next generation, which we all want to see, particularly those of us in rural constituencies like my own of Cavan-Monaghan. It will ensure that the fair deal is fairer, more accessible and more affordable for family farms.

This has been a hugely emotive issue for family farms and communities across Ireland and one that Fianna Fáil has now acted on. I am happy to see critical steps have been taken with the publication of this vital Bill. The Minister of State has listened, heard and responded to the calls from family farms and businesses seeking fundamental reforms, which she has achieved. I hope the Bill receives the full cross-party support it deserves so these hugely important changes can be delivered without delay.

The nursing homes support scheme, commonly known as fair deal, is a scheme of financial support for those in need of long-term nursing care. The scheme aims to ensure the care is accessible and affordable for everyone and that people are cared for in the most appropriate settings. Under fair deal, residents make contributions to their care based on a financial assessment of their income and assets. In the assessment, the capital value of an individual's principal private residence is only included for the first three years of a resident's time in care.

This is known as the three-year cap. The nursing homes support scheme has been in operation for the past ten years and there is broad agreement that the scheme operates well and continues to provide appropriate financial assistance where it is required. However, the Government recognises that the current three-year cap and financial assessment of a person's income and assets applies to family farms and businesses only in the case of sudden illness or disability. This situation may place unnecessary financial pressures on families and would challenge the future viability of farms and businesses. I am delighted that this amendment deals with the issue. The Bill delivers on the programme for Government commitment to address it by introducing additional safeguards to the scheme to promote and protect the sustainability of family farms and businesses that will be passed down to the next generation.

The Covid-19 pandemic has brought into sharp focus the vulnerability of many older people, especially those living in long-term residential care. It is critical that the public investment in long-term care services is maintained for those who need it. Care must remain accessible and affordable at all times.

The nursing homes scheme has been in operation for the past ten years, since 2009, and on 31 December 2020 more than 22,000 people were participating in the scheme at an annual cost of more than €1 billion. That is an endorsement of the popularity and usefulness of the scheme. Participants in the scheme contribute up to 80% of their assessable income and a maximum of 7.5% per annum on the value of assets held. In the case of a couple, the applicants' means are assessed at 50% of the couple's combined income and assets. The first €36,000 of an individual's assets and €72,000 in the case of a couple are not counted at all in the financial assessment.

I extend my heartiest congratulations to the Minister of State, Deputy Butler. She is only ten months in office. She spoke about this issue on many occasions in opposition. I am thrilled for her and for lots of people across the country that the matter has been acted on and the Bill is being delivered and implemented.

I have had direct experience of people close to me being in need of primary care. I thank all the staff working in nursing homes and in primary care. A close family member with complex needs is now being cared for at home. The care, compassion and empathy his family have received from the primary care service have been second to none. I include carers, dieticians, physiotherapists, speech and language therapists, occupational therapists and GPs. It has not been easy during the pandemic for staff with such expertise to go into homes, but they have willingly delivered the service and allowed people the opportunity to be cared for at home if that is their wish. I cannot overstate what that means to a family, a husband, a wife, children and the extended family. That was the case in particular during the pandemic because such restrictions had to be imposed on nursing home and hospital visits. That is something the Minister of State, Deputy Butler, has addressed in order to allow families to get in to see their loved ones. I compliment and congratulate the Minister of State, not only for listening but also for delivering.

3:37 pm

Photo of Pa DalyPa Daly (Kerry, Sinn Fein)
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There is little doubt that the Covid-19 pandemic has exposed some of the issues regarding how we take care of the weaker in society, in particular the elderly. At one stage, much was made of the differing death rates between Ireland and the UK, where the use of nursing homes is more widespread, and places like Spain and Italy, where it is more common for multiple generations of the same family to reside together. Needless to say, the comparison eventually fell foul of the rising case numbers, and while heroic efforts were made by staff and others to keep the virus out of nursing homes, many eventually succumbed to the awful reality of the virus. I understand that half of the deaths occurred in nursing homes.

The Oaklands Nursing Home in Listowel made national headlines during the second wave when the virus found its way in from the community. HIQA previously expressed concerns in the lead-up to the outbreak. I believe what happened in Oaklands and in other nursing homes must be part of a public inquiry into the State's response to Covid-19. While there is a place for good, private operators, the outsourcing of elder care to private operators has caused problems. The HSE should have more of a role. When problems emerged in private nursing homes they called on the HSE for assistance. I pay tribute to all healthcare workers, but especially to the ones in the Cork-Kerry community healthcare area, who rolled up their sleeves, went into places and sorted out the problem, putting their own lives at risk.

I would also like to see a review of how elder care is provided generally across the country, including a review of HIQA. It is clear that there is significant demand from families to get their loved ones into a HSE-run nursing home in County Kerry, in particular in north Kerry, where there is no HSE-operated home. I reiterate my call for the HSE to commit to the provision of a new community nursing home in north Kerry.

We also need to change radically how we provide and fund these facilities. A public model is easier to regulate and, when we consider that 80% of all residents in private homes avail of the fair deal scheme, we are effectively operating a publicly funded model already. People requiring elder care are some of our most vulnerable and they deserve better.

Photo of Seán CanneySeán Canney (Galway East, Independent)
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I wish to share time with my four colleagues.

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Ceann Comhairle; Kildare South, Ceann Comhairle)
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Is that agreed? Agreed.

Photo of Seán CanneySeán Canney (Galway East, Independent)
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This Bill is welcomed by everybody. I thank the Minister of State, Deputy Butler, for bringing it forward with such haste. The Bill is long overdue. I wish to mention the previous Minister of State, Jim Daly, who worked on the Bill. He probably got some of the legal wrangles sorted out for the Minister of State, Deputy Butler, and I want to acknowledge his work.

It is important that we protect family farms and businesses. It has been an anomaly in the system that there was no cap on the contribution in the same way as there was on a private house. It will make sure that businesses are safe. There is a lot of trauma involved when a member of a family has to go into a nursing home. If there are financial worries as well, it is important that we try to sort them out. The exposure that existed was genuinely a worry for many families with farms or businesses, as it meant they might have to sell the farm or business to pay for the nursing home care.

I wish to refer to a woman in my constituency, Maura Canning, whom I met some eight years ago. She was campaigning on this issue on behalf of farmers and their families. She never gave up, she just kept at it. I acknowledge the work she did on the issue over the years to bring it to this stage. She deserves credit.

I also acknowledge the work that has been carried out by staff in nursing homes in the past 15 months. They have always done the work, but it came to the fore, especially in the family-run nursing homes, how they performed in their duties against all the odds to try to protect as many of their residents as possible. I had first-hand experience of that in Green Park Nursing Home in Tuam where I saw what they were doing. The pandemic was very tough on staff and we must acknowledge the input of every member of staff. We must also acknowledge that when a crisis developed in certain areas, members of the public who had medical training donned their nurses' uniforms again and went back to help out. That is a sign that we are all in it together when it comes to care for the elderly.

I wish to raise the significant differential rates being paid to the private nursing home sector, especially to family-owned nursing homes. This is something I have come across and Nursing Homes Ireland, NHI, has spoken about it on numerous occasions. Different nursing homes are getting different rates of allocation from the HSE and there is no apparent reason for that.

In one case where a nursing home is providing dementia services, the HSE does not recognise that as an additional service that they provide and it refuses to give them any type of increase in their rate. That needs to be examined because there is such a variation in what is being paid to nursing homes, yet the services they provide are the same. That is wrong and needs to be upended to make sure everybody is treated fairly.

Small, private family nursing homes, those that have a 50-bed or 60-bed unit, have to make sure they can meet all their bills. They are providing local employment and they need to be treated with parity and equality. There is no reason different rates should be available to different nursing homes. It is archaic. It is something that was brought in at one stage but now, if percentage increases are being offered, it means the person on the lowest rate will end up with less money. There is also no recognition for specialist units. I request that a review be undertaken as a matter of urgency.

In addition, there is no independent appeals process if people feel aggrieved with the rates they are getting. The process is reviewed within the HSE and it takes months to do that. In the meantime, the nursing home is left on the old rate, which is causing a severe financial burden, especially as they are now investing more and more in safety and in strategies to ensure they deal with every kind of pandemic that arises into the future.

3:47 pm

Photo of Peadar TóibínPeadar Tóibín (Meath West, Aontú)
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The HSE confirmed to me in recent days that approximately 750 people who caught the virus while in hospital have died. We know that 2,000 people who also died of Covid-19 in the State were nursing home residents. These are truly shocking statistics. When we add those two figures together, we learn that 56% of all the people who died of Covid in this State did so in either hospitals or nursing homes. A majority died in facilities that were either run by or regulated by the State. While many people were pointing the finger of judgment at pubs, masks and beaches, more than half of Covid deaths were among people in the care of the State.

We also know that where people died from Covid in a nursing home or in HSE care, these were very tragic situations. They were often situations where people had an injury or a fall and were presented to hospital for examination, caught Covid in that hospital, deteriorated quickly and, sadly, passed away. One of the most tragic aspects was that it was due to the shortage of staff in many nursing homes and hospitals. This led to difficulties with people finding out what was happening in nursing homes. At St. Mary's in the Phoenix Park, families only learned about outbreaks through news bulletins and, scandalously, this was all too common. In response to a parliamentary question, the State Claims Agency told me that at least five families are suing the State regarding the circumstances of family members catching the illness in hospitals or nursing homes.

Last week, the Department of Health told me that 74,283 people had signed up for the Be on Call for Ireland recruitment campaign but a mere 355 of them were actually recruited. That is hard to believe. I listened to nurses from nursing homes and hospitals crying on the phone to me, telling me they needed staff as soon as possible. Some of them were actually going on social media, asking members of the public to help them.

It also emerged last week that the Government is carrying out an inquiry into the State's handling of the pandemic, which I welcome, and we had called for that. Nursing homes should be the primary focus of that inquiry. I have much respect for the Minister of State and it must be borne in mind that many of the fatal mistakes that were made with regard to nursing homes were made before she went into government. Let us take, for example, the fact that when the pandemic broke out, nursing homes decided to close their doors to visitors, only to be slapped on the wrist by NPHET and the Department, and told that the doors should remain open and closure was not necessary. We were also told in reports that the HSE intercepted supplies of PPE, oxygen and staff that were designated for nursing homes, and “intercepted” is the word that was used by the health spokesperson for Fianna Fáil at the time, Deputy Stephen Donnelly. Freedom of information documents show that the Minister, Deputy Simon Harris, repeatedly ignored meeting requests from Tadhg Daly of Nursing Homes Ireland during that time. On 16 April last year, the Minister of State, Deputy Butler, furnished this House with a survey she had conducted of nursing homes, which found that 60% of them had no supply of PPE.

I welcome the fact the Government is launching this inquiry but we need to have a discussion about how it will run. We need to have a discussion in Leinster House on the terms of reference of this inquiry. There is no way this inquiry should fail to have the input of all elected representatives in the Dáil and all of the 26 counties of the State. The Government, the previous Government and the HSE have serious questions to answer about what happened in nursing homes and in hospitals around the country, and how the pandemic was handled. We need to get to the truth of it.

Photo of Peter FitzpatrickPeter Fitzpatrick (Louth, Independent)
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I will first talk about the Bill and then nursing homes. I welcome the Bill, which introduces a three-year cap on the financial contributions of family-owned and operated farms or businesses when calculating the cost of nursing home care. The cap applies where a family successor commits to working the farm or business continually for a minimum of six years and commits to working the farm or business not less than 50% of their normal working time. The family successor must also have worked on the farm or business for three out of the previous five years.

Commonly known as the "fair deal", the nursing homes support scheme, established in 2009, is a system of financial support for those in need of long-term nursing home care. Under the scheme, a financial assessment is carried out by the HSE to determine how much each applicant will contribute to the cost of their care. Participants contribute up to 80% of their assessable income and up to 7.5% per annum of the value of any assets held towards the cost of their care, although a participant's principal residence is only included in the financial assessment for the first three years they are in nursing home care, regardless of how long they spend in care. Anyone who is ordinarily resident in the State and needs long-term nursing home care can apply for the scheme.

Where an individual's assessed weekly contribution is greater than the cost of care, they do not qualify for financial support. Therefore, applicants with substantial assets or incomes are unlikely to qualify for financial support. The capital value of an individual's primary private residence is only included for the first three years of a resident's time in care. This is known as the three-year cap. However, to date, the three-year cap has only applied to family farms or businesses in cases where a farmer or business owner suffers a sudden illness or disability and, as a result, requires nursing-home care. When the three-year cap does not apply, this can result in financial pressures on these families and could challenge the future viability of the farm or business. Introducing a three-year cap on the financial contributions of family farms or businesses will help protect the sustainability of family farms and businesses that will be passed down to the next generation. The changes have been long-awaited and will bring relief to many families.

The maximum contribution, based on the capital value of a farm or business, will be 7.5% per annum for three years only, provided that all the conditions of the scheme are complied with. The current system sees farm families and business owners required to set aside 7.5% of the value of their land annually to fund a place in a nursing home. This means the family farm could be lost to the next generation after 14 years as it would drain the value of the farm to pay for the care of a family member in a nursing home.

Many older people were not going into care out of fear that the farm will not be there to hand on to the next generation. This should not happen. I am relieved this new legislation will resolve the situation. Care must remain accessible and affordable, including for those families with a farm or a business. Many of those with farms and businesses have worked extremely hard to build their business from the ground and they employ local people in the area. They deserve this additional safeguard to protect the sustainability of family farms and businesses.

It is important that we protect our older generation as much as any other citizens. Many families are grieving at the moment. The bottom line is that they simply want to know what will happen to loved ones. I am glad there will be an inquiry. It has gone on a long time and there has been a lot of bad publicity for nursing homes during the Covid-19 pandemic. In fairness, some deserve it, but some do not. Given my experience as a Deputy for the past ten or 11 years, I have nothing but respect for nursing homes.

My mother was in a nursing home for three years and the staff, management and everyone involved in the nursing home did a fantastic job. It is very important that the nursing homes that abused, or whatever they did to these residents, are held accountable. I have visited many nursing homes in my own town of Dundalk. They and the families want closure. I appeal to the Minister of State on this, as it is very important.

We must also mention the HSE. When it came to equipment for the nursing homes, they were left wanting. The HSE really let the nursing homes and the families down, and the nursing homes feel that themselves, and I hope the investigation also looks into the HSE's performance. The nursing homes in Dundalk have done really well but when it came to getting food delivered, some small businesses in the town actually refused to go to the nursing homes. That is not right.

Many families are grieving, which I know from my town of Dundalk. They have lost their mothers, fathers, uncles and aunts and they just want answers. This is going on for more than 12 months. I ask the Minister of State once again to look into it.

3:57 pm

Photo of Verona MurphyVerona Murphy (Wexford, Independent)
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I am happy to see this Bill come forward. It has much to do with the Minister of State's progress since taking office. When we talk about farming, we are often limited in what we can say and do within the parameters of EU rules and regulations, often to the detriment of farming communities. However, with the fair deal scheme we cannot blame others or pass the buck on the treatment of farmers. Successive Governments have been solely responsible for this unequal treatment of farmers and it is welcome that steps are finally being made to level the fair deal playing field. I will attribute that to the Minister of State.

The nursing home support scheme is a vital State support, which ensures those in need of care are able to avail of it in an affordable way but up to now for farmers and farm families it could better be described as the "unfair deal". It has been an unfair deal because farmers have been expected to pay higher contributions for their care than others. The scheme in its design did not take into account the unique situation in which farmers found themselves. The 7.5% contribution from the value of assets towards the cost of care is capped for all other sectors but not capped for farmers. That means if a farmer had been in long-term care, as Deputy Fitzpatrick said, for 14 years, then the farm could actually be lost. It is not just the farm. In most cases, family farms, farmed for decades, are passed down generation after generation. The Bill is, therefore, very welcome. It is a step in the right direction but even its passing will leave some outstanding issues to be addressed. Members of the farming community have shared with me their continuing concerns. The demands made by the Bill are quite restrictive. The successor is tied to farming the land for six years after the client enters the nursing home. It places a heavy burden on the successor who will still have to commit to paying fees of up to €200,000 over the initial three-year period.

We must remember that a farm is a working asset and if the farmer has to sell land to make payments, we hurt their ability and the ability of future generations of the family to make a living from the farm. The average farm income is well below what we would call an industrial wage. It could be as little as €24,000 when the annual nursing home charge can be between €50,000 and €60,000. Farms will be mortgaged to meet care payments, which will restrict the ability of farmers to borrow for farm development or machinery and other related capital expenditure necessary for progress. I appeal to the Minister of State to examine ways to address this.

Life expectancy has steadily increased. In 1950, life expectancy in Ireland was approximately 65 years. Now, thankfully, it is approximately 82 years and projected to continue rising. As people are likely to live for longer, it stands to reason that the average time spent in long-term care is also likely to increase. This will affect people in every walk of life but I believe it will have the greatest effect on farmers and their families. We must be proactive in preparing for it.

I will support the Bill as it is a step in the right direction that will make a positive difference to farmers and farm families who find themselves in these situations. However, I hope the Government will take on board the issues I have raised and that were raised with me by the farming community and take the steps necessary to solve the problems. I acknowledge the input of Alice Doyle from the IFA in Wexford, as well as the nursing staff in our nursing homes who have been under severe pressure because of Covid, just like all the front-line staff, who have, in most cases, done a stellar job.

Finally, I endorse the point that there are many small nursing homes. Deputy Canney spoke about how bed funding is allocated to different nursing homes. It is a significant issue in Wexford. In Wicklow, €250 more is paid for a nursing home bed. I have looked into why that is the case but have not been able to come up with an answer.

Photo of Colm BurkeColm Burke (Cork North Central, Fine Gael)
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I thank the Minister of State for bringing forward the Bill, which I very much welcome. I also join in paying tribute to all those working in nursing homes, the staff, care assistants, the people who provide the meals and the management in all the homes across the country. It has been a very difficult 18 months for everyone. The current scheme provides that 80% of the person's income goes towards nursing home cost. If they are the owner of a dwelling house, it is 7.5% per annum for a maximum of three years, so the maximum that can be taken when a person has a dwelling house is 22.5% over that three years, if they survive for that period. The same cap does not apply to businesses and to farms and, therefore, I very much welcome the proposed change in the Bill which was clearly set out in the review published in 2015.

Sometimes the State is slow to act on the changes required. I can go back to a ward of court case in 1976 called Maud McInerney in the Supreme Court where the court decided that nursing home care came under the definition of "medical care". Therefore, anyone with a medical card was technically entitled to free nursing home care. It took a further 28 years before the Department of Health and the health boards reacted. They continued to deduct 80% of pensions even though there was no proper regulation or legislation to allow them to do so. It is only when a number of us in the legal profession challenged it in 2004 that suddenly changes were made. It should not have taken 28 years for a proper structure to be put in place. Until the time of the fair deal scheme, it was hit and miss whether someone got a bed in a public nursing home or had support if he or she was in a private nursing home. It was interesting how, in 2004, emergency legislation was rushed through in three days which tried to make nursing home charges retrospective. The then President, Mary McAleese, referred it to the Supreme Court and, in February 2005, it found it unconstitutional. That meant it was back to the drawing board and a refund of more than €400 million to people who had been charged in nursing homes over previous years. This raises the question of why it takes us so long to bring about necessary change. I very much welcome what occurred after 2004 and the introduction of the fair deal scheme. What was done was very fair and brought about the necessary changes except for those who were farmers or in business.

5 o’clock

The necessary change was not made for them. I recently encountered the case of a man who had paid more than €480,000 in nursing home charges, which is a substantial amount, over ten years before he died because he was not in the fair deal scheme.

Let me address the provisions of the Bill, particularly section 3 and the circumstances that arise when a farm is transferred and the transferor needs nursing home care within five years of the transfer. If a son or daughter to whom a farm is transferred borrows substantially to invest in it and his or her parent ends up in a nursing home, the question of how to service the debt arises when the debt is registered against the farm at a later date. We must ensure that the interest rate is not above the current bank interest rate. This needs to be examined carefully.

I am sure every Member has come across very difficult cases. I have had a case involving a son who had a farm transferred to him and who had it in his possession for more than five years. His father died and then he was killed tragically himself in an accident but had no will made. The farm reverted to the mother, who ended up in a nursing home. A question arose over the entitlement to take the farm into account in determining what should be paid to the nursing home. Those are very genuine circumstances. I came across the case of a man who died and left his farm to his son and mother. The mother ended up in a nursing home but the farm was not yielding a sufficient income to pay the nursing home charges. Fifty percent of the value of the farm was taken into account in calculating the charges. These are very genuine cases. We need to be careful when putting in place the regulations. While I very much welcome the three-year cap, a valuation does not necessarily identify whether there is sufficient income to service the debts. We need to be careful about this.

On nursing home care and responding to the changes needed, we all want to develop home care. In rural areas, there are major challenges in getting people to give care. We do not have a sufficient number of people who can provide the type of home care in question. We need to determine how we can encourage more people to provide the service and obtain the necessary training and skills. That is the biggest challenge we will face in the next ten years. The number aged over 65 is currently 720,000. By 2030, there will be 1 million. We need to increase the number of people who can provide home care immediately if we want to keep as many people in their own homes for as long as they want to stay in them.

I thank the Minister of State for introducing this legislation. I look forward to working with her to have it passed and implemented at an early date.

4:07 pm

Photo of Donnchadh Ó LaoghaireDonnchadh Ó Laoghaire (Cork South Central, Sinn Fein)
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As Deputy Burke outlined, nursing home care and care homes will become a more considerable issue politically and socially in the years to come, undoubtedly because of our growing and ageing population. The Deputy outlined that there are challenges in this regard. Undoubtedly, there are but it is important that we acknowledge that it is good that people are living longer. What is important is ensuring that if we live longer, we live a life of good quality, be it at home or in a nursing home.

The pandemic highlighted the fact that there were significant issues in some homes, including governance issues and failings, but it should be acknowledged that the standard of care in many homes is very high. However, we have a system that operates on an ad hocbasis. There is a mixture of community, private and HSE-led services in a sector that we need to consider as public. The State needs to regard the sector as one in which a minimum standard of care is provided. It needs to be responsible for that. It should outsource less and allow others to take less responsibility, as is the case in education and health services, generally, and in many other public services. We need to ensure a minimum standard. This is essential. Forthcoming legislation needs to address this.

The three-year cap is sensible and logical. The circumstances in which people can find themselves when engaging with the fair deal scheme can be extremely challenging so we need to be as fair as possible to them. I welcome the changes in this regard.

There are two other areas we need to address. To flag an issue, I have come across people entering the fair deal scheme or seeking a nursing home bed who have come from mental health facilities and through the mental health system. There is a challenge in this regard in respect of getting transition funding cleared. It is sometimes the case that, by the time the transition funding is cleared, a bed can be gone, meaning the family in question or the nurse helping them has to start the work again. We need to make the system a little more transparent and effective in this regard.

The vast majority of people want to be cared for at home for as long as possible. It is what patients, citizens and families want. It is also probably better medically. We need a statutory home care set-up. We need to think about legislation underpinning this. At the heart of this are the home helps. We need to ensure they are well paid and that their employment supports are secure. We need to have more of them because the waiting lists are far too long.

Photo of Mattie McGrathMattie McGrath (Tipperary, Independent)
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I congratulate the Minister of State on this. We have had many battles over St. Brigid's hospital, Carrick-on-Suir. We have been waiting for equality and fairness for farming families and self-employed people. My colleagues in the Rural Independent Group and I will table amendments because there are still anomalies regarding farmers not being treated fairly. Regardless of how long it took to get this right, everyone accepted it was wrong. It took four or five years to get to where we are. Former Minister of State, Jim Daly, did a lot and tried his best. I acknowledge that it was the current Minister of State who got it over the line. I compliment her on that. There are still aspects that are so inherently unfair, however. There is a yearly cap of 7.5% of the value of the home, capped after three years, but I am referring to those with a farm or business. We should remember a farm is no good unless a farmer is able to work it. If it is going to be stripped away for years, it is no good. What will happen those who were severely punished? I realise the legislation cannot be made retrospective but surely the individuals should have some redress because farms and small businesses have been rendered useless by the annual charges. We have to look after our elderly. They were always revered in this country and we respected them but now there is a tragic situation.

The differences in the prices of public and private nursing homes, as mentioned by Deputy Canney, are shocking. The cost of the public ones is shocking. It is also shocking that there can be so many anomalies.

I salute the staff, management, nursing home owners and their families for the sterling work they have done in the past 14 months. They were abandoned by the Government but they did great work. I salute Mr. Dermot Dougan of Clonmel especially because he has added a massive extension to Melview nursing home. There is a spanking new, pristine nursing home only up the road from the Minister of State, Deputy Butler, in Carrickbeg. There are supposed to be negotiations on taking patients out of St. Brigid's, which is no longer with us thanks to the Minister of State and the Minister. I ask the Minister of State to meet Councillors Kieran Bourke and David Dunne and the action committee, nurses and doctors. She is responsible for the care of the elderly and palliative care. All the people going into the facility were older people but now the palliative care beds are denied to the people of the surrounding area, including the Minister of State's county, Port Láirge. It is very unfair and downright wrong. The people funded those beds and all the associated technical equipment. I ask the Minister of State to have an open meeting with the relevant individuals.

There is no point in telling Damien Tiernan and Waterford Local Radio that he spoke to them and offered a meeting. They were not offered a meeting. They were refused.

Getting back to what happened in the nursing homes, 2,000 people died in them. Just think about it. They could not get PPE, staff or anything. They were crying out for help. Doctors were refusing to go in to sign the death certificates. Nurses and nurse managers were asked to sign the death certificates. They were put in body bags and gone and the families did not see them. It was horrific. We must have an investigation into what happened. It was shocking. Some 750 people picked up the virus in hospitals and died, including a good friend of my own, John McGrath, Ballyporeen, who I spoke to on Christmas Eve. He went into Cork University Hospital, and he and three other patients on the ward got Covid, and he is no longer with us. That is a shocking indictment of the HSE, the Minister for Health and anybody involved with it.

We have to have a totally independent review of what happened. There is no point in setting up an investigation chaired by some Secretary General from some Department. We must get an outside, external, independent person from a different country to see the blackguarding going on with the people in nursing homes. They were abandoned. There was no PPE. PPE on the way to them was diverted, as was oxygen. If we did not have oxygen, we would all die. Oxygen which was so badly needed was stolen from the nursing homes. That kind of blackguarding and the mismanagement in the HSE since it was set up is just appalling, with the lack of accountability and the wages paid to the CEO. It is despicable. We clap for the nurses but we will not pay them.

Some 75,000 people signed up for Ireland's call, in the spirit of the meitheal. The Leas-Cheann Comhairle loves Irish terms. Only 3,500 were taken on. They wanted, in the spirit of the meitheal, to serve their country, but they were denied because of a conglomerate and a cabal in the HSE. It kept all these people out, saying it wanted to keep and control all the overtime for itself. Caring for the people is one of its last worries. The Health Information and Quality Authority is not fit for purpose and should be disbanded too. If it suits it, it will come in, but it will not go into the crowded corridors in the hospital in Limerick or South Tipperary General Hospital, but it will come in and close down good nursing homes. There is a lot of blackguarding and unfair treatment by HIQA. We need a full and proper inquiry, not a toothless inquiry, into what happened in nursing homes and hospitals.

4:17 pm

Photo of Carol NolanCarol Nolan (Laois-Offaly, Independent)
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Tá áthas orm labhairt faoin reachtaíocht seo. Tá an reachtaíocht seo fíorthábhachtach agus ba liom buíochas a ghabháil leis an Aire Stáit Butler as ucht an tsárobair a rinne sí chun na hathruithe a bhaineann leis an reachtaíocht seo a chur chun cinn. Ba mhaith liom é sin a rá go poiblí.

On 7 April, I welcomed the Minister of State, Deputy Butler's, confirmation that the Attorney General had provided a measure of legal certainty about the fair deal reforms, which are so badly needed. We know that, the length and breadth of the country, many farming families and small businesses have really struggled to make ends meet. I acknowledge and commend one man in particular, a farmer from Kilcormac in County Offaly, in my constituency, Joe Carroll, who led from the front on this issue. Joe had his own personal reasons and story and a significant struggle over the years. He played a major part in ensuring this issue was brought to the fore, in campaigning for fairness and to ensure we are where we are today. I hope the rest will progress quickly. It needs to. We cannot leave farming families and small businesses waiting a day longer. We need to get this over the line. I hope that will be done. To date, in fairness, promises have been delivered on.

Until recently, the HSE was providing financial support in respect of more than 23,300 individuals within the scheme. This gives some sense of how urgent the reforms are. We also know the HSE reported that this support amounted to €969 million, including some €51 million in the form of loans to residents to assist them in paying their contributions. The HSE also estimates that an additional €343 million was paid directly to nursing homes in 2018, in the form of residents' contributions. Those contributions have to be seen in the context of the motion tabled on the fair deal scheme by the Rural Independent Group in May 2017. At that time, the Rural Independent Group pointed out that family farms make a vital contribution to growth and employment in rural areas, forming the backbone of our rural economy. It is estimated that farm families spend €8 billion per year in the Irish economy, most of which is spent locally, supporting local jobs and local enterprises. This is clearly not just a sensitive area with regard to addressing people's care needs but also a significant economic issue, with almost 550 nursing homes involved in providing care under this scheme.

On the proposals before us, I share the concerns about the lack of capacity for the reforms to be made retrospective. We have seen that the Irish Cattle & Sheep Farmers Association, ICSA, has described this move as a scandal. The ICSA rightly points out that the three year cap was approved by Government in 2019 and that any calculation over the three years should apply from back then. I ask the Minister of State to look at that aspect to see if this can be applied retrospectively. I believe it is the right and fair thing to do. We have to end up with a system that is more just and equitable than the current arrangement. To that end, I hope to continue to engage constructively with the Minister of State, Deputy Butler, and others so that goals to that effect can be achieved.

Photo of Danny Healy-RaeDanny Healy-Rae (Kerry, Independent)
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I thank the Minister of State, Deputy Butler, for bringing us to where we are today. At least we will have a cap of three years on the family farm, as there is on all residential properties. I am still not happy with this because I believe the land should not be assessed. It should be the family home, the same as everybody else. Why treat farmers, publicans and shopkeepers differently from everyone else? Why should their business places be assessed? I will give an example. A poor farm could be valued at €500,000. To pay 7.5% of that would amount to €37,500 a year, for three years. That would be €112,500 the young fellow or whoever takes on the farm will be responsible for paying back. If that young fellow had to provide a house for himself, with a mortgage, and to pay back this loan, he would not get much out of the work of 60 or 70 cows and he would be fairly run down to the ground before he would be paid back. It is not right. The family farm should not be assessed in the first place.

Even though farms may be worth big money, they do not always generate big money. That is what we have to know here. The Minister of State said that family members must have been involved in the enterprise for five years previously and that they must farm the farm for six years in future. That is a fair commitment. What we are not recognising properly is that farmers have a constant battle on their hands, long hours of manual work, red tape and regulations. When they have dealt with everything else, they have to contend with the weather. Many finish up in bad shape physically and maybe mentally too. That needs to be recognised. To say that some young fellow or his wife must continue to farm does not consider that they have children who may be going to school or that there may be apprentices. It is wrong to stop the farmer who is left behind from leasing the land, because that would generate money for him or her.

Every one of us here has a duty to ensure that every law that is brought in is democratic. This assessment of the family farm is not democratic. The family farm is handed down and the farmer wants to hand it down again to the next generation. That has been done traditionally in Ireland.

I respect the Minister of State very much because she keeps people in mind at all times. However, she needs to consider this again. The family farm should not form part of the assessment. It is not fair, it is not right and it is not democratic. In the normal case, income and savings are assessed and the first €35,000 of savings are not reckonable. In many cases, farmers do not have €35,000 in savings because, as has been said here, many of them do not even make €20,000 a year. It is very wrong to say that the person left behind when, all of a sudden, the worker on the farm finishes up in a hospital and then in a nursing home cannot rent out the farm. It is very wrong to include it in the assessment in the first place.

4:27 pm

Photo of Michael CollinsMichael Collins (Cork South West, Independent)
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I thank the Minister of State for bringing this Bill before us today. It has been a long time in the offing. There was a lot of discussion on this issue with the previous Government since I was elected in 2016 but it led to little or nothing. Perhaps there was some work going on behind the scenes but it was certainly not being addressed in the manner in which it should have been, so we appreciate the Minister of State bringing this Bill before the House.

The nursing home support scheme, generally referred to as the fair deal scheme, was established in 2009 to provide financial support to eligible residents to help them with the cost of their nursing home care. Residents are required to make a contribution towards the cost of their care depending on their means while the HSE contributes the balance. In 2018, the average rate charged in public nursing homes was €1,564 a week. The agreed average maximum price chargeable for private or voluntary homes was €968 a week. This difference shows that the cost associated with private care homes is 62% less than that associated with public care homes. For 2018, additional funding of €23 million was required from other Exchequer sources to meet such deficits. In 2015, the HSE committed to publishing the weekly cost of care base charge rates for public nursing homes. Charge rates were published for 2016 but not for 2017. Will the Minister of State advise if these weekly cost of care base charges data are being published? If not, why not? It would provide transparency for everyone and not least for patients and their families.

Presently, people using the scheme who are moving into nursing homes contribute up to 80% of their income and up to 7.5% of the value of any assets held towards the costs of their care. The value of a person's home is only included in the financial assessment for the first three years of that person's time in care but this three-year cap does not apply to family-owned, family-operated farms or businesses when costs are calculated. The 7.5% per annum levy means that farmers and business owners face indefinite contributions based on their assets. In some cases, this threatens their very viability. The scheme clearly discriminates against them. The Bill makes no provision for the making of retrospective payments in cases where the farm has been included as an asset in the calculations. This is grossly unfair and must be addressed by the Government. This issue has dragged on for many years and, as such, a retrospective repayment should be made to families. It is a scandal that the resolution to the fair deal scheme has been dragged out for so long. I am not pointing the finger at the Minister of State, but at her predecessors who allowed the issue to drag on for so long.

I also commend the people who work in community hospitals. The staff work so hard. I refer to hospitals in my own constituency, from Schull Community Hospital right over to Kinsale. There are great workers out there but some of these hospitals are not up to HIQA standards. One comes to mind. It is a fabulous hospital which serves a massive area, Clonakilty Community Hospital. The bottom line is that the HIQA standards were meant to apply well before now but the matter has dragged on and on. No matter how good the staff in Clonakilty are, if the building is not corrected and brought up to standard in the same way as other hospitals such as those in Schull, Skibbereen and Castletownbere, where work is ongoing at the moment, that will obviously have a knock-on effect on that local community hospital. Will the Minister of State look into that? I recently had a meeting with the HSE which is saying that it is not on the agenda, which is bad news.

I also thank the Irish Farmers Association, IFA, and the Irish Creamery Milk Suppliers Association, ICMSA, which have worked very hard on the issue of the fair deal scheme and have been pushing this agenda for many years. As Deputy Nolan said earlier, the Rural Independent Group tabled a motion on this matter a few years ago because we saw the need and we saw the difficulties farm families were having because of the unfair way in which the scheme was being rolled out.

Photo of Michael Healy-RaeMichael Healy-Rae (Kerry, Independent)
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I thank Deputies Michael Collins, Danny Healy-Rae and Nolan for allowing me some of their speaking time on this very important subject. I also thank the Minister of State for being here to introduce this very important legislation. While it is a step in the right direction, it does not go far enough. I want to look back on the campaign that brought us to where we are. I thank all of the people who lobbied their politicians up and down the length and breadth of the country. I thank the people in Kerry, including those in the Kerry branches of the IFA and ICMSA. I too remember Joe Carroll. I remember meeting him and I do not mind saying on the record of the Dáil that he was a terribly nice man who really put his heart and soul into this campaign. He made a very strong impression on me with his own life situation. Similarly, many other people with whom I have been dealing over the years have been adversely impacted by the rules and regulations surrounding the fair deal scheme as it was.

A terribly important issue when speaking about farms, which I would love to knock on the head once and for all, also applies to pubs, shops and other type of business. When I hear people putting values on such businesses, it is obvious that they do not know what they are talking about. If a farm is worth a given amount of money - and I do not care what it is worth on paper - it is actually worth nothing, because it is not being sold. It is a tool for a family to make a living. It is a mechanism to make money. That is all it is. When one hears of a farmer expanding a farm and purchasing more land, all that farmer is doing is trying to improve his or her income. They are custodians of the land.

I thank our nursing homes and community hospitals for the work they have done over the pandemic. I thank the staff and the management for the efforts they have made in really difficult times. It has been very hard on those people because they were taking care of very vulnerable people and doing their best to protect them.

Photo of Catherine ConnollyCatherine Connolly (Galway West, Independent)
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I thank the Deputy.

Photo of Michael Healy-RaeMichael Healy-Rae (Kerry, Independent)
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My four minutes are never up. I had four minutes.

Photo of Catherine ConnollyCatherine Connolly (Galway West, Independent)
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The Deputy had three minutes.

Photo of Michael Healy-RaeMichael Healy-Rae (Kerry, Independent)
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I am sorry. I though the Leas-Cheann Comhairle had said four at the beginning. I will just finish by expressing thanks for the opportunity to speak on this issue. This is a step in the right direction but there is more to be done.

Photo of James O'ConnorJames O'Connor (Cork East, Fianna Fail)
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I know the Minister of State, Deputy Butler, has put an enormous amount of work into this particular issue. I am glad to see that progress is being made. I am sure there are many issues that still need to be teased out but I have every confidence that she will deliver. I come from a farming background and the Minister of State and I share a constituency border. We are very much at the heart of dairy country in Ireland. This particular issue is of the utmost importance to people working in agriculture in the dairy industry and to family farms right across the country.

The Nursing Homes Support Scheme (Amendment) Bill 2021 updates the fair deal nursing home support scheme to give greater protections to farm families and businesses. This was also a firm commitment in the Fianna Fáil manifesto last year. This change to the scheme will mean that after a three-year period, the value of family-owned farms will no longer be considered when calculating the cost of a person’s nursing home care. This will happen where a family successor commits to working the farm or business. This change is essential to the viability and sustainability of family farms, allowing them to be passed down to the next generation. It will ensure that the fair deal is fairer, more accessible and more affordable for farm families.

The capital value of an individual’s principal private residence is only included in the financial assessment for the scheme for the first three years of that individual's time in care. This is known as the three-year cap. Currently, this unqualified three-year cap does not apply to productive assets such as farms and businesses, except in the case where a farmer or business owner suffers a sudden illness or disability and, as a result, requires nursing home care. This Bill seeks to address this issue by introducing additional safeguards to the scheme to further protect the viability and sustainability of family farms and businesses that will be passed down to the next generation of the family. The proposed change is to cap the period in which financial contributions are based on farm and business assets at three years, where a nominated family successor commits to working the productive asset within the first three years of the resident’s time in care.

This has been a very emotive issue for many farm families across the country and it is one on which Fianna Fáil has now acted. We are happy to have now made this critical step forward with the publication of this vital Bill.

We have listened, heard and responded to the calls from farm families, the IFA and businesses for these fundamental reforms. I pay tribute to the IFA for its significant work on this issue. There is more to be done and, speaking as someone from a farming background, I look forward to engaging with the association on a continuous basis.

This Bill to amend the nursing homes support scheme will place a cap of three years on the financial contributions of family-owned and operated farms or businesses when calculating the cost of nursing home care. This will occur where a family successor commits to working the farm or business. The scheme, commonly known as fair deal, is a system of financial support for those in need of long-term nursing home care. It aims to ensure that care is accessible and affordable for everyone and that people are cared for in the most appropriate settings. The Government recognises that the three-year cap on the financial assessment of a person's income and assets applies to family farms or businesses only in the case of sudden illness or disability. This may place unnecessary financial pressures on those families and could challenge the future viability of their farms and businesses. The Bill delivers on the programme for Government commitment to address the issue by introducing additional safeguards to the scheme to promote and protect the sustainability of family farms and businesses that will be passed down to the next generation.

The Covid-19 pandemic has brought into sharp focus the vulnerabilities of many older people, especially those living in long-term residential care. It is critical that public investment in long-term care services be maintained for the people and areas that need it. Care must remain accessible and affordable, including for those families with a farm or business.

Where my community of Youghal is concerned, I am looking forward to engaging with the Minister of State on expanding the local care facilities in our area of east Cork. It has a rapidly ageing population in addition to having quite a young population and further investment in the region is needed. I thank her for her engagement so far and look forward to working with her.

4:37 pm

Photo of Denise MitchellDenise Mitchell (Dublin Bay North, Sinn Fein)
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I welcome the opportunity to contribute on the Bill, which I hope will finally deal with the scheme's inequalities and make the scheme fairer for those who are going into residential care for longer than a couple of years. The care we will get in our senior years is something that we all worry about. We want to be sure that we receive the best care possible and keep as much of our independence as we can. We want to be treated with dignity and respect.

We need to start considering how to deal with the care of older people in a way that is fair to everyone and does not leave people with large debts. International best practice in elder care must be examined. Independent living in single units with services and wrap-around supports on site must form part of our planning for elder care living. We need to introduce a publicly funded model of residential care. The current model is another example of the Government relying too heavily on the private sector to provide what should be a public service. We must also consider how we use home help hours. The lack of available hours and supports is the reason some people need to move into residential care. They have no alternative.

The Bill is welcome and improves some elements for some people, but we need a complete rethink of the nursing home system and how our home help supports operate. We must consider how we treat older people and ensure their dignity and respect when we help them in whatever way we can to have as much choice as possible. We need to be much more ambitious than just tweaking a system that is struggling.

Photo of Thomas PringleThomas Pringle (Donegal, Independent)
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I thank the Leas-Cheann Comhairle for the opportunity to contribute on the Bill. I have been asking parliamentary questions for some time about the Bill's progression, as its provisions may impact on a large number of my constituents. Some Donegal farming families have been in contact with me about this amending legislation and were anxious to see what it would contain. The IFA farm family and social affairs chairperson in County Donegal has been in regular contact with me about it since December. The chairperson was originally in touch last year with proposed amendments to the Bill. A three-year cap was seen as a priority and a number of other issues were highlighted as important for the IFA, including the exclusion of some farms with leased land from the cap. In County Donegal alone, there are more than 32,000 ha of leased land according to Central Statistics Office figures and a large number of farmers will be affected. This would mean that many families would not be able to avail of the three-year cap. The IFA also called for no reduction in the look-back clause.

The IFA was concerned that some people would not meet the criteria for the three-year cap as outlined in the heads of the Bill. For example, the identified successor, usually a son or daughter, may have been working abroad and only returned when a parent was in need of care. Such successors would not meet the criterion of having worked the business or farm for a given number of hours in three of the previous five years.

This week, I met the IFA farm family and social affairs chairperson in County Donegal to hear the IFA's ongoing concerns with the Bill. Despite having raised the issue last December, it seems that leased land is still excluded from the three-year cap. There has been no reduction in the five-year look-back clause either and no change on retrospective charges to 2018. The IFA is still worried about families that will be excluded on the basis that they do not meet the criterion of having farmed the asset for a portion of time in three of the preceding five years. The association raised all of these issues a number of months ago. According to the chairperson, she had been informed that it was unconstitutional,

... to place a Burden/Mortgage on a deed which may have been transferred e.g. within 2 yrs. of a person needing Nursing Home care to a Successor, all taxes paid, the folio/Deed registered in the name of the new owner. The Successor new registered owner becomes responsible for the debt of the previous owner.

The IFA questions whether this complies with Irish and European property rights. The chairperson said:

This burden on the Deed will impede the Successor from borrowing to upgrade as Banks look for a "clean Deed". The Executive has the first call on any loan.

Perhaps the Minister of State will address these issues when concluding.

The chairperson and I also discussed how Donegal was one of the counties with the largest number of farmers receiving farm assist. They do not receive a credit as others do, for example, those on jobseekers' payments. These credits are important, as they are calculated for contributory pension purposes. The Donegal representative of the IFA acknowledges that there is the option to pay €500 annually, but many cannot afford to do so.

The fair deal scheme is to be amended in terms of how farm and business assets are treated in the financial means assessment of applicants. The Bill will extend the availability of the three-year cap to family-owned and operated farm and-or business assets in cases where, for the first three years of an applicant's time in care, a family successor commits to working the farm or business. The explanatory memorandum to the Bill states that the intention of the Bill "is to ensure that, in situations where the farm or business' productive income is being relied upon as a principal livelihood, and the farm or business is being handed down to the next generation, the viability and sustainability of such farms or businesses is protected as a result of having a degree of clarity surrounding the total cost of care." If that is the case, then surely the IFA's concerns should have been addressed by now.

Last October, the review of the fair deal scheme had to be . The review ran into problems in accessing important information that was found to be "sensitive" under data protection laws. Three years ago, the Committee of Public Accounts requested a value for money review to examine the cost differences between public and private nursing care homes. The review was delayed due to legal issues. The sets the maximum prices for private care. It had been hoped to access the data from the NTPF, but this had to be abandoned and accessed instead through Nursing Homes Ireland.

The Comptroller and Auditor General's report into nursing home care found that, in 2018, the average maximum price for private homes was €968 per week compared to an average of €1,564 per week for public nursing homes, a difference of 62%. As usual with many data sets in the Irish economic arena, however, it is difficult to create a meaningful comparison because of the differing methods used to determine weekly rates. The CEO of the HSE stated that the difference in price was due to a number of factors, including pay-related issues, with generally higher staff pay rates and conditions in public nursing homes as well as higher staffing ratios.

In my experience in Donegal, the reason for these cost differences is that public homes tend to have the patients with higher dependency and higher care needs. This is taken into account. Private homes tend to have fewer nursing staff on each shift. According to the Comptroller and Auditor General's report, there are around 10,000 applications for the scheme each year. Something that has not been addressed by the Government is a statutory right to home care and this is the next thing that needs to be looked at.

The Bill before us is lengthy and technical. I note the Minister of State, Deputy Butler, has said a number of Government amendments will be brought forward on Committee Stage. Will she reconsider the issues that I have raised? I will submit amendments to support them. We need to make sure this is done properly. Often, when people are at the point where they are looking into this, they are also dealing with the stress and upset of a loved one needing full-time care.

There are 27 sections in the Bill, which consist of amendments and insertions to the Nursing Homes Support Scheme Act 2009. Section 3 provides for the application for appointment of a family successor for the farm or business. Section 4 deals with the charge against interest in chargeable assets. Sections 5 and 6 look at the duties of the Health Service Executive.

On Tuesday in her opening speech, regarding section 5, the Minister of State said:

Persons wishing to avail of the three-year cap must have been in care for three years and have appointed a family successor in respect of relevant assets. The charge on the asset must also be in place. The executive will determine whether the applicant will qualify for the relief, with all the conditions for qualification being outlined.

Will the Minister of State clarify that this means what I think it does? My reading of this, and of the ten detailed subsections in section 5 of the Bill, is that if a successor is not appointed until two years after the person goes into care then that is when the timer starts. This would mean that it would be two years plus the three years, so five years in total would be counted. Equally, if someone did not appoint a successor until two years and 11 months after being in care, then the three years would start after that date. Is this the case? If so, I do not believe this is fair. In the Irish Independenton 19 May, the Minister of State is reported as having said this legislative amendment to the scheme will now extend the principle to cap contributions based on family-owned and operated farm and business assets at three years. This makes it sound like the cap timer starts from when the person enters care. We need clarity on this.

Section 7 requires the HSE to conduct at least one review regarding compliance with the conditions set out. Will additional resources be provided for the HSE to carry out this review? Will there be an appeals process for this provision also? The explanatory memorandum on this section states that where more than one family successor has been appointed in respect of a relevant person the executive will carry out a review in respect of each family successor, even though only one successor is used to assess for payment of the scheme.

Sections 8 and 9 make provisions for the death of the person receiving care or the family successor, or a change in circumstances of the family successor also. Section 10 deals with a change of family successor following the transfer of a particular family asset. Section 23 provides for the Health Service Executive to keep records and prepare an annual report for the Minister. Section 25 amends Schedule 1 of the 2009 Act by repealing some existing provisions on farm and business assets.

As I said, the Bill is lengthy and technical. It is an important Bill and I will support it. I will also try to amend it on Committee Stage. This whole area can be confusing and distressing for people and I am sure many other Deputies regularly assist people and make representations for constituents who are trying to navigate their entitlements. I hope clear and accessible information will be provided in a timely manner to those who have been awaiting changes for many years, particularly where no change will be applied retrospectively. It will also be vital that people are aware this is happening. As the transfer of land is taking place, provision should be made for this. Solicitors as well as the families should also be aware of it so they can work on the basis it will be a planned action. I would appreciate the Minister of State addressing the issue of the timing as to when people enter the scheme when she is summing up.

4:47 pm

Photo of Marian HarkinMarian Harkin (Sligo-Leitrim, Independent)
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I welcome the Bill and I thank the Minister of State, Deputy Butler, for her work to improve the legislation. The Bill seeks to update the legislation so the viability and sustainability of farms and small businesses are protected where the productive income from the farm or business is the principal livelihood of the appointed successor. This is a common sense approach.

Debate adjourned.