Kieran O'Donnell (Limerick City, Fine Gael)
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I welcome the opportunity to discuss nursing homes and the care of older people. To begin, I want to acknowledge the "RTÉ Investigates" programme that was broadcast on 4 June. This was a very hard-hitting and harrowing programme which highlighted a litany of poor care standards in two nursing homes, showing clear neglect and abuse of older people, namely, the Residence, Portlaoise, and Beneavin Manor in Glasnevin.

The welfare of the residents and their families was obviously at the forefront of my concerns following the RTÉ programme. I am very conscious of the impact this programme will have had on the residents, their families and the staff in the nursing homes featured in the broadcast. I am also conscious of the impact the programme will have had on the nursing home sector more generally. It is important to acknowledge the committed, compassionate and dedicated providers and care staff operating in nursing homes across the country. Like everyone else watching the programme, I was shocked and deeply concerned at the level of non-compliance with care standards in evidence from the distressing footage that was aired. In a subsequent RTÉ "Prime Time" programme broadcast this week, we also heard personal testimony from Paul Guy on behalf of the family of Audeon Guy, regarding the poor ongoing care that their father has been receiving in Beneavin Manor.

As Minister of State with responsibility for older people, I want to state categorically that poor care, mistreatment, neglect or any other form of abuse of any person living in a long-term residential care centre is completely unacceptable. I expect the highest standards of care to be upheld for every resident in every nursing home across the country, and anything less than this standard will simply not be tolerated. The distressing footage aired during the "RTÉ Investigates" programme highlighted serious issues of non-compliance within these nursing homes.

As the national independent regulator of nursing homes in Ireland, I expect HIQA and the office of the chief inspector to utilise all powers available to them to ensure rigorous oversight and accountability in nursing home care. I met with HIQA on Wednesday, 4 June to discuss regulatory activity relating to the nursing homes featured in the "RTÉ Investigates" programme. At this meeting, HIQA’s chief inspector confirmed its continuous intensive engagements with the two nursing homes in question and committed to providing me with an update on progress this week. I assure the Members of the House that I, the Minister for Health and the Department of Health continue to closely monitor developments regarding both nursing homes. The welfare of residents and their families will remain our highest priority. The Minister will be meeting with HIQA shortly.

I have formally requested that HIQA furnish me with a comprehensive overview report of all of the nursing homes in the Emeis group. The chief inspector has committed to providing an interim report by the end of this week and a full report by the end of next week, providing an overview of regulatory history, including but not limited to regulatory compliance, escalating enforcement actions and any additional conditions of registration. HIQA has publicly acknowledged the importance of examining its processes and methodology. It is essential that these are continually being looked at for ways to improve the inspection and regulation of nursing homes.

On Tuesday of this week, I had a constructive engagement with representative bodies and stakeholders from the nursing home sector, with an immediate focus on delivering the highest quality care to the residents of nursing homes in Ireland. I want to be very clear that every nursing home resident deserves and should expect the highest standard of care at all times. To achieve this, it is paramount that registered providers of nursing homes adequately support their staff. Having effective governance and management arrangements in place ensures staff are equipped to deliver person-centred care to residents. That includes training and staffing.

I met with the HSE chief social worker and HSE staff and management from the two nursing regions where the two nursing homes are located yesterday. The HSE confirmed the directors of nursing from both local community support teams have been onsite in both nursing homes and continue to engage with them. A review of safeguarding concerns raised in respect of the two nursing homes is also ongoing. The HSE has confirmed it will be engaging with all nursing homes in the Emeis group over the coming week. With Department of Health officials, I also met HSE senior staff and management from the six health regions yesterday. This engagement was constructive and centred on supporting residents and staff in community nursing units across the country to deliver the highest quality of care.

I turn to adult safeguarding. I know there have been many calls since the "RTÉ Investigates" and "Prime Time" programmes aired for the introduction of adult safeguarding legislation. I also know that many Deputies have been calling for this legislation for much longer. I am on record as stating that the introduction of safeguarding legislation for the health and social care sector is a priority for me and the Minister for Health. The Department of Health, in collaboration with the Department of Children, Disability and Equality, is finalising an adult safeguarding policy for the health and social care sector. Our intention is to bring it to Government before the summer recess. This policy has been informed by research, stakeholder engagement and an extensive public consultation carried out last year. It has also been informed by the Law Reform Commission report from 2024 and the Mcllroy review of adult safeguarding in the HSE, also published last year. The policy will provide a framework for strengthening adult safeguarding structures, processes and supports across our health and social care services, inclusive of the public, voluntary and private sectors. Importantly, it will commit to the introduction of safeguarding legislation in the sector and will set out, at a high level, proposed legislative provisions. The Government has included a health (adult safeguarding) Bill in its legislative programme to facilitate this and it is recognised that this will be an important development in protecting vulnerable adults from abuse. We look forward to engaging with Deputies on this important legislation over the coming period.

I want to be clear that legislation on its own cannot and will not address the failings in care we have witnessed in these two nursing homes. We must remember that we already have safeguarding requirements in legislation for nursing homes. The 2013 care and welfare regulations contain specific requirements in respect of adult safeguarding, including the following: the provider must have a safeguarding policy and must take all reasonable measures to protect residents from abuse; all incidents or allegations of abuse must be investigated by the person in charge and notified to the chief inspector and records kept; and staff must be trained in the detection and prevention of and responses to abuse. We also have national standards for safeguarding, which were developed jointly by HIQA and the Mental Health Commission.

This is not to say we do not need further legislative provisions. We will be bringing this legislation forward as a matter of priority. However, the distressing images we saw on "RTÉ Investigates" and "Prime Time" demand a fundamental change in culture, one in which poor care, poor practice and abusive and inappropriate behaviour are not tolerated, and one in which staff feel empowered and supported to call out poor practice and know exactly how to do this. The forthcoming policy on adult safeguarding for the sector will not only provide the framework for legislative change, but also for a wide-ranging reform programme across the sector to ensure that a culture of safeguarding and of intolerance for poor care is fostered and embedded at all levels.

Safeguarding in its widest interpretation is about safe services. We all have a fundamental right to feel safe, especially in the case of residents of nursing homes, in what is their home. As Minister of State with responsibility for older people I remain fully committed, working with the Minister for Health, to introducing this robust national policy on adult safeguarding for the health and social care sector, strengthening Ireland’s existing legal, policy, and operational safeguarding framework and driving necessary reforms to enhance protections within the health and social care sector.

Although engagement with our older population clearly indicates their preference to age in their own homes for as long as possible, it is recognised that care provided in long-term residential care settings will continue to be an important part of the continuum of care for older people. Across the country, nursing homes in the public, private and voluntary sectors play a vital role in the provision of long-term care and other services.

It is acknowledged that the nursing home sector has evolved in Ireland over the past 30 years from a predominantly State-led service to a situation today where approximately 80% of nursing home services are provided by the private sector. I am fully aware of the investment trends in the long-term residential care market, the growing consolidation of the sector and the complex investment and ownership structures that now exist. It is therefore important that all aspects of the nursing home sector are scrutinised over the coming period to ensure service delivery and configuration meet the needs of service users in a sustainable and safe manner.

For those people who require long-term residential care, it is imperative we ensure they have access to safe, high-quality and regulated care services in a timely manner. Most people avail of this care through the nursing home support scheme, commonly known as fair deal. Fair deal was designed to protect and support vulnerable older people, to give them a home and to ensure equal access to nursing home care. It has given people the opportunity to live in a safe environment in a sector that holds to the highest standards of care. For those who avail of long-term residential care, it is critical this high standard of care continues to be provided in settings that meet their needs. The fair deal scheme will receive Government funding in excess of €1.2 billion this year.

The Government is also committed to continued investment in healthcare infrastructure which supports the highest quality care for our older population and to utilising planning and resource allocation measures as a lever to reduce regional inequalities in long-term residential care supply. This investment includes the ongoing community nursing unit programme, a major capital infrastructure programme which was launched to ensure that up to 90 of our public community nursing units and community hospitals would be refurbished or replaced in order to provide the best quality environments for our older people and to meet HIQA standards. A sum of €4 million was allocated in budget 2025 to staff and open 615 public community beds this year in capital projects that are coming to fruition through this programme.

The programme for Government commits to building more public nursing home beds and this is an absolute priority for me, the Minister for Health and the Government. The Department of Health, alongside the HSE, is developing a new public long-term residential care additional capacity plan, which will be published in 2025.

This plan will be informed by an update of the 2018 health service capacity review, currently being undertaken by the Economic and Social Research Institute, which will identify future capacity needs in the sector. The ESRI report on older people’s care will be published this month. It is also of paramount importance that the built environment and location of long-term residential care settings support high-quality care and positive experiences for our older population. The Department of Health is therefore committed to creating new design standards for long-term residential care settings for older people across all sectors.

The aim of the design guide is to describe and illustrate what good building design looks like for long-term residential care settings for older people, and to provide a common benchmark against which the standard of these settings can be measured. In December 2023, a public consultation on the draft design guide for long-term residential care settings for older people was launched, and a report on the public consultation reflecting the feedback received was published in January 2025. This is a matter I am working with my Department officials to progress as quickly as possible.

Earlier this year, I launched the nursing home residential premises upgrade scheme. This is a €10 million scheme that will support nursing homes to carry out structural works to improve compliance with standards published by HIQA under regulation 17, which concerns the nursing home premises itself. The maximum that can be claimed by an individual nursing home under this scheme is €25,000.

I am aware that while our commitments in the programme for Government are ambitious and achievable, the scale of the demographic challenge ahead is significant. In this context, in March 2024, the Government established an independent commission on care for older people. The commission is charged with examining the provision of health and social care services and supports for older people and with making recommendations to the Government for their strategic development. Subsequently, a cross-departmental group will be established under the auspices of the commission to consider whether the supports for positive ageing across the life course are fit-for-purpose and to develop a costed implementation plan for options to optimise and implement these supports. The commission on care is due to publish its first report shortly.

The programme for Government 2025 pledges to publish, resource and implement a national action plan that will take account of the work of the commission on care to ensure that long-term care is timely, comprehensive, and affordable, and examine and enhance the mix of professional care options, including homecare, community-based care, independent living options and long-term residential care facilities.

As all Members of this House will be aware, the Irish population is growing across all regions and age groups, with the most significant growth seen in the older age groups. The number of people aged 65 years and over is estimated to have risen by more than 40% between 2013 and 2023 and is expected to double again to 1.6 million by 2051. In 2020, it was also estimated that there were approximately 64,000 people living with dementia in Ireland. This number is expected to rise to 150,000 by 2045.

The improved health outcomes and extended life expectancy that have been achieved in recent decades must be acknowledged and celebrated. We all clearly recognise the benefits that our older population offers to society. Ageing populations will, however, present many healthcare, social, and economic challenges in the coming decades. Thoughtful preparation combining policy and institutional reforms, investment in capital infrastructure and technological innovation can enable this country to meet this challenge and take advantage of the real opportunities presented by demographic change.

Investing in services for older people has been a governmental priority over recent years. There has been an increase of approximately €1 billion in funding for services for older people since 2020. This year alone has seen an increase of approximately €350 million on the amount secured under budget 2024, bringing the total figure to approximately €3 billion in budget 2025.

Sláintecare is the most significant reform programme in Ireland’s health sector and Sláintecare reforms are changing how health and social care services are provided. Sláintecare is focused on providing the right care, in the right place, and at the right time. Instead of relying on hospitals as the primary location of care, the focus is on providing more care in the community, or at home. This is also accompanied by a strong emphasis on prevention, which will help people stay healthier for longer, and reduce the number of people who would otherwise need medical care in an acute setting. The recently published Sláintecare 2025+ plan sets out an integrated and whole-of-system reform programme to be implemented over the period 2025-27 and is designed to respond to the demographic challenges that Ireland is facing. The plan builds on the progress made in implementing successive programme for Government and Sláintecare implementation strategies between 2018 and 2024. It is an ambitious and multifaceted programme designed to move Ireland towards a universal healthcare service. The 2025 programme for Government is dedicated, among other things, to the vision of creating a caring society, and commits to a range of actions that will advance a social care model which supports older people to live full and independent lives in their own homes and communities, with the appropriate wraparound supports. It is incumbent on all of us to work collaboratively to realise this vision.

Home support is an essential service for thousands of people each day across the country and is highly valued by service users and their families. Since 2020, the Government has increased the budget for home support by more than 70%, from €487 million to €838 million in budget 2025. The delivery of home support hours is increasing year on year and will continue to do so as demand is expected to increase due to an ageing demographic and older people’s wish to stay at home for as long as possible. The programme for Government commits to the design of a statutory home care scheme, which is an absolute key priority for me as Minister of State for older people. In the time I have been in this post, this is something I very much want to progress.

The Department of Health is progressing the development of a regulatory framework for providers of home support services to support this commitment. The new system of regulation for home support will ensure the public can be confident that the services provided are of a high standard and bring Ireland in line with best international practice. The legislation to be developed will regulate home support services in Ireland by establishing a system for registering providers of these services, under which it will be an offence to operate a service without being registered. Alongside this, HIQA is currently finalising draft national quality standards for submission to the Minister. The first step we must take in statutory homecare is to bring in legislation to regulate homecare providers. We then need to define what statutory homecare is and look at a funding model. This is something I am absolutely committed to but the first step is to legislate for homecare providers.

The programme for Government has a strong focus on community supports for older people, including day centres and meals on wheels. Day centres are a crucial part of social care provision in our communities that provide invaluable support for people who may, for any number of reasons, experience isolation and loneliness. Currently, day care services are provided across the country by private, voluntary and HSE-funded day care centres. Since its establishment, the meals on wheels service has also been an invaluable resource in helping older people in our communities to maintain their health and independence through the provision of healthy meals.

In line with Sláintecare priorities, the enhanced community care programme is a major reform programme. The objective of the programme is to deliver increased levels of healthcare, with service delivery reoriented towards general practice, primary care, and community-based services. The focus is on implementing end-to-end care pathways that will care for people at home and over time prevent referrals and admissions to acute hospitals where it is safe and appropriate to do so, enabling a "home first" approach. As part of the enhanced community care programme, the integrated care programme for older persons model aims to improve the quality of life for older people by providing access to integrated care and support that is planned around their needs and choices. These interventions support older people to live well in their own homes and communities without the need to access acute care settings. The integrated care programme for older persons seeks to ensure older people with complex care needs can access care quickly, at or near home, through care pathways specifically designed for them and targeting fragility, fall prevention, and dementia. The Department of Health and the HSE also support a number of complementary support co-ordination models which help our older population to age in place for as long as possible and reduce the rate of older people transferring to long-term residential care.

The healthy age friendly homes programme is an innovative partnership between the local government sector through Age Friendly Ireland and Sláintecare. The programme commenced in 2021 and saw the introduction of a new person-centric, robust, support-co-ordination service that will enable older people to continue to live in their homes or in a home more suited to their needs and will help older people to live with a sense of independence, autonomy, and to feel part of their communities.

The HSE has also partnered with ALONE as part of the roll-out of the enhanced community care programme to develop a support co-ordination service. The focus of the service is to support older people to live independently at home for as long as possible by facilitating access to services including befriending, social prescribing and assistive technologies and by co-ordinating linkages to local community groups. These services support the enhanced community care model and facilitate the HSE to deliver a co-ordinated system of care, integrated around older people's needs.

The programme for Government 2025 also commits to a new all-of-government national housing plan to follow Housing for All. In my dual role as Minister of State with responsibilities for older people and housing, I am committed to a focus on housing options and choices for our older population in the context of the new housing plan. It is vital that we continue to increase the housing options available to older people and to facilitate the integration of supports in a more coherent way between the housing and health sectors. To this end, the Department of Health and the HSE, alongside the Department of Housing, Local Government and Heritage, are supporting a housing with support demonstrator project in Inchicore, Dublin. This is a collaborative, cross-sectoral and cross-departmental project that recognises the need for a joined-up approach to addressing the critical issue of creating housing choice for our ageing population, enabling people with lower care needs to live independently for longer. It is the hope that this project will act as a pathfinder project for the future mainstreaming of this form of housing. I was pleased that this innovative housing project reached a milestone recently, with the first tenants receiving the keys to their new homes.

As I have stated, an ageing population means that the prevalence of dementia is increasing. I am committed to improving services for people with dementia and their families, and just over two years ago, in May 2023, the HSE published its new Model of Care for Dementia. The model of care sets out care pathways to advance timely diagnosis and post-diagnostic support and care for people living with dementia in Ireland and sets targets to achieve this goal. To support the implementation of this model of care, the Government has funded new specialist diagnostic memory services in locations around the country. Establishing these essential services will ensure there is timely access to both diagnosis and post-diagnostic supports and a reduction in waiting times. There has also been €19 million in new recurring investment in dementia services over the past five budgets and the Government is committed to continuing to invest in improving services for people with dementia.

This Government has also made specific commitments to improving dementia services in the 2025 programme for Government, and since my appointment as Minister of State with responsibility for older people, I have been working in earnest towards their implementation. In May, I was pleased to announce the implementation of one of the programme for Government commitments, the development of a national dementia registry for Ireland. The national dementia registry will provide us with vital data on many aspects of the care of people with dementia. This was a top priority for representative groups and people with dementia. I am pleased we have been able to initiate the creation of that register, which will be hugely beneficial in addressing the needs of people with dementia. The Government will continue to build on the already substantive investment in dementia over the next five years.

My absolute focus over the lifetime of this Government will be on ensuring Ireland can genuinely call itself a great country in which to grow old. As Minister of State with responsibility for older people, I want to ensure our older population feel valued and respected and when health or social care services are required, that our older citizens receive the best care possible, whether in their own homes and communities or in long-term residential care settings. I also firmly reiterate that poor care, mistreatment or any other form of abuse of any person living in long-term residential care centres is wholly unacceptable and will not be tolerated. Every resident of a nursing home deserves dignity, respect and the highest standards of care. As Minister of State with responsibility for older people, I, the Minister, Deputy Carroll MacNeill, and the Government are absolutely committed to ensuring everything possible is done to ensure the distressing scenes we witnessed in the recent "RTÉ Investigates" programme do not happen again in any nursing home in the country. We saw clear neglect, abuse and violations of basic human rights for older people. I want to restate and be clear that every nursing home resident deserves, and should expect, the highest standards of care. I cannot repeat that enough.

When this issue broke, like everyone else I watched the programme. My immediate reaction on seeing the wanton neglect was to reassure older people and to deal with the issue for the older people in the two nursing homes, namely, the Residence and Beneavin Manor. I rang Bernard Gloster after the programme was aired to ask that the HSE would put in safeguarding teams and direct its nurses into the two nursing homes. I had met representatives from HIQA earlier that day. The names of the two nursing homes had been released by RTÉ, so I immediately sought a meeting to ask the HIQA to continue with intensive engagement, provide a report by the end of this week, an interim report on the Emeis group overall and a final report next week. I had follow-up meetings with the nursing home sector to ensure it was reaching out to its members on the provision of safe care through nursing homes. I then met with representatives from the HSE and its community nursing home units and asked that they would do likewise in terms of reaching out to nursing homes and residents and regarding what is happening as we speak. I met with the HSE safeguarding teams and with the directors of nursing. I had meetings with them yesterday regarding their interaction.

What happened should not have happened. The issues in Portlaoise were identified in the two HIQA reports. The Beneavin report did not highlight that fact. These are questions I have put to HIQA, such as how this happened and why the compliance plans were not implemented. This is a basic process. Like everyone else, I have one concern above everything else - politics aside; I have been at this 20 years - and that is the care of older people. What we witnessed in the two nursing homes was unforgivable. No one should be treated in that way. We have to do whatever is required here. We have to get a system that provides reassurance to residents and their families regarding the delivery of safe healthcare the length and breadth of Ireland. We all know there are nursing homes delivering great care. There are great staff delivering great care. Once again, however, I go back to the key point. Older persons in nursing homes must be respected and cared for. What we saw in the "RTÉ Investigates" programme, and I commend the team on its work, was neglect and abuse of older people of such a magnitude that it can never happen again. In my role as Minister of State, working with my colleague the Minister, Deputy Carroll MacNeill, and with the Government, I will be working night and day to ensure this is rectified and never happens again.

Natasha Newsome Drennan (Carlow-Kilkenny, Sinn Fein)
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Last week, we witnessed highly distressing scenes of neglect and abuse at two Emeis-operated nursing homes in Dublin and Portlaoise. These were scenes the Government had long assured us were consigned to history. First and foremost, my thoughts are with the individuals and families affected. I hope counselling and health services have been made available immediately to them. If not, the Minister of State must ensure this is done today. I also commend Clare Doyle and the various whistleblowers who contributed to the unearthing of the abuse of the residents of the nursing homes. Clare's words were exceptionally powerful and deserve repeating. She said she felt as though she was having one of those dreams when something awful is happening and you are screaming into the abyss. She described it as feeling that desperate because she knew the real human suffering that was happening. She continued, "These are our parents, our aunts and our uncles. As a professional, I was shocked, I was angry. As a human being I was heartbroken."

These revelations of systematic institutional abuse at residential home care come 20 years after Leas Cross and ten years after Áras Attracta. In the intervening years, scandal after scandal has underlined the inadequacy of existing legislation, with a major gap in the law in the absence of an adult safeguarding Act and insufficient resourcing and empowerment of safeguarding teams. Emeis Ireland is the largest nursing home operator in the State. In recent years, it has expanded to more than 2,400 nursing room beds across the State.

Astonishingly, the Government has allowed this to happen despite revelations of widespread abuse at the company's centres in France. HIQA has inspected multiple Emeis-run homes and has identified repeated non-compliance across its reports. Malnutrition was a feature echoed across the report and the RTÉ documentary clearly identified not only understaffing but gross misconduct and total disregard for individual care plans. The staff were not being governed properly and poor practice was clearly routine. Poor practice seems to be the standard that was expected and encouraged.

The residence in Portlaoise is only one example of how Emeis runs its nursing homes in Ireland. The residence has been inspected on multiple occasions by HIQA and on no measure in the latest report was it found to be fully compliant with regular standards. It was not only non-compliant but repeatedly non-compliant, with little evidence of even trying to improve its standards. HIQA found that the provider had failed to implement the compliance plan submitted following previous inspections and that the overall governance and management of the centre had deteriorated since the previous inspection. Most worryingly, staff were unaware that a resident at high risk of malnutrition had been reviewed by a dietitian in January and as a result, interventions to manage nutritional risks were not completed. In layman's terms, people at the home were suffering from starvation and neither management nor the owner seemed to care or even inform staff of changes to care plan. Malnutrition, to an ordinary person, is a major red flag. Food is a basic requirement for survival. Without that, what hope have you got? Yet, it seems nothing happened to stop this. There were no financial penalties or closures.

The RTÉ documentary made clear that care plans were not being used appropriately, if at all, and certainly were not being referenced when decisions were made on staffing and resourcing. HIQA found repeated failures to ensure that staff were appropriately trained and supervised and identified that records were not being managed in line with regulations. It even found that records relating to family complaints were not being documented. RTÉ revealed that Emeis was plámásing families with tales that it would improve services but nothing in practice was changing.

I am particularly taken by this quote from the CEO of Emeis: "Our jobs are profoundly human. Each of our gestures, each of our actions has a direct impact on the residents". What were those impacts? They were bedsores, bruises, calls for help going unanswered, starvation, deprivation of liberty, a lack of dignity, a lack of respect and a lack of care. How did operator get away with it? Is it because the operator knows how to play the system to make sure that enough staff are around when there are inspectors or visitors but are then cut to a skeleton crew when nobody is watching? It seems to know what to say and when to say it but does something entirely different when it thinks no one is watching.

The problem at the heart of all of this is privatisation and the consolidation of nursing home care in large, multinational, for-profit corporations. Over the past few decades, Fianna Fáil and Fine Gael have gutted the public residential care sector in favour of private homes. More than 80% of residential care for older people is now provided by the private sector and this is rising every day. That is not a criticism of private nursing homes. There are many fantastic local centres run by honest people who provide top-quality care. There are many fantastic nursing homes around the country but there are far too many homes run like prisons, maximising profit instead of making sure they meet people's needs. To even call what we saw last week prison-like conditions does these residents an injustice. These conditions are worse than prison and are a total deprivation of liberty. These are supposed to be people's homes but what we saw was anything but a home. It could be any one of our loved ones suffering from it.

Deputy O'Donnell's first job, as Minister of State responsible for older people, is to get safeguarding legislation done. The Government has been prioritising this for years but has done nothing. This legislation must establish an independent safeguarding authority with real powers and resources to act on individual clinical concerns. There must be mandatory reporting of concerns of abuse and neglect. HSE safeguarding teams should be brought under the remit of this authority and they need to be significantly expanded to do their job. Safeguarding teams and social workers must be given a legal right of entry and permitted to investigate concerns unannounced at any time, and where management and corporate leadership make decisions that lead to poor-quality care and the loss of the health or life of residents in the care of services they are responsible for, there must be accountability. There has to be accountability, not only at staff level but at organisational level. There are failures to govern safely, such as those identified in the "RTÉ Investigates" report. There must be a step change in investment in public nursing home capacity to reverse our over-reliance on the private sector.

The Minister of State must also engage with smaller operators and community homes to see what they need to stay viable in an increasingly complex sector. Care for older people, and for the Minister of State and me as we age, is in need of radical change. He should review the mandate of the commission on care and ensure it can future-proof the model of care for ageing and he must develop a comprehensive social care policy to support independent living.

Sinn Féin has proposed a home-first approach to care backed by a statutory home care scheme that forces the system to redirect resources to home care. It is essential that the Minister of State get the statutory home care legislation right. The current Bill before the House does not go anywhere near far enough. Home care must be prioritised. This will have profound implications for the nursing home sector as the complexity of people's needs will rise. We must empower people to live full, independent lives, not only adding years to life but adding life to years. Last week, the Taoiseach defended the existing regulatory system. He said laws are in place to deal with this. Those laws are clearly not working, and everyone has been telling the Government for nearly 20 years that they are not enough.

In my previous role, I was a carer for 18 years. For 18 years, we gave the best of care. There are people who are cut out for these jobs; not everybody is made for them. On what I have read in the reports, in my previous role, when inspectors came in there were two of them for two days. We had three residents. We had care packs. It takes a long time to go through them. I would have had 100% faith in them until I read those reports. I have read the four reports. There was one person on one day for 24 patients. The final report involved two people for two days for 70 patients. That is not enough.

Matt Carthy (Cavan-Monaghan, Sinn Fein)
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Older people, indeed, all of our vulnerable citizens, deserve to be treated with dignity and afforded the highest quality of care and the services that they need. What we saw, though, in the revelations in the "RTÉ Investigates" programme was appalling, showing shocking abuse and serious failures and neglect. I can only imagine how upsetting it was for the families of the people who were revealed to them in that programme, for others who had family members resident in those homes and, indeed, for anybody who had a relation in a nursing home to see such abuse and mistreatment.

What we saw was vulnerable people left without basic care as the homes had an inadequate supply of basic items such as bedsheets, towels, sanitary wipes and gloves. We saw others, quite disgracefully, being roughly handled. The company at the centre of these revelations, Emeis nursing homes, bears primary responsibility for what was exposed in the investigation. Emeis, of course, has to be held to account for how these vulnerable people were mistreated, but we also have to deal with fundamental failures and the abuses that were exposed and recognise that Government policy over recent decades has played a role in all of this. This is not the first scandal in an Irish nursing home.

Indeed, much commentary is being made of the fact that 20 years ago the Leas Cross scandal led to the establishment of HIQA. I heard what the Minister of State said. Leaving politics aside, I accept that all Members of all parties will be equally disgusted. When he watched the programme, surely the Minister of State reflected on the specific, determined and protracted policy of privatisation of our nursing home care. The privatisation of the care of our most vulnerable citizens, regardless of whether it is elder care, home care or healthcare, is wrong. It does not work. The provision of such care should be something in which the State takes a leadership role.

I heard what the Minister of State said about older people in nursing homes needing to be treated with respect. That is absolutely right. The first step in treating our elderly with respect is to stop treating them as a commodity. When the Government privatises and, in particular, commercialises the provision of care, a profit motive is introduced. Serious questions have to be asked. We know that the move away from the public nursing home model has had a profound impact. Local family-run nursing homes are telling us they cannot survive financially. Has anyone questioned this question: if they cannot survive financially, how is it that multinational institutions are able to come into Ireland, operate at such a large scale, and not only survive but be financially profitable? It is clear that corners have been and are being cut. We have to recognise that when you privatise a service, you have a race to the bottom. People who are on the minimum wage are caring for the most vulnerable people in society. People who were portrayed in that programme are on the minimum wage. Essentially, people who have an invaluable role in our society - caring for our elderly or other vulnerable citizens - are earning the same wage as a teenager on a summer job in a meat factory. There is something profoundly wrong with that situation. We cannot point to others without recognising that political decisions led to that scenario. We have to move away from the privatisation and commercialisation of our healthcare system, in the round. We need to start with the provision of care for elderly members of our community who have contributed all their lives to our society.

I heard what the Minister of State said about the prioritisation of home care. I agree with him. Every person I know wants to grow old in their own home if that is at all possible. I am sure the Minister of State also knows that when families the length and breadth of this State try to do that for their families, they are met with obstacles from the State. If they want to care for their loved ones themselves, they are assessed for whether they can get some support on the basis of somebody else's income. The Government parties made a commitment to the abolition of the carer's allowance threshold, but we have not heard a single word about that since the general election. We also have the situation where those who need home help hours cannot get them. What has been happening within the home help system over the past two decades? Privatisation has been going on, with commercial companies providing a service that the State should be providing. I hope that Deputies from Government parties will reflect on the decisions that were made over the past number of decades and ensure we actually have the sea change that is required to ensure we will never again see scandals such as this.

Dessie Ellis (Dublin North-West, Sinn Fein)
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We all want the best for our elderly relatives when it comes to their care in the latter part of their lives. They have paid their taxes and contributed to the growth and prosperity of the country. The least they deserve is to have a life without worry or stress in their twilight years. Some parents are cared for by family members in their own homes or in the homes of their adult children, but when this is not possible such care is provided in nursing homes. While many elderly people can thrive in a nursing home and live a second life, the move to such a facility can be traumatic for others. The care home will understand this. A good care home will ensure that the transition from a family home to a nursing home is done with sensitivity and the greatest of care. A good nursing home will have a positive impact on the well-being and mental health of the elderly person as well as the family members who were unable to provide care in the home for their elderly relative. They can be assured that their parent will receive 24-7 care with daily living, assistance with personal care, eating and mobility, as well as medical care and supervision. A good nursing home offers peace of mind to families that their elderly relative is being cared for in a safe and supportive environment that allows them to live as independently as possible while receiving expert nursing care, rehabilitation and a range of social activities to promote engagement and social interaction including outings, entertainments and hobbies. It will have trained nurses providing specialised care, including wound care, administering medications and managing chronic conditions. It should also provide rehabilitation programmes to help residents to improve mobility.

A priority of nursing homes is to provide a safe and secure environment for the elderly resident. As Ireland has a growing elderly population, nursing homes form a crucial part of the healthcare system by providing long-term care for those who need it. When any part of this falls down, the impact will be traumatic for the residents and their families. Unfortunately, as we saw from the recent “RTÉ Investigates” programme, in nursing homes and in particular in Beneavin Manor in my constituency of Dublin North-West, the quality of care is not the same in every nursing home. The RTÉ report has raised important questions about the adequacy of care received in this particular nursing home. It is clear from the investigation that Beneavin Manor has failed in the provision of a quality care service to residents. The investigation has raised serious questions about whether residents’ needs are being properly met.

A big problem with private nursing homes is the high turnover of staff which can also impact the staff-to-resident ratio. Staff can be overworked. If the nursing home is understaffed, it will struggle to provide personalised care, which can result in inadequate care for the resident. A 2021 study found there was an average turnover rate of 27% among nursing home staff. However, private and voluntary nursing homes experienced even higher turnover rates of 38% for nurses and 54% for healthcare assistants. The many reasons for this high turnover of staff include low pay in the sector, poor training opportunities, lack of personal development or career progression and very challenging work-life balance in the sector. These factors impact on staff morale and have the knock-on effect of impacting on the care for the elderly resident.

The factors that contributed to the scandalous care of one particular resident in Beneavin Manor, whose story featured in the RTÉ investigation, are laid out in the HIQA report into the nursing home. This report raised concerns around the provision of care in the home and its risk management. It also highlighted the need to address issues relating to record management systems, such as contracts for services, food and nutrition, resident protection, information for residents, infection control and the use of restrictive practices.

Our vulnerable elderly citizens need to be protected. Over the years we have had too many nursing home scandals. It is also scandalous that we are still waiting for the enactment of the Adult Safeguarding Bill 2024, which will establish the national adult safeguarding authority. This Bill and the new authority will help to safeguard adults who are at risk of harm and abuse, provide mechanisms for reporting incidents and protect the rights of adults in vulnerable situations. We cannot rely on HIQA. There needs to be a mandatory reporting of abuse. Social care teams must have a legal right to entry to investigate complaints. Our senior citizens need to be protected. Families need to know that their elderly relatives are receiving the care and respect they deserve in their later years.

Louise O'Reilly (Dublin Fingal West, Sinn Fein)
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In 2004 the Sunday Independent reported on the Rostrevor nursing home in Rathgar. It had obtained a report that was dated August 2000. That report described the facility as being dirty and grubby throughout. It referenced an elderly man being fed his meals on a commode. Further inspections revealed that health board recommendations had not been implemented. A frail elderly man was found cold and unkempt. The report said that there was little evidence of continence wear provision for clients. The indignity of this is hard to believe. Four months later, in 2001, ongoing breaches of nursing home regulations were found. The then south-western health board subsequently said that the threat of revocation of the licence was not pursued in 2001 because the issues had been addressed. However, nothing improved. In August 2004, the health board sought an injunction from the High Court to have the home closed. The owner, Therese Lipsett, was fined but the nursing home stayed open. I ask Deputies to bear in mind that Micheál Martin, the famous learner of all the lessons, was the health Minister at the time and throughout this.

If we fast forward to 2011, when Fine Gael was in government with the Labour Party, we will see that HIQA brought the HSE into the same nursing home. All the lessons that were supposed to be learned were not. The Irish Mail on Sundayused the phrase "house of horrors" to describe the conditions. Nothing had changed. When that nursing home was closed down in 2011, I was asked to go there to give some advice to the workers because I was representing healthcare workers at the time. They were migrant workers. They were absolutely petrified. The residents had been taken off. They were the whistleblowers and they were left completely abandoned. Jesus Christ, Minister, when they described to me how they were told to behave, how they were instructed and how the instructions came from the top, I learned about what happens. That is why we are here to look to the Minister of State and the Government to show some leadership on this.

The first time Rostrevor and the Lipsetts, who are the owners, came to public attention was before Leas Cross. The second time was six years after Leas Cross. The latest "RTÉ Investigates" programme is 20 years after Leas Cross, yet we see that very little is changing. The State gives these lucrative contracts to unvetted providers for emergency accommodation, and the provision of services for international protection applicants. You are making millionaires off the back of human misery and indignity, and poor treatment of our older and vulnerable people. You have been warned; it is not just the Opposition saying this. The ESRI told the Government very clearly. Brendan Walsh said:

Ireland is at an important juncture in establishing a sustainable long-term care system for older people. The COVID-19 pandemic had a terrible impact on LTRC residents and workers. But this period also saw large changes in supply, ownership, and financing, and the LTRC sector faces a number of challenges as it emerges from the pandemic.

He went on to say that the system is increasingly reliant on "a small number of profit-driven operators". That is the problem. A small number of people are trying to make a profit off the withholding of incontinence wear from old people. I am struck by the indignity of It. They are making money by cutting corners on incontinence wear, staff and food in order to chase profit, and the Government is facilitating it. The Rostrevor nursing home revelations shocked everyone when they came to light. Micheál Martin was the Minister for Health and Children at the time, and he is the Taoiseach now. There is an unbroken pattern here. Fianna Fáil and Fine Gael have their hands and their fingerprints all over this because it is their policy.

I could not watch all of the "RTÉ Investigates" programme. I had to look away for some of it because it is heartbreaking. What is most heartbreaking of all is that this is not new. This is not news. This did not just happen. This has been happening for decades. I hope the Minister of State is true to his word today when he says that he is serious about tackling this issue. I hope he does that. He and his legacy will be measured against how elderly people are treated. He knows that people should be given a reasonable choice to stay at home if that is what they want to do. The Government does not give them a choice. It forces them into nursing homes and we see how they are treated. The Minister of State's words are one thing but his actions will tell a lot.

Marie Sherlock (Dublin Central, Labour)
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I welcome that we are having this debate today but we should not be here. I give huge credit to the "RTÉ Investigates" team for putting together that programme. If HIQA had been doing its job, we would not have had to have it. Clare Doyle should not have had to take that enormous step on her part to tell the stories that had been relayed to her. I would argue that we need to hear more from her because I believe she has more to say. To the Guy family in Glasnevin and to the other families of the residents in Portlaoise and Glasnevin, I say that we are all extremely conscious that one of the most difficult decisions any family will ever take is to put a loved one into a nursing home. It is a decision that places enormous trust in strangers to treat that person with dignity and respect in their final years. We have seen a fundamental breach of that trust.

My very serious concern, as I said earlier, is that when all this dies down, the only focus for the Government is going to be ensuring that HIQA tries a bit harder and gets its act together and that we have the added safeguarding legislation. This is separate from the work on home care supports, which is a very important body of work that needs to happen. We will always need nursing homes in this country. If the figures prove correct, we will have more than half a million people over the age of 80 in 25 years' time, including people living in rented accommodation or, as in my constituency, three generations living in a single home. We are going to need nursing homes and we have to get it right.

As I have been thinking about this over the last few days, two things have struck me. First, a raft of reports are sitting in the Minister of State's Department gathering dust. We have a report from 2022 on workforce planning. We have the pilot on staffing. We have the learnings from Covid from 2020. We have the guidelines from the start of this year on the maximum size of nursing home beds. They have all fallen off the bandwagon and off the agenda. There has been no prioritisation in government regarding this, and no action. That has to change. The other key feature is the overwhelming extent to which our State relies on the private sector. When we say "the private sector" we have to be careful, because it is a real mixed bag. It is true that 80% of nursing home care is within the private sector. As my party leader, Deputy Bacik, said yesterday, ten funds now control 30% of nursing home beds. Some 38% of all beds are controlled by large long-term residential companies and they are growing. In the 2000s, we saw the nursing home sector turbo-charged by the tax exemptions brought in by the Fianna Fáil Government starting in 1997 and continuing well into the 2000s. Now we are seeing that REITs are beginning to operate in the sector. They are able to go in as property companies, propcos, and buy up buildings or set up buildings, and then they have what is known as an opco to operate. There is a business model there that is designed to maximise profit, separate out liabilities and exposure, particularly with regard to accountability, and ultimately put our State and most crucially the elderly people in these facilities in an extraordinarily vulnerable position. The State and the Government over the last ten years have done little or nothing to ensure there is increased scrutiny over those facilities.

I was talking to a medical professional yesterday who has long years of service in the nursing home sector, and who has significant funds in the bank. He went to the bank to borrow to purchase a small nursing home in the south of this country. He could not get a loan and that nursing home is now in the hands of a conglomerate. That is happening across the country. There are small nursing home providers, many although not all of which do great work, and they need to make upgrades to their nursing homes. They are being refused funding. Then they find themselves in difficulty with HIQA and we see the closures on the scale we have seen over recent years. Approximately 20% of nursing homes closed between 2020 and 2022. There are fundamental decisions for this Government to make about what type of nursing home sector it wants in the future. In particular, does the Government want the small nursing home providers across the country or not? They are not getting support from the banks and they are certainly not getting support from the State. They would also hold a view with regard to HIQA that there have been kid gloves for the bigger operators and less so for them. That has to be teased out over time but it is certainly an allegation they would make. We have a growing set of market-driven and profit-driven nursing home operators and that has to change.

The key issue in all this is the impact on care. Earlier today I talked about the vast number of people in the private nursing home sector who are on the minimum wage, and the incredible turnover figures of 54% in 2022 among healthcare assistants. We are all talking about the turnover in the childcare sector and other sectors. I do not think the figure of 54% can be beaten across any other industry in the country. There is a reason for that, and it is how they are treated, the lack of resources and all the things we saw in that programme last Tuesday night.

They are being deprived of resources, being made to work extremely long hours and getting paid a pittance. The reality is that this Government has report after report sitting there with regard to how we need to change pay if we are to improve quality. I wish to quote to the Minister of State the Report of the Strategic Workforce Advisory Group on Home Carers and Nursing Home Healthcare Assistants that his Department put together in September 2022. It has two important recommendations. The first is that "All private-sector and voluntary providers should be invited to give a commitment to pay home-support workers and healthcare assistants, at a minimum, the National Living Wage". The Minister of State's Government has abandoned trying to go next or near a living wage for all workers. What has it done for healthcare assistants in nursing homes? I do not think I have ever heard a reference from this Government concerning this issue. The reality is the operators of the system need to be told they need to put a joint labour committee in place in co-operation with trade unions representing workers and ensure there are proper terms and conditions. The second key recommendation was that there should be "An appropriate mechanism to reach agreement ... in respect of pay and pensions" for the workers in the sector. It is within the power and the gift of the Minister of State to bring unions and those operators into a room and tell them they need to agree better terms and conditions.

The second key issue concerns minimum staffing levels. The reality is that we have minimum staffing levels in the North and in other countries but they do not exist here. HIQA has no requirements with regards to staffing levels. We can only imagine that ensuring sufficient staff are in place is not a priority for those operators that are purely profit driven. It is not a priority when the bottom line is to make a greater number of bucks. It is not a priority when ultimately there is a race to the bottom. We are talking about our loved ones here. We are talking about our older people who are very vulnerable and need respect, care and dignity. We are not talking about looking after tins of tomatoes or something else. We are talking about real people here and the State has reacted by not putting down minimum staffing requirements. The reality is that if we do not do so, we are going to continue to see these crises occurring time and time again.

There has been a pattern from Leas Cross to what was revealed about the private nursing homes and how many of them fell apart during the pandemic to what we saw on our screens last week. It is that private nursing homes have not found themselves well equipped to be able to deal with situations when a crisis hits. We again have reports from the Minister of State's Department with recommendations as to how to better equip them in future. It is the State's role to do it. Crucially as well, however, the State must take a leading role now. Is the Minister of State comfortable with the level of private sector provision of nursing home care in this country? Is he comfortable that we are entrusting the care of our loved ones - older people who need respect and dignity in this State - to very large operators whose sole motivation in many cases is profit? Is he comfortable that people are being paid the national minimum wage while looking after vulnerable people in this State? If he is not comfortable with this situation, we need to see action please. This is not just about HIQA, and it is not just about ensuring we get the home care support scheme in place; it is about ensuring the Government puts legislative provisions in place. I see that in the Health (Miscellaneous Provisions) (No. 2) Act 2024 there is provision, I think it is in section 101B(3), for the Minister to prescribe that information be furnished by nursing homes and other centres to a chief inspector with regard to persons employed and details of employment. There have been no regulations in this respect and we need to see them as soon as possible.

Mark Wall (Kildare South, Labour)
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Go raibh maith agat. We have been here before. It has been 20 long years, as other Members said, since we saw the distressing footage of conditions at Leas Cross nursing home. Unfortunately, what we saw on the "RTÉ Investigates" programme replicated those horrific and dark days. I thank Aoife Hegarty, the "RTÉ Investigates" programme and, of course, Clare Doyle, the whistleblower, for exposing these abuses.

What we saw on the programme aired was simply elder abuse. Older people were manhandled, pushed around and, heartbreakingly, forgotten. It was tough watching for me to listen to a loved one calling out for help and nobody answering. I cannot but imagine how the families of these people who had effectively lost their dignity in these homes must have felt when they saw the programme. The lack of basic medical equipment such as hoists, wipes, gloves or even clean bedsheets was alarming to say the least. What we saw in these programmes was simply profiteers more worried about profit and lining their pockets than caring about basic human dignity. The joy of the staff rewarded with four packets of wipes from a manager is an unwanted highlight from this investigation. The lack of gloves, incontinence pads and clean sheets was up there with the horrific treatment of our fellow human beings.

As I said, this is all about the bottom line for these companies. It is about how much profit these uncaring companies can milk out of our older and disabled population. As was said, 80% of Irish nursing homes are private or voluntary and just ten investment funds own one third of all the beds in the system. An influx of investment funds in recent years has left our country with the most privatised system of care in the EU. As my party leader said yesterday, some things have changed since Leas Cross. HIQA was set up to set standards, to inspect and to shut down non-compliant public and private nursing homes. Clearly, HIQA is failing in its duty and in my opinion and that of many other people, it is now not fit for purpose. I listened and watched the torment of the family of Audeon Guy. As so many families in their situation do, the first place they looked for information on somewhere to take care of their father was the HIQA report on the nursing home. They were failed in this report, which painted a picture for them that was far from the reality we all saw for their father in these programmes. Since last week, so many families have said that they rely on information from HIQA. The cases we saw last week showed families unwittingly putting their relatives in harm's way.

HIQA's practices must be urgently reviewed but is it best practice to ask HIQA to also conduct an independent review into all nursing homes? After all, it failed to identify glaring abuses of practice that some journalists and a carer with a camera found. Of course, they had the ambition to find those abuses. This would seem not to be an isolated incident. Since the first programme aired, my colleagues and I have had a growing number of complaints from family members from around the country. The simple fact concerning this profit-driven industry is that so many families tell me the only contact they receive from the nursing home is the letter demanding payment. There is nothing about the care for their mother, their father or their relation and what they are receiving.

An area raised by the Minister of State and one I wish to raise concerns those families who look after their father, mother or relation at home. Since the horrific programme aired last week, I have been contacted by a considerable number of people who take care of their loved ones in this way. They do so because they believe it is the best place for them. Many families are now looking to do likewise. As the Minister of State said, there is a serious cost in this regard. The Government needs to do more to help families in this situation. The Government should consider opening a fair deal-type system to families to provide care at home. It should look at making the housing adaption grants easier to obtain. Additionally, of course, as was said, it should abolish the means test for carers. This would allow a family member to receive some payment for the work they carry out.

I agree with what the Tánaiste said today when he stated in response to my colleague Deputy Sherlock that we are overdependent on private nursing homes in this country. We are seriously overdependent in this regard. We need to invest more in public nursing homes. I use this opportunity to once again highlight the magnificent care provided by the staff and management of St. Vincent's Hospital in my hometown of Athy. We are waiting on a new 92-bed hospital. I welcome the progress made to date, but this is the type of care facility the Government needs to invest in and the State needs to look to in the future. We need proper staff levels and properly paid staff and we need to take care, as the Minister of State said, of older people once and for all. We cannot let what we saw continue.

William Aird (Laois, Fine Gael)
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I am here today following the disturbing revelations uncovered by the "RTÉ Investigates" programme concerning the residential nursing home in Portlaoise.

We must be absolutely clear that what was exposed was not just one failure in one private institution. Rather, it was a systemic failure of oversight, communication and, ultimately, duty. Frail and vulnerable old people were left in unacceptable conditions while warnings were ignored. Despite HIQA issuing poor reports over the past year, admissions to this facility continued. That raises immediate and serious questions. How many of these admissions came directly from local hospitals? Were local HSE managers, particularly community-based managers, aware of the severity of the situation? Why was there no communication between HIQA and the HSE? We must face a difficult truth. It appears the HSE has washed its hands of the responsibility of the clinical care of older people in private nursing homes. It appears that as soon as a person enters the private system, he or she vanishes from the radar of all public health infrastructure. That must end. We need to reassert HSE responsibility for the clinical care of all our older people in long-term care. The long-term care needs of older people must be overseen by the doctors and nurses in the HSE regardless of where they reside.

I wish to be clear that this is not an attack on the hardworking local staff working there, many of whom I know personally in Portlaoise. It is a call for structural change, which was already recommended by the Covid advisory group. At a national policy level, there are several immediate steps that must be taken. We must redouble our efforts to provide robust clinical oversight of the private nursing homes by the HSE and enact safeguarding legislation first proposed in 2017 without further delay. If a company director presides over neglect, he or she must be held accountable, up to and including criminal liability where appropriate. The safe staffing framework phase 3, which sets out the minimum staffing levels and skill mixes of nursing homes, must be implemented. The care of vulnerable older people should never be left to the mercy of profit-driven motives.

We must also rethink the infrastructure of residential care. Why are we still building massive institutional settings for older people when we have moved away from that model for people with disabilities or mental health conditions? The Department of Health has been sitting on draft design guidelines for smaller, homely, community-based nursing homes. These guidelines must be adopted and enforced. We must be honest about the consequences of continuing to favour large corporate homes. We must push for smaller community homes, which can be viable with proper supports. We must accelerate the introduction of the homecare legislation and the roll-out of the housing support grants. It is a must and needed immediately. The choice between limited home help and institutional care is not good enough. The Minister of State knows that. Older people deserve real options to live with dignity, independence and safety.

I have been a public representative in Portlaoise since 1979. When I was first elected, on my watch, we had the general hospital in Portlaoise, St. Vincent’s community nursing unit, Abbeyleix community nursing unit, St. Brigid’s hospital in Shaen and Mountmellick primary care centre. I have to say that I never received a complaint, not once. I served on the local health committee, the Laois health committee, the Laois and Offaly health committee and the Laois Offaly, Longford and Westmeath committee. I always say it - and I would say it if he was sitting where the Minister of State is sitting today - that the Taoiseach of this country did one of the greatest things in banning smoking in public places. The worst thing he did, which was worse, was disbanding the health boards. I was a member of the health board when he disbanded it. Everyone, of all political persuasions and none, who was on the health board that day said it was the worst decision ever made. What has happened ever since? We have gone downwards and downwards with crisis after crisis. We have another crisis here today. That is why I am asking the Minister of State to go back, exactly as he has said in the Chamber today, and relook, rethink and ensure our older people are looked after.

There are things we can do immediately. We can have a look at the homecare packages. We can do that with immediate effect. I know 99% of the people I have represented all my life always wanted to look after their parents in their own home. That is always the first thing. We can do that. I am pleading with the Minister of State to please act on this. None of us want to have to look at what we have seen on the television the other night again.

I wish to say one thing for all the Members’ attention. I was in attendance when the nursing home opened. If any Member would like to go to look at it, it is the most beautiful building, all decked out inside and everything. I never once thought I would come back and watch on television what was happening further up the corridor.

Paula Butterly (Louth, Fine Gael)
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There is no doubt that everyone has come into the Chamber to talk about the RTÉ programme. As a daughter who had a father in residential care, and as a sister who has a 55-year old brother in residential care with Lewy body syndrome, I actually could not watch the programme. Like many people who have a parent or a member of the family in residential care, we are often overridden by guilt. Even when it is the best option for our loved ones, we often wonder whether it is the best solution or whether we could have done something more, such as getting more support at home or pulling an extra hour or two out of the day in order to help them stay at home. I missed the programme on the first evening and avoided watching it thereafter. I find it difficult to go to visit my brother. I had the opportunity to listen to the son of that gentleman in the RTÉ programme. He voiced so many concerns that I, my family members and so many other people think about every day when you have a person in a nursing home. What was on the paperwork did not match up to the actual care happening on a day-to-day basis. It caused me to reflect.

The Minister of State and I have spoken on this issue several times. As a former councillor and a TD, I am passionate that we find a system to the equivalent of the fair deal scheme which will allow our parents and loved ones to stay in their homes for as long as they possibly can and, hopefully, until the end of their days. This is fundamental. The statistics and facts back it up. The longer we can keep our loved ones in their home, the better they are for it. We, as loved ones, are the better for it as well. They are healthier, more mobile, and more stimulated. All the things a family can give to a loved one is missing in a nursing home, no matter how good it is. I urge that we find a system to keep our loved ones in the home. I urge the Minister of State to bring that about. I know he is working on a similar fair deal scheme to keep people in the home. It cannot be that difficult. I am a great believer that where there is a will, there is a way. We can and must do this. We cannot be here again in one year or in five years talking about another “RTÉ Investigates” programme because this is not the first time. We know that during Covid there were plenty of issues in nursing homes in County Louth. The Minister of State will be well aware of those issues. There are still questions to be answered.

We also must take care of rural areas in particular. I come from a rural area in County Louth. We have to find a fair deal scheme that is fair to farmers which allows them to have a better access to the actual scheme. We also have to look at the carers because the carers often provide an invaluable service. They do not become a carer but rather a friend to the family and to the person they are talking care of.

Unfortunately, a bad road, pothole or laneway can mean the carers cannot get there because of the conditions of the road. Many of these carers are not paid appropriately. They do not get car allowances to do the mileage to go down country roads. Very often, simply because it takes longer for them to get there and back, they do not want to go to the rural areas because they can do three or four calls in the same time it takes to do one call in a rural area. We need to revisit what we are doing for the carers who have such a responsibility towards our loved ones. I ask the Minister of State to review that too.

Colm Burke (Cork North-Central, Fine Gael)
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I can go back to 21 years ago when my legal office and another legal office identified a major discrepancy where over 80% of people’s pensions were being deducted in public nursing homes. We identified that the health boards and the Department of Health did not have legislative powers to do that. As a result of that challenge, over in excess of €450 million had to be refunded to 20,000 families. That challenge subsequently led to the creation of the fair deal scheme. The whole idea of the fair deal scheme was that everyone would be treated equally first in regard to the financial payment and second in regards the care and support they would receive.

What we saw on “Prime Time Investigates” is not acceptable and must not be tolerated. All these are people who have worked, paid taxes and reared families. This is not the way to treat them in their final years. Management and owners have the prime responsibility. What we saw here was not the necessary care. Even care supports required for individuals were being rationed. This is not acceptable practice. We all have a part to play in the care of those who have gone before us in relation to how they and previous generations have built up this country and have contributed to our education system, to our local authorities and all the services we enjoy. They all played a part in that and it is important we give them their support when they need it. It is important we look at the whole issue of funding. For instance, at the moment, 80% of people in nursing homes are in private homes but they only get 60% of the funding whereas 20% are in public nursing homes which get 40% of the funding. In fact, the public nursing home receives €1,969 per bed per week where a private nursing home gets €1,206. Public is €1,969 and private is €1,206. That is a difference of €763. As well as the cost of staff and electricity that private nursing homes have to pay, they also pay commercial rates to local authorities as well as interest on loans that were taken out to build those nursing homes. Those are the costs they have. If we want to have an adequate system, we must provide adequate funding and make sure the staff employed in the private nursing homes are there in sufficient numbers and that they have adequate training and communication skills. It is so important for communicating with anyone who needs care, whether they are in a nursing home or hospital. They also need time to listen to those people they are caring for. Older people want to make sure they are being listened to. It is important we have the people with the necessary skills in relation to all the people they are caring for. It is also important we ensure there is adequate review of their medical needs and it is not a case of prescribing the same thing months after month without a proper review.

We need to make sure that is happening in our nursing homes and that the necessary support is provided. During Covid we were able to develop supports. It is an easy option for a nursing home to transfer someone into a hospital and take the burden off the nursing home. We set up teams from hospitals that would visit nursing homes. In one case of more than 350 people in nursing homes, there was a review by a medical team from the hospital. Only 20 of the 350 had to be transferred into hospital. We need to develop that to give support to the nursing homes as well to make sure we have proper and comprehensive healthcare available in nursing homes rather than transferring people into hospitals. I will mention one last example of a 97-year-old man who was transferred to a hospital from a nursing home. He died four hours later. I do not think that is acceptable. Care should have been provided in the nursing home and the supports need to be given to the nursing homes so that they can provide that care.

Pat Buckley (Cork East, Sinn Fein)
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I thank the Minister of State for his opening remarks. First, I commend the whistleblowers on this. I keep saying here that you get absolutely battered for helping people and telling the truth in this country. The Irish population is ageing and growing, which is associated with higher levels of ill health and greater demand on all types of health and social care services. This obviously poses great challenges but we in Sinn Féin believe we should see improved health as an opportunity as well as a challenge, celebrating and enabling the contribution older people make to our communities while building a health service that cares for us as we age. In the words of the Democratic Programme of the First Dáil, we are committed to the care and support of Ireland’s older people “who shall not be regarded as a burden, but rather entitled to the Nation's gratitude and consideration”. The footage shown on the “Prime Time Investigates” programme on Emeis nursing homes was far from showing our older people gratitude and consideration. It was shocking, disturbing and nothing short of abuse. Too many elderly people in our country are living in facilities that are underfunded, understaffed and under-regulated. When I saw the footage of a frail female resident with dementia, considered a serious fall risk, being left alone on the edge of her bed for seven minutes at night while confused and agitated and seeking a toilet break, I thought of my own 79-year-old mother and how angry and let down I would feel if that were her. Families are now lying awake at night wondering if their loved ones are safe, whether their basic needs are being met and if they are being treated with the compassion and respect they deserve. Families should be able to trust that facilities are meeting the standards our elders deserve.

Even with greatly enhanced home and community care for older people, many families still have to make the difficult decision to place their loved ones in a nursing home as they require full-time care. Given this, it is essential that people are supported in long-term residential care and that the highest standards are maintained. We need to ensure that safe, clean and dignified conditions are maintained in all our nursing homes. We cannot continue to rely on HIQA alone. Sinn Féin has long called for adult safeguarding legislation, mandatory reporting of abuse and a legal right of entry for social care teams to investigate complaints. The “Prime Time Investigates” programme proved just how critical those reforms are to prevent neglect and abuse. Sinn Féin calls on the Government to immediately enact the adult safeguarding legislation as this would provide a legal framework to support safeguarding, additional powers for social workers and relevant social care professionals and agencies separate from the HSE, which is empowered to oversee safeguarding policy and practices across the public and private sector and in the home. We need to legislate to provide the legal right of entry to any designated care centre for relevant social workers and social care professionals.

Nursing home staff are overworked and underpaid. They are doing their best and that is all they can do in their impossible circumstances. They deserve better training, fair wages and the resources necessary to provide high-quality care. Currently, they are being left without the most basic items such as bedsheets, towels, sanitary wipes and gloves. To add insult to injury, families face high costs to pay for this long-term care.

There has been next to no investment in public care homes. Over 70% of our nursing home capacity is now private. This was facilitated and enabled by successive Fine Gael and Fianna Fáil Governments and this is the result. When profit is prioritised over people, it is always the vulnerable who pay the price. In this instance, it was our older generations.

The privatisation of nursing home care cannot come at the expense of quality and care. We need to tip the balance back in favour of public capacity with robust regulations and the appropriate safeguarding and protection. If we do not do this, in the words of Professor David Robinson, a consultant geriatrician in St. James's Hospital, "This is going to shorten people’s lives and the lives that they have will be more miserable because of the situation that they’re in".

This is not a matter for tomorrow. This needs to be addressed urgently. The cost of inaction will be measured in human suffering. We owe our elders not only respect but our action. The Government has a responsibility to protect the most vulnerable in our society and I call on it to make elder care a national priority not next year, after the next crisis, but now.

Pádraig Rice (Cork South-Central, Social Democrats)
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The "RTÉ Investigates" programme was shocking, disturbing and difficult viewing. Nobody in this country should be treated in that way. It is clear that the nursing homes in question were understaffed and under-resourced and patients were treated in an appalling manner.

What concerns me and many of us is that this is a repeat of the scandals of the past. What we are seeing is history repeating itself. We saw Leas Cross 20 years ago. Deputies have set out previous scandals. Time and time again we have had failure after failure. I wonder what lessons have been learned. I have absolutely no doubt we will be back here again talking about another scandal because there has been a lack of action for decades on these issues.

HIQA, which was set up in response to Leas Cross, has serious questions to answer on the credibility of its inspection reports. We need to review the powers and operation of HIQA and how and when inspections take place. It was clear from the RTÉ programme that a lot of issues happen at night, and there are questions about whether HIQA carries out inspections at night. That needs to be examined. HIQA needs to examine the minimum staffing requirements and put regulations and rules in place so that nursing homes are well staffed and resourced.

Ultimately, we have an issue with the model of care. There are serious issues with the for-profit model of elder care. International research shows us that there are worse outcomes compared with public and not-for-profit care homes. Over the past 35 years, in Ireland we have had an explosion of the for-profit nursing home care model. In 1990, 32% of nursing homes were private. By 2023, the figure was 81%. There has been a real shift. These are policy and Government decisions to shift from a public and not-for-profit model to a privatised model that is leading to poor outcomes for people.

Across the country,smaller and community based nursing homes have closed in villages and towns across the country. There are ten large investment funds which hold one third of nursing homes and, therefore, a huge amount of control over nursing homes in the State. In 2020, Leo Varadkar and the Tánaiste, Deputy Simon Harris, said that the model had to change. What has changed in the past four years? We now have the most privatised nursing home sector in all of Europe.

There have long been calls for safeguarding legislation. A Private Members' Bill was introduced in the Seanad in 2017, some eight years ago. There were calls for better protections for vulnerable adults. In the meantime, the Law Reform Commission has published a report. Absolutely nothing has happened. There has been a failure on behalf of the Government to legislate, put basic protections in place and protect the most vulnerable adults. The HSE has a safeguarding policy, but that does not apply to private nursing homes. HSE social workers do not have the right to enter private nursing homes, an absolute scandal that needs to change. The Minister of State and Government have the power to make that change. The Government controls the legislative agenda and has the power to pass safeguarding legislation. We have waited far too long. There has been report after report on adult safeguarding and all of the other issues that need to change stacking up in the Department .

Ultimately, most older people want to remain in their home, and we know that. The Tánaiste, Deputy Simon Harris, said in 2017 that he would put this on a statutory footing. It was incredibly frustrating to listen to him say in the Dáil earlier that he is committed to putting legislation on a statutory footing, when he committed to it when he was Minister for Health in 2017. What kind of commitment is it if it takes eight years to do the very basics around home care?

We need a right to, and the regulation and funding of, home care. It seems to me that nothing is happening. As a result, we have the privatisation of nursing home care and people being moved towards nursing homes as the default because the home care system is not properly regulated or resourced and there is no rights-based approach, something which needs to change. In this House, we are constantly talking about productivity in other parts of our State. We need more productivity in this Parliament. We need legislation to be passed. We need a right to home care. We need safeguarding legislation.

I call on the Minister of State to give us a timeline and commitments today on when that key legislation will be passed. It is within the power of the Government to make the fundamental changes that would make a real difference and prevent these scandals happening again.

Sinéad Gibney (Dublin Rathdown, Social Democrats)
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Growing old is a privilege, one which, it is to be hoped, many of us in the Chamber will be able to enjoy. In Ireland we have a lot to do in order to deal with our attitudes toward ageing and the way we treasure and nurture our older population. We should not infantalise them, as we did during Covid. When it comes to this issue around care, we need to offer choice. The reality is that we are all living longer and are healthier, and are also facing into much more complex healthcare plans for people as we age because of the demographic realities.

Choice, public care and prevention are the key elements we need to focus on this area. When we talk about choice, what we are saying is that older people should be facilitated into their older years and their families and communities should also be facilitated to allow them to make the choices they want to make in respect of their own health care. If that means remaining at home or living in facilitated environments or nursing homes, that spectrum of choice needs to be available to them.

In terms of public care, it is sad that we are seeing, as in so many areas, a trend towards privatisation. We heard earlier about the trend in direct provision where instead of building State-run centres there has been a reliance on private facilities. Similarly, in this area we have so much reliance on private providers when this is something the State should be providing. That is the vision of Sláintecare, in terms of healthcare and the public system, that we know we want to get to, namely, universal healthcare provision.

We are also missing a trick as a population and Government. We talk a lot about automation and the displacement of labour we will see through automation. The one sector that cannot be automated is care. We can never rely on robots and machines to provide care. Yet, we continue to undervalue care in our society. Of course, it is mostly carried out by women. I am referring to care roles in nursing homes, voluntary care roles in communities and families and teaching roles. They are all areas where, if we actually placed more value on them, we could invest in our future, future-proof our labour force and provide for the choice we want.

I want to talk about prevention because I come from the human rights space, where a lot of work goes into prevention. In 2017, when I was director of the Irish Human Rights and Equality Commission, we discussed the ratification of the convention against torture and the implementation of a national preventative mechanism. We are still talking about that. Legislation has not been passed. That is something that can provide for the preventative mechanisms which will make sure that this does not happen because it goes beyond the remit of HIQA. It is a fantastic organisation in a lot of ways and there are really good people and structures in it, but it has been fighting constantly for an additional remit to allow it to do its job.

The optional protocol to the convention against torture and the national preventative mechanism, if properly implemented, would mean that this is prevented and never actually happens. HIQA would have better facilities for unannounced and unannounced visits. There would be mechanisms in each sector, meaning there would be an inspector of prisons in justice and HIQA for the healthcare and nursing home sectors, but they would be beefed up in terms of their strengths and powers. That is the legislation we need. Proposals have been in place for a decade but legislation has not been passed. That is something the Department should examine. What we need for older people is safety, security and certainty, and these are elements which can bring that about.

Rory Hearne (Dublin North-West, Social Democrats)
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It is another scandal. It is another failure of our State to protect our most vulnerable. The failings of care that have been revealed in the "RTÉ Investigates" programme are horrifying. Vulnerable residents were left unsupervised, there was a lack of basic supplies and there was the rough handling of older people. One of the nursing homes featured is Beneavin Manor in my constituency of Dublin North-West. Members of the public throughout the constituency, and the country, who have family in nursing homes are distressed and worried. How can they trust that their loved ones are being cared for properly after seeing these failures?

Paul Guy, whose father was one of the residents highlighted in the "RTÉ Investigates" programme, reached out to me and I spoke to him today. Paul and his family described the shock and distress at seeing footage of their 80-year-old father being roughly handled at Beneavin Manor in Glasnevin. Paul said that no one should be handled like their father was, that these were human people who lost their dignity, and no one should have to go through that. The family had relied upon HIQA reports on Beneavin Manor for guidance in selecting a nursing home. The most recent publicly available HIQA inspection for Beneavin Manor dates from November 2024. It references residents being happy, inspectors finding the centre well managed and the quality and safety of the services provided being of a good standard. Clearly, as the "RTÉ Investigates" programme showed, this was not the reality for elderly people resident there such as Paul's father.

Shockingly, Paul told me today that no one from HIQA had been in touch directly with him to give him an apology for how his father was treated. He and his family have not been given the decency of an apology from HIQA and the State regarding their failures to protect his father and ensure he received adequate care and was protected from harm in a nursing home. Will the Minister of State and HIQA give him and his family the decency of an apology for the State's failure to safeguard his father?

Why does it take the airing of vulnerable adults being treated terribly on national television before we see action on this? The question is whether we will see action on this. The key issue Paul asked me to raise was that he wants to see immediate action from the Government, as set out by Safeguarding Ireland, to implement the framework for adult safeguarding, as published by the Law Reform Commission in April 2024, and to get the interagency working group up and running, with an appropriately skilled senior civil servant seconded to it, to implement and put in place a national safeguarding authority. Will the Minister of State commit to Paul and to the families affected to moving immediately to implement this?

Implementing this framework is the first step towards ensuring residents in care homes are protected. Ultimately, they are not being treated with the care or dignity they deserve and the Government has a responsibility to ensure this does not happen again. We still do not ensure that the delivery of care for the most vulnerable people in our society is done through a human rights approach, one that puts their dignity, and the State's responsibility to guarantee their safety and protection, central to service provision, whether it is children in State care, children in homelessness or adults who are resident in nursing homes. This is just not good enough.

Aidan Farrelly (Kildare North, Social Democrats)
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I thank the Minister of State for his opening remarks. What has concerned me and many others since the airing of this damning and tragic show is that when I speak to those who are working in the sector, and when we speak to families, what I consistently hear is that this is the tip of the iceberg. The fear that is out there in the sector, among the staff and families, is about what we do not know. What is left to be found out about this? It is of real concern and the Minister of State knows this; he does not need me to tell him.

When we have broken policy, and when we have a broken system, then we cannot but expect to have a broken culture. What the show has done is put a magnifying glass on a severely fractured elder care sector and system. When we as a State allow our responsibility to be taken over by the private market, we run the gauntlet because what happens is that those whom we trust to care for our most vulnerable, who stand to make a significant profit from it, will treat it as a commodity.

What do we ask the Government to do? We are not going to overturn an 80% private system overnight. It is of incredible importance that robust policy and legislation be in place so that elderly people are not failed, staff in the sector are adequately trained and resourced, and when these situations arise, the bodies we trust in the State to react have the teeth to do so with meaning. It starts with fixing the broken policy and the broken legislation, so that we hope to improve the culture and no longer fail those vulnerable people in our society. It is about dignity and human rights. It is about our values.

Paul McAuliffe (Dublin North-West, Fianna Fail)
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Like many in the House, my heart was breaking when I watched the programme last Monday. The Beneavin nursing home is literally five minutes from where I live. There are neighbours and friends who have relatives in Beneavin nursing home. However difficult it was for any of us to watch the programme, I cannot imagine how difficult it was for them. I know many people could not bring themselves to watch the programme.

Having watched the programme, there is one area we have to call out very clearly, namely, those with direct responsibility for the neglect and lack of care. They are, in the first part, those people who carried out the acts. When someone is willing to close the door so his or her colleagues do not see that he or she is taking a shortcut, that person knows it is wrong. That person is closing the door. When people are filling out forms that are not correct, they know it is wrong and it is not professional for them to do so. There is a basic lack of decency and human compassion when this happens. There is a basic lack of supervision and management. When there are not sufficient supplies in a nursing home, including basic sheets and incontinence wear, there is a basic lack of management and procurement. The people who are responsible for this are directly responsible.

There is also a basic absence of culture. They say culture is the quickest form of management. Things can be acceptable and unacceptable. In organisations where culture is strong, things will be called out by work colleagues without a manager having to be in front of someone. It was very clear there was no ethos or culture of care in these nursing homes. I say this with great regret because I have been in them. I have seen the people being cared for. I had thought these places were good places for older people. Over the years, I have received many requests for people to get into the Beneavin nursing home because it was seen as a premium nursing home, accessible and providing care locally. This was because the HIQA reports were very positive for Beneavin, unlike Portlaoise. As a family who recently had a relative in nursing home care, I know HIQA reports are important to families when they are selecting a nursing home.

I spoke to a number of families this week, including those who had relatives directly on the broadcast, who were incredibly upset. I cannot tell the Minister of State how upset they were. There were families who were not featured in the broadcast who have great concern and have still received very few answers. There were also relatives who felt they had a positive experience in the home. I was very fearful of traumatising these people or opening up doubts in them, particularly the many people whose relatives had passed away. I spoke to three people this week who had concerns.

One of these was a lady called Christine, whose relative featured in the programme. I spoke to a lady called Patricia, whose relative had passed away but had made a complaint to HIQA last year with regard to Beneavin. I also spoke to a lady called Phil. Each touched on things that are broken in the system.

This week, HIQA provided a briefing for the three TDs in the constituency. It was a useful briefing that provided insight. It acknowledged additional powers and resources, which were given to it last year, and that the inspection report was based on an unannounced inspection. With some reassurance, HIQA announced that there had been two visits by six inspectors in the three Beneavin nursing homes over the last week, but it has not yet contacted the relatives, which is really important. There is no trust in the provider anymore. HIQA needs to step in and explain what it explained to the three local TDs this week. We did not get any sensitive GDPR-related information, but we had contact and an opportunity to question it. Families are entitled to that too.

HIQA pointed out a number of worrying concerns too. There appears to be no baseline staffing ratio, as there is in the acute setting. There is no baseline education or training requirement. In a childcare setting, there is. Why is that not in place in a senior setting? HIQA also pointed out an area which alarmed me, namely, that there are three separate legal entities on the Beneavin site, all of which are under Emeis, but the holding company, which owns multiple legal entity providers, is not accountable to HIQA. That is an area the Minister of State should be concerned about, particularly because the number of these have grown and there are large numbers of nursing homes under a single provider. We have to get around that issue.

I raise the amount of money going into these homes. The nursing home support scheme or fair deal scheme was a positive way of reducing the huge financial burden on many families. Families were paying thousands of euro, and the fair deal scheme prevented that. As a member of the Committee of Public Accounts, this is a procurement issue. We are procuring services from these providers. I understand that millions of euro was going into Beneavin alone every year. Somebody needs to stand over the delivery of that procurance. It is not about standards. Standards and HIQA are important, but if I am the customer procuring the service, I should also be responsible for ensuring that the service is delivered. There should be an independent standards authority. However, the HSE, the nursing home support scheme and, in essence, the Government, are the ones procuring this service. We have to make sure we are getting value for money. I am thinking of all those families.

The way we make this better is by improving what we have. I disagree with some Members of this House who said nothing has changed since Leas Cross. Any basic assessment of the framework would state that this is not true. We now have HIQA. As other Members have said, HIQA does much good work. The methodologies need to be examined. We need to talk more about the basic care and have a greater focus on it, but let us not run away from what happened here. An undercover camera captured what no inspector would ever see and captured behaviour that was effectively being hidden. The people directly responsible for carrying out those services, who manage those services and are paid to run those services are the ones responsible.

Martin Daly (Roscommon-Galway, Fianna Fail)
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Like the Minister of State and every Member in this House, I was deeply disturbed by the scenes broadcast on the recent "RTÉ Investigates" programme. While immediate and decisive action is required in those specific cases in Glasnevin and Portlaoise - and I fully support the Government's commitment to that - this must also be a catalyst for wider reflection. How are we going to care for a growing population of older people, many of whom will require some level of support to live with dignity and independence? Our population is ageing rapidly. That is a mark of progress in public health, but it presents serious challenges. We must ensure that our care system is prepared, not just for immediate pressures, but for the longer term demands that will come with demographic change.

Many of our older people are living longer, more healthy, independent and productive lives, which is to be welcomed. However, when their living needs change, it must not be a binary choice of home or a nursing home. There are people in nursing homes today who would be better served by sheltered or supervised living in the community. It is essential that we get the regulatory framework right. I welcome that the Minister of State has met the chief inspector of HIQA and that he plans to appear before the health committee shortly. I also welcome the Government's commitment to progressing safeguarding legislation while recognising existing protective legislation, policies and protocols.

While regulation is vital, it is only one part of the solution. Culture within care organisations is equally important; culture ultimately determines the quality of care experienced by patients. We know culture comes from the top down. What we saw in those recent reports was not simply individual misconduct, although such behaviour is inexcusable, but the product of a deeply healthy organisational culture, where management is driven primarily by profit, and staff are clearly undervalued, undermanaged and deprived of the most basic tools to do their job. In such an environment, it is inevitable that standards would degrade and that staff would become demoralised, demotivated and disconnected. Culture is more difficult to measure, but we must find a way to do that.

We must find a way to financially sanction those private companies that do not manage those nursing homes properly. As a GP who has worked closely with more than ten nursing homes over the last three decades, including excellent, small, community-based homes such as Nightingale in Ahascragh, Oakwood in Roscommon, St. Francis in Kilkerrin and Mountbellew Nursing Home, I have seen the difference that a positive personal culture can make. Older people are living in their communities in those homes, often with contemporaries whom they know, and are cared for by staff whom they also know. Unfortunately, many of these smaller homes are now struggling to remain viable. I am told it takes a congregation of 70 people in a nursing home to make it profitable for private operators. In my area, two excellent homes closed, namely, Ballygar Nursing Home and Brideswell Nursing Home in Athlone. My own grandmother lived for two years and died in Ballygar Nursing Home. She was given excellent care. One of the most natural things in the world was that my children would wander in to visit and chat to her on their way home from school over those two years.

We have become too reliant on large, corporate and congregated settings, where that sense of community and personal connection is lost. I know the Minister of State and the Government are committed to increasing the provision of public nursing home places, especially for people living with dementia and Alzheimer's. However, we must look beyond institutional models. We need to build a continuum of care that enables older people to live in their homes and communities for as long as possible. We must also use smart technology to enable them to do so. Nursing home care should be the last resort, not the default option. That means being more ambitious about innovative care models, such as retirement villages, where independence is preserved and intermediate levels of support are provided. It also means addressing the current barriers to home care. Too often, where home care packages are approved, they cannot be delivered due to workforce shortages. We must look seriously at the terms and conditions for home care workers, and invest to make this a sustainable and respected career pathway.

I also urge that we examine closely the comparative cost of long-term institutional care with community-based and home care. In many cases, keeping a person at home is better for their well-being and is more cost-effective for the State. The older people we are speaking about today have contributed immensely to the life of this country. The least we owe them is a system of care that honours their dignity, respects their humanity and allows them to live with purpose and autonomy for as long as possible. I support the direction the Government is taking, but we must think more boldly and build a modern model of care that truly meets the needs of a changing Ireland.