Marie Sherlock (Dublin Central, Labour)
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I move:

That Dáil Éireann:

notes that:

— investigative journalism by RTÉ has again exposed distressing and unacceptable practices and conditions in private Irish nursing homes, 20 years on since the Leas Cross scandal;

— the failure of the State to provide sufficient public long term residential care places has led to the growing privatisation of nursing home care, while the State picks up the majority of costs through the Fair Deal scheme;

— 30 per cent of nursing homes were privately owned 20 years ago, rising to nearly 80 per cent now, with Emeis Ireland one of the largest operators, with 27 nursing homes;

— research by the Economic and Social Research Institute, since the Covid-19 pandemic, outlines the consolidation of the sector into larger operator groups, and the decline of independently owned, family run nursing homes;

— there are serious shortcomings in the inspection and enforcement regime by the Health Information and Quality Authority (HIQA), with inadequate regulatory oversight, ambiguity in the application of existing powers, and a lack of appropriate powers beyond the power to stop admissions or remove a license;

— there are no minimum staffing levels required in nursing homes, or binding guidance provided to operators;

— there is no sectoral pay agreement in place, and the 2023 PwC report entitled "Challenges for Nursing Homes in the Provision of Older Persons Care - Private and Voluntary Nursing Home Sector", documents a staff turnover rate in the private nursing home sector of up to 38 per cent for nurses, and 54 per cent for healthcare assistants; and

— the Ombudsman's Wasted Lives: Time for a better future for younger people in Nursing Homes report, updated in 2024, documents that over 1,200 people under 65 remain in nursing homes due to a lack of appropriate alternatives;

recalls that:

— the French parent company of Emeis Ireland, formerly known as Orpea, required a State-led bailout in 2022, after the publication of Gravediggers, a book exposing the mistreatment of care residents, where the company maximised its profits and dividends to shareholders, based on a complex strategy of drastic cost cutting and the maximum use of public funding; and

— the Law Reform Commission published a comprehensive report on A Regulatory Framework for Adult Safeguarding in April 2024, and the Programme for Government commits to a new national policy in the health and social sector;

recognises that:

— the nursing home sector has become dominated by big business, and a for-profit model will not provide the standard of care demanded by families and carers;

— with an increased role for home care support for older persons in future years, the profile of nursing home patients will become more complex, more dependent, and in need of greater levels of specialised care in the future;

— increased powers and resourcing for HIQA alone will not resolve concerns about a profit-led model of care;

— the Covid-19 pandemic exposed the vulnerability of residents in private nursing homes; and

— the Commission on Care for Older People is examining the provision of health and social care services and supports for older people; and

calls on the Government to:

— take clear steps to ensure the State takes over the 27 nursing homes controlled by Emeis Ireland;

— prioritise the quality and safety of care of older persons in overhauling how nursing homes are funded and regulated, and provide HIQA with stronger enforcement powers;

— fundamentally reform the Fair Deal funding model for nursing homes – public, private and voluntary, starting with an end to the individualised negotiation process between the National Treatment Purchase Fund and provider, the introduction of service level agreements, ringfencing of funding for labour costs, and the introduction of specific rules relating to the control of the nursing home property and operating company;

— legislate to ensure minimum safe staffing levels, and implement the outstanding recommendations in the Covid-19 Nursing Homes Expert Panel report, and the 2022 Report of the Strategic Workforce Advisory Group on Home Carers and Nursing Home Healthcare Assistants;

— require nursing home operators, in receipt of public funding, to recognise trade unions and engage in collective bargaining, to ensure competitive rates of pay, terms and conditions;

— ensure nursing home operators provide professional development education for staff within working hours, including mandatory safeguarding, infection prevention and control, and dignity at work training;

— limit all new nursing homes operations to 84 beds, and set out a schedule for all existing nursing homes to transition to an agreed appropriate size with HIQA;

— ensure the revised National Development Plan includes a funded programme to develop new public long term residential care, through community nursing homes, to meet the needs of our aging population;

— implement the Law Reform Commission report, by passing the required legislation as a priority in the autumn and establishing an independent national agency;

— introduce a new Fair Deal for care by implementing the long delayed statutory Home Support Service for Older People scheme, to support older people to age positively in their own home and community;

— adequately resource the home care sector, to deliver more care in the community and introduce a Fair Deal one-stop-shop, to support families and reduce red tape; and

— finally implement the recommendations of the 2021 Ombudsman's Wasted Lives: Time for a better future for younger people in Nursing Homes report, and commit to fully funding the under 65s programme office.

We have spent considerable time in recent weeks talking about nursing homes and I want to move that conversation on today. I do not doubt for a moment the personal commitment of the Minister of State, Deputy O'Donnell, to reforming the nursing home sector. However, when I read the amendment that was put down to the Labour Party motion, a motion that we designed to improve the nursing home sector, frankly, the amendment is disgraceful. It is completely devoid of any sense of urgency. It is complicit in endorsing a model of care run by big business in Ireland that we believe has to change.

Everything about the response to nursing homes in recent weeks since the “RTÉ Investigates” revelations screams of painfully slow caution. The kid gloves have to come off. We owe it to the older people in this country. I have spoken before about the very difficult decisions that families make to put a loved one into a nursing home. It is an admission that the needs are too great and the capacity in the home or the community is too small. As one woman said to me, for many families, it feels like it is an admission of failure.

Our motion, which I am proud to be proposing on behalf of my colleagues in the Labour Party, seeks to do a number of things but, principally, to mandate the Government to respond with a sense of urgency to the frightening issues that we are now seeing in a number of Emeis nursing homes. I will speak shortly of what was published last night. We want fundamental reform of the fair deal pricing scheme. To be frank, how that scheme is structured and the loose controls around it are driving some of the appalling practices that are currently going on in our nursing homes and in the care of the elderly in this country. Critically, we need legislation to ensure safe staffing levels and protections for staff in nursing homes.

I will ask the Minister of State a question. He has read HIQA’s final report into the 27 Emeis nursing homes and, by the way, he knows that the report is incomplete because a number of reports still have to be progressed. He knows that HIQA had previously found things were fine when they were not. He has seen the alarming findings for Blainroe, The Residence Carton, Brentwood, Kilminchy and Athlunkard. What is he going to do? With all of the information at his disposal, all of the information about the protected disclosures that have been sitting there for two years and all of the information that HIQA effectively failed in its duties, is he prepared to sit around and wait for the nursing homes to transform themselves? The safety and welfare of residents should not be made to wait.

It is worth recalling that protected disclosures were made two years ago about nursing homes that were not covered in the “RTÉ Investigates” programme, where residents were made to sit on commodes unattended for a significant period of time, where kitchen staff were let go and home care assistants diverted into the kitchens away from their tasks looking after residents, and where there was an increase in the number of admissions and no proportional increase in the number of staff. All of that was effectively ignored, and I do not know what happened with HIQA, but it was not addressed. There were failings.

If we are to be honest, if we had a doubt about the care of any of our family in a nursing home, we would not stand around and wait. We would do something immediately. There is a precedent in that the HSE went in to directly operate and manage 13 nursing homes during the pandemic. It was possible then and it should be possible now that the Minister would direct the HSE to go in and directly manage those Emeis nursing homes that have given rise to serious concerns. If we are serious about affording dignity and respect to older people, and providing assurances to them and their families, we need to see decisive action from the Government.

The pedestrian pace of the response from the Government speaks to a wider issue of the gaping holes in how the nursing home sector is regulated and inspected, gaping holes that are no accident. Our parties differ in that we in the Labour Party believe there must be no role for big business in the running of nursing homes in this country, no role for prioritising profit over resident safety and care. Few other sectors have a guaranteed source of income, a regulator that gives a wide berth and the certainty that demand is going to grow enormously in the coming decades. This sector gets €67.5 million from the State in the fair deal nursing home scheme and it is demanding hundreds of millions extra, with very few conditions attached.

The reality is that we have little or no oversight because many of those companies are unlimited companies. It is a sector where almost half of the beds, 48%, are now in the hands of just 15 operators, seven of which are Irish, four French and the rest German, Spanish, Dutch and Chinese. They are not here for the good of their health.

They are here because they see a serious investment opportunity. They were the figures in 2023 according to CBRE. The situation would be even more concentrated now. This is a sector that saw 26 nursing homes close between 2020 and 2023, the vast majority of them with fewer than 40 beds, while the growth is now in nursing homes with 100 beds or more. Of the 16 nursing homes under construction in 2023, nine had 100 beds or more. Three had 146 beds, 150 beds and 151 beds, respectively. That is not a nursing home; that is a warehouse. All of those have no minimum staffing levels.

This is a sector where the business model has profoundly changed over the last number of years and become increasingly financialised and where REITs will own the building and leech sizeable rents from the operating company. Then we wonder why there is no money for incontinence sheets, gloves and the basic resources to provide some degree of dignity to people in their old age. This is not the type of sector we want to have caring for older people in this country. The State absolutely has to step in and drive the growth of nursing home places, but we cannot take our eye off the ball with regard to private operators. We in the Labour Party believe there has to be a fundamental overhaul of the fair deal pricing scheme. The opaque non-transparent negotiation between operators has to end. We need service-level agreements specifying the precise level of care. We need tight restrictions on who owns and controls the operation and building of nursing homes, and we need legislation on minimum levels of staffing care.

In some ways, nursing homes are a misnomer. They are not staffed by nurses. The care is provided by healthcare assistants, yet there are people working in nursing homes who do not have QQI level 5 qualifications. I could rock up to a nursing home in the morning, start work there and then get my qualifications accordingly. That has to change. There are recommendations from the Leas Cross report going back to 2006 that have yet to be implemented. I believe this could be a watershed moment with regard to the revelations we have seen relating to Emeis. This needs to be a watershed moment in how we dramatically and fundamentally overhaul how nursing homes are run in this country. It is within the Minister of State's gift. An awful lot is riding on his efforts. We need, for the dignity and respect of older people in this country, to see a dramatic change in how they are regulated and inspected.

Mark Wall (Kildare South, Labour)
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We need a fair deal for care. This means ending the privatisation of nursing home care and giving older people the choice to age in their own homes and communities, with a statutory right to home care. This right to home care has long been promised by successive Governments since 2017, but we have yet to see any real progress on this. Instead, the only option that older people and their families are faced with is nursing home care. The average length of stay in a nursing home is around three years. This reflects the level of decline that many older people experience due to privatisation, where shareholders are more concerned with profits than the care and wellbeing of older people. We have seen a small number of multinational corporations and foreign investment funds take a stranglehold on the nursing home sector over the last 20 years. Some 30% of nursing homes were privately owned. That has risen to nearly 80%.

Emeis Ireland is one of the largest operators in this country, with 25 nursing homes, six of which are in my own county, Kildare. The "RTÉ Investigates" programme shone a light on the distressing and unacceptable practices of Emeis Ireland. Our motion seeks to address the failures of big business to implement effective measures to provide quality care and basic compassion to older people. As a society, we must accept that the privatisation of care cannot work. It is already a failed model. We need a radical reform of the nursing home sector, with minimum staffing levels, giving stronger enforcement powers to HIQA, and delivering adult safeguarding legislation.

This motion is the start of a national movement where we want to end corporate care and move towards care in the community. We have an ageing population and the demands on healthcare and services will only increase. We must therefore look at our changing demographics and expand the continuation of care for older people through developing infrastructure, implementing a statutory home care scheme and increasing staff to support care in the community and in the home. I note the Minister of State's bona fides from his contributions in this House and the Seanad and that he is determined to facilitate people to "live in their own homes".

I have dealt with a number of cases over the last couple of weeks and a huge issue at the moment is where people are waiting for housing adaptation grants from local authorities, yet they cannot move into their homes because those housing adaptation grants have not been sanctioned. Surely an intervention from the Minister of State would allow those people to go back to live in their own homes and allow that bed to be freed up for somebody else. I will allow my colleagues to come in. I hope the Minister of State will listen to this motion today because unfortunately what we have seen in the Government's amendment to the motion is not a Government listening or caring, but a Government promoting privatisation.

Gerald Nash (Louth, Labour)
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The failures of care exposed by the media in recent weeks are not just a failure of one private nursing home operator. This is a failure by our State, a failure of public policy, a failure of regulation, and an abject failure to uphold the dignity of those who have no option but to put their care into others' hands. It would be naive of us to think that we have seen is anything other than the tip of the iceberg. Just look at Aoife Hegarty's reports today. The abuse, the poor care, the corners cut and older men and women lying alone in their own waste are because the company that operates the nursing homes that they call home will not employ the staff they need to appropriately run the places that aligns with the fluffy PR, what we see on their websites, and what they expect to see.

This is the conclusion of two things. One is the calculated and deliberate crowding in of private operators over the course of 25 years, propped up by our own money and a regulatory regime that is hands-off and is not feared by a sector that owns almost 80% of all nursing homes in the State. Combined, this is a recipe for disaster. The perverse irony is that it is those vulnerable, ageing citizens, who paid for the tax incentives to develop a slew of private nursing homes in the 2000s, who are now paying the price themselves in the very homes built on their backs, paying on the double now with their dignity. We have an industry that constantly has its paw out for additional resources from the State. At the very least, if the Minister of State is to sign off on additional fair deal money, the industry should be expected to engage in a joint labour committee, JLC, employment regulation order arrangement for a fairer deal for their workers. This is what the State demands, for example, of the childcare sector, using the JLC system to ensure that State money is properly used to improve the pay and conditions of staff. The same should apply in the nursing home sector.

If we learned anything from the scandalous deaths at Dealgan House Nursing Home in Dundalk in 2020, it should be that there should be a national clinical governance programme, operated by the HSE and applying to all nursing homes. In the other words, in the interests of all older people and all residents, there should be HSE oversight. That should be standard and applied right across the board, whether the nursing home is public or private.

George Lawlor (Wexford, Labour)
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As someone whose family is lucky enough to be in a position to keep their mother in her home while she requires care, with the help of some wonderful carers and my sister living with her, the spectre of what we saw on our TV screens a number of weeks ago was truly appalling. Families across the country looked on in horror as evil appeared on our screens. I do not need to rehearse all the condemnations that have been rightly chorused, but seeing the footage was a chilling catalogue of all that is bad about the private sector takeover of the care of the elderly in this country. We have a situation where the care of the elderly in some, not all, but a considerable number of units is far from being either caring or considerate.

Yesterday, I listened to an amazing, articulate and well informed woman on my local South East Radio, Dr. Margaret Kennedy. She is part of a campaign called Equality Not Cruelty. Its campaign is focused on the urgent reform of HIQA and ensuring that ill-treatment and violations of dignity, respect and care in residential nursing homes never happens again. This amazing 72-year-old woman, who lives with a neuromuscular disease, succinctly and articulately summed it up for so many in her situation. She said her group spoke for disabled people and older people in its campaign. She said when she saw the images on her television screen, it was clear that older people were being commodified. She said that older people were being warehoused in these places and that money was the root of all the difficulties. Who could disagree? She went on to say that these places are called nursing homes, but nobody should call them homes of any kind, because that is certainly not what they are. She had listened with interest recently to a discussion at an Oireachtas committee where someone from HIQA spoke about a care deficit.

I agree with her that this is an extraordinary phrase to use when describing criminal offences whereby people have been assaulted or criminally abused. That is not a care deficit; it is criminal activity. How can there be 198 abuse reports about Beneavin Manor in Dublin and 40 reports regarding The Residence Portlaoise, but it takes the work of an RTÉ investigative team before we talk about it here in the Oireachtas?

Our motion calls for the nationalisation of the 27 nursing homes controlled by Emeis Ireland. That is the least we can do to send a signal to those sailing close to the wind that we are sick to the teeth of profit driving their motives in looking after some of the most vulnerable people in our society. Like every public service that is overrun by the greed of boardrooms, this sector has once again shown that when it comes to the provision of essential services in the State, greed always trumps the good. The ideology we have seen over the years absolutely fosters that approach.

Eoghan Kenny (Cork North-Central, Labour)
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I second the motion. I thank my Labour Party colleagues, particularly Deputies Wall and Sherlock, for their work on it.

I do not for a minute doubt the Minister of State's personal view on this issue but what we saw in the "RTÉ Investigates" programme proved there absolutely are systemic issues within HIQA. The fact HIQA took more than four months to investigate issues identified by RTÉ is beyond belief. We are talking about care of our much loved older people, who deserve dignity and respect as they age.

Following the programme, staff members of private nursing homes in my county of Cork made contact with my office to inform me of very serious concerns they have raised with management and, in some instances, directly with HIQA. Often, those concerns go unnoticed and receive no response. Accountability is crucial when it comes to care of older people. Families and staff members across the country have spoken about HIQA's failure in its statutory remit to investigate and resolve issues when they arise locally. Ensuring procedures and processes are in place to protect the vulnerable in society is the job of HIQA but it is not happening.

The motion calls on the Government to provide HIQA with stronger enforcement powers. Its staff must have the ability to perform unannounced inspections and see for themselves what the reality is. If we are real with ourselves for a minute, we will acknowledge that HIQA announcing that an inspection will take place makes no sense. The polish is out, the forms are signed and appropriate settings are put in place. If inspectors go in unannounced, they will see for themselves what is actually happening in organisations across the country. It is important to recognise that there are genuine, caring and hard-working care assistants, nurses and doctors working in nursing homes. However, that is not the case across the entire sector.

The motion has a specific focus on the fair deal scheme. That scheme is not fit for purpose. We must introduce a statutory home care scheme that allows our old people to live with dignity and respect in their home and community. The overall focus is on the care being provided to older people.

In a nursing home in my home town of Mallow, as Deputy Sherlock referred to, the kitchen staff are being given the option of redeployment or they will be got rid of completely. The job they have been doing will now be the job of the care assistants. A complete line of work is being taken out. Care assistants may now have to feed people who cannot get out of bed, a job which was previously done by the kitchen staff.

This is one of a number of serious systemic issues. As I said, I do not doubt the Minister of State's personal opinion on this but he has an opportunity, within his Department, to change what is ongoing and to address the systemic failures in care for our older people. HIQA's role in that care must be made an absolute priority for him, his Department and the Government. Families across the country are calling on him to do that.

Kieran O'Donnell (Limerick City, Fine Gael)
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I move amendment No. 1:

To delete all words after "Dáil Éireann" and substitute the following: "recognises that:

— a national policy on adult safeguarding will be introduced for the health and social care sector, as set out in the Programme for Government, and this policy will commit to the development of adult safeguarding legislation for the sector, including nursing homes, and will build on the range of existing legislation, policies, and procedures already in place in the sector for preventing, reporting, and responding to abuse;

— a framework for safe nurse staffing and skill mix will be developed for nursing homes, and this framework is a systematic, evidence-based approach to determine the number of nurses and Health Care Assistants required to provide safe and quality care, based on patient need/dependency; and

— the remaining provision, Section 68 of the Patient Safety (Notifiable Incidents and Open Disclosure) Act 2023, will be commenced, providing additional powers for the Health Information and Quality Authority (HIQA)/Chief Inspector with regard to serious patient safety incidents in nursing homes, and the Chief Inspector will have the power to carry out a review of an incident which may have caused an unintended or unanticipated death or serious injury to the patient, and which occurred in the course of the provision of care to that patient;

notes that:

— a review will be established of the effectiveness of the Chief Inspector's inspection and monitoring processes, and this review will include such elements as how to further strengthen the monitoring of leadership, culture and governance in designated centres, how to better capture indicators of staff culture and other areas of service delivery, which is critical for safe and good quality support for residents;

— a plan for additional public nursing home bed capacity will be published, and the Department of Health, alongside the Health Service Executive, is currently developing a new public long-term residential care additional capacity plan, which will be published in 2025, and the delivery of additional public long-term residential care capacity is required to deliver on Programme for Government, Sláintecare, and Project Ireland 2040 commitments;

— new design standards for long-term residential care settings for older people across all sectors will be created, describing what good building design looks like for long-term residential care settings for older people, and providing a common benchmark against which the standard of these settings can be measured, and the Department of Health report entitled 'Design Guide for Long-Term Residential Care Settings for Older People Public Consultation Report', was published in January 2025;

— ownership structures will be reviewed to enhance transparency and strengthen accountability in the long-term residential care sector, and carrying out an evaluation of the implications of complex corporate ownership structures against current regulatory powers will identify opportunities for regulatory reform;

— the Government has reiterated its well-established commitment to the development of the statutory home care scheme in the 2025 Programme for Government, and the first element in delivering this is the Health (Amendment) (Licensing of Professional Home Support Providers) Bill 2024, which will establish a licensing framework for professional home support services and provide for regulation by HIQA;

— the Programme for Government commits to strengthening the nursing home sector, by increasing funding for the Nursing Homes Support Scheme, also known as Fair Deal, while investment in Budget 2025 was €67.6 million, and this followed on from an increase in 2024 of €45 million; and

— the Government established an independent Commission on Care for Older People, which 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, including long term residential care; and

further notes that from 2021 to 2025, the Government provided funding of €21.4 million, to enable people under the age of 65 to transition to an alternative community-based placement and provide in situ supports as appropriate.".

I welcome the opportunity to address the House on matters raised in respect of nursing homes in the Private Members' motion tabled by the Labour Party. I do not doubt Members' sincerity in bringing it forward. We all want to get to a point where we have a better, fitter nursing home service for the elderly.

I again acknowledge the "RTÉ Investigates" programme that was broadcast on 4 June. That hard-hitting and harrowing programme highlighted a litany of poor care standards in two nursing homes, namely, the Residence Portlaoise and Beneavin Manor in Glasnevin, and showed clear neglect and abuse of older people. The welfare of both the residents and their families was obviously at the forefront of my concerns following the RTÉ programme. I am very conscious of the impact the 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 it will have had on the nursing home sector more generally, including residents and staff. It is important to acknowledge, as all speakers have, 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. I again state categorically that every nursing home resident deserves, and should expect, the highest standards of care at all times. 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 by providers for every resident in every nursing home across the country. Anything less than that will simply not be tolerated. I welcome the confirmation that referrals have been made to An Garda Síochána.

I have had significant engagement with HIQA and with key stakeholders in the nursing home sector, including the HSE and representative bodies from the sector. I am continuing this engagement with an immediate focus on delivering the highest quality of care to the residents of nursing homes in Ireland. Responsibility for the safety and care of residents ultimately rests with the individual provider of each nursing home and its staff. The governance and management of nursing homes is a critical aspect in ensuring the safety and welfare of all residents. Staff must be equipped with the tools and supports they need to provide those in residential care with person-centred care.

As the national independent regulator of nursing homes in Ireland, I expect HIQA and its chief inspector to utilise all powers available to them to ensure rigorous oversight and accountability in nursing home care. HIQA's role is to ensure the systems, structures and processes put in place by a nursing home work to ensure safe and effective care and support for those in residential care. Department officials and I met with HIQA on 4 June to discuss regulatory activity relating to the nursing homes featured in the "RTÉ Investigates" programme. At the meeting, HIQA's chief inspector confirmed its continuous intensive engagements with the two nursing homes in question.

On 13 June, as requested, HIQA furnished me with an interim report on its engagement with the two nursing homes featured in the "RTÉ Investigates" programme. That interim report was published on 17 June. It details HIQA's inspection of the two nursing homes since the programme was broadcast and its ongoing work in this regard. It also provides a brief overview of the Emeis Ireland group. HIQA has completed a series of unannounced inspections of both nursing homes, in the evening, in the early hours of the morning and during the day, to ascertain the level of care being provided at all times. Both providers were issued with an official warning of cancellation of registration should they fail to implement significant improvements in the care of residents.

On 20 June, as requested, I received a further report from HIQA giving an overview of the 25 nursing homes in the Emeis Ireland group. The report provides a comprehensive overview of regulatory history, including, but not limited to, regulatory compliance, escalating enforcement actions and any additional conditions of registration. That report was published yesterday.

The Minister, Deputy Carroll MacNeill, and I, together with Department of Health officials, met with HIQA on 17 June and on 30 June to discuss both reports. At those meetings, HIQA advised it is continuing its intensive engagement with the Emeis Ireland group of nursing homes. The contents and findings of both reports are being considered, including the need for additional regulatory powers in respect of nursing homes, with actions in this regard to be taken as a matter of priority. I cannot emphasise enough that this is an absolute priority for me and the Government.

HIQA has acknowledged the importance of examining its processes and methodology. It is essential that they are continually reviewed to find ways to improve the inspection and regulation of nursing homes. HIQA is undertaking a review of the effectiveness of the chief inspector's inspection and monitoring processes.

This review will include such elements as how to further strengthen the monitoring of leadership, culture, governance and management in nursing homes, how to better capture indicators of staff culture and other areas of service delivery that are critical for safe and good quality care for residents.

I have requested that, when compliance issues are identified in a nursing home, HIQA monitor more closely the corrective actions taken by the nursing home towards achieving compliance and that this information be included in HIQA's published reports. This makes common sense. When a report is published at present, it deals with what happened on the day of the inspection. I want the report not to deal with the day of the inspection but the compliance actions required to be implemented and whether they were implemented. A report is in real time. When people read inspection reports on the HIQA website, they will see not only what happened on the day of the inspection but also what has happened since. When they are looking for a nursing home for their loved ones, they will know what the situation is now. That is very important. I have asked HIQA to implement this and it will do so.

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 Irish long-term residential care market, the growing consolidation of the sector and the complex investment and ownership structures that now exist. Deputies have referenced that in almost all of the contributions. It is, therefore, important that all aspects of the nursing home sector be scrutinised over the coming period to ensure that service delivery and configuration meet the needs of service users in a sustainable and safe manner.

This scrutiny includes a review of ownership structures to enhance transparency and strengthen accountability in the long-term residential care sector. Carrying out an evaluation of the implications of complex corporate ownership structures against current regulatory powers will identify the required regulatory reforms. As it stands, HIQA can regulate the individual company that is the service provider but does not have jurisdiction over the parent company or the umbrella group. I want that changed and we will implement that.

The chief inspector of HIQA will soon have additional powers with regard to serious patient safety incidents in nursing homes when section 68 of the Patient Safety (Notifiable Incidents and Open Disclosure) Act 2023 is commenced. The chief inspector will have the power to carry out a review of an incident that may have caused an unintended or unanticipated death or serious injury to a patient and occurred in the course of the provision of care to that patient.

The Minister, Deputy Carroll MacNeill, and I are fully committed to introducing an adult safeguarding policy for the health and social care sector, including nursing homes. The policy will commit to the development of adult safeguarding legislation for the sector, including nursing homes, and will build on the range of existing legislation, policies and procedures already in place in the sector for preventing, reporting and responding to abuse. The policy is at an advanced stage and our intention is to bring it to the Government as a matter of priority. The Government has included a health (adult safeguarding) Bill in its current legislative programme to facilitate this, and it is recognised that this will be an important further development in protecting vulnerable adults from abuse.

I would also like to advise the House of ongoing work by the Department of Health to develop a framework for a safe staffing and skill mix for long-term residential care settings for older people. The framework is a systematic evidence-based approach to determine the number of nurses and healthcare assistants required to provide safe and quality care based on patient need. This work is nearing completion, and I expect to receive recommendations for how it can be implemented shortly. Furthermore, in my discussions with HIQA, I have asked it to ensure that, where there is a change in the staff profile in a nursing home, there be a requirement to notify HIQA. This is a very important point. It is a practical measure that can be taken by HIQA.

The Government is committed to continued investment in healthcare infrastructure that supports the highest quality of care for our older population. It is recognised that long-term residential care will continue to be a crucial part of the overall continuum of care. The programme for Government commits to building more public nursing home beds and, in this context, 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. The delivery of additional public long-term residential care capacity will deliver on programme for Government, Sláintecare and Project Ireland 2040 commitments. This plan will be informed by the HSE capacity review report on future capacity for older people, which was published on Monday by the ESRI.

We have spoken about the built environment. It is 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 Government is, therefore, committed to creating new design standards for long-term residential care settings for older people across all sectors, providing a common benchmark against which the standard of these settings can be measured.

Statutory home care is a priority for me. I am working on the legislation for home care providers, which will be the first step. I will look to bring it to the Minister, Deputy Carroll MacNeill, and the wider Government as a matter of priority. We are increasing funding for home care. With regard to the age profile of the population, we have set up the Commission on Care for Older People and it will shortly publish the first module of the work it has done.

I, as Minister of State with responsibility for older people, the Minister, Deputy Carol MacNeill, and the wider Government are committed to ensuring everything possible is done so that the distressing scenes we witnessed in the recent "RTÉ Investigates" programme do not happen again in any nursing home in the country. I want to state clearly that every nursing home resident deserves and shall expect the highest standard of care. My abiding concern is older people in nursing homes. Everything is about improving care and safety for them.

Alan Kelly (Tipperary North, Labour)
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What was shown on the "RTÉ Investigates" programme - well done to those who made it - was disgraceful. We have many fine private nursing homes, but when we allow the development of a for-profit model for investors - there are large-scale investors in a large proportion of these nursing homes, as the Minister of State knows - that have borrowed money at low interest rates and there is no sectoral agreement on workers, we are looking for trouble.

We have a lax regulatory regime whereby HIQA simply does not have the powers in respect of this sector that it should have, as the Minister of State has acknowledged, to be fair. The "RTÉ Investigates" programme happened because we let it happen. HIQA was in nursing homes not long before the programme was made and it took a significant period of time before it reassessed one. This is when things fall through the cracks.

We have a real problem in this country when it comes to managing nursing home care and care for the elderly. We need a complete reboot of the statutory home care scheme to support people to stay in their homes. There is the scandalous issue of the thousands of under-65s who are left in nursing home care.

There are practical measures we need to take. In the new national development plan, we need massive public investment in public nursing homes. We need one in Roscrea. It has been promised for decades. To be fair to the people of Roscrea, I do not think there is any town in Ireland that is more deserving of a proper nursing home to replace the Dean Maxwell. We need them all over the country.

We also need to start giving consideration to our demographics, in particular how many people will be over the age 65, 70 and 80 in the years to come. We are not prepared for this. I speak with a lot of knowledge on this. We are not preparing for issues relating to more and more people living longer and having dementia.

The type of care we provide also needs to change. Many public nursing homes have to take high-dependency patients purely because private nursing homes cannot, in some cases, take them or, perhaps in a minority of cases, will not take them, something the Minister of State knows. I know this because I have tabled parliamentary questions, the replies to which show that, in many cases, people are left in hospitals for months, if not years.

Collectively, we need large-scale public investment in nursing homes. We need a sectoral agreement to pay workers properly. We need a regulatory regime that ensures these people are not let down and nursing homes and the standards they have to maintain do not fall through the cracks.

Ciarán Ahern (Dublin South West, Labour)
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I commend my colleagues, Deputies Sherlock and Wall, for tabling the motion. All of us in the House were outraged by the "RTÉ Investigates" programme, which showed the appalling levels of abuse and malpractice in older people's care settings. These are some of the most vulnerable people in our society. They depend on the help of others to meet their basic needs, as any one of us here might well need some day.

To see the conditions these older people were living in, and the routine violation of their human dignity, was shocking. It is incredibly upsetting to consider that any of our relatives living in long-term residential care could face the same indignities and abuse. These abuses are widespread and long term. We have heard the pleas of care champions and other relentless campaigners who continue to call for a statutory inquiry into the mistreatment and neglect in our nursing homes, which had particularly devastating effects during Covid.

The proliferation of private providers is at the heart of this issue. For me, the key takeaway from the "RTÉ Investigates" programme was that the State's failure to provide sufficient care for older people through home care and residential care has enabled the ever-increasing privatisation of the nursing home sector. We can clearly see that a model of profit maximisation above all else will never provide adequate and dignified care to those who need it.

In almost all cases, people who require care and personal support, including older people, would prefer the care to be delivered in the comfort of their own home and community. The Irish Longitudinal Study on Ageing and the ESRI have both reported that institutionalisation is being imposed on many older people and disabled people who should, and wish to instead, be enabled to live at home and be included in their community. This is their right under the UN Convention on the Rights of Persons with Disabilities.

As a State, we have institutionalised people as a default social care response. From the Magdalen laundries, to psychiatric institutions, to direct provision, to congregated care settings in nursing homes, again and again these systems, profit making and the lack of State regulation involved have been shown to cause serious abuse.

Our current home care system is not fit for purpose either and this needs to change if we are to get out of this never-ending cycle of coercive and neglectful institutionalisation. Much of our home care system is privatised yet we have been speaking about statutory regulation of home care and a statutory entitlement to home care for decades. These promises were included in the programmes for Government in 2016 and in 2020. Now, the current programme for Government commits to designing a statutory home care scheme. After all this time how are we just getting to a design stage? We are now in the third successive Fine Gael Government that has committed to statute-based home care. Is it hoping for third time lucky?

We know the best outcomes for older people in terms of their health and well-being are when they can remain in their own homes and communities and receive the care they need there. Home and community-based care, and residential care that is embedded in and open to community participation, is best for all of us.

Robert O'Donoghue (Dublin Fingal West, Labour)
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I thank my colleagues, Deputies Wall and Sherlock, for tabling this important motion. The care system is increasingly in crisis. From cradle to grave, we have seen care farmed out to private investors who think of profits and not people. The current crisis is driven by two factors in particular. These are the natural ageing of the population and the State's hands-off approach to providing care. We have seen a shift towards privatisation in the commodification of care and the outsourcing of our own social responsibility. While the "RTÉ Investigates" programme was shocking, unfortunately many families who have placed loved ones in care knew this was inevitable. Many complaints have gone unanswered or uninvestigated. There are serious shortcomings in HIQA's inspection and enforcement regime. The high staff turnover rate creates a damaging cycle that compromises the quality of care that people receive and this alone demands urgent attention.

Care for older people must be reframed as an essential part of our social infrastructure, on a par with education, health and housing. Nursing homes should not be the default solution for ageing. Instead, they should be reserved for situations where end-of-life or intensive medical care is genuinely required. They are certainly not for people under the age of 65 due to a lack of appropriate alternatives. The priority should be on delivering care in the community, allowing older people to thrive and live with dignity and independence in their own homes for as long as possible.

Just yesterday, a journalist outside asked how much this was going to cost. That question is everything that has gone wrong with how we do care. We should be outraged that the first concern is the price tag and not the person who needs the care in later life. We cannot and should not put a monetary figure on dignity, well-being or the rights of older citizens. Caring for older people is not a cost to be calculated; it is a fundamental responsibility of any decent society. We owe them care not because it is profitable but because it is right.

We have seen a shift in the valuation of care economically and socially. Mainstream economic thinking often treats care as a cost rather than a vital investment in people and society. The commodification of care has prioritised cost efficiency over individualised high-quality care. This is also evident in the treatment of our care workers. Care provision is predominantly delivered by the private sector, even though it is largely funded through the public purse. This work remains low paid, insecure, under-regulated and undervalued. Many workers lack basic protections and benefits. If private nursing homes are to be funded by the public purse, they should not block trade unions organising to make sure they have decent and conditions. We need a new approach that resets care as a public good and not a private commodity. The future of care lies in public investment, community-based services and the priority of people over profit. It is time we moved away from a nursing home default model and towards a system that truly supports older people to live full and dignified lives.

Natasha Newsome Drennan (Carlow-Kilkenny, Sinn Fein)
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I thank the Labour Party for tabling the motion. All of us here at some stage will have to think about whether our parents will be in need of nursing home care. It is a very difficult and uncomfortable conversation for any family. It is something we would all like to think our parents will not need but this simply is not how life goes.

We put immense faith in these nursing home providers that they will show love and compassion to the people who raised us as they reach a vulnerable stage of their lives. The "RTÉ Investigates" report has shattered this faith. It showed that despite more than 200 complaints being made about one nursing home, no action was taken against it. The HIQA report showed clearly this nursing home was not only non-compliant but repeatedly non-compliant, with little evidence it was even trying to improve its standards. There were residents with bedsores and bruises. Calls for help went unanswered. There were incidents of starvation, deprivation of liberty, a lack of dignity, a lack of respect and a lack of care. How did the operator get away with it? There was not a single cent in financial fines. Where is the accountability?

How did it take an "RTÉ Investigates" report and not the concerns of family members and loved ones for action to be taken? What kind of message does this send out to families who have concerns about the care being provided to their loved ones? How upsetting and distressing these past few weeks must have been for the loved ones of residents in that nursing home is unimaginable.

The consequences of successful Fianna Fáil and Fine Gael Governments are being laid bare. There has been a complete and utter failure by Governments to put in place robust and effective policies and regulations. There has been a push for a model of privatisation, with fast and loose regulations, and a failure to provide HIQA with the powers it needs to effectively police the sector. We have seen scandal after scandal exposing these failures and neglect but what we have not seen is action from Fianna Fáil and Fine Gael.

There is still no adult safeguarding legislation in place. 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 these teams need to be significantly expanded to do their job. Safeguarding teams and social workers must be given a legal right of entry and be permitted to investigate concerns, unannounced, at any time. Furthermore, where management and corporation leadership make decisions that lead to poor quality care and the loss of the health or life of residents in the care of the service for which they are responsible, there must be accountability.

We need to see a step change in Government policy, one that will invest in building capacity in public nursing homes and residential homes. 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. The current laws are clearly not working, and for almost 20 years everyone has been telling the Government that they are not enough. It is now three weeks since the "RTÉ Investigates" report. What will it take to finally see some action from the Government?

More than 80% of nursing home beds are provided by the private sector. This is the Government's answer to everything but it is simply not working.

What we have seen on RTÉ is just the tip of the iceberg. I certainly would not like to end up in one of these nursing homes, nor would I want one of my loved ones to be treated like an animal. If I treated the animals on our farm badly, with dirty beds, starving them, etc., I would be prosecuted. Why are people treated with such neglect, calling and pleading to use the bathroom and left to lie in their own urine as punishment? Is this where our Government is at, letting big business make huge profits by mistreating our older people?

Speaking as a carer, this is not what we want. I was in the public sector. HIQA had the authority to come into our place. There were two HIQA inspectors for three residents. We cannot expect two HIQA inspectors to go into a nursing home with 90, 70 or however many patients. There have to be more.

Louise O'Reilly (Dublin Fingal West, Sinn Fein)
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When I think of HIQA, I am often reminded of an article about the British royal family that stated that they believed that everything outside of Buckingham Palace smelled like fresh paint. HIQA is probably the same. Announced inspections are not working and give people far too much time. There have to be unannounced inspections. HIQA needs to be better resourced. None of us wants our loved ones to be treated in such a manner. That is a given and we do not need to see it. However, HIQA is sometimes all that stands between a vulnerable person and mistreatment. The Government - I was about to say "we", but I am taking no responsibility for this - should give HIQA the powers it needs.

In 2004, the Rostrevor nursing home was investigated by the health board. On one occasion, bed sores on an elderly incontinent patient were found to have been contaminated by faecal matter. Before prosecutions even took place, the health board went to the High Court to try to have the home shut down. There was evidence that staffing, training and drug administration rules had all been breached. One nurse had been rostered for 72 hours in one week. No fire drills were carried out, despite residents smoking in their rooms. The owners at the time, the Lipsetts, argued that they had resolved the problems. There were no powers to shut the home down at that stage. The owner was struck off the nursing register because she failed to act on sexual abuse allegations. That happened between 2004 and 2005. Micheál Martin was the Minister for Health and Children for part of that time. In 2011, I had occasion to be in that nursing home when it was eventually shut down. If I live to be 1,000 years old, I will never forget what I saw and heard from the people working there. The way in which the residents were treated shocked me to my very core. I did not think it was possible that people could be treated in that manner. It was very shocking. The workers were treated every bit as badly as the patients and residents in the nursing home.

Two weeks ago, I sat in my constituency office for well over an hour with a woman whose dad had been a resident in the Beneavin Manor nursing home. She detailed to me the litany of complaints she had made on behalf of her father. She had brought them to the attention of HIQA, the owner and the upper people in the nursing home. It was during Covid. Her dad was only allowed to have one visit, but he got that one visit every single day. Hard and all as it was for her to live it, it was hard to hear about it as well. I thought afterwards about the people who did not have anybody to speak up for them. She was in every day to see her dad and she could still see he was being mistreated. What about the people who do not have anyone to speak up for them? That is why HIQA is supposed to be there. That is why we need the adult safeguarding legislation. We need the Government to stop talking about it because talking about it is interfering with the Government actually doing something about it. We really need to see that legislation, not just a "strong commitment". We need to have a conversation about privatisation. When profit motive is introduced into the care of vulnerable people, this is the inevitable consequence. Privatisation is Government policy; it needs to be reversed.

Johnny Mythen (Wexford, Sinn Fein)
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I thank the Labour Party for bringing this important motion to the floor. The statistics alone tell the true story of long-term residential care in our country. More than 80% of nursing homes are now owned by private bodies, with Emeis Ireland being by far the largest operator, owning more than 27 premises in total. When private companies are driven solely by profit, whose solidarity and loyalty only lie with their shareholders and their main goal is to increase dividends, there is a high level of risk that the residents themselves will become a secondary element in such a financially motivated model. This explains why the system is subject to bad conditions, bad-quality service, cutting corners such as staff shortages, low wages, and unavailable medical devices and supplies, as was exposed by the recent "RTÉ Investigates" programme on 4 June. What is needed is the State to assist and fund smaller community nursing homes and to invest in public nursing homes and community beds. Many of these small homes provide excellent-quality services to their residents. More often than not, they personally know the residents and their families as well.

Unfortunately, in my hometown of Enniscorthy, the Moyne Nursing Home recently closed, with the loss of 30 jobs. The management, the Earle family, stated: "For the past nine years we have put our blood, sweat and tears into making Moyne Nursing Home the home from home that it is today." The family stated: "Since we took over the running of the home back in 2013 we have prided ourselves on providing the highest standards of care to our residents". The family also stated that adequate funding was not provided by the Government to ensure adequate standards set by HIQA were met.

Safeguarding legislation must be introduced and an independent safeguarding authority established, as our spokesperson on health, David Cullinane, has advocated for many years now. The reporting of concerns about abuse and neglect must be made mandatory and whistleblowers must be protected. The Government must act now. More than 820,000 citizens are older than 65 years of age. With the prediction of a steady and substantial increase in the next two decades, this must ring alarm bells. A comprehensive social policy to support independent living must be implemented. A sea change in the State's current policy of privatising nursing homes must be radically invoked or we will be facing many more scandals in the near future like that exposed by RTÉ. The State must bear a duty of care to our ageing population. I ask the Government to please support this motion.

Thomas Gould (Cork North-Central, Sinn Fein)
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In recent years, I have had the privilege to work with Pat Coyle and the Care Champions, a group that came into existence because of what happened to their loved ones during the Covid pandemic and how badly they were treated. Their stories are heartbreaking. I have witnessed the guilt and the hurt they feel because of the way their loved ones were treated. They feel their loved ones were abandoned. Care Champions and Pat Coyle have tried to engage with the Government in a constructive manner. They are not about pointing fingers of blame. They want to ensure that what happened to their loved ones will never happen to anyone again. They want to be positive and constructive, not negative.

The Care Champions just want to work the Government and the Opposition so that people in nursing homes or hospitals, vulnerable older people and vulnerable sick or disabled people are not let down the way they were let down. To listen to their stories and hear how they feel about what happened to their families was just heartbreaking. They have made freedom of information requests, they have looked for meetings, and they have looked for the Government to implement the changes that were supposed to come about after what happened during the Covid-19 crisis. This has not happened. The Government is now talking about an inquiry. There will have to be a proper, full, open and honest inquiry, not an inquiry that is going to pay people, but an inquiry to get to the facts of what happened so that these people can have their stories and voices heard.

The "RTÉ Investigates" programme was horrendous. Care Champions told us the organisation is not surprised but, based on what it has found out in its own investigations, it is surprised that other people are surprised. The scenes in the programme were absolutely disgusting. Some 200 complaints were made against one nursing home, yet it took RTÉ to highlight the issue, and fair play to it. RTÉ can be criticised at times, sometimes rightly, but in this case its journalists did really important work to try to protect vulnerable older people when the State and HIQA were letting them down. Action needs to be taken.

How many other nursing homes are operating in the same manner? One of the hardest decisions a person or family can ever make is to put someone into a nursing home. Recently, a member of my family who is sick had to go into a nursing home while recovering. We could only visit between 2 p.m. and 4 p.m. That is no good for anyone who is working. I am lucky we have a good family and people are flexible and able to manage things. In the hospital, we were only allowed visits from 6 p.m. to 8 p.m., so there were no visits during the day. We should encourage more people to visit vulnerable people, not reduce access to them.

All of this is coming about because of a privatisation agenda that Fine Gael, supported by Fianna Fáil, has driven for decades. We see money and profit being put before people. How can that be right?

A nursing home owned by the State, Heather House at St. Mary's health campus in Gurranabraher, had a brand new dementia unit built and it has been lying empty for over a year because of a lack of resources and staff. At a time when people are crying out for dementia places in nursing homes the Heather House dementia unit is lying idle. The Minister of State needs to act on that.

Ruairí Ó Murchú (Louth, Sinn Fein)
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It is hard to believe we are back here again. It is 20 years since the Leas Cross case, which led to a commission of investigation and the establishment of HIQA. Like many of my colleagues, I believe HIQA needs to be given some of the powers it has requested. As Deputy O'Reilly said, we need some facility for unannounced visits of a particular type. We cannot be utterly reliant on "Prime Time" to safeguard our older people. We have huge levels of failings. It is crazy to think that 200 complaints were made about a particular nursing home and nothing was done about it. Everyone has said we have an issue with privatisation, accepting that there are good private and public nursing homes. We need to make sure all of them are good. The Government has walked away from the public system. In everything this Government touches, there is an overreliance on the private sector. In the nursing home sector, 81% of homes are private and 19% are public. This is not good enough and it means the likes of Emeis Ireland are a major part of home care. Without safeguards, there are huge questions to answer.

Any time I talk about nursing homes I find it difficult not to deal with Dealgan House and the 22 families who lost loved ones in the early period of 2020 during Covid. They, like Care Champions and many other advocates, are not impressed by the Government's approach to that. I do not even know what the term is because it is hardly an inquiry. It is a review of the period of Covid-19. We need some sort of compellability. We have heard the Taoiseach and many others speak about what they do not want to see in relation to commissions of inquiry or commissions of investigation. That is fine but it is not fine to be a commentator. The Government has the power to decide what type of inquiry can be initiated, with whatever checks and balances are required. That is what we need.

We really have to get real about delivering a home first policy to facilitate those in their own home to be helped by their families. This will require a statutory support scheme that is up to scratch. We need to see the adult safeguarding legislation delivered. This has been necessary for a long time and has been spoken about for far too long in this House. We need to make sure all those necessary pieces are put in place.

When we are talking about residential care-----

Mairéad Farrell (Galway West, Sinn Fein)
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Go raibh maith agat, a Theachta.

Ruairí Ó Murchú (Louth, Sinn Fein)
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-----there is still a particular issue with the capital assistance scheme. I spoke to the Minister for housing about it. It needs to be delivered. It is creating an issue because those who should be getting disability housing in St. John of God services and other services cannot get it because the councils are not able to deliver and the funding is put in with the tenant in situ scheme and the rest.

Mairéad Farrell (Galway West, Sinn Fein)
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Your time is up.

Ruairí Ó Murchú (Louth, Sinn Fein)
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Apologies.

Liam Quaide (Cork East, Social Democrats)
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I commend the Labour Party on its motion. We fully support it. It has been an honour to meet in recent weeks with Safeguarding Ireland, Care Champions, and the Irish Association of Social Workers to discuss adult safeguarding and systemic problems within our nursing home sector and other care facilities. I look forward to engaging with Inclusion Ireland, Sage Advocacy and others to this end in the coming weeks and months.

There is consensus among the advocacy groups that the Law Reform Commission report into adult safeguarding, published last year, is the roadmap that we need to follow to implement comprehensive adult safeguarding legislation and to establish a national safeguarding authority. It is worth mentioning that, following the Farrelly commission report, a lot of commentary reflected on the fact that the commission of inquiry was extremely expensive, did not produce clear recommendations and was very unsatisfactory in many ways. If we had a national safeguarding authority, it would greatly reduce, if not entirely eliminate, the need for these commissions and tribunals. It would have a safeguarding focus in how it conducts investigations.

Safeguarding Ireland has highlighted that the Bill currently proposed by the Government in its legislative agenda is too narrow in scope and would be a missed opportunity if pursued. It is vital, therefore, that we go back to the Law Reform Commission's report.

The recent "RTÉ Investigates" programme, which brought adult safeguarding back into sharp focus, documented appalling standards of care at two nursing homes that form part of one of the largest private for-profit care providers in the State. It was chilling and terribly sad to witness the casual neglect of and repeated insults to the dignity of those nursing home residents. Profiteering and the care for some of our most vulnerable citizens do not go hand in hand. A major overhaul of our care system is needed.

The "RTÉ Investigates" programme documented abject failures to respect the basic care needs and dignity of nursing home residents as an everyday occurrence. These are yet more examples of how our care system is failing vulnerable adults and is subject to poor oversight, a lack of mandatory reporting structures and weak enforcement powers. While the content of the programme was shocking, many people were not surprised by these patterns of mistreatment. These patterns are likely not isolated to this particular nursing home provider. For me, a stand-out moment of the "RTÉ Investigates" programme was when the more experienced care assistant advised a colleague that she too had notions of a better system at the outset of her career. She said:

I know you feel sorry and I feel sorry for everybody here. They do not go out, the activities are shit, all this system is shit, you understand, but this is how it is, you know. Ours is just to do our job and to go home. I wouldn't put my mother here, even if it was my last breath.

That exchange captured how basic empathy can gradually break down in a service that is under so much strain, where there are not enough staff to share the workload and where items for attending to the basic care needs of residents are not provided. We cannot let a sense of inevitability set in that this is just how it is now for elder care.

The need for comprehensive adult safeguarding legislation has been repeatedly raised by the interest groups I mentioned.

It has been highlighted in particular following the Leas Cross scandal 20 years ago, the Áras Attracta scandal in 2014 and the Brandon, Grace and Emily cases, and the Government has failed to act. Unlike with child protection, there is no single, comprehensive adult safeguarding law in Ireland. Instead, adult safeguarding relies on a patchwork of legislation, policy documents and fragmented departmental responsibilities. There does not appear to be an ideological barrier that I can identify to explain why the necessary legislation has not been pursued. The only conclusion I can draw is that successive Governments have neglected this area because they have not felt sufficient political heat on the matter. It is incumbent on all of us to ensure that it retains the focus it currently has.

Aidan Farrelly (Kildare North, Social Democrats)
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I thank the Members of the Labour Party for bringing forward such an important motion. I thank the Minister of State for his opening statement, which is comprehensive, but it is unfortunate to see the Government amendment and what is contained in it. We have spent a considerable amount of time speaking about this since the TV programmes aired and the experiences highlighted. Profit can never be the guiding principle for care. If we use that as a starting point when we discuss reform, we will all start to see we agree with each other much more than we differ in terms of ideology. Over the past 30 years, we have allowed the sector to move from being a public good to a profit-making endeavour for the majority. How this manifests itself is in the experiences highlighted by the "Prime Time Investigates" programme and many more.

I have spoken to staff in those settings. They have spoken about their hurt as the weeks and months have gone on. For many, it misrepresented the love, care and compassion they have for the work they do. They have also highlighted concerns in relation to the response and we have seen that now in terms of admissions being stopped. It is said there is an element of window dressing in settings now where we are seeing staff numbers being considerably increased in the last weeks and months as a response. Why it took such revelations is beyond me. Why businesses are allowed to operate relatively free of control is a starting point that we should consider.

Profit cannot be the guiding principle for care. The Minister of State will agree with me on that. I think we all agree with that. If that is the starting point, then we acknowledge that reform is needed through HIQA and the HSE. It starts with us considering a move back from the 80% private dependence to a much more publicly-funded and publicly-regulated sector.

Sinéad Gibney (Dublin Rathdown, Social Democrats)
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Trust in nursing homes has been lost. With everything that has come to light in recent months, the one overwhelming response, which really concerns me deeply, is that people are now afraid of nursing homes, or perhaps more afraid, because revelations like these have been coming out for decades. Old age should come with a security and a certainty that a person's needs are met, they are safe and they treated with dignity. It is the duty of policymakers to not only address the issues raised by the recent abuses which have come to light, but also to rebuild this broken trust. We need a system that is both safe and trusted. Without both, we are not delivering that vital security to people and their families.

Unfortunately, as we have heard from many today, this is the natural product of privatisation of care. When care work is conducted on a for-profit basis, we encourage the work to be done to as close to the bare minimum of standards as possible. I have worked in both the private and public sectors - not in the care sector - but it is a simple fact that in a for-profit environment, the bottom line is it. Everything that is done in such an environment is for profit; it has to be because that is what the organisation is set up for. The public sector is a very different environment, where there is either a mandate or a job to do that is not driven by money. We have to get our heads around that when we are thinking about the provision of care in this State.

People who work in nursing homes around the country tell us about the chronic short staffing, the lack of oversight and the lack of resourcing. These conditions are a recipe for disaster for people living in nursing homes who are then vulnerable to that poor treatment. We did not need and RTÉ programme to tell us this. Any healthcare assistant around the country could do exactly that.

As this motion points out, 80% of nursing homes in the State are now in private hands. Without addressing the failure of the State to provide nursing home care, to provide for safe staffing levels and to take responsibility for the care of older people, we will not see the change that we need.

I have mentioned one piece of legislation in previous debates and I want to raise it again. The Inspection of Places of Detention Bill has been delayed multiple times. It provides for what many people have talked about here today, namely the unannounced visits. The Bill has the remit and jurisdiction to potentially deal with nursing homes. I encourage the Government to look at that as something that could bolster the remit of HIQA and give it the powers it needs.

We will be supporting this motion. I commend the work of the Labour Party on bringing it forward. As with other Deputies, I share a real rejection of what the Government has put forward as a countermotion, because it simply fails to recognise the urgency and the importance of this issue.

Charles Ward (Donegal, 100% Redress Party)
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I thank the Labour Party for putting forward this very important motion on nursing homes. I support it and its calls to prioritise equality and safety in the care of older people. Overhauling nursing homes is what we need to look at. As someone who has worked on the ground and worked for the company involved in the documentary, I am not surprised. To say that 80% of nursing homes are now in private hands and are profit driven is beyond a joke at this stage. I have worked in nursing homes and I can safely say that every aspect of those homes is profit driven. It goes from the food people are given to the deodorant and the soap they use. It is a shocking indictment of society that everyone has to go around their nursing home smelling the same and looking the same. If it comes to it, they have to buy clothes for people. That is how bad it is. If their clothes are damaged, the nursing home may not provide them with clothes. The person's relatives might be in another part of the country. That company in the documentary would not necessarily be just looking after old people. It could be a mix of people in the home. It is profit driven. We need to emphasise that we have lost humanity when profit comes before our elder citizens.

Like my colleagues, I found the "Prime Time Investigates" programme extremely difficult to watch. In the documentary, we saw older people not being treated like humans. The documentary demonstrated consistent patterns of neglect and lack of care in nursing homes across the country. It is deeply concerning. We have been getting phone calls over the past few weeks about certain issues within private nursing homes all over the State. I was a healthcare worker prior to being elected. I know exactly what is happening on the ground.

HIQA has an issue here. It is coming in and doing inspections after this is not good enough. HIQA coming in is like the old analogy of locking the stable door after the horse has bolted. We find ourselves in a ridiculous situation. We are revisiting this 30 years after previous investigations and TV programmes. No lessons have been learned and profit is allowed to be the driver.

The average age of the population is now higher than it has ever been before. The number of people aged over 65 in Donegal has increased by 19% since 2016. We have to start properly and publicly investigating care of our growing population. It is clear we can no longer rely on private companies to deliver care. The current service providers are only motivated by profit, which is evident in the constant cost-cutting measures that are used. We need serious investment into the creation of public nursing homes with community beds.

I support this motion's call to ensure the national development plan includes a funded programme to develop new, public, long-term residential care, through community nursing homes, to meet the needs of our ageing population. We need to engage in long-term thinking and strategic planning. People cannot be expected to rely on their families any more to take care of them as they get older, given the number of young people who have been locked out of home ownership and forced to emigrate. We need to ensure that we have enough residential homes to cater for our ageing population and that these homes are well-staffed, comfortable and safe.

I also highlight the fact that residential homes are not covered under the Government's defective concrete scheme. We know of a few residential homes in Donegal that are affected by defective concrete. This must be taken into account. Families with loved ones in a nursing home have more than enough on their plate and they should not have to worry whether the building a family member is residing in is safe or structurally sound. However, this is a worry being forced on many family members in Donegal, on top of the worry about whether their loved ones are being treated with the decency and respect they deserve. Some of these families might have been forced to put their loved one into residential care because their home was unsafe due to defective concrete. I know this for a fact. Mould is always an issue in such a home and if someone living in it has respiratory problems, there is no choice as they have to be got out of the house to prolong their life.

The defective concrete crisis has its tentacles in every aspect of daily life in Donegal. What the Government is not seeing on the ground is that for people impacted by this crisis, it is a constant presence in every aspect of our life, including in nursing homes and community centres. It goes right across the spectrum of every aspect of our lives. Crèches and schools are also affected.

The Government underestimates just how much this crisis is a part of everyday life in Donegal. For example, there is an estate in Mountain Top in Donegal where every house in it has defective concrete. There is a nursing home and an office block at the entrance into this lovely estate, which is no longer lovely as it is decaying, and both of them are defective. The families of the residents in the nursing home are stressed and worried, but there is no scheme in place for them.

I will return to the subject of nursing homes. I worked in a nursing home up to my election. The staff in nursing homes are extremely caring people. There were a few bad people. Former staff members called me to say they feel uneasy at work and that they are being watched. HIQA can show up at 6 o'clock in the morning. It is meant to do that. However, HIQA is responsible here too. If a member of staff is taking a resident, who is mobile, to bed, HIQA can watch every aspect of that in the hallway but as soon as the staff member takes the resident into his or her room and closes the door, HIQA is not allowed into the room. A HIQA inspector can only observe staff and residents in public doorways. He or she cannot go into a room and watch a member of staff put a resident to bed. That is wrong. We do not know if best practice is being taught. If a resident is being put in a hoist, if the door to the bedroom is closed then the HIQA inspector cannot see him or her because they are in the hallway.

I will give another example while I am at it. The residential place where I was working is a high-security locked unit. It is a circular building with a walkway around it and rooms off the walkway. People were in sections and staff looked after a section. HIQA decided that was not right. It said we should open up the whole place and let people wander around. Staffing levels were at a bare minimum. We saw the fall rate and transfers to hospital go through the roof. The decision was made by a HIQA inspector as to what should happen, so what worked for the previous 15 or 16 years was discontinued and we went on a different route. It is unacceptable that residents are left in dangerous situations because of staff shortages, which is an everyday occurrence.

One can see the faults when one has one's feet on the ground. HIQA must also take responsibility and look at the way things are done. It is fine to have 6 a.m. inspections, but let us put it where there is best practice. For example, when people can train online as a healthcare assistant at FETAC level 5. They can spend €1,800 on it, walk into a nursing home and get work experience and also get a job. Whereas, I trained for two years' part time to up my skills with Elspeth Vaughan in the ETB, one of the best training courses one could get. We did everything to a very high standard. When someone with this standard of qualification goes into a private nursing home, straight away he or she gets calls from the HSE with offers to join it and promises to give us this or that. I would not be moved. I worked for the minimum wage, but I would not be moved because I cared for the people. That is what is missing. The fact is that we no longer care for the people we look after. It is profit driven. We need to get back to a place where the elderly people are the most important ones.

Michael Collins (Cork South-West, Independent Ireland Party)
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I thank the Labour Party for bringing forward this very important motion today. I am sure there is not one person in the Dáil who saw the documentary who was not disgusted by the way our elderly were being treated. If big businesses are treating our elderly in such a terrible way, we must ensure we do all we can so that this does not continue.

That said, we cannot tar everybody with the one brush because there are some great nursing homes. We must make sure the bad are weeded out but the good are secured and looked after. I meet Tadhg Daly from Nursing Homes Ireland fairly often and we discuss the lack of funding. I have gone to a lot of nursing homes. They tell me straight that there is a massive lack of funding.

We all know the great community hospitals that are out there that are funded to within an inch of their lives. If HIQA walks in the door and improvements have to be made, they are funded by the State. The situation with nursing homes is that if HIQA walks in the door and says improvements must be made, the funding must come out of their coffers. I am very seriously concerned because while nursing home staff and management are doing everything they can to make sure everything is right, it is impossible to do that if the budget is tightened beyond belief. That is the situation here and the Government have let things slip.

I also have very serious concerns about care of the elderly going forward as the elderly population is rising. I know a lot of the hospitals in my constituency, and I never heard of an extension being proposed for any one of them. When I ring to inquire about bringing in a patient I am told, for example, that 15 or 20 people are on the waiting list and the person does not have a hope of getting in there. They might pass away before they get the chance.

One stunning hospital we have is in Schull. I would be delighted if the Minister were to get a chance to come and see it because it is a perfect example of what a community hospital should be. In fairness, there are other similar places throughout the country. The hospital has 21 beds. As far as I know, there were 21 beds there 100 years ago. Something has got to change. Somebody must have the vision to say the hospital in Schull and in other places need an extension of 25 or 30 beds, so that people will have a home if they need it. That is a very big issue for me.

I also talk about Aperee Living nursing home, which had serious issues some two years ago. We lost the facility in Belgooley. At that time, I said in the Dáil that the nursing home in Belgooley should be taken over by the State because there were enough people in need of a nursing home. One can imagine old people losing their nursing home and having the living daylights frightened out of them, yet nobody stepped in. The nursing home was let go. It was the same with Aperee Living in Bantry and the nursing homes in Conna in Fermoy and in the Mallow area. They all went into liquidation. People are living in fear that they are going to lose their home, which is basically what can happen. The State must have a mechanism to step in, as outlined in the motion, and to take over the running of a nursing home if it is badly run or someone has been found guilty of serious infringements. That is the road we must travel. It did not happen in Belgooley and the patients were herded out like cattle.

They were shoved everywhere and anywhere. There was no respect shown. They were told a nursing home would be found and that if they did not take it, they should be taken home. That is not good enough. We need to wake up and understand how to respect our elderly. If the State had stepped in and put the money into that nursing home that it needed, and that the owners did not seem to have or did not want to invest - I did not know what was going on there - it could have taken up to 80 people. It could have taken pressure off nursing homes in west Cork.

Dementia units are also badly needed. We need to invest and ensure there are more carers and that there is not a means tested for carers. We need to invest in home help. However, the biggest problem I have with home help, which keeps people at home - we do not need people going into nursing homes every day of the week - is many of the older home helps are walking away. They were fantastic and mainly women. The problem is they have to carry around tablets and computers to do their job. That is not what they should be doing. They should be in the house looking after the patient. Unfortunately, it has gone to another level which they might not be capable of reaching but they certainly were the world’s best at looking after the elderly person in the home. Unfortunately, I am hearing of private companies being brought in because staff cannot be found as they are walking away. They were willing to stay had they been allowed to work rather than going home to spend an hour tapping on a tablet or on a computer, sorting things out. Their work was on the ground; delivering for and looking after people. That is the area the Minister of State needs to return to as well as carers and the means tests. They are important areas.

The recent increase in the means test for carers is a positive step. It is imperative that the means test is completely abolished to better support families to care for their elderly parents at home. Additionally, there is a critical need to expand the availability of home help services. One of the most pressing issues is the insufficient provision of home help for individuals transitioning from hospital care. This shortage often results in elderly patients being placed in nursing homes. By significantly increasing home help services, we can reduce the necessity for sending our elderly population to nursing homes, thereby allowing them to remain in the comfort of their own homes.

Last week in the Dáil, we in Independent Ireland brought forward a motion with 23 points on how to fix the housing crisis. While making my contribution on it, I showed those in the Chamber a picture of Jennifer Marley who is 88 years of age. She was becoming homeless. She had no home. Her next move, unfortunately, was to a nursing home. She did not need a nursing home as she lived independently. There is no social housing in west Cork. I have been on choice-based lettings, CBL, for the past ten weeks and I believe once in ten weeks a couple of houses came up in west Cork. That is an astonishing situation west Cork finds itself in. There are no council houses available. A local housing body - the Government needs to invest money in housing bodies - that had received money from the State and had built a number of houses, thankfully, stepped in and looked after that lovely lady, and deservedly so. The problem is I am in the same situation this week. I am holding up another picture of a 77-year-old man, Gus Dempsey, who asked me to do this. He is homeless as of today. His house burned down six months ago. A neighbour gave him a house to move into but he is now in a situation where he has no home tonight. He does not know if he will have to sleep on the street. His neighbour was brilliant and kind but told him his family was coming home and he had to leave by a certain date. The man is in a desperate situation. Will he end up in a nursing home? This is the crisis we have in this country. Our elderly people are being abused one way or another. We have completely taken our eye off the ball in respect of their future and what will happen in this country.

If these people become homeless, will they be rammed into a nursing home when they do not need to be in one? They need a home they can call their own. It is a simple thing. I thank all the housing bodies. I am involved in two of them and we have approximately 20 to 25 people housed in 16 houses in Schull and Goleen. They are absolutely thrilled. They have all the services they need at their door. The medical centre is right beside them. We opened 12 of these houses recently. This is a fantastic service and we need to spend more time looking at that.

The future is bleak for a person who is elderly. It is bleak right now but what will it be like in ten years’ time? There is no planning here and I said that to the Minister of State. I have not heard of any planning permission from any community hospital or nursing home in the whole of County Cork for an extension of rooms. We need to look at this issue and not have someone like Gus Dempsey at 77 years of age worrying whether he is going to sleep in Ballinspittle on the side of the road, on the street or under a bus shelter. That is a situation we find ourselves in between last week and this week with two different people aged 88 and 77. We resolved the 88 year old's situation and my office is frantically trying to resolve that of the 77-year-old. Any help the Minister of State can give would be greatly appreciated.

We need to look to the future, which is not happening. The fair deal scheme is an unfair deal for farmers in regard to nursing homes. The promises made here over a number of years are being broken. I have two or three pages on the areas of unfairness. If one is leasing land, one is murdered and caught in a system that is part of the assessment.

I know time is tight. I am very passionate about certain areas here. I do not want to tar everyone with the same brush. The community hospitals and nursing homes I know of are running fantastically and are doing great work. It is upsetting for many of them and for their staff to think the finger is pointing at them when it should not be.

Mattie McGrath (Tipperary South, Independent)
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This is a timely and sensitive motion. The programme on RTÉ shocked everybody. Many people knew of the many changes in nursing care and the methods of care in our nursing homes. I salute the many hundreds of small nursing homes and some quite big ones in Tipperary, in particular St. Martha’s and Bramleigh Lodge in Cashel and the many others I could name. They do an excellent job but they are under fierce pressure. There is discrimination against them.

The HSE-owned nursing homes have bigger subventions than the small private nursing homes. We have commodified healthcare and nursing care. I have seen that with my own two eyes. We were waiting on a 60-bed HSE nursing unit in Cashel at St. Patrick’s Hospital. Former Deputy, Martin Browne, and I were told at a meeting a year and a half ago that site was not suitable. I do not know why it took so long to come up with that. We are now looking for another site for a 60-bed unit. We should look at the pressure that would take off nursing homes and people who need nursing care. I salute the nurses, attendants and management of community and small family-run nursing homes and some of the bigger ones as well. I visit them quite often and the standard of care is very good. Where there is wrongdoing and abuse taking place not only the management but the persons perpetrating it should be prosecuted. It is elder abuse of the worst kind.

Tipperary used to have Tipperary District Hospital and St. Brigid's in Carrick-on-Suir until two years ago when it was unceremoniously closed. It was taken over during Covid mar dhea before it was closed down. It had 15 beds and three lovely hospice suites. It was a very functional and practical place and should be reopened. The people of south-east Tipperary, east Waterford and south Kilkenny all used it. It had excellent management and staff. As for St. Theresa’s in Clogheen, I cannot say enough about it. It was a district hospital and has been expanded and upgraded. It has two fabulous hospice suites where many people go at the end of life and have dignity. Families are also looked after there. It is under the care of matron Anne Walsh, director and manager, and the excellent staff. I have many friends and relations, including my own mother, who were there. They got the best of care and treatment. That model works rather than the model of allowing big conglomerates to expand and expand at the expense of others.

A lot of blame rests with HIQA as well. I remember a lovely nursing home in Carrick-on-Suir when I came in here first in 2007. It was a flat building with no steps. The owner-manager did her best but HIQA was down on her like a tonne of bricks even though another nursing home was built in the same town and was never visited. I heard reports again this morning that HIQA is saying it does not have the power to deal with bigger companies and conglomerates. It must have the power to do so. It is the same care and people need to be looked after. What did it do to that woman? It kept criticising this, that and the other and began restricting the number of beds. It eventually closed six beds. When she needed to get a loan from the bank to upgrade the nursing home to what HIQA wanted, the books did not add up because of the closures. HIQA closed the nursing home by stealth. It forced her to close. Lo and behold one day two inspectors took a tour and had dinner to taste the food and said the food was quite bland.

I do not know what they expected. Was it the Gresham Hotel they were going to or some place? The food was excellent, but that nursing home is no longer in business. It was unceremoniously closed down by HIQA, which was an utter disgrace. I raised it in this House at the time. Now HIQA seems not to be able to touch these big sacred cows. We are told it does not have the power. If it has the power to do it with a small nursing home, why should it not have the same power for these? We are talking about human beings; individuals who are not able to be at home, where they would prefer to be, and who need care. We are all facing that.

I remember when my kids were small, buying a sticker for the rear window of my car that said "Be nice to your children. They pick your nursing home". That sticker was there for many people. Unfortunately, there is not much choice nowadays, but speaking for myself, I am heading to that period of life. It is sad we have commodified this to such an extent. As I said, we are talking about people, human beings. Our parents, grandparents, friends and neighbours deserve respect. HIQA is not fit for purpose. It should be disbanded, but above all it should be made to account for why it can close small nursing homes while allowing the conglomerates to do what they like.

Danny Healy-Rae (Kerry, Independent)
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First, I thank the Labour Party for giving us the opportunity to talk about this important topic.

It is an emotive subject when families have to make the decision to put someone into a nursing home. I vividly remember when my father was not great and a decision had to be made. I am glad we were able to keep him in his own home with Kathleen Fitzgerald. I thank all the people, including Noreen Sullivan, Jackie Ahern and William Leary. I will leave people out and I am sad about that but I thank all the people who helped him in his final days. He died in Tralee hospital and I thank the staff there and the staff in Killarney district hospital for the great attention and care they gave him every hour and day he was there. They are wonderful people and we want to thank them. We will never forget them.

He said a nursing home was kind of a departure lounge and that when people go into one, there is not much hope of coming out again. That was one of the things he felt and said. For many people, when they are not improving, not getting better but getting worse, families have to make the decision. Many people keep their loved ones at home and they should get more help to do so. The Denmark model is that there are hardly any nursing homes in Denmark. We should strive to better our homecare system and it would save us a lot of money.

At present, I am hurt by what we saw on RTÉ. There are a lot of great nursing homes, including family-run nursing homes. We have them in Kenmare, Killarney and other places. We are lucky enough in Kerry that we did not have them, but I worry about the big business companies that own a number of nursing homes. They have a different model. They have to make the thing pay. They are not like Mother Teresa. I worry about the system where public nursing homes are getting more funding than private nursing homes. It costs the same to operate the bed or room. They should get the same funding. There should be no excuse at any time to mistreat or treat badly elderly people. They are the people who got us to where we are today, people who strived day in and day out to rear families, keep employees going, provide homes for their families and so forth. Surely they deserve the Government's best to ensure they are properly looked after by carers and home helps.

There is another dimension that is valuable and is not appreciated enough. It is where people come to sleep with elderly people, not in the beds with them, but in the house to be there for the whole long night and stay until the morning. They should be rewarded better than they are. Families have to pay for that themselves. The State should intervene. We are talking about people who are trying to stay in their homes for as long as possible.

We should strive to develop a system like the model in Denmark, where people are looked after in their homes. We see too often when people are awarded home help - on leaving the hospital, they are told they qualify for home help - that then there is no home help available. The staff are not to be found. That is an awful time for families. The help should be there the minute they land at home or the following days. They should not have to wait. What happens in a lot of cases is that these people have to return to hospital. That is another reason our beds are full in our hospitals. That happens because the home helps are not in place and it is terrible.

One of the reasons I decided to support the Government is that it said it would get rid of the means test. I am looking forward to that and to helping the carers of Ireland, because they are the massive people who do Trojan work-----

Mairéad Farrell (Galway West, Sinn Fein)
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Go raibh maith agat.

Danny Healy-Rae (Kerry, Independent)
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-----to keep people-----

Mairéad Farrell (Galway West, Sinn Fein)
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Go raibh maith agat, a Theachta. Your time is up.

Danny Healy-Rae (Kerry, Independent)
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-----looked after. All right. I am sorry.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I thank Deputy Healy-Rae for his comments on abolishing the means test for carers. We are systematically trying to get to the point where it has been abolished. I recognise the changes that have been made because what we want to see, as the Deputy said, is people staying in their own homes for as long as possible for their dignity, comfort and connection with their families and because that is the model we want to have. There is a substantial body of work on that, which the Minister of State, Deputy O'Donnell is leading. I thank him for his work on that.

This is an exceptionally important time to discuss this issue again in the House, recognising our collective focus on making sure that people can stay at home for as long as possible, that those who are in nursing homes are safe and have dignity, and that we see a significant change to what we saw in recent weeks. I thank the Labour Party for bringing forward this motion to give us the opportunity to discuss it. To clarify, in opposing the motion, we do not claim there are no challenges in the sector or anything of the kind, but rather we are taking the opportunity to set out the pathway for which we should be held to account in the next number of years.

It is fair to recognise that nursing homes in the public, private and voluntary sectors play a critical role and will retain a critical place in the provision of long-term care and other services. They will remain a vital part of the continuum of care into the future and we have to make sure all the other services are in place so that it is an appropriate part and not an over-indexed part of the continuum of care for older people.

I also need to acknowledge the "RTÉ Investigates" programme that was broadcast on 4 June. I echo the words of the Minister of State with responsibility for older people, Deputy O'Donnell, by stating in the strongest terms possible that every nursing home resident deserves and should expect the highest standards of care and dignity at all times. Poor care, mistreatment, neglect or any other form of abuse of any person living in a long-term residential care centre is completely unacceptable and cannot be tolerated, nor can it be tolerated in any other setting.

I do not wish to repeat what he said, but I acknowledge that in his opening speech the Minister of State outlined a range of actions the Government is taking, which we hope will contribute significantly to improving the nursing home sector and care of older people. I thank him for his always forensic approach to the data he has and for his interrogation of what he believes needs to be done. I have witnessed and, I hope, supported him in that forensic analysis with HIQA and others about the work done to date and what is yet to be done. A fit-for-purpose regulatory regime for the sector is of paramount importance. As the national independent regulator for nursing homes, HIQA and the office of the chief inspector need to use all the powers available to them and to communicate with us about how we can enhance and develop those powers. The Minister of State, Deputy O'Donnell, outlined that he and I have met HIQA a number of times in recent weeks to try to further those ends. HIQA has acknowledged the importance of examining its processes and methodology and will undertake a review of the effectiveness of the chief inspector's inspection and monitoring processes.

One of the things the Minister of State, Deputy O'Donnell, and I identified in particular is the need for more real-time reporting of how that may be done. The update must also be provided in March, for example, if a report is published in March for an inspection concluded in October. There should be a follow-up measure to check what may be outstanding at that point.

I would also expect the same in respect of hospital inspections, a number of which I reviewed this week. Where there are points that need to be followed up, I would prefer to have a real-time assessment of those. We have very strong confidence in HIQA, notwithstanding what has happened over the last number of weeks, because of its institutional experience and the role it has played to date. It is always going to be the case in any developed liberal democracy that we have to assess strongly the institutions we have, even those that have worked very well, and continue to work to improve them, particularly as the circumstances around them change. That is especially the case in respect of the ownership of nursing homes and how that has evolved over the last period.

The Government is fully committed to introducing an adult safeguarding policy for the health and social care sector, which will provide a framework for strengthening safeguards across all private, public and voluntary services. The policy is at an advanced stage and our intention is to bring it to the Government as a matter of priority. My hope is that would be before the August break. To update the House, the Minister of State, Deputy O'Donnell, and I met the Law Reform Commission in respect of that yesterday and we looked at some of the detail, thinking and analysis that went into its report as it considered various models of how to get to the point of achieving a policy that is going to be effective, independent and capable of being introduced quickly. We had a good opportunity to tease through some of those issues. I respect the work of the Law Reform Commission, the very considerable effort it has put into developing its policy and the draft Bills it has produced. The Minister of State, Deputy O'Donnell, and I had a good opportunity yesterday and we will reflect on that as I bring the policy direction to the Government over the next number of weeks.

The policy will set out, at a high level, proposed new legislative provisions for the sector. It will also set out a wide-ranging programme of non-legislative measures across our sector to achieve a culture of safeguarding that is fostered and embedded at all levels. More broadly, it is important to reiterate that investing in services for older people is a Government priority and has been. 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 almost €3 billion in budget 2025. A figure means nothing without a context but, of course, that is €3 billion out of an overall budget of €25 billion. There is significant investment but that does not mean we do not need to continue to do better, particularly at a time when there is a growing and ageing population. Deputies are already familiar with the measures in the nursing home support scheme known as fair deal. That fair deal scheme will receive Government funding of in excess of €1.2 billion this year, and the programme for Government commits to strengthening the nursing home sector by increasing funding for fair deal. It is important that we continue to work on that.

The programme for Government also commits to building more public nursing home beds and that is an absolute priority for this Government. The 2025 programme for Government is, I hope, dedicated, among other things, to the vision of creating a caring society, a compassionate State and one that is funded to be able to do those different things. We are trying to advance a range of actions that will genuinely advance the social care model, and support older people to live a full and independent life in their own homes and communities with appropriate wraparound supports.

Another element of that, which is so important, is our increasing use of virtual technology in the healthcare sector more broadly to enable people to get appropriate care as close to home as possible, always with a view to keeping people in their own homes and spaces for as long as possible, recognising all of the different challenges that people have. While our commitments in respect of Meals on Wheels, nursing homes and a range of different issues are challenging, I believe they are achievable but I have to reiterate to the House the scale of the demographic challenge that is ahead. We are going to have to think about and work together on it in every possible way.

Our population is growing rapidly and it is ageing. That is an extremely good thing. It is fantastic that people are living longer lives in Ireland and that our life expectancy is increasing but it will bring a different challenge for all of us here to be able to support and represent people in an appropriate way. We will have to recognise that people are going to be diagnosed with more illnesses as they age. Again, this is a good thing, as opposed to the alternative. Nevertheless, the intersection of those illnesses with where they live and how they are supported is something we are going to have to concentrate our minds on, while making sure we are using every lever in both the healthcare and social care sectors to support people at home. That is a good thing for people's dignity and for the economics of supporting people, which must also be there. Very happily, these things coincide. I look forward, over the period of this Dáil, to working with all Deputies to try to achieve those different goals.

In conclusion, let me go back to the essence and purpose of this debate, which is prompted by the desperate and dreadful scenes we witnessed in the recent RTÉ programme, which highlighted appalling deficiencies in care and with respect to people's dignity in some long-term residential care settings in Ireland. Of course, primary responsibility absolutely lies with the individuals who committed those actions, and the organisations that worked in a way that enabled or facilitated them, or did not intervene or address them. It is also the case that we have to improve HIQA's processes and standards but we must never lose sight of the fact that everybody has a choice about how they turn up to work and how they treat people on a day-to-day basis. Those choices were very wrong in every instance we saw on that RTÉ show. It is simply unacceptable and I think we are absolutely unanimous in our perspective on that.

The Minister of State, Deputy O'Donnell, and I have a range of work to do, on which we will continually update Deputies, and they will hold us to account on that. I thank Deputies for the opportunity to discuss this today.

Duncan Smith (Dublin Fingal East, Labour)
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Two weeks before the "RTÉ Investigates" programme, a man in his 80s came to my clinic. He makes a bare minimum of 14 trips a week to the nursing home in which his wife is living. He visits in the morning to make sure his wife's day can begin with care, dignity and love. It is not the nursing home's job to provide love but it is its job to provide care and dignity. He goes again at night to make sure her day ends with care and dignity. He visits a number of additional times during the week when his children cannot make the trip. He stopped short of saying there was abuse but what there is in that nursing home is neglect. There is neglect because there are not enough staff, and the staff are not there to provide the work that is needed to care for his wife. He is in his 80s; his wife is older, she is unwell and she is being let down by this system.

This system for older people and their care is almost completely broken. There are elements performing better than others. One element that is performing better and has done for the last number of years, though not perfectly, are our HSE-run and publicly owned and funded care homes. We need to be reinvesting in a public model of care. We need to be taking over private homes such as the 27 Emeis nursing homes that are performing so poorly.

What these private nursing home conglomerates will welcome is our money. They will welcome the Minister's money and the State's money but what they will not welcome is trade unions. They are not welcome. They will not be allowed into their facilities to organise their staff to ensure there are safe staffing levels, proper pay and proper terms and conditions. I thought Deputy Charles Ward's contribution as a former worker in this sector was really interesting. He highlighted the tensions between private and public staffing and how the HSE, when it finds out that a staff member is performing well and has a good reputation in a private nursing home, will go in and hire them. More often than not, that worker, for understandable reasons such as pay, pension and standards of care, will move to the HSE. Deputy Ward mentioned his own case, where he would not be moved because he cared for and was committed to his residents.

This model is broken. I reject the fact that the Minister felt she needed to put a countermotion down in order to set out a charter by which she would measure her own progress. As Minister, she has many opportunities to do this. She should be supporting our motion and what Deputies Sherlock and Wall, on behalf of the Labour Party, have put forward here today. We will continue on this. It may not be on the front pages of the newspapers every day anymore but it will be front and centre of what the Labour Party will be pursuing in the health and care agenda for the lifetime of this Dáil and beyond.

Conor Sheehan (Limerick City, Labour)
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My grandad was actually in one of these affected nursing homes in 2024.

The Minister of State, Deputy O'Donnell, would know this nursing home very well. It backs onto our constituency. My grandad was there for over a week when he was discharged from hospital. He said the staff were lovely, and they were, but there were not enough of them evidently. He was often left to go to the toilet on his own. My mum, who is his primary carer, said that when she collected him from the nursing home, the main thing that she took away from it was that he was not washed at all while he was there. He had been there for over a week.

The creeping privatisation of elder care, the warehousing of people and the complete disregard for their basic human rights is one of the worst things that we have done in this country. We have the most private nursing home beds in Europe. In 1990, public nursing homes provided nearly 50% of all beds. By 2023, that had plummeted to 16%.

My sister is a nurse. While in college, she worked in many private nursing homes as a healthcare assistant. I remember vividly - it has never left me - her saying to me once that, during the pandemic, she would not have been shocked if nearly every single patient in a private for-profit nursing home in which she worked had died of Covid-19, such was the shortage of staff and the lack of care. We know the difference a good, well-run public nursing home makes to a community. In our own city, we have the recently redeveloped and enlarged 75-bed St. Camillus's nursing home. This was announced in 2015 by the then Government, representing €450 million of a capital injection into publicly owned nursing homes. Since 2009, we have spent €15 billion subsidising private for-profit nursing homes through the fair deal scheme. Much of that money would have been better spent on investing in building capacity in the public system. Public nursing homes have higher staffing levels and a lower turnover of staff and are generally better run.

I feel that HIQA is failing people here. It is nothing really but a report-writing, box-ticking entity. It is time now for the State to step in and to step up where these private nursing home providers are failing. We need to pass adult safeguarding legislation as a matter of urgency. We have the template. The Law Reform Commission has drafted two Bills. We need to do this before the summer.

Verona Murphy (Wexford, Independent)
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Deputy Bacik will appreciate that it is time for Leaders' Questions.

Ivana Bacik (Dublin Bay South, Labour)
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I thank all those who spoke in support of our Labour motion on nursing homes and care. I thank in particular my colleagues Deputies Marie Sherlock and Mark Wall for leading on this motion. We in the Labour Party have put this forward with one key purpose, namely, to ensure dignity for those of our citizens who are ageing. Everyone in Ireland should be supported to age with dignity. We have set out a series of constructive steps to achieve that dignity that we speak about. In particular, we speak about three things: we want to see a breaking of the hold of big business on the nursing home sector; we want to empower HIQA and ensure minimum standards of care are required in the sector; and we want to see the rapid passage of long-promised adult safeguarding legislation.

Of course, home care should be the gold standard. Everyone wants to be supported in his or her home. However, nursing homes will always be needed when a higher level of care is required. Sadly, we know from Aoife Hegarty and her excellent team in RTÉ that abuse and neglect across nursing homes is all too often the case for our older citizens. This is not limited to Emeis nursing homes, albeit we saw some egregious examples of abuse and neglect. In our motion, we call for these nursing homes to be taken over by the State. We stand by that.

According to those who work in private nursing homes, we see denials of dignity every day. One care worker spoke to me about the cheapest of facilities and materials, the limits on numbers of staff and no human touch in the care provided. What is the root cause of this? It is due to the for-profit motive that unfortunately lies at the base of our nursing home sector.

Our motion seeks to tackle what is a systemic ageism that has allowed this creeping privatisation, this commodification of care. That has resulted in the diminution of standards and in the sort of neglect that we have seen all too often. We need to ensure that the constructive steps we have outlined are now taken by the Government with urgency so that we can see a return to the sort of dignity that our older citizens expect and need. We must ensure older persons have a voice in the process. That is why we have placed an emphasis on the need for the Government to take the steps that Safeguarding Ireland and the Law Reform Commission have set out so clearly. I welcome the Minister's indication that the Government will bring forward the safeguarding legislation before the August break. I very much hope she will. We will certainly welcome and support that if it is done. This is about ensuring a reset of our care model, ensuring that we move from commodification to compassion and from the disrespect we are currently seeing across the system to a model where the dignity of our older citizens is paramount and nobody has to suffer the awful indignities that we saw far too many people suffering in those nursing homes that were under the spotlight in the RTÉ programme.

We will work with the Minister on this. We are very disappointed at the amendment. We believe the Minister could have supported our motion, which is a constructive one. We think the amendment does nothing to reassure older people and their families that this Government is going to tackle the scandal in nursing homes with the urgency it requires. The amendment is derisory and we ask the Minister to withdraw it and enable us to unite across this House in the support of our older persons and dignity in older age.

Verona Murphy (Wexford, Independent)
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In accordance with Standing Order 85(2), the division is postponed until the weekly division time this evening.