Seán Power (Kildare South, Fianna Fail)

I thank Senators for tabling this motion, thereby giving me an opportunity to outline the improvements in services for older people which will result from the unprecedented additional funding that has been made available in this year's budget. I remind Senator Finucane that the allocation of €150 million is in addition to the money that is already being spent on services for older people. The new developmental investment package is intended to develop further the services which improve the lot of older people who wish to remain at home in their communities in dignity and independence. It demonstrates the Government's commitment to older people by putting them at the heart of future health policy.

As Senators are aware, most older people wish to remain in their communities for as long as possible. That may necessitate additional home help or more developed home support, including various therapy services. There is evidence to demonstrate that families caring for elderly relatives can continue to provide care in partnership with the support services which have been put in place for those who require them. It is estimated that approximately 28% of nursing home residents have a low to moderate dependency level. Many such people could have continued to live at home if appropriate supports had been made available to them at the appropriate time.

The Government's investment package is evidence of its determination to provide an important form of health care to a generation that contributed significantly to the prosperity we enjoy today. The package involves the provision of additional resources of €150 million in a full year —€110 million in 2006 and a further €40 million the following year. As a reflection of the new emphasis on home and day care, some €109 million, or almost three quarters of a full year's expenditure, is being committed to community care supports. It should be borne in mind that such funding is in addition to the extra funding that is being made available for disability, mental and primary care services in the 2006 Estimates. It is part of the Government's policy of developing the general and community care programmes. The funding will be allocated to home care packages, the home help service, day and respite care centres, specialist palliative care, meals on wheels, sheltered housing, elder abuse prevention, the development of the nursing home subvention scheme and additional bed capacity for those requiring residential care.

Home care packages, which deliver a wide range of services, have been piloted successfully in several HSE regions over recent years. The packages involve the services of nurses, home care attendants, home helps and various therapists, including physiotherapists and occupational therapists. They vary according to the care needs of the people in question. Some packages place an emphasis on home care assistants while other packages require a greater level of therapy and nursing. I assure Senator Finucane, who called for home care packages to be made more flexible, that there will be much greater flexibility in the operation of the scheme.

Older people living in the community, or those who are inpatients in an acute hospital and are at risk of admission to long-term care, will be prioritised. Home care packages will be made available to older people who have been admitted to long-term care and now wish to return to the community. They will also be offered to people who are using existing core services, such as the home help service, but need more assistance to continue to live in the community. Home care packages are delivered through the Health Service Executive by a range of providers, including the executive itself, voluntary groups and the private sector. The scheme, which will be as flexible as possible, will be highly responsive to the real needs of individuals. If family members or friends of an older person wish to provide such services, they will be encouraged and supported to do so, in conjunction with the HSE, voluntary groups and the private sector.

Approximately 1,100 home care packages are provided to people at present. By the end of next year a total of 2,000 additional home care packages will have been provided. This will amount to almost a trebling of the current service provision. The additional 2,000 packages will support more than 2,000 persons as, for example, individuals could in some cases need a care package on a temporary basis. The major thrust of this initiative is to be directed at older people. However, there will be some flexibility, so that a person who is under 65 and may need home care may receive it, as appropriate.

Home helps are an essential part of supporting older people at home and thereby delaying or preventing admission to long-stay residential care. They also help to keep people out of acute hospitals or help their early discharge from hospitals. There is a continuing demand for home helps because of the increased number of older people in our country. An additional €33 million in a full year is being allocated for this programme, €30 million of which will be for 2006. This represents a significant increase over the 2005 allocation. The additional funding of €30 million will provide 1.75 million more home help hours. As with home care packages, it is expected that these additional resources will be implemented in a flexible way by the HSE so that particularly vulnerable individuals, who need a home help, but who are under 65 years of age, can access the service. We have had a couple of pilot schemes throughout the country providing home care packages which have made a real difference to people. Often it is only something small that makes the difference between a person being allowed to remain in his or her own home or having to go to long-term care. That is the area in which we are going to invest the money. When one is in Opposition the amount is never enough. We would have no difficulty spending more money on older people if we got it. I am happy with the increased funding being made available and I am confident it will make a real difference to the lives of many of our older people throughout the country.

Day care and respite care are an integral part of delivering a comprehensive community service for older people. The service provided may include the following: a mid-day meal, a bath, physiotherapy, occupational therapy, chiropody, laundry and hairdressing; social contact amongst older people; respite for family members and-or carers; and social stimulation in a safe environment for older people with mild forms of dementia.

The provision of €9 million in a full year will allow for an additional 1,325 places per week in such centres. The number of older people who will benefit from these new places will be substantially more than 1,325, since, over the whole year, one place can provide a service for more than one person. While we speak about the importance of investing money, we also have to change attitudes. We have had cases where a person's circumstances changed and the first thought of others was what hospital or home they could get the person into. We have to change that attitude. Nursing homes and hospitals should be a last option rather than the first. Our investment will be geared towards changing that attitude and making it possible for people to remain in the comfort of their own homes for as long as that is possible.

The sum of €9 million is being allocated to specialist palliative care, including home care and community initiatives in 2006. A further €4 million is being allocated in 2007 to develop the service, giving a full year cost of €13 million. While recipients of specialist palliative care are not necessarily older people, this nonetheless shows the commitment to develop community based programmes.

There will be a significant increase in the resources available to the meals on wheels service to develop the service. An estimated €10 million was spent on the service in 2004 and additional funding of €2.5 million will be provided next year together with a further €2.5 million in the following year making for an increase of approximately 50% on the 2004 level. The meals on wheels service is a crucial part of the range of services which help support older people to continue living in their own homes. I had the pleasure of attending an awards' function recently where there was a man who was involved in a number of voluntary organisations, one of which was meals on wheels. In saying his few words, he mentioned one case where he delivers a meal to a man whose nearest neighbour lives more than half a mile away. Often when leaving that home he asks himself the question, which is more important: his visit or the meal he was delivering. Apart from the meal it is a great contact. One does not necessarily have to live in rural Ireland to be lonely. One could live in O'Connell Street and be the loneliest person in Ireland.