Seán Power (Kildare South, Fianna Fail)

I welcome the opportunity to respond to the issues raised in this debate. I thank Senators for their contributions. Many important issues were raised, with Senators viewing the issue from the background of their own experience and some from the perspective of the careers they had before becoming Members of the House.

Senator O'Toole spoke about the publication of the report and the difficulty that arose about the legal concerns expressed by the HSE at the time. He did not consider these to be real concerns. As the HSE had commissioned the report, it was its property. It raised this difficulty at an early stage. The problem was that people were mentioned in the report, probably in a critical fashion, and not given an opportunity to respond. That was probably due to the terms of reference given to Professor Des O'Neill. However, that is not meant as a criticism of the report. The Minister indicated that whatever legal issues had arisen should be overcome, as we were keen to have the report published. It is clear from the final report that the people and organisations mentioned in it, directly or indirectly, were given an opportunity to respond, as their responses are included.

One of the comments made in the report by Professor O'Neill is that what happened in the nursing home equates to institutional elder abuse. Efforts are ongoing within my Department to deal with instances of elder abuse and to improve and develop services for older people. Following the publication of the report, Abuse, Neglect and Mistreatment of Older People: An Exploratory Study, by the National Council on Ageing and Older People in 1998, a working group was established to advise on the formulation of procedures and guidelines on elder abuse. The working group published its report, Protecting Our Future, in 2002 after carrying out a comprehensive work programme.

While the prevalence of elder abuse in Ireland is not known, studies in other developed countries indicate that about 3% to 5% of older people living in the community may suffer abuse at any specific time, which implies that between 12,000 and 20,000 people living in the community in Ireland may be suffering from abuse. There are no figures available on the incidence of abuse in institutions but, unfortunately, such abuse does occur. While we are concentrating in this debate on the abuse which took place in one nursing home, the majority of abuse occurs in older people's homes.

Protecting Our Future recommended that the issue of elder abuse should be placed in the wider context of health and social care services for older people. Elder abuse is a complex and difficult issue to define precisely. It may involve financial, physical or sexual abuse or it may arise due to inadequacy of care. The report made recommendations on health services structures, awareness, education and training, financial abuse, advocacy, legislation and research and education, which would include the establishment of a national centre. It also recommended that an elder abuse national implementation group should be established to guide the implementation of the recommendations outlined in the report. Such a group was established under the chairmanship of Professor Desmond O'Neill, a consultant in the medicine of old age, in December 2003.

Awareness training for Health Service Executive staff has been provided in line with the report and the HSE has been involved in awareness training with volunteer staff, including the national senior citizens helpline. The issue of elder abuse is being incorporated into professional training courses in areas such as gerontology. In addition, a number of research projects have been undertaken, including the examination and review of medication for older persons in continuing care settings. The Health Service Executive recently advertised for senior case workers and it is expected that 27 such workers and four dedicated elder abuse officers will be appointed by the end of the year. Discussions are ongoing on the structure of a new research centre for elder abuse and work continues on the preparation of a tender document for the new facility. In the period 2003 to 2005, approximately €2.5 million in additional funding was allocated to the elder abuse programme and €2 million was allocated in the 2006 budget to facilitate the implementation of the full range of recommendations in this area.

The cornerstone of Government policy in the care of older people is to support and maintain people in their home environment, whether that be the family home, a community residence or a residential centre, assist those who become ill or dependent to regain their independence where possible, encourage and support care in the community and provide a higher quality of hospital care when people can no longer be maintained in dignity and independence at home. With regard to Senator Bradford's comments on nursing homes, our aim is to provide as much care as possible at home so that nursing homes are the last option rather than the first.

I acknowledge the significant investment made by this Government in the care of older people and palliative care, as represented by the additional €110 million announced in the budget for 2006 by the Minister for Health and Children, Deputy Harney. The full year cost of the services outlined in this package is €150 million. The Minister for Finance has indicated that older people will be one of his priorities in this year's budget. While I would be first to acknowledge that services for older people were under-funded for a long time, a serious attempt was made last year to address that imbalance. The €150 million allocated last year represents the start of a major investment programme in services for older people.

Home care packages deliver a wide range of services and, in recent years, have been piloted successfully in several regions. Such packages include the services of nurses, home care attendants, home helps, physiotherapists and occupational therapists. Last year, approximately 1,100 home care packages were provided and we are in a position to provide an additional 2,000 packages this year. The HSE has informed the Department that a total of 3,095 additional home care packages were provided up to the end of September 2006. Not only can home care packages keep people out of hospitals and nursing homes but they can also facilitate early discharge of patients. Patients and their families have thus far been very appreciative of the supports on offer.

Home help services are an essential part of supporting older people at home, serving to delay or prevent admissions to long stay residential care. They also help to keep people out of acute hospitals and support early discharge. An additional €33 million full-year cost was allocated for this programme under the 2006 budget. This funding is being used to provide 1.75 million more home help hours this year.

Day and respite care are an integral part of delivering a comprehensive community service for older people. The provision of €9 million in a full year allows for an additional 1,325 places per week in such centres.

There is a significant increase in the resources available to meals on wheels services. Apart from the nourishment provided through these services, they also offer social contact to people who would otherwise be very lonely.

Senator Cummins referred to the need to provide more resources for sheltered housing projects. One such project is the Nás na Riogh Housing Association, which is converting an old convent into units for older people and facilities for intergenerational community activities. The building, which is located in the heart of Naas, will provide opportunities for younger and older people to mix on a daily basis. Some older people encounter a lack of stimulation when they enter homes and go downhill very quickly as a result. Although it will not be complete for some time to come, the Nás na Riogh Housing Association project will be a model which can be replicated throughout the country.

It is clear from the 2006 budget package that the Government is firmly committed to developing services for older people. The emphasis on developing home care packages and the increases in the home help and meals on wheels schemes and other community-based supports are assisting older people to remain in their own homes and communities for longer, in accordance with their wishes. In addition, extra funding has been provided to the nursing home subvention scheme to support the increasing numbers of people who are entitled to subvention and to reduce waiting lists for enhanced subvention.

The Health (Nursing Homes)(Amendment) Bill 2006, which addresses the issue of subvention schemes, is being debated in the Dáil. While I would be the first to admit that inadequacies exist in that area, the Government is actively considering funding for long-term care to address the challenges faced by older people and their families. Tough decisions will have to be taken but we will not avoid them.

It is right that we should devote substantial additional resources to services for older people. Older people have made a great contribution to our society and to our present economic and social success. Through our investments, we are saying that younger generations value the contributions made by older people and respect their needs and continuing role in society.