Mary Henry (Independent)

I welcome the Minister of State to the House. The legislation has been brought forward because we have legal advice once again that primary legislation is required to give these provisions a statutory basis.

I support the Government's aim to keep people within the community and in their homes as they grow older, and this is what most people want. However, I have not found in practice that there is as much support as people need. I commend those voluntary organisations which give social support to so many people as they grow older, some of which, such as Action Age, have been specifically set up to help older people. I also commend the ICA in rural areas which plays a very caring role in ensuring that those who live on their own do not become isolated. Senator Glynn is correct when he refers to the lack of visits received by people in residential institutions. It is frequently the case that older people receive fewer visitors to their home. As a doctor I frequently heard people say that what they missed most was people calling to see them, especially in winter.

The situation regarding keeping people in their homes is lamentable. The money may be available but I have frequently found the supports, which are supposed to in place, are not. I will give an example of the type of complaint I have received. Changes can be made to people's houses if they have difficulty using baths, taps, etc., but before they can get a grant to have work done they must be visited by an occupational therapist. A person could be on the waiting list to see an occupational therapist in the public service for years. Even if a person employs a private occupational therapist to carry out an assessment at considerable expense — perhaps €180 or €200 — there is a considerable delay. This is counterproductive because people may be able to stay in their own homes if they were in a position to use the facilities in them in a better manner. I have seen what can be done following one of these assessments by an occupational therapist. It is remarkable and has transformed people's lives. While money may be provided, the organisation on the ground sometimes leaves much to be desired.

The Oireachtas Joint Committee on Health and Children discussed older people with chronic illnesses at this morning's meeting. We discussed, in particular, the lack of neurological services. In the past, we discussed the lack of rheumatological services. These are two areas in which older people, in particular, may need to see a rheumatologist or a neurologist having been referred by their general practitioners because of the development of arthritis, Parkinson's disease, Alzheimer's, as was mentioned by Senator Glynn, or any of these chronic conditions for which there are huge improvements in treatment. However, people need to get this treatment early on. We do not want to see them wait for four or five years for it, as is happening, because they will be so much more disabled. Although we are putting money into this area, we will not be in a position to keep these people at home. We should not only look at the person's situation in the home and at bringing in a home help, which would be useful, but we should also deal with whatever medical problems associated with ageing he or she has.

Many HSE staff are extraordinarily helpful to older people, including community nurses, public health nurses and mental health nurses, and are very conscientious about what they do. However, they are very thinly stretched in many places and they do not have the back-up teams they need in some areas. The postman is even an important person for many older people. There was a huge campaign years ago in regard to door to door postal deliveries. One forgets how important postmen are to older people.

The home help service is very good and I am delighted to see more money is being put into it and that the hours are to be extended. It is essential to do so because there are more older people each year given the better survival rate. I have had several complaints about the fact that when the very good and industrious home help goes on her — it is usually her — well entitled break of two weeks, it is not possible to find a locum to look after the person. I asked Mr. Aidan Browne of the HSE at a meeting of the Joint Committee on Health and Children if people were entitled to a locum. The answer was that they were if a locum was available. However, if the person is severely limited from a mobility point of view, that is not a very helpful reply. We must ensure there is someone available to take over the work of the home help for those two weeks. The money may be provided but we must ensure the structures are in place.

When Professor Desmond O'Neill, who wrote the report on the Leas Cross nursing home, appeared before the Joint Committee on Health and Children, we discussed nursing homes in general. He was asked what type of advice he would give to people who had an older relative or someone who was disabled whom they wanted to put into a nursing home. He said the first type of nursing home he would advise was one run by a voluntary organisation. These are the not-for-profit nursing homes, many of which have a background in a denominational or religious organisation which would have set them up years ago. Thankfully, they continue to operate and from what Professor O'Neill said, they seem to be well run. The next type of nursing home he would advise is the public one. Senator Finucane mentioned the large drop in the number of beds in the public nursing home service. The Minister of State said he would put another €22 million into bringing forward long-stay beds. I hope these beds are in the public service.