Mary Henry (Independent)

While I do not have a problem philosophically with public-private partnerships or with private nursing homes being set up, we must note that these are being set up to make a profit and that they are businesses. The people who received the tax breaks to set them up have set up businesses and it is a hard business in which to make a profit. Some nursing homes charge as little as €650 per week. If a person progresses to being a high dependency patient, that would not cover anything. One would have to pay someone nursing such a patient €10 per hour, although they will not be a qualified nurse. It would cost €80 for someone working an eight hour day. One is talking about huge money for staff, not to mention money borrowed or the extra facilities one might have to provide. The cost of these nursing homes varies from €650 to €1,300 per week. There is almost certainly a huge difference in the amount of care being given. I am concerned about that as people become more dependent. The maximum subvention is €190.50 and while I know it is to be increased, it would go nowhere towards helping with the cost of a nursing home.

Many of these private nursing homes have been set up in the country because it is much cheaper to buy land there. That is the reason there are people from Dublin in nursing homes in Galway. The number of visits they will get from their relations from Clontarf and Rathfarnham will be strictly limited. We must ensure the public service gets back to what it was. One cannot blame people who have set up a business and find themselves in a loss-making position, no matter how compassionate they are, wondering how they will deal with the situation.

People are always suffering so I visit accident and emergency departments now and again, particularly in the evenings, to see how they are getting on. One sees very distressed older people who are frequently disorientated and who have come from nursing homes. Perhaps the people who have come with them are trying to get them admitted because they are too ill for them to deal with.

I am glad the Minister of State is to introduce standards in these homes because they are very much needed and that there will be a reassessment of people while they are in care. It is good that assessments on the degree of a person's dependence will be done by medically qualified people. I do not mind whether they are employed by the HSE or whether they are private practitioners hired by the HSE to do the work. However, it is essential they have some type of medical background, whether in nursing, physiotherapy, etc., because it is not fair — complaints have been made to me — to have clerical officers ask people in fairly public situations if they are incontinent. Such questions do not respect the dignity of the person. I am glad that the person who complained to me about this resisted answering strongly and said she would only take such questions from someone entitled to ask about such a personal matter.

I wish to refer to the situation regarding the value of people's houses and the intention to recoup 5% of their value if a person's house is valued over €500,000. Many of us, especially in Dublin, have through no skill of our own ended up with houses worth more than €500,000. I hope my children will not try to get me to downsize rapidly in case their inheritance is removed or diluted. I do not know what problems lie ahead as a result of the significant increase in property values in this country, even for people in fairly modest houses. I do not think a house can be bought in the Dublin area for under €400,000. Therefore, virtually everyone will be within the grasp of this provision.

I wish there was not within the Bill such a feeling of dependency on the private sector because private nursing homes are set up as businesses. People going into such businesses are not necessarily uncaring, but they frequently find the profits they expect are not forthcoming.

While subvention rates are not very high, in some psycho-geriatric institutions, the HSE pays in full for people in high-dependency units. I am glad this is recognised in the Bill because some people can go nowhere else. The problem with Leas Cross occurred in this context, but in that case the HSE tried to empty a long-term psychiatric institution into an unsuitable institution. The owner of Leas Cross had a contract or business arrangement with the health board and if he had not taken the patients he was sent, he would possibly have lost his contract. We must examine this sort of situation. As a colleague of mine, Dr. Mick Molloy, wrote in a recent article, acute beds might be quite a cheap way of keeping elderly patients if it were not for the fact that this blocks getting elective work done within acute hospitals.