Terry Leyden (Fianna Fail)

I welcome the Minister of State, Deputy Seán Power, and his officials from the Department of Health and Children to the House. I am pleased to have an opportunity to speak on the Bill relating to the care of the elderly, a topical issue. I do not intend to revisit the Leas Cross issue which has been discussed in the House previously. I would like to ask the Minister of State a few questions and hope he will respond to them later in the debate.

What is the current position on the repayment of nursing home charges which were illegally imposed? How many people have been repaid? Are many repayments outstanding? I understand that a considerable sum of money — approximately €300 million — is involved. Most of those who have received refunds are pleased with the service provided for them. That is history because the Government has acted appropriately on foot of the decision of the courts. Some estates have not received moneys because decisions have not yet been taken in those cases.

It has been brought to my attention that residents of psychiatric nursing homes are not catered for in this legislation. I would like the Minister of State and his officials to indicate whether my information is correct. I have received a query about the matter. I understand the allowances due to people in long-stay psychiatric hospitals were taken from them and lodged for them in banks.

I would like to speak about nursing homes in general. I accept that many of the concerns about the Bill relate to the question of the primary family home. When the legislation and regulations were first introduced, I was still a member of the former Western Health Board. At the time the family means test was introduced, which meant that sons and daughters were contacted to find out how much they could contribute. That system was not working. It was impossible to operate. The family member who inherited the land or the house, rather than the family member who had left 20 years earlier and become wealthy and successful, was deemed to be liable for meeting the costs of the upkeep of the parent in the nursing home. That system collapsed and was withdrawn. Under the new system that has been introduced, the person in the nursing home is assessed. I think the family home should be excluded from the assessment. If a person in a nursing home sells his or her family home, he or she is deemed to be a permanent resident of the nursing home. Such a person is not able to retain the aspiration of returning to the family home. I am sure the Minister of State will ensure the HSE takes a humanitarian approach to this matter. The Bill provides for every circumstance to be taken into account.

As I have said previously, it is ludicrous that the staff who assess and process medical cards are required to undertake a review every year. It is the most time-consuming and cost-ineffective method of assessing a person's right to a medical card. A person's circumstances do not change very much in a single year. Even though medical cards are renewed in most cases, each medical card holder has to contact the local community welfare officer who has to fill in a form which then has to be processed. The officer may have to travel to the medical card holder's home to see him or her. At the end of this process, it is usually decided that the medical card can be renewed. All that work is unnecessary. Random checks, perhaps one in ten, could be done or it could be done every three or five years. The staff could be gainfully employed because the community welfare officers are used to carrying out assessments. I appeal to the Minister to streamline the application system and the speed with which decisions are made.

I have no complaints on my books about the western region. I may create a demand from people who say they have a case but I speak as a long-serving Oireachtas Member from County Roscommon. I welcome representations and, like every other public representative, I am available to people.

I heard the debate in the Dáil which may have been somewhat over the top. The Bill is before us at a bad time in terms of yesterday's very good budget because it created a certain reaction and the possibility of people picking holes in this Bill. I appeal to anyone listening to this debate, which is broadcast on the Internet worldwide, that if they have an issue regarding a nursing home subvention in my area, I would be delighted to take up their case. To date, however, I have not received any complaints. Complaints in general have decreased compared to previous years. Even the enhanced subvention system has been handled extremely well.

In the last case I dealt with, the person died before the final decision was made. She had a very good teacher's pension which meant she did not qualify but covered the cost of the nursing home. Her house would have been taken into consideration in the process but, unfortunately, she went to her reward. She was very well cared for in a private nursing home.

On the overall regulation of nursing homes, there is a tax incentive for the building of nursing homes but there should be a certification of the need for a private nursing home in an area. There is no justification for adding additional nursing homes to the list when there is adequate space in the area. We have three major nursing homes in County Roscommon. The Sacred Heart Hospital, which I had renamed from the Sacred Heart Home because it is more of a step-down facility close to the county hospital in Roscommon, provides a full geriatric service. A geriatrician attends the facility and it has a medical officer in attendance full time also. It now has an Alzheimer's ward. I hope the Minister will give a major capital grant to refurbish one of the wards for another Alzheimer's unit or to build a new unit, which is in order. We also have the Plunkett Home in Boyle and Aras Mathair Pol in Castlerea, two well-run nursing homes about which I never get complaints. The private nursing homes in County Roscommon are very effective and a number were established recently.

I emphasise that the decision-making process to provide private nursing homes should not be tax led. Nursing homes should be provided because the State requires them in certain areas and where a need has been identified in certain areas, a certification should be given that they will be subvented. If a person wants to build a nursing home on the basis that he or she will not get subvention for the patients, that is his or her own business but that aspect should be considered.

I want to mention one nursing home in the public sector with which I am very impressed. It is located in Achill Sound and is one of the most beautiful nursing homes in the country. It was built beside the sea. It has its own oratory and is near the House of Prayer, although it is not connected to it. Every room in that nursing home displays the name of the person resident in the room on the door. When I visited I thought these were consultant rooms because every room had a nameplate on the door.