Maria Corrigan (Fianna Fail)

I welcome the Minister of State and I welcome the opportunity to discuss this Bill. I also welcome that where people will require long-term nursing care, the three main aims of this Bill will ensure such care will be accessible, affordable and anxiety free.

As colleagues have noted, the current position is one which causes considerable anxiety for people, their spouses and their families. The costs of nursing fees are escalating and they appear to be the only costs not being reduced. Depending on where one lives, prices and costs can vary but there are very few nursing homes that are not charging the guts of €1,000 per week per person, which is quite a substantial cost for people to bear.

This also comes at a time which is upsetting and distressing for a family or spouse, if a member of a family can no longer live in the family home and where it is necessary to identify a place in which the family must have the peace of mind that those in care will be safe, secure and in receipt of the care needed. The family would also know that there will be long periods when those being cared for will be out of the family's sight. It is a significant leap of trust and faith to take and to combine that with financial worry as to how that care will be paid for should be unnecessary as it exacerbates an already very difficult position.

I have met constituents, as I am sure other colleagues have, who fear that as they try to meet costs, they will see life savings depleted at an alarming rate. They are aware that they may live longer and require such savings which may become fully depleted. If one is paying approximately €1,000 per week, a year of nursing home care would come to approximately €50,000. If a person has limited savings, his or her concern will be what happens to a loved one in a nursing home when the money runs out. There is anecdotal evidence of people being asked to leave nursing homes because their families are no longer in a position to pay those fees, which would be particularly distressing. This Bill will provide comfort and relief for family members and spouses feeling the pressure of those mounting nursing home costs.

I apologise if the Minister of State has answered the following question. With regard to how the contribution is to be calculated, where it is reckoned at the time of care and the family opts to defer payment until after the death of the person or spouse, how would a change in asset value be reflected in the reckonable amount? Will the amount be specified in value rather than as a percentage at the time of care? If assets subsequently decrease in value and money is not available, what will be the position? If the individual or couple have other financial commitments - they may have undertaken an action on behalf of a son or daughter, owe money or be discharging other financial commitments - will the amount of disposable income available to them be calculated on a net or gross basis for the purposes of determining the 80% amount?

While the Minister of State is present, I take the opportunity to address a number of aspects specifically relating to the Bill, although I do not wish to repeat what colleagues have raised. I apologise if the issues have been mentioned. I will address specifically the issue of capacity within the Bill. I am aware that there is a concern from advocates, including Age Action Ireland, in this regard. What regard will there be for the individual's personal opinion? I welcome the functional approach to capacity but I am very conscious that such an approach recognises that capacity can vary over time and be issue specific.

I note that on how we will determine capacity, there is a specific reference to two medical practitioners. What is the definition of a medical practitioner and will it include psychologists, for example, where the profession has established competence in the determination of capacity? It is the only profession that has established competence in the diagnosis and assessment of cognitive functioning and, arising from that, there are a number of questions.

Is there a mechanism to reflect a variation in capacity over time? For example, in the case of the onset of dementia, there can be occasions where a person would have very lucid periods and the definition we have provided within the Bill could be met. There would be other occasions when it would not be possible to meet that definition. A functional approach to capacity is such that we recognise it can vary over time and be time and issue specific.

I welcome the commitment within the Bill given to individual choice and recognise in regard to functional capacity that we could very well have a position where an individual will not have capacity in the decision around the financial arrangements. The person could very well have capacity with regard to which nursing home would be used. Will there be a provision for that?

Where capacity is determined not to be present for an individual, what measures will be put in place to monitor formally resident satisfaction with the nursing home that is to become a person's permanent home? Where capacity is determined not to be present, a very strong case is to be made for the adult to be designated a vulnerable adult, and particular regard should be given to such a person's circumstances in the context of an audit by the inspectorate. I welcome the commitment to inspections and ensuring all nursing homes will be registered and audited. In cases where individuals are determined not to have capacity, particular regard must be paid to them in these audits and that their families or carers be included.

Will there be a specific process for the care needs assessment? Some concerns have been expressed as to who will conduct them. Will there be an appeals process? What is the timeframe for implementing the legislation's proposals? Is it planned to apply this legislation to the numbers occupying acute hospital beds? That does not provide them with a good quality of life, wondering if they will keep the acute bed or be moved somewhere different. It is also not a good use of public moneys.