Rónán Mullen (Independent)

I support the statements of my colleagues. We may try to take different ways up the mountain but we all agree there should be more than one person involved in an assessment and that the various needs of a person subject to an assessment should be spotted. In this regard I thank Age Action Ireland and Nursing Homes Ireland for their briefings. Mr. Tadhg Daly of Nursing Homes Ireland is present today.

My approach in amendment No. 7 is to suggest the deletion in page 13, subsection (5), line 6, of "a person or" to move towards what Senator Norris referred to as a multidisciplinary, multiperson approach and that more than one person should be involved. This is the very minimum one would expect and there should be no question of the term "a person or". The fact the legislation is so worded suggests the Government is a good way off realising the complex and multidisciplinary nature of what is required.

Amendment No. 9 proposes the insertion of wording after the word "Executive". The assessment referred to in subsection (5) should be carried out by persons who may be employees of the executive with experience in caring for older persons and this is the nub of the issue. I do not intend to press any of my amendments today but I call on the Minister of State to give consideration to the question of whether we should go even further. I may go further myself on Report Stage. It is not just an option but it should be a requirement that a geriatrician or a psychiatrist specialising in old age should be involved in the care assessment. My reason for this suggestion is that when decisions are being made by, for and to the benefit of a person who may need long-stay residential care, there may be a number of competing interests and sometimes those competing interests may be unconscious on the part of the people who hold them. I refer to an example suggested to me by a geriatrician who has great expertise in this area. He suggested that a younger person who is worried about Mammy or Daddy and feels they may need to go into a nursing home, has the best interests of their loved one at heart and there is no doubt about that. However, they also want their own peace of mind. I will put it bluntly that Mammy or Daddy, on the other hand, might prefer to contemplate falling down the stairs and even being on the floor overnight rather than losing their independence. It may well be that a person who has experience, such as a geriatrician or a psychiatrist who is a specialist in old age, who would see that older person in a consultation, might well be able to tease out some of the issues causing concern to the older person in question. It seems to me that geriatricians and psychiatrists have the kind of experience of dealing with cases that makes their participation not something to be considered as a desirable inclusion if possible but as something that should be mandatory. I ask the Minister of State to give consideration to this proposal.

Amendment No. 10 was earlier ruled out of order on the basis of the usual excuse that it might involve a charge on the Exchequer. I fully support what Senator Norris said in that regard. It is very important for us to be able to consider legislation properly. For example, in the case of amendment No. 10, I was suggesting that it would not be a matter of "may" but rather of "will". My proposal was that a care assessment will include an examination of the person concerned. It seems to me that it should be a mandatory situation that it would be required that there would be a registered medical practitioner or a registered nurse, an occupational therapist or a chartered physiotherapist or any combination thereof and, as I have added, a geriatrician or an old-age psychiatrist. It seems to be very lame to exclude my proposal on such a technical ground when I am proposing that it should be mandatory rather than optional to include such expertise. This goes to the heart of this legislation. To exclude such a proposed amendment on a technical ground shows up the inadequacy of our procedures as they stand.

Amendment No. 12 proposes:

In page 13, subsection (7), lines 34 to 36, to delete all words from and including ", as" in line 34 down to and including "thereof" in line 36 and substitute the following:

"a registered medical practitioner and/or a nurse with an occupational therapist or chartered physiotherapist."

Senators Norris and McFadden have spoken to these proposals adequately and I submit that between all of us, we are making clear the need for full and thorough assessment as distinct from something that is partial or that could be done just by one person. On that basis I will conclude my comments.