Rónán Mullen (Independent)

I will start on a positive note by welcoming the Minister of State's amendment. I may be jumping ahead slightly but it is relevant to what we are discussing. It follows from a request I made last week and I thank the Minister of State for following through on her commitment in that regard. That was essentially to move from the singular to the plural in dealing with the assessment issue. I am grateful that now the assessment cannot be a one-person job because the law will require more than one person to be involved. I thank the Minister of State for rendering my amendment unnecessary to that extent. However, I think the Bill falls far short of what is needed in the area of assessment. I support Senator Fitzgerald's comprehensive definition of "multi-disciplinary team". I may be incorrect, but in proposing an amendment that will define "multi-disciplinary team" do we not also need to argue for its direct inclusion and name it as being required?

I should make another point en passant. The difficulty in dealing with legislation at this time of the year is that it is like the 46A bus - it is all coming together pell-mell. Given the quality of the contributions I heard from my colleagues last week, I think more time is needed to allow the Government to reflect on the identified deficiencies in the spirit and letter of this legislation. Nowhere is that more obvious than in the failure to take the psychological dimension into account. The list of matters to be evaluated or taken account of in the care-needs assessment includes cognitive ability, extent of orientation and degree of mobility. All that is good but where is the reference to the person's psychological state of mind and degree of motivation? The psychological aspect is crucial if one is to assess a person's needs properly.

I am grateful to Senator Bradford for recalling what I said last week on Committee Stage. I clearly made the point that when decisions are being made about long-term residential care, there may be competing interests, albeit unconsciously. At the time, I said there may be well-meaning children who are just anxious that their mother is safely looked after and has three meals a day. The mother, on the other hand, might want to be independent, even if that means running the risk of falling down the stairs on occasion. I accept that my language was crude and graphic, but it may be that independence is what the person involved prizes most. That is why the care-needs assessment must be carefully considered.

I am grateful to Senator Norris for tabling an amendment which reflects specific points of concern that I raised last week. They included the need for an assessment to include the role of either a geriatrician or an old-age psychiatrist. I commend Senator Norris for his amendment that would, if accepted, require a geriatrician to partake in each care-needs assessment. The amendment should be widened to include the concept of an old-age psychiatrist, but the principle is honoured in Senator Norris's amendment, and it should be mandatory.

While I am grateful to the Minister of State for accepting the point that more than one person should be involved in making an assessment, I am not happy that the Bill provides that this assessment would take a truly holistic approach by taking account of the person's state of mind and motivation. To do so, the legislation should specifically require the involvement of an old-age psychiatrist or a geriatrician. To that extent I argue that such a role should also be included in the definition of "multi-disciplinary team", as included in the amendment tabled by Senators Fitzgerald and McFadden. In addition, there should be a requirement to have a multidisciplinary team. I thank the Minister of State for what she has done, but I do not think it goes far enough if one is to have a proper assessment of persons in need of long-term residential care who are to avail of the so-called fair deal.

Last week, I mentioned that people have a right to be concerned about the Government's approach in this area. After all, this Government has presided over a situation where, although people have an entitlement to fully paid nursing care, less four fifths of the non-contributory old age pension, the fact is that people involved in assessing older persons have been discouraged from telling them about their entitlements. I reported the words of one geriatrician who told me that when persons in need of long-term residential care were being assessed and were advised - this was before they considered getting the subvention scheme, which would cost families a lot - that they should be aware of their entitlement to the full package, less four fifths of the non-contributory pension, that was effectively frowned upon by the authorities, despite the fact that this was a constitutional right. When they were advised to go softly on advising people about their eligibility, they said "If you wish to tell us that they are not so entitled, please clarify the legal situation". They were then told cryptically, "You know the score", but what exactly was the score? Was it that the State was not willing to pay and did not want citizens to know their rights?