Colm Burke (Fine Gael) | Oireachtas source

I move amendment No. 1:

To delete all words after "Seanad Éireann" and substitute the following:

- acknowledges that demographic trends must be taken into account in the planning of public services and determining policy in relation to meeting the healthcare and social care needs of the population, within available resources;
- endorses Healthy Ireland, the Government framework designed to improve health and wellbeing for all people, at all stages of life and in all sections of society, and to support the implementation of strategies such as the National Positive Ageing Strategy;
- notes and supports the policy of the Government, which is to facilitate and support older people to remain living in their own homes and communities for as long as it is viable for them to do so;
- acknowledges that the options to be considered in designing services and supports for our older population include not only residential provision but also community and home-based supports and new models of residential care;
- Notes that in 2014 an additional €23m has been allocated to strengthen the alignment of the model of care towards home and community supports;
- notes that this is in addition to the budget of €315m for home help and home care package services, which are delivered to some 56,000 people at any one time;
- notes that a key priority in the HSE National Service Plan 2014 is the implementation of a Single Assessment Tool to uniformly assess dependency levels, allowing resources to be targeted towards those with the greatest needs and enabling supports and services to be designed in the most appropriate way possible;
- notes that the review of the Nursing Homes Support Scheme which is currently underway is examining a range of issues relating to supports for older persons, including alternative approaches to balancing residential and community services and supports;
- acknowledges the recent report on Long-Term Residential Care, commissioned by Nursing Homes Ireland, as a contribution to the debate on how future needs can be met;
- acknowledges that decisions in relation to the provision of residential care must be taken by Government in a way that balances all interests and that places the needs of older people themselves first.

I welcome the Minister of State to the House. I welcome this debate because we need to keep the focus on areas where there will be major changes in the demands on the health service - in particular in this area - in coming years. The Minister of State is already aware of those demands and has been very proactive in dealing with the challenges we face, which I welcome.
I listened to the proposer of the motion. For a number of years we were developing policy on a hit-and-miss basis. The last real reform in elderly care occurred as a result of court challenges in 2004. It took that kind of action before we saw major reform in dealing with the area of elderly care. We have major challenges given that there are 535,000 people aged over 65, which will grow substantially to 990,000 by 2031. At present approximately 22,000 people are in various nursing homes under the fair deal scheme, with 19,549 in private nursing homes and 2,382 in voluntary nursing homes and a further 6,489 in public nursing home facilities. The total comes to 28,420.
Since 1988 bed capacity has increased by more than 84%. People in Ireland are living longer. The number of people aged over 80 has increased by 20% over the past six years alone and some 68.9% of beds in nursing homes are occupied by people aged over 80. The challenge is that people are living longer and putting a greater demand on care of the elderly.
Taking into account the investment in providing the buildings, equipment support staff and everything else, Age Action calculated that in 2006 the average cost of a nursing home bed was more than €1,100 per week. The question arises as to how we deal with the growing number and how we plan for the long term. I have looked at the number of nursing home beds for those aged over 65 in other countries. Austria has 70 beds per 1,000; Ireland has 47; Germany has 48; and Italy has only 16 beds per 1,000 of population.

The provision of additional nursing home beds is not the answer to all of the difficulties we face in this area. The last budget included an allocation of €350 million for home help and other schemes to assist those who require support at home. An additional €23 million was added for that purpose this year, despite the huge demands we face in terms of reducing borrowing levels and retaining existing services. The way forward is about developing and growing support levels for people living at home. It is one of the issues on which we must engage in a very proactive way.

An issue of particular concern, which I have raised on more than one occasion in the past, relates to step-down facilities, an area in which we have not been sufficiently proactive. It is an issue we must examine carefully. The report of the first national audit of dementia care in Ireland makes interesting reading. It shows that where patients with dementia were admitted from their own home to hospital and subsequently discharged back to their own home, the average hospital stay was 22 days. In the case of people admitted from a nursing home to hospital and then discharged back to a nursing home, the average hospital stay was 17 days. Finally, when a patient is admitted from his or her own home to hospital and subsequently discharged to a nursing home, the average stay is 59 days. If we take it that the average weekly cost of hospitalisation per patient is €6,000, then the difference between 59 days and 22 days amounts to a cost differential to the taxpayer of €36,000 per patient, a sum which would make up a substantial portion of that patient's nursing home care. I am not sure of the numbers involved, but the huge gap in average hospital stays clearly highlights the need to examine the provision of step-down facilities.

We need to do significant forward planning in this area. I do not agree with Senator MacSharry regarding the setting up a formal forum, but I accept there is a need for joint consultation on an ongoing basis between all stakeholders. It is something I have suggested at the health committee and in this House. Nursing Homes Ireland has pointed out that while it enjoys ongoing consultation with the Department, there is a need, from time to time, for a joint approach which would encompass not just policy planning but how to deal with issues as they arise. That is a little different from Senator MacSharry's proposal to set up a forum dealing with policy.

I welcome this debate. It is a debate that must be ongoing and comprehensive if we are to deal with these issues and have adequate forward planning.