Colm Burke (Fine Gael) | Oireachtas source

I move: "That the Bill be now read a Second Time."

I welcome the Minister of State and her officials. I thank the Minister of State for the work she is doing in the area of elderly care.

In 2011, the Law Reform Commission published a report on the regulation of people who provide home care or who care for individuals in their own homes. The research relating to the report was carried out in 2010. As a result of that report, I have published the Health (Amendment) (Professional Home Care) Bill 2016. I originally brought the legislation forward during the lifetime of the previous Seanad but, unfortunately, it was not reached. I sincerely thank the Minister of State for taking the time to come to the House to deal with the matter today.

I hold strong views on this issue. I will outline the current position. If a person serves prison time for any offence, there is nothing preventing him or her from setting up, on the morning he or she is released from prison, a company that undertakes to provide professional home care to elderly people. What I am saying is not to be taken out of context. I am merely highlighting the fact that there is no strict regulation in respect of who can provide the type of service to which I refer.

The Law Reform Commission set out a number of recommendations in its 2011 report. A key recommendation was that the Health Information and Quality Authority, HIQA, should be empowered to regulate and monitor undertakings that provide professional home care, whether public sector, private sector, for-profit or not-for-profit. While the main beneficiaries of the proposed new HIQA regulations would most likely be those over 65 years of age, the proposed system should apply to professional home care provided to any adult over 18 years of age. This was another recommendation contained in the Law Reform Commission report. The HIQA national standards for professional home carers should be specifically tailored for the home-care setting. Obviously, the regulations for nursing homes would be different from those relating to home care. The recommendations build on the 2008 draft HSE home-care guidelines. That is how the HIQA standards were subsequently agreed in respect of nursing homes. Draft guidelines were published by the Health Service Executive in 2008.

The proposed standards should have regard to specific principles, including the right of a care recipient to independent living, privacy, dignity, quality of care and protection from abuse. There should be a specific register of professional home carers which would set out specific requirements in respect of the registration and monitoring. The terms and conditions of home-care arrangements should be agreed between professional home carers and recipients. This should be recorded in a care contract to ensure maximum protection for the care recipient. These are some of the recommendations contained in the 2011 report.

Almost six years have passed since the publication of the report and I believe we need to debate the issue. Significant change has occurred in demographics in Ireland. According to the 2006 census, 11% of the population was over 65 years of age. It is predicted that 15.4% of the population will be over 65 years of age by 2021. Another major change has taken place in the population over 85 years of age. My understanding is that the number of those over 85 years has increased by 20% the past six years alone. Things are changing a great deal. This is a great thing about our health service. I realise many people criticise it and some of those criticisms are justified. However, despite all the criticism, people are living longer and looking after themselves better and for longer. Moreover, there is more information with regard to how not to put one's health at risk.

Another figure is relevant. In 2002, a total of 114,000 people were living alone. The prediction for 2021 is that the corresponding figure will be 210,000. This is relevant for the older population. For example, let us consider the figures for our hospitals. Up to 51% of all hospital beds are occupied by those over 65 years of age. As our population continues to age, there is going to be more demand on our health services.As our population ages, more demand will be placed on health services and on general practitioners. It is predicted in one report that consultations with general practitioners by members of that older age group will increase by 33% by 2021. In some European countries, there are four people retired for every two people working. The demographics in Ireland will also change. With regard to the current structure, if we consider the cost of the fair deal scheme and that more than 23,500 people are in private nursing homes and another 6,000 or 7,000 are living in community settings, that is not what everyone wants. An increasing number of people want to remain in their own homes. I recently attended the birthday party of a lady who is 100 years old and who lives alone. I am sure other Senators could cite similar examples. A relative of mine who is 95 years old and confined to a wheelchair is residing on her own but she can only do so because home care is being provided.

The Law Reform Commission report of 2011 refers to the fact that there is imbalance in the focus on residential care as opposed to home care. The position in this regard has not changed substantially in the past five years. We need to change the whole focus. There are certain categories of people who will require residential care. However, the number of people we should try to keep out of residential care will continue to rise and we need to ensure that we can continue to increase the number of home-help hours provided. I have the 2015 figures and I am sure the Minister of State has more up-to-date ones. Approximately 10.4 million hours of home care were provided to 47,915 people last year. We have major challenges ahead of us.

I will briefly go through the detail of the Bill, which sets out the amendments to the various sections of the 2007 Act. It defines what constitutes a designated centre and states that professional home care "means services which are required to ensure that an adult person, that is, a person aged 18 years and over, can continue to live independently in their own home and includes, but not limit it to the services of nurses, homes care attendants, home help, various therapies and personal care and palliative care". It also sets out the amendment to section 8 of the Act of 2007, which deals with the standards of professional home care. The Bill further sets out the various changes we need to bring about in order to put a proper regulatory structure in place. In fairness to the people delivering services, be it through the HSE or private contractors, they are providing very good services right across the country. I hope the 10.4 million home-care hours currently being provided could be increased to a major degree because this would ensure that we could assist many more people and that there would not be the same pressures on nursing homes and hospitals.

Another relevant issue relates to hospital discharges. I dealt with a case recently of an elderly person living alone who was discharged from hospital. I am not clear about the connection between the hospitals and the people working in the community. No home care provision was set up for the person in question. Therefore, they were very much reliance on their family members who live 50 to 60 miles away. Much more co-ordination is required in that area. Our hospital service also needs to have contact with the people who are contracted to provide the support to people in the community.

The Bill sets out in great detail what is needed but it also makes adequate provision for the Department to bring forward the necessary regulation. It would have to examine it and deal with the regulation that needs to be brought in to provision supervision and so on. When a Law Reform Commission report is brought forward, it is important that it is not simply left on a shelf and that we proactively examine what is the best way forward. We cannot afford to leave this sector totally unregulated. Unfortunately, in the case of many care facilities down through the years, we relied on the skills and judgment of those we thought were properly managing them but now we find that report after report has to be compiled. That is not the way we should allow this area to be managed. We should set up a regulatory structure. The Bill deals with this issue and I know it is not written in stone. I would like to hear the Minister of State's comments on it. I would also like the Department to be very proactively involved in developing the legislation and the level of regulation required in this area. I thank the Minister for taking the time to be with us this afternoon.