Catherine Ardagh (Fianna Fail) | Oireachtas source

I move:

That Seanad Éireann:

noting that:  the Department of Health contends that home care can be a cost-effective alternative to long-term residential care for some older people;

 despite significant increases between 2008 and 2015 in those aged 65 years and over and those aged 85 years and over, there was a decrease in the number of people receiving home help and home care packages;

 it has been argued that the implementation of the Fair Deal Scheme, in the absence of any similar structured scheme for home-based care, may draw people into residential care prematurely;

 the majority (63 per cent) of people with dementia live at home and the annual cost of dementia is €1.69 billion per annum, 48 per cent of which is attributable to informal family care;

 insufficient provision of home help and home care packages channel people to long-term care, causing the institutionalisation of people with dementia; and

 people with dementia have a preference to remain living at home for as long as possible and that with the right support, this is possible for the majority; and acknowledging that:  €22 million was allocated through the National Dementia Strategy Implementation Plan for the delivery of intensive home care packages for people with dementia and that these packages are operating in eight pilot sites;

 Budget 2017 provided an additional €10 million in new development funding for home care and for continuation of the additional €30 million for home care announced in July, 2016;

 the Minister of State at the Department of Health with special responsibility for Mental Health and Older People has announced plans to begin a consultation process on the development of a statutory scheme for home care; calls for:  an approach to home care that addresses the inequity of service provision that currently exists across the country;

 positive aspects of the Nursing Home Support Scheme to be adopted for home care such as the standardised process for assessment, certainty of entitlement and centralised, multi-annual, ring-fenced funding;

 flexible home care for people with dementia, which meets individual needs and moves away from a time-to-task approach;

 increased investment in 2018 to meet the particular needs of people living with dementia in the community; and

 adequate resources to ensure full implementation of the National Dementia Strategy.

I thank the Minister of State for attending to take this matter.

We are now thankfully living longer and most of us will live independently for the rest of our lives. Fewer than 5% of all our elderly require care late on in life and all parties agree every effort should be made to facilitate this in so far as possible in the comfort and security of their own homes. Fianna Fáil believes that the funding allocated to enable older people remain at home provides not only the best value for money but also the most humane result for older people. There are many thousands of families helping their loved ones to stay at home when they are ill or frail and they receive very little assistance from the State. This needs to change, especially to deal with the growing challenge of dementia care in Ireland.

A June 2016 report on home care by the Irish Association of Social Workers, Age Action Ireland, the Alzheimer's Society of Ireland and University College Dublin's school of social work offers a joint assessment of home care in Ireland. It was a timely study and a welcome contribution to the debate on how best to care for our older people. We have already heard numerous reports of people finding it difficult to access adequate home care. We saw this yesterday with the tale of the Devereaux older couple who thankfully were reunited in the same care home but we saw how their family had to resort to going on the national airwaves to ensure they got the care they deserve and require. It is important we understand why this is the case and what can be done to resolve the difficulties people have in accessing home care and nursing home care.

Fianna Fáil believes that the funding allocated to enable older people to remain at home not only provides the most comforting and dignified care but also the best value for money for the State. In 2015, the HSE estimated that some 2.2 million extra hours of home help and a further 3,500 home care packages for older people are required. Unfortunately, this was not provided for in 2016 service plan. We are firmly of the view that these additional resources must be provided for older people. We acknowledge there is a commitment in the programme for Government to increase home care packages and home help hours but we are concerned that there is a lack of detail surrounding how these commitments will be achieved.

The June 2016 report clearly highlighted the inconsistencies between the various local health areas when it comes to the availability of home care. This must be addressed as a matter of urgency. It is unacceptable that there are so many inconsistencies in the system with many older people missing out on home care just because of the area in which they live. Real progress in meeting the challenge of home care must be made during the lifetime of this Oireachtas. It is the preferred option for older people and it is well acknowledged that the care based around the home is vital for keeping people active in their own communities, which, in turn, has enormous health benefits for the individual.

I will refer to a case highlighted by Joe Duffy. He interviewed a lady six months ago who was in a nursing home. She was there for respite care as she had broken a limb and once that healed she wanted to return home. She went back on the national airwaves and Joe helped her to grow a small campaign, and she ended up returning home where she wanted to be. She wanted to be near her friends and her bridge club. Ultimately, hers is a story that resonated with many people whose mothers, fathers, aunts and uncles want to be at home. That is the best and most comfortable place for older people.

The 2017 HSE service plan announced that no additional home help hours will be provided. This will put severe pressure on families and it will continue the chronic overcrowding in our hospitals. As we do not have enough nursing home beds and people are not able to get the home help they need at home, people are keeping their loved ones in hospitals and this is causing some delay in ensuring beds are vacant for people who are more urgent cases. The HSE service plan ignored the crying need for additional home help hours across the country and it will ensure that thousands of older people will be left without the support they need. The plan also ignores the commitment in the programme for Government to increase the number of home help hours.

The 2016 Fine Gael manifesto pledged an additional 2.2 million home help hours over the next five years. We should have been seeing in the region of 400,000 home help hours being announced for 2017 if it was keeping to its commitment.The upshot of this decision is that further pressure will be put on the already stretched nursing home system as older people will not have the support they need to stay in their homes. Health professionals all say the outcomes are better for older people if they remain in their own homes supported by home helps and their families. In addition to adding to the pressure on the nursing home system, a lack of home help hours will ensure that older people with chronic conditions remain in the hospital system long after they are deemed able to leave.

Fianna Fail introduced a Bill in the Dáil, led Deputy Willie O'Dea, that seeks to expand home care. The fair deal scheme is provided on a statutory basis but home care packages are discretionary and not provided on a statutory basis. It is too ad hocand not transparent. The Fianna Fáil Bill proposes that home care services be offered to people in place of long-term residential care in circumstances where the provision of a home care package is less costly to the State, compared to long-term residential care. My colleague, Deputy O'Dea, pointed out that home care services can offer a better outcome for patients and such services are less costly to the State compared to residential care.

If this Bill is passed, it will be an enormous step forward in helping to empower older people. It will enshrine in legislation the right to services that will allow them stay in their own homes and communities as long as possible. This not only benefits the individuals concerned and their families but also the State due to fewer demands being placed on long-term residential care.