Colette Kelleher (Independent) | Oireachtas source

I welcome the motion, which focuses in particular on people with dementia. I would also like to welcome the new Minister of State and look forward to working closely with him, as I did with his predecessor.

As well as a growing population of older people, there are almost 55,000 people living with dementia in Ireland, 63% of whom live in communities. Most of us know someone, such as a family member, relative or neighbour, for whom this a reality. The numbers are set to grow to 68,000 people in ten years' time. Dementia is a significant challenge for people, their families and society as a whole.

People with dementia need a wide range of supports which reflect the complex and changing needs of the condition. They need an early diagnosis and the support of a locally based dementia adviser, of which there are only eight. We need one for every primary care area, which would be 90. In order for people to live well with dementia they also need access to a range of services as the condition advances.

Home care is critical. It allows people to stay at home, remain part of their communities and do all the things we know are good in order to enable them to live well with dementia. Familiarity is critical because people often do not want to go into a respite centre, even for a fortnight, because it is too disorientating. People prefer to be at home in the place they know. Dementia-specific home care is consistent and continuous. People with dementia cannot have services which involve chopping and changing.

Sometimes things take longer for those living with dementia. A person may require social supports. They may not need to be fed or dressed, but they might need someone to pop in to remind them to cook because they may simply have forgotten to do so. There is strong evidence that low-level and flexible support in the home, in particular for those living with early and mid-stage dementia, can be very successful in keeping people living well in their own homes.

Home care is vital in supporting dementia family carers. The social and health care system relies on family members to provide care for people with dementia, and this can often be burdensome and stressful if they are left to go it alone. One of the main reasons people burn out and people with dementia have to enter long-term care is because of family burnout. A report was published by Trinity College last week, the De-Stress report, which told us this, as if we did not know it already.

We know that the majority of people with dementia want to live at home in a familiar environment and remain linked to their communities. That was highlighted last year in a report published in July by UCD, Age Action, the Alzheimer's Society of Ireland and the Irish Association of Social Workers. It was also confirmed in last year's pre-budget submission from the Alzheimer's Society of Ireland, which I launched. There were some 25,000 signatories to it.We must listen to people. I know that there is a consultation process, but we should not have to wait for it to take place as we know what is involved from what people are telling us. Not only has the case and preference for home care been proved, it is also cost effective and cheaper than residential alternatives. The availability of a home care service enables the health care system to work effectively for patients’ timely and appropriate discharge. People get worse when they go into hospital. They lose functionality and often do not come out again. It is not the right place for them. While it is official Government policy to support people to enable them to stay at home, it is not happening. One need only look at the relative spend between long-term residential care and community-based care. Between 2009 and 2015, funding for residential care was increased by €84 million, whereas funding for home care decreased by €11 million. One possible explanation and an issue which must be addressed is that there is no statutory entitlement to home care. It is discretionary. When the budget runs out, it runs out. However, there is an entitlement to residential care under the nursing home support scheme. I support Deputy Willie O'Dea's Bill to have it put on a statutory footing.

Last October I was delighted to set up the first all-party Oireachtas group on dementia. The group is co-convened by me and Deputy Mary Butler, while Senator Máire Devine is an active member. We hosted high-level round table discussions on home care which the then Minister of State attended. Again, we received the same message. However, we teased out the issues involved. The core issues can be boiled down to three Rs, namely, regulation, as proposed by Senator Colm Burke, resourcing of hundreds of millions of euro and the right to home care. Reflecting on this, the all-party group on dementia made its submission to the Citizens’ Assembly, with a right to home care being one of the five recommendations. Although home care is provided in different guises, it is not regulated. Given its nature and that the most intimate care provided in the home is often unsupervised, there is a strong case for regulation which is what Senator Colm Burke's Bill would do. Anybody can set himself or herself up as a home care provider. One could be a criminal today and set up as a home care provider tomorrow. That is not good enough for the vulnerable persons in question.

On resourcing, I was glad when the Sláintecare report acknowledged the need for home care as part of a modern health system, although I believe the report vastly underestimated the level of investment needed. If we are serious about building a home care system, we need to lay out a funding path which will lead towards an annual €1 billion investment in home care. It would be money well spent. The active care report published by DCU yesterday showed that we spent more on health and social health care per person among the eight countries it examined but in the wrong areas such as emergency hospitalisation rather than meeting people's needs and preferences.

As the motion calls for, we also need full implementation of the national dementia strategy. I am particularly interested in the 500 intensive home care packages which are meant to reach 130 people. What are the up-to-date figures? On a right to home care, I am aware that the outgoing Minister of State promised consultation. It would be great to hear the details from the Minister.

The issue of home care for people with dementia has been raised time and again. I receive calls from Members of the Oireachtas who want to know how they can secure a service. Recently, I was speaking to Deputy Anne Rabbitte about a 101-year old person who wanted to stay at home but who had to beg for a home care package. It is time for the Government to listen and, most importantly, act. With the party proposing the motion, I hope it will support the Alzheimer Society of Ireland’s 2018 pre-budget call for a €35 million investment in home care for people with dementia, which must be built on year on year. It is not about turning up at events tomorrow, taking a photo, tweeting but doing nothing to secure a meaningful and realistic investment and system designed for a national infrastructure of home care services, as is common across Europe. The party or the Minister who has the foresight and the courage to build a high-quality, equitable infrastructure of home care services, like that of roads, railways and schools, will actually have a place in history. We remember people like the former Minister for Finance, Deputy Michael Noonan, who helped us to turn the economy around and Donogh O’Malley who gave us the universal secondary education system. The Minister and the party that do this, not just talk about it, turn up at events and agree with everybody, will be well remembered for a long time. That is why I am supporting the motion and urge every Member to support it too. I am supporting it only as a stepping stone to a meaningful commitment to building home care services on the scale needed to ensure Ireland will be a humane place for people with frailties and conditions, as well as a good place in which to grow old.