Colm Burke (Fine Gael) | Oireachtas source

I welcome the Minister of State. I am not following him, but this is our third time to run into each other today in various debates. This is an important issue in how we plan health services. While over €760 million has been put into older people services, of which €373 million is for home care provision, it is a service we will have to continue to grow for several years. Over 10.5 million home help hours are provided annually, but there is still much work to be done. Over 16,750 home care packages are provided, but there are many more people looking for them. We need to ensure those who want to do so can stay at home and that the necessary supports will be available without them having to go into a nursing home.

We may have major challenges in nursing homes provision. There are over 23,000 people participating in the fair deal scheme. If we continue to have a growing number of older people in nursing homes, either under the fair deal scheme or in community hospitals, we will require something like 40,000 beds within ten years. There is a population of 600,000 who are 65 years of age. Within ten years that number will reach over 1 million. That will have knock-on difficulties for hospital services in that 5% of all hospital beds are occupied by the over 65s. Accordingly, if want to get people out of hospital fast, we have to ensure there are adequate facilities available.

One of the issues at which we need to look also is the provision of step-down facilities. In many cases, people want to go home, but they are not well enough to do so, even with home care provision. They need a step-down facility, an intermediary between hospital and going home. This is another area we need to examine seriously. I know that the Department has examined how home care is provided in other countries such as Germany, the Netherlands, Sweden and Scotland and is working to ensure we can provide a comprehensive forward plan in this regard. I noticed some criticism of nursing homes in some contributions. In the past 24 hours I have been contacted about three nursing homes which are closing down, not because of HIQA inspections or health care concerns but due to their financial viability. Not long ago, a Member complained in the House about the rate of pay in nursing homes. Nursing homes have costs to meet such as insurance and rates. I heard of one nursing home, the rates bill of which had gone from €50,000 to over €100,000 in less than 12 months. They have all these hidden costs to meet. This is about home care provision, for which we need to plan carefully.

Senator Colette Kelleher is right is about the regulation of home care providers. There are over 30 companies providing home care packages, but they are self-regulated. While it also involves the Health Service Executive, HSE, it is not adequate. In this House we introduced the Health (Amendment) (Professional Home Care) Bill 2016 which had stemmed from the Law Reform Commission's report which had set out clear guidelines for how we should move forward in this area. It is important the Department also take it on board.I believe that we need to fast-track the planning on how we now fund home care. The number of people over the age of 65 is increasing. That does not mean that because someone reaches 65 years of age, they suddenly require a home care package. Also, the age profile of the over 85s is going to grow dramatically. Some Senators have referred to that figure already. It is important, therefore, that we plan.

There is an interesting case of someone I know very well that goes to show how well home care can work. The person is 95 years of age, confined to a wheelchair and living on their own. As a result of home care, they can live quite safely and securely on their own. Under absolutely no circumstances does that person want to go into a nursing home setting. With the help of the people providing home care, they can plan to go out shopping, to the post office or to the bank when it suits. It is still working out. Even though there is a home care provider coming to the person something like four times a day, it is still far cheaper that the person being in a nursing home full-time. It does work. There are many people in nursing homes who would love to be back in their own homes but, unfortunately, the supports they need are not there.

The one other thing we need to keep in mind is that it will be a major challenge in rural areas as regards trying to get people to provide that home care. That is something we need to seriously consider. How do we deal with rural areas in which there has been a decrease in population, but there are many elderly people and many people who want to stay in their own areas and their own homes? How do we meet that challenge? That is another issue we have to face.

I thank the Members for tabling this motion and for having this debate. We need to plan, make sure that it covers all the angles and ensure there is maximum protection for the person receiving the home care.