Colette Kelleher (Independent) | Oireachtas source

I welcome the Minister of State, Deputy Daly, to the Seanad and welcome the opportunity to speak on this important issue. I was delighted to see the reference to home care because, as with my colleague, Senator Swanick, I want to speak on that issue.

While the focus of this discussion is on the fair deal scheme, I want to focus my remarks on home care and the need to provide a real alternative to residential-based care and for the inclusion of this preferred option in the fair deal scheme. Every year the State spends about €1 billion on the fair deal scheme, which benefits 23,000 people. In comparison, approximately €370 million is spent on home care, with 49,000 people receiving home help and 16,700 people receiving home care packages. This €370 million is not earmarked; it runs out and is not demand led. Members will know this from their constituency offices where people will be coming to them who are in dire straits and looking for support. Yesterday I was advising an Oireachtas colleague about what she could do with a man in a very rural area where residential care is not an appropriate option. The poor man is on his knees but the budget in that area has run out.

We need to shift the focus and provide more people with home care options. I always give the example of Denmark which has not built a nursing home since 1987 because there are alternatives. They have nursing homes. We will always need nursing homes but they have a range of other supports including home care to go alongside that. As most Senators will know, home care enables people to fulfil their will and preference to live at home in a familiar environment linked to their communities for as long as possible. This is particularly the case for a person with dementia for whom living in a strange environment is really difficult, even for respite care. Home care is also a cost-effective alternative to long-term residential care for some older people and an integral part of a well-functioning primary care system. Good quality home care supports ensure that people get the care they need, where and when they need it.

Home care as currently constituted needs to be improved in three core ways. First, we need a statutory right to home care. I am glad to hear the Government is considering a statutory scheme because without it, fair deal for residential care or acute beds will always trump home care. Unless there is an entitlement to it, the budget will be squeezed and will run out. There is an anomaly in the current law that provides entitlement to residential care through the fair deal scheme, but not to home care. Brendan Courtney and his family are a very high profile example of that.

Second, home care should be regulated. The services provided in private homes are very personal and the people receiving them may be vulnerable to abuse or harm. We must ensure that the services provided are of the highest quality and that those providing them have been vetted and trained. There should also be regulations on the consistency of care. To that end, the proposed home care Private Members' Bill by Senator Colm Burke is very welcome. I would love us to spend time on a Thursday on that Private Members' Bill to bring it forward. We need to look at it as a matter of urgency. If we want people to live at home successfully we also need a menu of community-based care to suit individual needs, which includes broader community-based services, such as day care and respite care.

It is also vital that the same approach to how services are accessed, delivered and monitored is applied universally. At the moment the kind of assessment people get depends on what part of the country they are in. It is not equal or fair. If one lives in Macroom, one might get a good deal but a person living in Manorhamilton might not get such a great deal. That kind of postcode lottery is not fair on individuals. Equity of access must be a core principle of any new home care system. At present there are different forms of assessment, a lack of information around services and, wrongly, geography rather than need is determining access to care.

Third, to be effective and to meet the needs of the growing older population, home care services need to be well-resourced and demand led. Teasing out a fair funding model must be a priority. At present a lot of money is invested in residential care services. Within a decade the State should be spending in the region of €1 billion per annum on home care services. If we want to increase home care we need to push resources towards community care but at present we are spending nearly four times more on residential care. Earlier this year, Deputy Mary Butler and I, as co-conveners of the all-party group on dementia, organised a round-table event on the future of home care with key stakeholders including the Minister of State's predecessor, Deputy McEntee, representatives from the Department of Health, the HSE, NGOs, academics and Oireachtas Members. At that meeting Professor Eamon O’Shea from NUIG provided an excellent analysis of the funding options. If the Minister of State has not done so already, I encourage him to engage with Professor O’Shea because he has spent his entire career looking at this matter. He has the answers; we do not need to reinvent the wheel so people can remain in their homes. The Minister of State knows the pressure on the health system when people go into hospital and cannot be discharged because there are not suitable options like home care. People also deteriorate in hospital. It is not a suitable place, particularly for people with dementia. Sometimes we make people more unwell because they are in the wrong place.

By providing a right, regulating it and resourcing it, we will ensure that we have a well-functioning home care system that works for people. I am anxious to know what the next steps are and the timetable post-consultation. The Minister of State has said it will be in the coming months but I would like something a bit more specific. Will we see an uplift in funding for home care in budget 2018 which I and others are advocating for as part of the all-party group on dementia? The Minister of State is very kindly launching our proposals on Thursday.

Will the Minister of State commit to amending the fair deal scheme to include home care?