Friday, 16 July 2021
Nursing Homes Support Scheme (Amendment) Bill 2021: Committee and Remaining Stages
Mary Butler (Waterford, Fianna Fail)
I think anybody familiar with my work on older people over the past five years, when I was the main Opposition spokesperson for older people, will recognise that I constantly raised issues relating to safeguarding, premature entry into nursing homes, capacity issues and challenges and the fact that, for example, 70% of people in nursing homes have dementia. Everybody will recognise that I have a history in that respect.
I acknowledge concerns about safeguarding in nursing homes and the potential vulnerability of nursing home residents. The nursing home sector has been severely challenged in the past 16 months and I think everybody recognises that. Once again on the floor of the Seanad, I express my deepest condolences to the families of the more than 2,051 people in nursing homes who lost their lives. In recent weeks, there has been media coverage of neglect in nursing homes, and to that end, in the past two weeks I met representatives of HIQA, residents of Ballynoe Nursing Home in Cork and their families. Much active work on nursing homes is ongoing, although people might not be aware of it.
I recognise that financial abuse of older people is a serious issue. The majority of nursing home residents exhibit high levels of dependency and some form of capacity limitation, including dementia. The assumption within the Bill, which is reflected in the Assisted Decision-Making (Capacity) Act 2015, is that individuals in the scheme have full mental capacity until the contrary is established. In such a case as a person is established not to have full mental capacity, a care representative can be established. The Bill sets out the method by which a care representative is appointed and the function he or she can perform in making decisions related to the person’s care. The care representative must be appointed by a court. Furthermore, the full implementation of the 2015 Act is expected to have an impact on this function, given that it is the Department’s intention to ensure the fair deal legislation is aligned with this new legislation.
A range of other individuals, including the care representative, can act as a specified person on behalf of a person in care. Only the care representative, however, can represent a person in applying for ancillary support, that is, the nursing home loan, or in seeking the relief provided by the Bill in terms of appointing a successor to a productive asset. That is because these processes involve the placement of a charge on the land. Appropriate structures, therefore, are in place to ensure safeguards in the case of individuals without full capacity.
The Bill, as drafted, will require the Minister to carry out a review of the operation of its provisions no later than five years after it comes into effect, which will be laid before the Oireachtas. The terms of this review are not set out in any more specific detail. We might expect, however, that it will cover any operational challenges, the policy impact and the cost to the State, as well as any unforeseen consequences in regard to areas such as financial abuse. It would not be appropriate to extend the scope of this review far beyond the terms of the specific amendments to the legislation we are debating, nor would it be appropriate to single out financial abuse as the only specified issue for this review to consider.
Turning to the adult safeguarding policy, the existing framework of standards, policies and procedures for the safeguarding of adults who may be at risk of abuse, harm or exploitation within the health sector includes the joint national adult safeguarding standards developed by HIQA and the Mental Health Commission, MHC, the significant inspection and other regulatory powers of HIQA and the MHC, and the structures and processes established by the HSE to support and further develop its national operational policy on safeguarding.
Further measures are being developed to strengthen the adult safeguarding framework in the health system, including the revision of HSE operation policy and the development of a national policy on safeguarding in the health sector covering all settings. This will address potential policy and legislative gaps, provide national direction and address relevant cross-sectoral issues such as information sharing. Significant policy development work has been undertaken on this policy. I acknowledge the work of my neighbour when we were based in Leinster House 2000, the then Senator Colette Kelleher. An inter-sectoral steering group has been established, stakeholder consultation has been carried out and a large volume of evidence has been commissioned and gathered. While I recognise the concerns raised by the Senator, I cannot accept the amendment.