Alice-Mary Higgins (Independent) | Oireachtas source

I move amendment No. 3:

In page 59, between lines 34 and 35, to insert the following: “Report

33.The Minister shall, within 12 months of the passing of this Act, lay a report before both Houses of the Oireachtas in respect of situations where a person applies for financial support to be made available to them in relation to residential care services and where that person subsequently transitions to a different care model. This report may set out legislative measures or procedures which might be implemented to facilitate such persons in their exit from the Nursing Homes Support Scheme, including provisions which may be made in relation to the removal of an interest, or farm, or a relevant business.”.

We will not have to go over some of this issue again when debating this amendment, because it relates to the subject we just discussed. I refer to statutory home care, the promise of and need for such home care in different situations and the imperatives under the United Nations Convention on the Rights of Persons with Disabilities, UNCRPD, to ensure decongregation and deinstitutionalisation. We must also move towards a statutory model of home care for older people. Things can change and circumstances can alter, and this is the aspect we must consider. Rules are in place in this regard, but a strong assumption is also inherent in the way the nursing home support scheme is designed and conceived. It is evident when people try to find information on changed circumstances and options in that regard.

It feels very much like a one-way street. Once people become part of the fair deal nursing home support scheme, it is hard then for them to see what the route of it might be. People sometimes enter schemes such as this after suffering catastrophic health events, but their circumstances may later change. One concern in this regard involves people who may have entered the scheme because of having developed a disability or experienced a serious health event. Normally, those people would have transitioned to community care. The impact of Covid-19, however, has meant that such care may not have been available and people might have found themselves in residential care instead. A particular vulnerability has emerged in that regard in the last year.

People in such situations might well decide later that it is not the model of care they want. Circumstances may change. A son or daughter may return from abroad or someone else might become available who could be a carer and that would alter the situation. Community care and statutory care provision might also become available soon. When such changes of circumstances occur, then, how do the people concerned get out of this scheme? How is it possible to exit it? Where an asset is involved, whether a farm or a business, how do they exist that aspect as well? What mechanisms are available in that regard?

It happens sometimes that people leave the scheme. People have managed to do it, although not often. It is not, however, always a transparent option and it is not always clear that such an option is even on the table. People might not know such a possibility exists. If people did, they might derive a great deal of comfort going into this scheme to be aware that in one or two years' time, they could potentially exit the programme if it turned out not to be the best model of care for them in the longer term.There should be a clear mechanism or way so people know how that would work and what are the expectations. Again, that is in line with the UN convention on rights for people because it is not just about a choice on care at one point. It is about the ongoing right to change your mind, to choose again and choose differently. A person may become particularly vulnerable, have a health event, have a disability, his or her spouse may die, he or she may find themselves at a point of vulnerability and his or her family may be under pressure. In all of those particular circumstances, as Senator Malcolm Byrne described, nursing home care might seem like the only or the best option but it would be really good if it was clear there was a route out. An actual specific mechanism in relation to the statutory entitlement to home care will be necessary. While people have a statutory entitlement and there is a scheme in place in the form of the nursing home support scheme, people do not have the same options on the table where home care is concerned nor do they - this is the last thing I will say on this - have the same options where personal needs assistants are concerned. These are different from home care support and it is the other direction we must be travelling in, so that people can have personal needs assistants available to them to allow them to live independently and fully.

This was really a report to ask how we build those exit doors, how we build them properly and how we mind the person as well as how we disentangle the asset, in the case of a farm or a business.