Mary Butler (Waterford, Fianna Fail) | Oireachtas source

We need to bring this conversation back into context a little. I understand where the Senator is coming from. There is absolutely no impediment in legislation or practice to prevent a person who is receiving care under the nursing home support scheme from leaving nursing home care and returning home or to a different setting.

The nursing home support scheme was put in place in 2009 to ensure there would be no financial barrier to anyone who needed long-term care. I will give an indication of how seriously the Government takes this. Last year the cost of the nursing home support scheme was €1.4 billion and approximately 22,500 people availed of the scheme. The amount of financial aid that came in from costs people paid to support their care was €350 million. We will be turning our eye towards the budgets very soon. When I look at my budget, there is €1 billion gone out of it to support the scheme. It is a very good scheme that has worked very well.

What we are doing today is correcting an anomaly that came from the 2009 Act whereby farm families and those with small business were not treated as fairly as people who had a principal private residence. That is the nub of why I stand before Senators; it is to correct that anomaly. Many organisations like the IFA, Teagasc and Agriland have been raising the matter of the anomaly for many years. That is the whole purpose of this Bill. There is also an amendment that was included in the Bill in the Dáil on Wednesday. It is a really important one and there has not been much conversation around it. It provides for a situation where a person moves into a nursing home and their house is sold in the meantime. Previously, if a person stayed in the nursing home beyond three years, the 7.5% he or she had to pay was not capped at three years. This amendment has been included now and we have been working very closely with the Department of Housing, Local Government and Heritage on it. It means that when a person is in a nursing home and his or her house is sold, there is no impediment to selling the house. We know 37% of people who enter nursing homes are there for six or seven months. Not everybody is in a nursing home for a long time. There are some people who are but not everybody. That is important. We also must put this in the context of the majority of people who go into nursing homes being very sick, very old, having complex care issues and some of them are vulnerable. They need that support of 24-hour nursing care and because of the nursing home support scheme they are able to get it. It is not common, but a number of people do regularly leave nursing home care to return home, move into different nursing homes, or into different care settings.

Over the last 12 months people have actually decided to stay out of residential care because of Covid and because of the visiting restrictions. They opted to stay at home more and to try to get supports through home care and also privately in order to do that. That should be acknowledged as well. In cases where there are financial challenges, it is worth noting access to the scheme is predicated on a care needs assessment which determines whether long-term residential care is necessary for the individual in question based on their clinical needs, community supports and overall level of dependency. There is a nursing home loan as well that 15% of people in the nursing home support scheme avail of. Without labouring the point, the scheme is here to support older people who need nursing home care and it means anybody who needs nursing home care is able to afford it. That is the point that must be made.

As I said earlier, work is ongoing in the Department to determine the optimal approach to the development of the new statutory home care scheme within the broader context of the ongoing reform of the health and social care system, as envisaged in the Sláintecare report. As I said, the work encompasses the development of the regulatory framework for the new scheme. The pilot of a reformed model of service delivery is due to commence in 2021. Regarding the development of a regulatory framework for home support services, I am pleased to say the Government gave approval in April to draft a general scheme and heads of a Bill to establish a licensing framework for publicly-funded for-profit and not-for-profit home support providers. I intend to progress this general scheme and heads of Bill as a priority with a view to bringing it through the Houses at the earliest opportunity.

It is also a Government priority to ensure older people have sufficient housing options in place to meet their needs. Last Tuesday myself and the Minister of State, Deputy Peter Burke, were in Navan where the Age Friendly Ireland healthy homes approach was launched. Nine local authorities throughout the country are taking part in a pilot programme where 4,500 people will be assisted to "rightsize" their home, that is, not to downsize their home but to rightsize it. That is the new buzzword. Supports will be given to a person if he or she needs, for example, advice on how to get a solicitor if he or she needs to sell his or her home, or a person might need advice on property tax. It covers all these things older people may find hard to navigate if they do not have a family member to support them. Age Friendly Ireland is doing phenomenal work and I congratulate the people involved on the work they are doing. We want to support older people to remain living in their own homes or in a home more suited to their needs through the provision of targeted supports. The most important thing for older people is - one finds this if one talks to older people - the option to live in their own home for as long as possible, with the correct wraparound supports. That is what we all aspire to. There is always going to be a small minority of people who need nursing home care. It is great that we have the facility and that there is a scheme to support financially any person who wants or needs nursing home care.

I accept and appreciate the issues that have been raised about the up to 1,700 people under the age of 65 years who have been placed in nursing homes, maybe because of disabilities, acquired brain injuries or reasons like that. I accept the report that was there although I thought the sample was very small, in that it referred to 17 people out of 1,700. As I said, we will continue to work with the Minister of State, Deputy Rabbitte, to do the very best we can. It is important for the House to accept there is a huge amount of work going on. I do not think it would be appropriate to introduce a legislative amendment to this Bill, which is focused on family farms and businesses, focused on this question. I therefore cannot accept it. I understand there are many wider issues which I will be returning often to the House to debate but today this Nursing Homes Support Scheme (Amendment) Bill 2021 is purely intended to change an anomaly that was there since 2009. Many colleagues in both Houses have spoken about this for many years and I welcome all the positive comments on it.