Mary White (Fianna Fail)
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I welcome the Minister of State to the House. He is aware I have embarked on a new policy document on a new approach to ageing and ageism. Housing for older people is a major aspect of how we look after older people in the future. My research and work on the ground shows frustration at the lack of choice of housing for older people. The vast majority of older people wish to live in their homes independently and with dignity for as long as possible. The overwhelming majority of older people have a fear of entering long-stay residential care. Does the Minister of State agree? None of us would like to live in such care.

Older people who require hospital care are categorised as "delayed discharge" patients because the care they require after being discharged is not available in their own community. Some will not apply for subvention and others with subvention do not have sufficient funds for long-stay care. They do not wish to sell their home and their families do not have money to fund long-stay care. My research suggests the crux of the matter is the lack of housing and care options for older people. There has been a remarkable growth in institutional long-term care. Half of the €1 billion allocated to the elderly is spent on 5% of residential home care costs. The Government policy from 1988 entitled The Years Ahead, recommended that people be looked after as much as possible in their homes or communities. This policy has not been implemented because of tax incentives for residential homes. I am not opposed to tax incentives but half of the €1 billion is spent on residential care.

A report entitled The Housing Needs of Older People by Dr. David Stratton of Age Action Ireland, found that older people considered institutional long-term care the only option because they lacked the support needed to make informed choices about future accommodation. In any event, their choices are limited due to the lack of forward planning by the Government. The Government has not delivered the policy it decided on in 1988. This is the reason there is so much congestion in Dublin hospitals.

The Minister of State is well-informed about St. Brendan's high-support unit in Mulrany, County Mayo. This was set up by Dr. Jerry Cowley, a Deputy in the other House. Older people who need medical help can continue to live locally with all the care and support required provided by visiting professionals. The older people can continue to live independently and with dignity.

Despite the policy document of 1988, the Government's aim of keeping people in their homes for as long as possible, and the wish of the majority of older people to remain at home as long as possible, the reality is that investment has been directed to long-stay care facilities, leaving many older people with no choice but long-stay care. Many cannot bear this choice and I would hate it.

I call on the Government to publish a new strategy for older people, reflecting the wishes of older people and offering them a real choice. Government resources should be directed accordingly in an equitable way rather than claiming there is insufficient funds to pay for this housing. The Government needs a policy to provide a halfway house between residential home care and remaining in one's home. Every county development plan should designate space and finances for sheltered housing.

Those for whom it is no longer acceptable that they stay at home, who may need medical help two or three times a day, would be better off in sheltered housing, not in residential home care. I do not want to criticise all residential homes but in any I have visited I have seen the older people sitting passively, looking at the television. On this I also speak to those in the Visitors Gallery——

Rory Kiely (Fianna Fail)
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The Senator will speak to the House and she has exceeded her time.

Mary White (Fianna Fail)
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We need a middle ground. If older people are not able to cope at home, live alone, need medical help and do not wish to go into residential care, they should live in middle-ground sheltered housing. The Government needs a policy on sheltered and support housing. I do not blame the Minister. He must not take this personally.

Seán Power (Kildare South, Fianna Fail)
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I thank Senator White for raising this matter and for the interest she has shown in older people and services for them. The latest figures supplied to the Department by the Health Service Executive on delayed discharges in the Dublin area teaching hospitals indicate that on 14 March 2006, 398 people were categorised as delayed discharges. The number of older people in this category was 349. Of the 349 older people, 68 refuse to apply for subvention for long-term care and 60 are assessed as ineligible for subvention for long-term care. A further 65 applications are being considered by the HSE. However, a number of persons could refuse to complete the application process or may be ineligible once assessed, and therefore the number refusing to apply or ineligible may be significantly greater.

The nursing home subvention scheme was introduced to assist with the cost of private nursing home care and it was never intended that a subvention payment would meet the full costs of private nursing home care. The number of older people who are granted subvention and who would still not have sufficient funds to pay for long-term care is not quantifiable because the actual nursing home selection and fee is agreed between the patient and the individual nursing homes. The HSE may pay more than the maximum rate of subvention, currently €190.50 per week, in a case, for example, where personal funds are exhausted. The application of the scheme in an individual case is a matter for the HSE in the context of meeting increasing demands for subvention subject to the provisions of the Health Act 2004. The average rate of subvention paid by the HSE generally exceeds the current approved basic rates.

The Health (Nursing Homes)(Amendment) Bill 2006, which is being published today, will ensure that the existing subvention scheme for private nursing home care is grounded in primary legislation and will help the HSE to implement the scheme on a standardised basis across the country. It should be noted that an additional €20 million funding has been allocated in the budget 2006 to the nursing home subvention scheme for residents of private nursing homes. This represents an increase of 14% over 2005, which has an estimated spend of €140 million. In addition, €8 million has also been provided to cover the cost of 250 extra nursing home beds which the HSE has sourced from private nursing homes. The HSE is also in the process of acquiring a further 250 extra beds from private nursing homes to accommodate older people requiring nursing home care.

An interdepartmental working group was established by the Tánaiste and Minister for Health and Children, Deputy Harney, and the Minister for Social and Family Affairs, Deputy Seamus Brennan, to identify the policy options for a financially sustainable system of long-term care. This group has now reported and its report is currently being considered by the Cabinet.

I draw the Senator's attention to the commitment that this Government has shown to older people's care issues and point to budget 2006, which allocated additional resources of €150 million to services for older people and palliative care, €110 million in 2006 and a further €40 million for 2007. The investment package is focused on caring for people at home, in accordance with their expressed wishes. It is a major step in focussing new resources on home care first and foremost, while still supporting appropriate residential care. This is in line with international trends and also reflects the growing independence of older people who want to stay living in their communities for as long as possible.

Reflecting the new emphasis on home and day care, almost three quarters of the full year costs, or €109 million of the €150 million, are committed to community care supports. This investment is a response by the Government to older people's preference to be cared for at home rather than going into residential care. Often older people require some additional home help or more developed home support, including various therapy services. All the evidence shows that families caring for elderly relatives continue to provide care in partnership with the support services put in place for those that require it. It is estimated that 28% of nursing home residents have a low to moderate dependency level and many of these residents might have continued to live at home if the right supports had been made available to them at the appropriate time.

Home care packages deliver a wide range of services and have been piloted successfully in several regions in recent years. They include the services of nurses, home care attendants, home helps and the various therapists including physiotherapists and occupational therapists. A home care package will vary according to the care needs of the individual. The home care packages will also be available to those older people who have been admitted to long-term care and who now wish to return to the community. In addition, the packages will be offered to people who are already using existing core services, such as home helps, but need more assistance to continue to live in their community.

The packages are delivered through the HSE by a range of providers including the HSE, voluntary groups and the private sector. The scheme will be as flexible as possible and highly responsive to the real needs of the individual. Some 1,100 home care packages were in place at the end of 2005 and by the end of 2006 a further total of 2,000 additional home care packages will have been provided which will amount to a trebling of the current service provision. The priority for home care packages will be older people who are inpatients in acute hospitals or those who are living in the community who might otherwise have to avail of long-term care. Additional investment has also been made in the many other areas of community support including home help, day and respite centres, meals on wheels and sheltered housing. Again I thank the Senator and I hope I have clarified some of the issues she raised

Mary White (Fianna Fail)
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I thank the Minister of State.