Máire Hoctor (Tipperary North, Fianna Fail)
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I thank the Cathaoirleach and Senators for giving me this opportunity to make a statement on the nursing homes support scheme and on the standards for residential care settings for older people. The Government is committed to ensuring access to quality nursing home care for all who need it. Two key initiatives in this area are the new nursing homes support scheme, which will address issues of access and affordability, and the standards for residential care settings for older people, which will address the issue of quality.

The Minister for Health and Children and I published the Nursing Homes Support Scheme Bill 2008 on 9 October. The scheme is designed to remove real financial hardship from many individuals and their families who, under the current system of nursing home subvention, have to sell or remortgage homes to pay for the cost of nursing home care. Under the new scheme, there will be one transparent system of support towards the cost of care that will be fair to all, irrespective of whether they are in public or private nursing homes.

The basic commitments of the new scheme are that individuals will contribute towards their cost of care based on their income and assets, and the HSE will meet the balance of cost in nursing homes approved for the purpose. Individuals will not have to sell or mortgage their houses to pay for their care. They will not have to borrow to fund the care costs. They will not experience unaffordable care costs, nor will their families have to find money for their care. The scheme will equalise the level of State support available to individuals, regardless of whether they are in public or private nursing homes. This will meet one of the objectives of Towards 2016, which is that State support should be indifferent to whether a person is in public or private care. This is not the case at the moment.

The State currently pays approximately 90% of the cost for people in public nursing homes. In contrast, the State only meets about 40% of the estimated average cost of care in a private nursing home, while some people receive no support. The result is that many people in private nursing homes have to sell or mortgage their homes to meet their care costs. There are five key components to the new scheme, namely, the care needs assessment, the means assessment, the calculation of the individual's contribution to their care, the selection of the nursing home and the calculation of the level of State support.

The first step is the care needs assessment. A person, a family member or a guardian can apply to the HSE for an assessment of care needs. The needs assessment will be carried out by appropriate health care professionals using a common care needs assessment process. If a person is assessed as needing long-term residential care, he or she can apply for financial support. This will involve undergoing a means assessment, the purpose of which is to establish how much the applicant can contribute to the cost of his or her care. The means assessment will take into account a person's income and assets. In the case of a couple, the means are assessed as 50% of the couple's combined income and assets. The assessment will not take into account the income of other relatives such as the applicant's children. The scheme includes safeguards to ensure that a person's spouse or partner who remains at home retains at least the non-contributory State pension and that the person has a sufficient personal allowance.

Individuals will contribute 80% of their assessable income and 5% of the value of any assets in excess of the asset disregard per annum. The asset disregard will be €36,000 for an individual or €72,000 for a couple. The asset disregard provided for in the current subvention scheme stands at €11,000 so this represents a very significant improvement. If a person's assets include land and property based in the State, the 5% contribution based on such assets can be deferred. In effect, the HSE will advance a loan for that portion of the contribution. A charging order will be registered against the property enabling the money to be recouped from the person's estate when it is settled. That is known as ancillary State support.

In the case of the principal residence only, the deferred contribution will be capped at15%. This means that after three years of care, a person will not be liable for any further deferred contribution based on his or her main residence. If a spouse or certain dependents are living in the residence, the contribution will be further deferred during their lifetime. The dependants that qualify for a further deferral are known as connected persons. To qualify as a connected person, a person must be either a child under 21 years of age of the person who received care, a relative in receipt of certain specified social welfare payments or whose total income is not more than the maximum rate of contributory State pension or a relative who is the owner of a building to which the family home is attached. In addition, the connected person must have been living in the family home for at least three years before the original request to defer contributions was made and must not have an interest in any other property. A person can also opt to pay the contribution at the time of receiving care if he or she so wishes.

Once a person's contribution has been calculated, he or she will be supplied with a list of public and private nursing homes. The private nursing homes will have been approved for the scheme. As part of the approval, the price charged for care will have been agreed with the National Treatment Purchase Fund. A person can choose care in any of the nursing homes on the list, subject to a place being available and the suitability of the home to cater for his or her needs. If a person selects a public nursing home, he or she will pay a contribution to the HSE and the State will pay the balance. If a person selects a private nursing home, he or she will pay his or her contribution to the nursing home provider and the State will pay the balance.

Since the fair deal was originally announced, a new feature is the inclusion of a provision whereby a person may apply to the Circuit Court for an order appointing him or her as a care representative of a particular person. The appointment of a care representative is only necessary where a person does not have full legal capacity and wishes to apply for ancillary State support. However, a person appointed as a care representative may assist with any matter relating to the scheme.

A care representative must act in the person's best interest at all times and shall keep accounts of his or her actions. The following people may apply to be appointed as a care representative, a person's spouse or partner, a parent or child of the person, a brother or sister of the person, a niece, nephew, aunt or uncle of the person and a registered medical or other such health practitioner, other than the proprietor of a nursing home. A care representative will not need to be appointed if a person is already a ward of court or if a sufficient registered enduring power of attorney is in place. The inclusion of this protection is vital for older people, some of whom are among the most vulnerable members of our society.

While on the theme of protection, I would now like to turn to the second focus of my statement today, which concerns the standards for residential care settings for older people. We are all aware that the first choice for older people is to remain living at home for as long as possible with the support of their families and community support services where necessary. This is the essence of Government policy. However, when this is no longer possible, it is important that older people should have access to the best possible residential care available.

A fundamental principle of the health service reform programme is to put the users of health and personal social services at the centre of those services. We need to ensure the protection of residents, to safeguard and promote their health, welfare and quality of life, and to ensure that there is a focus on the well-being, dignity and autonomy of older people. We must also ensure that our older people receive appropriate levels of care in surroundings which are of a high standard. To ensure quality we must have evidence-based standards. Standards must acknowledge the unique and complex needs of the individual at the centre of care. They must recognise the additional specific knowledge, skills and facilities needed in order for service providers to deliver a person-centred and comprehensive service that promotes health, well-being and quality of life. They must set service providers the goal of providing a setting in which older people can experience a good quality of life.

The present standards for nursing homes are set out in the 1993 care and welfare regulations and the Health Service Executive inspects private nursing homes on the basis of these standards. Under the Health Act 2007, the existing inspection and registration systems for residential services will be replaced by a strengthened and expanded system. The Act strengthens and modernises the registration and de-registration process. Statutory responsibility will be given to the chief inspector of social services for inspecting and registering children's residential centres, residential centres for people with disabilities and residential centres for older people, including private nursing homes. The chief inspector will inspect centres against the regulations governing these centres and standards set by HIQA.

Last year we published draft national standards for residential care settings for older people. The standards were developed by a working group chaired by the Department of Health and Children and included the Health Service Executive, the Social Service Inspectorate and the Irish Health Services Accreditation Board.

As the Health Act 2007 provides that the enhanced inspection function will be taken over by the Health Information and Quality Authority, known as HIQA, the draft standards were formally referred to HIQA for consultation and finalisation. The authority established a wide-ranging working group to finalise the draft standards and I acknowledge the significant contribution made by that group.

Earlier this year, the HIQA board submitted its final draft national quality standards for residential care settings for older people to my colleague, the Minister for Health and Children, Deputy Harney, for her approval, as required under the Health Act 2007. There are 32 standards under the following seven groupings: rights, protection, health and social needs, quality of life, staffing, the care environment, governance and management. The standards apply to all homes, both public and private. They require the preparation of individual care plans for all residents, specify ideal training for staff, and emphasise good communications with patients and relatives.

As Minister of State with responsibility for older people, I have had the opportunity to visit many such facilities across the country. The standard of care being provided at present is, by and large, of a high quality. However, there is a consensus with which I think we can all agree — we must continue to ensure consistently high standards of care across the public, private and voluntary sectors. This is the core of what these standards are about. They are designed to encourage continual improvement. Their significance lies in the framework they create for nursing home care across the country, and for the provision of sufficient care to maintain the well-being of those cared for with regard to the nature and extent of their dependency. They are consistent with the Government's policies, principles and legislation.

Regulations will be introduced to underpin the standards and at the moment the Department of Health and Children is in the process of carrying out a regulatory impact analysis on them. As part of this process, we commissioned an independent consultancy to carry out a cost benefit analysis on the financial impact the standards will have in long-term residential settings. Furthermore, in October, my colleague, the Minister, Deputy Harney, and I, co-hosted a public consultation session in Dublin Castle on the standards in the context of the regulatory impact analysis. The purpose of that event was to provide key stakeholders an opportunity to feed into and inform the RIA before finalisation and to discuss the standards, their criteria and the proposed regulations in advance of their introduction.

Participants included representatives from voluntary and advocacy groups. Service providers were represented by Nursing Homes Ireland, a representative organisation for the private and voluntary nursing homes sector, and the Health Service Executive together with several private nursing home owners and several participants from the voluntary sector. Dr. Tracey Cooper, the chief executive of HIQA, was also in attendance together with a number of representatives from the medical professional organisations.

This consultation formed a vital role in hearing from key stakeholders and will feed in to the final analyses. It is expected that the RIA will be completed in the early part of November and that both the approved standards and regulations will be in place in 2009.

I thank Senators once again for inviting me to address the House. I look forward to hearing their comments both on the nursing homes support scheme and on the standards for residential care settings for older people.

Frances Fitzgerald (Fine Gael)
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I welcome the Minister of State to the House and thank her for being here today.

Máire Hoctor (Tipperary North, Fianna Fail)
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I thank the Senator.

Frances Fitzgerald (Fine Gael)
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She has certainly had a baptism of fire in her portfolio, given the difficult situation that arose recently concerning the medical card decision. We had a good debate on the matter in the House earlier. I hope the Minister of State will have an opportunity to familiarise herself with it because some very interesting concepts were aired during that discussion. It is the first debate I have heard in this House on the policy behind the decision, as regards how we can approach universality or selectivity. That question, which is at the core of our attitude to services, will increasingly come into focus. It certainly came into sharp focus when we had the debate on medical card eligibility.

I have a number of questions on the fair deal legislation. First, when will that legislation be introduced in the Oireachtas? Many Members are keen to know the timeframe for its implementation. Second, there is concern that the amount of funding allocated is lower than anticipated some months ago due to the budgetary situation. Perhaps the Minister of State can outline to the House the implications of that lower budget and how she sees it working out. Third, has the Attorney General given a view on whether there are any constitutional issues concerning the family home, taking money and the approach that underpins the legislation? I would be interested to know if any questions arose concerning the constitutionality of the proposed legislation.

We in Fine Gael have several questions and concerns about the legislation, including the implications a decision to fund long-term care might have for a family, the family home and for farmers. These questions need to be teased out. There will need to be a good information campaign on the legislative provisions in order that people will understand the choices they make. People can often make hasty decisions on long-term care due to a medical emergency, for example. They will therefore need to be familiar with the legislation because of the major impact it will have on families. I welcome its publication, however, and when it comes before the House we will examine it in detail.

Whether people are in nursing homes or other residential care settings, it is critical that they are assured of high standards and a good quality of life. We have had appalling scandals in this regard. While there are many excellent nursing homes and residential care centres, no more than in the area of child care, we must ensure that high standards are maintained. Last week, there was a report in The Irish Examiner on the inspection regime for child care facilities. It was interesting to read that report which reflected the kind of concerns that can arise. Even though families are placing their children in day-care settings, there is still some appalling bad practice in such centres. It is one thing to have standards but it is another to implement and monitor them. The question of the implementation and monitoring of standards and of ensuring inspectors' reports are acted upon is critical. This is evident in the area of child care and I expect the very same issues will arise in the implementation of standards in nursing homes.

There have been scandals, mishaps, oversights and errors, some of which have been life-threatening. We were all horrified when we saw the programme on Leas Cross and when the hidden camera recorded the way in which elderly people were dealt with. It has to be every family's nightmare to organise residential care and then to find out, accidentally or otherwise, that a loved one has not been receiving care but rather has been subjected to what amounts to cruelty or elder abuse. This is a huge issue and it is a great worry for families with loved ones of any age in residential care, but especially in the case of the elderly. If the decision is made for an elderly person to go into residential care, the State must be able to assure the family that it is concerned about the standards, that these will be monitored and that the family can have confidence in the care.

I welcome the changes to the health legislation which ensure all residential settings for both elderly and younger people will come under the scope of the standards. This is a really welcome development. I also welcome the wide consultation in which the Minister and the Minister of State engaged and the working group assembled to collate these standards. There is cross-party political agreement that we need to have a set of standards put in place to which all nursing homes must adhere to ensure the safety and dignity of patients and to provide a system which affords all older people in need of care the most competent and compassionate care available.

The Minister of State has provided some clarity with regard to the draft standards but I ask her to reiterate when the agreed standards will be published following the consultation. I ask the Minister of State to explain how the standards will be implemented. Some will be set out by way of primary legislation but how will the non-regulatory standards be enforced and implemented?

All nursing homes need to be registered by law. I refer to the draft standards and ask for clarity. They state that if the nursing home setting is not in compliance with the regulations, it may fail to achieve registration status or it may lose the registration status. However, it is likely in some situations that the residential care setting will be given a conditional registration for a defined period of time during which it will be expected to come into compliance with the regulations. I ask the Minister of State to clarify what this means. Will nursing homes still be able to register if they do not meet these standards? Who decides whether a service provider is refused registration status? The word, "may" is not clear and is open to interpretation. I am assuming the standards will be mandatory. I ask the Minister of State to clarify. If an operating service provider is found to be in breach of the regulation, will it be required by law to shut down the service until the regulatory standard has been met or will it be allowed stay open even if in contravention of standards? I ask the Minister of State for her initial understanding, even if some of this detail is not yet decided.

I am concerned that we could end up with a two-tier set of standards if there is ambiguity about the implementation of the standards. The nursing homes will be concerned and this is understandable given that the same issue about a transition period between adoption of standards and their implementation arose with regard to child care facilities. The question arises as to the cost of implementing these standards. Will the nursing homes be given help with the implementation of the standards? In the case of child care facilities, capital grants were often used by providers to make improvements to services. Different nursing homes will have different demands in terms of the amount of work or adaptation which they will require to meet the new standards. There may well be a discrepancy between public and private nursing homes. Is it intended to introduce grant schemes to enable nursing homes to pay for quality and standards upgrades? I refer in particular to public nursing homes. A number of them will need to change to a considerable degree to meet the standards which the Health Information and Quality Authority has outlined.

I welcome the concept of standards, as does everyone. It is clear these are overdue. We want to see the publication and implementation of the completed agreed standards as a matter of urgency. I would be grateful if the Minister of State would clarify the points I have raised. Lessons must be learned from the Leas Cross debacle and something similar must never happen again. I look forward to prompt action from the Minister of State.

Mary White (Fianna Fail)
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I welcome the Minister of State, Deputy Hoctor, to the House and compliment her, the Minister, Deputy Harney, and the Department of Health and Children on overseeing the National Quality Standards for Residential Care Settings for Older People, published by the Health Information and Quality Authority.

In the wake of the report by Professor Des O'Neill, consultant geriatrician at Tallaght Hospital, into the Leas Cross nursing home and its significant shortcomings as a care provider, it is heartening to see that such comprehensive quality standards are now being put in to place. Clear criteria of what is expected of a provider of residential nursing home care and what level of service a resident and his or her family can expect to receive are now provided. It is of paramount importance that we protect our most vulnerable citizens and give them the support they need to live their lives in a safe, caring and respectful environment.

According to Professor Des O'Neill, past research carried out at Tallaght Hospital has revealed that many general practitioners have observed substandard care in nursing homes, but many of them were unsure of where to turn to report this or how to take the matter further. Now for the first time, all residential care homes for older people which are run by both private and voluntary bodies and the Health Service Executive, will be inspected by an independent authority. Once the necessary regulations set by the Minister for Health and Children are in place, the social services inspectorate of the Health Information and Quality Authority will register and inspect all these residential care homes to ensure they meet the new quality standards.

Dr. Marion Witton, chief inspector of social services at the Health Information and Quality Authority stated:

At the heart of the new standards is a deeper focus on the individual needs of residents. Each resident must now receive a contract setting out what they can expect regarding accommodation, care and services. Residents' independence should be preserved and they should be able to enjoy a flexible daily routine which can be varied to suit their needs. Where appropriate, their lives in the residential care setting should reflect as far as possible the lives they lived before they entered their new home. The emphasis will be on evidence that residents are being looked after properly and that individual needs are being met.

It is evident that these standards have been devised to promote best practice in Irish nursing homes. This new system of registration, inspection and regulation will ensure improvements in the quality of care, and the registration and inspection process will act as a deterrent to unqualified people establishing sub-standard residential care homes. Our older people and their families can gain confidence from knowing that an independent authority is now registering and inspecting residential care settings against a defined set of national quality standards.

The provision of quality services to older people is a priority for us all and as we will all grow old, it is refreshing to see that in developing these standards, the authority adopted a comprehensive approach to ensure all stakeholders had the opportunity to have an input into the development of the standards. There has been public consultation, including direct consultation with the people who use residential care services, the people providing nursing home services, health care professionals, older persons advocacy groups, the Department of Health and Children and the Health Service Executive. Building on the excellent work done by the Minister, Deputy Harney, the Minister of State, Deputy Hoctor, and the Department of Health and Children on the fair deal, on which I spoke this morning, when the necessary regulations are implemented, this initiative stands to offer peace of mind to our older citizens in full-time residential care and to their families.

It is important that we implement the highest quality standards for health and social care services for our older generation. The implementation of these new standards will have a great and meaningful impact on the lives of our older people in full-time residential care. Older people should be allowed to lead full and active lives that are as close as possible to the lives they have already led. I envisage that these standards will work effectively to combat previously unsatisfactory staff-resident ratios in nursing homes around the country, putting an end to chilling reports of people having to go to bed at 6 p.m. because of staff shortages.

Older people and their families have a right to true and accurate information regarding nursing home facilities and quality of care. They should have a say in the running of the homes in which they are involved. We need to ensure that best practice is achieved by all providers of residential nursing home care and that all complaints are taken on board and acted upon. There is an ever-apparent need for transparency in the current system and I have faith that these guidelines will provide that.

These standards also serve to safeguard the finances of older people, which should ensure that no older person will be incorrectly charged for nursing home services again. This, coupled with the new fair deal scheme, will provide reassurance to people in full-time residential care and their families and prove to further strengthen the Government commitment to the welfare of older people in our community. Ultimately, this initiative is a very positive step in the health service reform programme and it is important the public is aware of these rigorous guidelines with which nursing homes will soon have to comply. As I stated in my policy document, A New Approach to Ageing and Ageism, published in June 2006, improving the quality of life for each individual in long-stay care should be our constant preoccupation.

The provision of nursing home care should not be cold-bloodedly about making money. Nursing homes must give tender, loving care to the people under their control. It is frightening and daunting for older people to think they will end up in a nursing home where there is no care or love and where their habits are not considered. I have been in a position to visit two nursing homes in the past three years and I was not impressed. We should not be afraid to speak out when we feel that people are not being looked after and are being forced into a routine. I find it frightening and Orwellian when one visits a nursing home to see all the older people sitting around in a circle. Something must change.

I read in The Guardian last year that Jon Snow, the Channel 4 newsman, brought his young daughter to visit an older person in a nursing home. The child's comment on the home was to ask what the older person could have done to deserve to be left in a place like that. We must consider the integration of older people into housing estates and the planning and location of nursing homes. In my travels around the country as a Senator, I find that many nursing homes are in the middle of nowhere. How they get planning permission is beyond me.

I wish the Minister of State, Deputy Hoctor, well. She did a mighty job at the parliamentary party meeting last night in answering all the questions on the fair deal. She was not daunted although it is a complicated issue. I wish her the best of luck.

Joe O'Toole (Independent)
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I welcome the Minister of State, Deputy Hoctor, to the House. She has had a difficult couple of weeks but if the job was easy, they would not get good people to do it.

Nicky McFadden (Fine Gael)
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That is true.

Joe O'Toole (Independent)
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The debate concerns an issue I have raised time and again in the past couple of years following the Leas Cross issue. I take on board many of the points made by Senator Fitzgerald in her contribution and I want to hear the Minister of State's response. I have had reservations from the beginning, which I have raised repeatedly, about setting up a new group of inspectors to check nursing homes. My view, which touches on the points raised earlier, is that we should set and organise certain regulations and standards which are required for nursing homes and include them in the wider remit of other specialists.

I do not believe there is any one qualified person who can go into a nursing home and check all the things we would want to check. The report on Leas Cross covered many different areas which are beyond the expertise of any one person, for example, the areas of prescription, running a pharmacy, nursing, attendance and care by doctors, health and safety, diet and other issues. No one person can deal with all these. I would like it to be included in the remit that, for example, local health inspectors would check the issues a health inspector would normally deal with in a restaurant, a pub or a general location; a fire officer would check issues to do with fire safety; a nursing specialist would check specifically the level of nursing standards; and similar would happen with regard to management, cleanliness, housekeeping, diet and so on.

I am not suggesting the Minister would organise and employ a whole raft of people dealing with the areas to which I referred. Instead, I am suggesting that a nursing home in an area would be added to the responsibility of a wider general area. For example, a dietician in the local hospital would have as his or her responsibility to check in a codified manner several times per year and then give an on-line response to a general collecting body which would gather the information as it becomes available.

This is a classic example of the kind of issue the Senators raised yesterday with regard to how we can save money in the public sector. This is to create a whole new body of people to do a job they cannot possibly do. Six months after they are appointed, I will be standing here on behalf of people who have written to tell me a certain nursing home did not have any visits or to ask what the inspectors are doing. They cannot do this job. No one person can check all the areas to which I referred unless he or she spends 25 years qualifying to do so.

This is a management issue. We need to organise the management of nursing home inspection in a way that employs the expertise already available, namely, specialists such as fire officers, health and safety inspectors, pharmacists, nursing inspectors and a variety of other groups. I speak as an Independent who is to an extent disinterested in the issue but I want to know how we can find an effective way of dealing with this question.

The crucial point is that if one was to organise this in the way I suggest, one would not have 25,000 pieces of paper. It would have to be organised as an on-line method so that each of those inspectors would be required to immediately fill in an on-line form which would go straight back into the more general collection. This would save us from much difficulty. We are aware of the issue of publishing reports on nursing homes. This report would grow as each different group or inspector attached to it outlines the situation that was found.

There is no other way this can be done. If I am running a pub or a restaurant, various officials will come in, such as a planning officer, a health and safety inspector or a garda to check the licensing laws. One would not dream of trying to set up a whole new team of people to inspect pubs or restaurants. One would expect those who had responsibility in those areas to do it.

We all reacted to what happened in Leas Cross and other places, which is understandable. However, it is not that simple. We need to consider this in a careful way to ascertain what gives the best value for money, effectiveness and efficiency. It will not be done by a new cadre of inspectors, which should be music to the ears of the Department of Health and Children and the Department of Finance.

Certain issues such as entertainment for and motivation of nursing home residents are important. I have occasion to visit nursing homes on a regular basis and I often see residents sitting around in a circle, as Senator Mary White said. However, at another nursing home I visit I have been impressed that its residents are entertained with singing and can avail of visiting services such as a hairdresser. In my experience most people who have a family member in a nursing home are happy with the level of care and support being given. I accept there were problems at Leas Cross and other homes but what we are doing here is running the rule over them.

Another issue is that many people believe brand new nursing homes have the best standards. In my experience, however, some of the older nursing homes give a far more personal and acceptable service. It all comes down to caring and having caring people working in a nursing home. Those caring people do not have to be Irish either. It all comes down to looking at how best to deal with people.

When people are concerned about the atmosphere in a nursing home, it is usually because of their own experience. People have difficulty in adjusting when they walk into a room with 20 very elderly people, some with Alzheimer's. All we want to do is reassure ourselves that we are approaching this properly and getting the standards right. I accept nursing homes cannot be the Ritz but it is about getting the basics right such as diet, exercise, comfort, cleanliness, nursing and pharmaceutical care.

I want the Minister of State not to take any received wisdom in this area but to make up her own mind on the basis of her own experience. If Ministers' judgment and expedience were not called for, then there would be no need for them. It is Ministers who run the country, not experts.

Mistakes have been made in other areas concerning inspection when cadres of inspectors were promised but not enough were appointed. I do not want nursing homes to be out there as independent satellites, as it were. I want them part and parcel of an operational system which will be dealt with like other aspects of the service industry. While it is an area that touches many of our loved ones, the Minister of State must step back from any sentimentality and decide how to do this best. I wish her well in her portfolio. It is not an easy one but people are supportive of what is required to be done in this area.

Larry Butler (Fianna Fail)
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I welcome the Minister of State, Deputy Hoctor, to the House and commend her on the exceptional job she is doing in this important area concerning our older people.

I agree with Senator O'Toole on how enforcing standards in nursing homes could be simplified. We do not want to complicate this area. Senator O'Toole also raised the availability of recreational facilities in nursing homes. I would like more emphasis placed on this area.

Leopardstown Park Hospital, one of the older homes which I often visit, is run to a very high standard with exceptional facilities. For example, the hospital has purpose-built little allotments in which residents can work and garden. Every year it has an exceptionally fine art exhibition and a Christmas and crafts fair, all produced by its residents. These types of recreational activities must be encouraged to be part of all nursing homes.

The evaluation of care packages must be considered in the development of future policy in this area. This is important because, as Senator O'Toole stated, we are trying to provide the best possible service. With approximately €400 million invested in community supports for older people, it is to be hoped this will reduce the number of older people having to enter nursing homes prematurely. Allowing older people to remain in their own homes is much more beneficial to them. Home care help is the cheapest package for keeping people out of nursing homes. Currently, there are 4,300 home care packages and it is fair to say the Government has committed significant investment to older persons' services. I look forward to this being improved further.

The Minister of State has done great work on the forthcoming legislation on nursing home standards. It will be introduced presently and will naturally be tweaked when going through the House. However, her presentation on it last night to the Fianna Fáil parliamentary party was exceptional. It is obvious the Minister of State has spent much time on it.

We must promote the best care practices in nursing homes as well as residents' rights, protections, health and quality of life. Nursing home staffing standards are also important. It is important that those who deliver the service are sympathetic and have the welfare of the older person in mind. We must ensure that when we are delivering services to older people, who have given us major benefit in their lifetimes, they are delivered with care and kindness and in a personal fashion. That is the most important thing we have to do.

Phil Prendergast (Labour)
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It is nice to see the Minister of State again. I welcome most of the standards proposed in this document, particularly those aimed at maintaining the dignity of those in long-term care. However, there are some areas that need to be examined more closely or at least need more explaining. It is essential, after all the delays over the fair deal scheme for nursing home residents, that we get this right first time and that proper standards are implemented quickly.

While the fair deal plan kept falling foul of the law, these standards could fall foul of a lack of clarity. My observations here are intended to be constructive but I cannot ignore the fact that the Minister was energised by the fair deal scheme because she was in search of revenue. These standards, however, are going to cost money — €110 million according to the Minister's own estimate last year — and, therefore, we need a timescale for the adoption of these regulations and we need a commitment that the finance required will be made available. The current economic climate, and the Government's predilection for cutting services rather raising revenue from the rich, could render these standards well-meaning but of little use. We cannot allow the Government to use these standards to create the illusion of finally taking action in the wake of the Leas Cross scandal. That has been well flagged by other Senators who have spoken, and everyone has been rightly appalled at what happened there. There is every reason to be concerned when we consider what has happened to older people in the past few weeks.

I want to be constructive and not approach this from a political point of view. However, just as there is a danger of political exploitation, there is also a danger of commercial exploitation contained in these standards. Private care can be a big business and any room for competitive advantage in the sector could be seized upon if all of the regulations are not clearly spelt out. We cannot have any ambiguity in the standards or in the timeframe for their implementation. Unfortunately, there are grey areas, which I fear could lead to some of these standards not being implemented for years to come, if in fact at all. For instance, there are regulations about the care setting in terms of decoration, bedroom size, bathroom-to-resident ratio and so on, but there is scope in the regulations for homes to defer these works for years. Perhaps they will not have to upgrade their facilities at all. The Minister will need to be particularly clear about the meaning of the following passage on page 6 of "National Quality Standards for Residential Care Settings for Older People in Ireland", which states:

In order to be registered the residential care setting must comply with the regulations. If the setting is not in compliance with the regulations it may fail to achieve registration status or it may lose the registration status. However, it is likely that in some situations the residential care setting will be given a conditional registration for a defined period of time during which it will be expected to come into compliance with the regulations.

In the case of those standards which are not regulatory standards, or standards linked to regulations, failure to comply will not in themselves lead to failure to be registered or loss of registration, but they are designed to encourage continuous improvement.

I am worried about the ambiguity of this because there is scope there not to follow through on compliance with the regulations. It sounds a bit like a get-out clause. If one nursing home can increase its margins by skirting the regulations, others are sure to follow.

On the subject of money, another concern is that the regulations provide no explicit protection with regard to charges. The individual care plan and contract should, I believe, include guarantees on fees, especially with regard to increases and new services. The standards quite rightly include rules about how nursing home staff deal with residents' money, but let us not forget what came out in the aftermath of the Leas Cross scandal. What about how the Government treats residents' money? For instance, where stands the medical card entitlement of people in care, with differing charges and differing levels of on-site medical care? What happens if they are unfairly or illegally dealt with by the provider, be it private or State? Should this not fall under the independent remit of the inspectorate? If not, will the upcoming nursing home Bill address this issue?

Monitoring of these standards is to be carried out by the Social Services Inspectorate. To be effective, it will need more staff and a set of effective inspection and reporting procedures. HIQA's document states a lot about the standards that should be observed but nothing about the practicalities of enforcement. Steps have been taken to recruit more staff — I am aware that we are operating under very tight constraints — but the Minister must outline how many inspectors she will appoint and the targets she will set for them. We need this type of detail in order to be assured that these standards can be properly enforced. We have good reason to be concerned about whether the inspectorate will be truly effective. Twenty-five years ago, the Department of Health itself recommended, in a major strategy document, independent inspections of nursing homes.

I thank the Minister of State for listening to the points I have made this afternoon. I agree with the points made by other speakers, particularly Senator O'Toole, about the practicalities of the issues. The dignity of older people must be sacrosanct and I believe the thrust of this forthcoming legislation is helpful. I look forward to its implementation and I look forward to the Minister of State's clarification of some of the issues I have raised today. I thank her again for the time she is giving to come to the House and listen to these debates, which are helpful in terms of how we deal with issues that are affecting us all. If they do not affect us now they certainly will in our future.

Déirdre de Búrca (Green Party)
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I welcome the Minister of State to the House and thank her for her statement. I welcome the opportunity to make a statement on the nursing home support scheme and the standards for residential care settings for older people.

There is much concern about the issue of care for the elderly. Many of our population are ageing and this presents people with questions about how best to look after their elderly relatives and, for the elderly people themselves, where they will receive the best care and whether it is affordable. Issues of quality and affordability are very much on the minds of older people and their families. Some of the scandals that were made public in recent years have heightened people's concerns. The nursing home support scheme and the standards for residential care settings for older people will go a long way towards alleviating some of that anxiety and making it clear what people can expect from the residential care provided for older people in this country.

In regard to the nursing home support scheme, I welcome in particular the care needs assessment that forms the early part of the process by which a person is supported by the State in accessing nursing home care and receiving subventions. The care needs assessment examines in a comprehensive way the individual person and his or her care needs. Most of us would accept that the optimal situation is for an elderly person to be looked after at home and that residential care should be required only when this is not a possibility. The advantage of the care needs assessment is that the needs of the older person can be assessed and a care plan drawn up. This could help to ensure a spectrum of services is provided, from the personal and social care services provided in the community to the supports and care provided in a residential setting. I hope many elderly people who have the care needs assessment will not need to enter residential care but may be able to access personal and other supports in the community.

When an older person has the care needs assessment, a clear process is set out for them and they then have a means assessment which looks at the key issue. The issue that causes much concern for older people is how much they can contribute to the cost of their care. A clear system has been proposed under this draft legislation that the applicant's means will be assessed as 50% of a couple's combined income and assets. The assessment will not take into account the income of other relatives, such as that of the applicant's children.

As the Minister of State mentioned, there will also be safeguards in place to ensure the person's spouse or partner who remains at home retains the maximum State non-contributory pension and that the person also has a sufficient personal allowance.

These details are all very important to older people and their families, who may be considering availing of residential care. I propose that the Minister of State provide information leaflets for older people and their families through citizens advice bureaus, on the scheme so all the information people want will be provided. If that was done the families would be empowered to identify the different stages of the process and the eligibility of their relative before needing to move through the process.

One of the effects of the system is, as the Minister of State highlighted, that it will create equality in the treatment by the State of older people who access private or public residential care. That could be positive if it means the equalisation of standards across the public and private residential nursing home sector. The result will be a sense of equality. The individual will be supplied with a list of public and private nursing homes and the older person and his or her family decide which approved nursing home to access.

The legislation will deal with people in existing nursing homes that are not approved and the individual wants to avail of this scheme and consider what his or her options are. I commend the role of the care representative. The person appointed to this role, when an individual does not have full legal capacity and wants to apply for ancillary State support, will be in a position to act in the person's best interests at all times. The legislation is very clear on who is eligible to act as a care representative in place of an older person.

The standards for residential care settings for older persons is based on the idea that older people must receive appropriate levels of care in residential surroundings of a high standard. This must be based on evidence-based standards. I agree with Senator Butler on the positive developments that have happened in nursing homes in areas such as recreation and stimulation of older people. We too often find older people in nursing homes and residential care settings sitting in chairs watching television, with very little real stimulation. It is to be hoped the new standards for residential care settings will include the idea that older people have a need for stimulation, recreation and occupational therapy, with some variety in their day. There are existing models in some newer nursing homes. It is to be hoped that the residential care settings will encourage these types of practices to become more widespread across all nursing homes.

I welcome the standards and the support scheme, and I congratulate the Minister of State on producing them.

Nicky McFadden (Fine Gael)
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I welcome the Minister of State. It has been three years since the damning crisis of Leas Cross and the total breach of the duty and standard of care owed to nursing home residents was exposed. The Government at the time said it would never happen again. In March 2008 the final draft of the standards for residential care were published. I, with my colleague, congratulate the Minister of State, but at the time there was a requirement in the draft legislation for a regulatory impact assessment. The Minister of State spoke about this in her speech and said that a cost benefit analysis had to be done by consultants to carry this out. What was the result of the cost benefit analysis and how much did the consultants cost? When will we know the outcome of the report?

The investigation into Leas Cross revealed some serious issues. I will not discuss them all because it is a horrific memory for all who saw the programme. It was an appalling abuse of the elderly, but it was an exception. The majority of nursing homes in Ireland, thankfully, provide excellent, quality care for our elderly.

I welcome, as part of the standards, the proposed individual care plans. The legislation is about caring for individuals. They are not like a herd of cattle thrown into a pen. These are people with feelings and requirements. I also welcome the intention to communicate with patients and residents. These are the people who have needs and requirements, and we urgently need to consult and talk with them.

Why has it taken so long to decide the standards? Senator Prendergast spoke on standards and the size of rooms. I agree there must be quality regarding cleanliness, nutrition and recreation, but we must be mindful of the fact that these are homes and people must live there. I visited many nursing homes — I have elderly relatives and friends who are in nursing homes — and I have been in cold, clean, white, clinical, brand new nursing homes, but I would not like to end up there. I would prefer to be in a homely, warm nursing home that is well established and has regular staff, enough staff so they can take time to talk and provide warmth and care. Courtesy and respect for our elderly population are important.

My uncle is in the Camilian Fathers nursing home in Mullingar. It provides the best care. One regulation a number of years ago stated that the curtains surrounding each bed were too short — they had been put in place the year before — and they all had to be replaced. They were of a specific fire regulation quality. It cost thousands to replace all the curtains because the regulations said they were too short, and the reason was the privacy and dignity of the client. That is important, but replacing them because they were too short was scandalous.

In St. Vincent's Hospital in Athlone we are proposing a new primary care unit with a view to moving all the patients to a new facility in Clonbrusk. There is a proposition that each patient will have his or her own room. I am not sure if it is necessarily the best approach for elderly persons to have rooms of their own. If they want them, well and good, but there is a staff shortage. How will the staff look after the patients in the individual rooms? It is nice to have a choice but I am not sure people want to be in rooms on their own. I imagine it could be very lonely if one is elderly.

I am also aware that owing to staff shortages, elderly people help each other out. They ring the bell for each other, help each other with their tea or whatever. I question whether we should have these clinical, brand new facilities without communication among the patients. It is not all about modern facilities but providing properly trained staff to look after the clients.

I welcome the main aspects of the legislation and ask the Minister of State to answer my questions on the cost of implementing these measures and how they will affect the older private nursing homes in terms of being able to afford to implement these changes.

Paul Bradford (Fine Gael)
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I welcome the Minister of State with responsibility for older people to the House. I welcomed the creation of a Department with responsibility for older people. It was an issue I raised on many occasions with various Taoisigh in the other House because I believed the elderly faced a huge range of issues that needed to be brought together under one office holder. I realise the office is relatively new but I hope it will serve as a focal point for Government policy in respect of our growing elderly population.

Notwithstanding that preamble, I want to comment on the Minister of State's contribution and her proposals concerning the elderly. The fair deal legislation was published jointly by the Minister of State and the Minister for Health and Children, Deputy Harney, some weeks ago. That legislation is something on which I, and many of my colleagues, have been requesting and seeking information in the past few months. I was disappointed to learn that the legislative timetable would seem to suggest the Bill will not be debated in the other House for some time and that it will be well into the future before it is enacted. I suggested to the Leader of the House that the Bill should be re-published as a Seanad Bill. It is not that we are idle in this House of the Oireachtas but the Seanad would be the ideal House in which to give that legislation the careful consideration it requires. I ask the Minister of State to take up that suggestion with the Minister for Health and Children because the quicker this legislation is brought before a House of the Oireachtas, debated in detail, amended where necessary and then enacted, the better. I would like the legislation debated in this House before Christmas if it is not possible to debate it in the other House.

Once the legislation comes up for debate it will provide much food for thought. I have had a quick glance at the Bill and the financial parameters it is putting in place will be welcomed by many and questioned by others. There is a whole ideology to take into account in regard to care of the elderly but the current structure of the subvention payments are not working. They may have been deemed to be of major help when they were introduced but now that the cost of nursing home care is significantly higher, a new framework is required. I am neither praising nor condemning the Bill because we need to have a full debate on it quickly.

I do not wish to bore the Minister of State or my colleagues but the issue of care of the elderly is something of deep concern to us all. We must never forget that care of the elderly must begin in the family and in the community. Maximum Government supports must be directed to families and communities because the majority of elderly people would wish to spend their golden years of retirement with their families and in their communities.

The outstanding Government scheme of the past 20 years has been the carer's allowance. We all complain about the income limits, the amount of payment, etc. and there is room for much improvement, but for every euro invested by this and previous Governments in the carer's allowance, the return has been tenfold. The carer's allowance has allowed many people remain in their home and in their community among their friends and families. Those people would be obliged otherwise to seek placement in nursing homes, be they public or private.

To the best of my knowledge the Social Welfare (Miscellaneous Provisions) Bill has just been published but I appeal to the Minister to seek maximum progress, flexibility and income disregard in respect of the carer's allowance. We also could seek improvements in the carer's benefit scheme at a time when more people are losing their jobs. There are many people who may have been in full-time employment and many households are facing a new situation where two people have to work but some of those jobs are being shed. In many cases, with the help of a carer's allowance or carer's benefit payment, some of those people would be in a position to look after their elderly relatives in their homes and their communities. That is something to which we must genuinely aspire.

Ideology in terms of right or left has no place when we talk about care of the elderly, nursing homes or support for the elderly. It is not right or left but right or wrong. If we want to have matters correct in that regard, we must aspire to allowing the maximum number of people retire at home. That is not an impossible financial or political equation. It is a question of where we direct the maximum amount of resources.

We must continue to improve the carer's allowance scheme. The figures presented to me some years ago by the late Minister, Séamus Brennan, on the removal of the means test for the payment of the full carer's allowance to people providing full-time care to people in need of it were surprisingly modest. I ask the Minister of State to trawl through the records and update them because even in today's constrained financial times we should be able to progress the carer's allowance payments to a more rewarding level and thereby encourage more people to stay at home.

The carer's allowance, the carer's benefit, community care grants and home care packages, which I welcome although they are not as advanced as they should be, should be the primary aspect of what we aspire to do for the elderly. I welcomed earlier the publication of the Nursing Homes Support Scheme Bill. I recognise that there must be a nursing home side to the equation as well because not everybody will be fortunate enough to have the capacity to remain at home. From the sense of family, community and tradition, I ask the Minister of State to concentrate on care within the family and community.

Regulations for nursing homes are very important. These must be to the maximum degree from the perspective of ensuring people in nursing homes have not just every facility but all the rights and protections they require. There have been too many sad and scare stories of an unforgivable nature. The idea of people maximising profits at the expense of vulnerable elderly people is shocking and we must be careful to ensure maximum standards and regulations are in place. I am sure we will go into all of that in greater detail in the debate on the fair deal legislation and I will play my role in the debate on that.

The preference of the majority of elderly people is to receive the highest possible level of financial support to allow them to remain in their homes and communities. This dream can be realised if proper Government support is provided.

Feargal Quinn (Independent)
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I welcome the Minister of State and what she had to say in her contribution. I compliment her on the enthusiasm she has displayed with regard to resolving this problem. I agree with Senator Bradford that the majority of older people would much prefer to be cared for at home rather than in nursing homes. As a result, we must give careful consideration to the carer's allowance. Since last month, we are aware of the strength of feeling among older people with regard to anything that might hinder them.

I do not have much personal experience of nursing homes. However, one of my wife's aunts entered a nursing home and I recall how valuable the care she received proved. I was executor of her will and I am aware that she appreciated that care. Everything we can do to provide assistance in this area will be worthwhile.

In the earlier debate, I referred to my concerns about people asking Ministers to spend more money without making alternative proposals. I am, therefore, very reluctant to suggest courses of action to the Minister of State. However, I wish to make a number of points. The national quality standards for residential care settings for older people undoubtedly represent a positive step forward. However, there have been numerous drawbacks, including the delay in implementing the nursing home support legislation — the fair deal — and cuts in home-care packages.

In the interest of improving standards in this area, the Irish Medical Organisation and the British Medical Association in Northern Ireland launched a joint policy document, "Care of Older People on the island of Ireland" on 2 October. The document in question suggests that there be clear lines of communication among all agencies and workers involved in the care process and indicates that this includes the areas of acute and primary care. It also suggests that all sectors should have round-the-clock access to details of older people's medication and clinical conditions. The document states that for those living alone in their homes, domiciliary and other health care services should be appropriate, co-ordinated and of a high standard, with minimal bureaucracy. It is difficult to disagree with these points.

The document further states that older people should be asked to identify their needs, that services should include opportunities for social interaction and that nutritional care should be made a priority. The latter two aspects are extremely important. One of the difficulties I encountered when my wife's aunt entered care was coming to terms with people, particularly younger individuals, using her first name rather than addressing her by using the salutation "Mrs." or "Miss" followed by her surname. We must take into account people's need for privacy in that context.

The document to which I refer contains evidence to the effect that the elderly are less likely to receive clot-busting drugs when they suffer heart attacks or strokes. These people should have the same access to such drugs as those in any other age groups. It is surprising that this issue, which must be addressed, emerged from the report in question. It is worthwhile drawing attention to "Care of Older People on the island of Ireland", particularly in light of the Health Information and Quality Authority's nursing home standards, because it highlights the numerous drawbacks that continue to obtain in nursing homes and in home care.

The other point I wish to make relates to the possibility of increasing the fuel and living alone allowances. This year has been extremely tough for the over 70s, particularly when one considers their concerns regarding the possibility that their medical cards might be taken away. Next year may be even more difficult for them. Increasing the fuel and living alone allowances would go some way towards assisting the elderly in society.

Members are always asking that additional moneys be spent. It is with reluctance, however, that I refer to the €2 increase in the fuel allowance to €20 per week from January 2009. Age Action Ireland has reported that many older people to whom its representatives have spoken indicated that they cut down on food and fuel costs during winter. If they do so, the elderly open themselves up to the dangers of respiratory illnesses and circulatory problems. Each winter, there are a great many deaths as a result of cold-related illnesses. Most of the victims are older people.

There has been no increase in the living alone allowance since 1996. Age Action Ireland indicates that up to 2,000 older people could die this winter as a direct result of inadequate heating. That is shocking. Ireland has one of the highest levels of excess winter deaths in Europe and there has been a 21% increase in winter deaths here compared with 10% in Finland and 14% in Austria. Neither of these countries has a climate that is as temperate as that which obtains in Ireland.

The Government could make an important and worthwhile contribution in respect of the areas to which I refer. Such a contribution would serve as a gesture to the many people over 70 years of age who are of the view that they were treated unfairly in the budget. I accept that this may be a different matter altogether but we have not paid adequate attention to the subject of those who need forms of care other than nursing home care.

I welcome the Minister of State's comments. I also welcome the proposals contained in the legislation, which I hope will be introduced as soon as possible.

Liam Twomey (Fine Gael)
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The Minister of State's contribution breaks down into two parts, namely, what she said about the fair deal — in respect of which I continue to have some reservations — and her comments on the standard of care available to elderly people in nursing homes.

The Minister of State indicated that it is the Government's policy to encourage people to remain living in their own homes for as long as possible. Everyone — older people, their families and the State — would prefer it if this were the case. When the Minister of State says that this is Government policy, it must be made quite clear that said policy will be followed up on. I have another job outside the House — as a general practitioner — which I do not have as much time to pursue as I would like. I am aware there are major difficulties regarding public health nurses, home care packages and access to services that allow elderly people to live at home.

There is no great commitment to allowing elderly people to remain at home, particularly when one considers the problems they encounter in trying to access services such as those provided by public health nurses. When elderly people are discharged from hospital, home care packages are often not available and, as a result, these individuals are left to their own devices. This is the first matter which must be addressed.

The fair deal involves a care needs assessment. Many people bought into the fair deal because they are of the view it involves nothing more than 80% of their incomes, plus or minus a contribution from their homes. The Minister of State indicated in soothing terms that there is nothing about which they should be concerned. It is clear, however, that all their assets will come into the equation. People may be obliged to dispose of the other assets before being considered under the fair deal. Only when they have nothing left but their incomes and family homes will these individuals be considered under the fair deal.

The care needs assessment is extremely important. The Minister of State did not indicate what such an assessment will involve or the length of time a person will be obliged to wait before one is carried out. If an individual is considered to be able to remain at home because he or she can dress, feed and wash himself or herself, regardless of whether he or she is afraid of living alone or is psychologically vulnerable, he or she will not be part of the fair deal. These people will not be able to access other residential State services and they will not be able to gain entry to public nursing homes. Once the State decides they do not qualify, they will get nothing.

Máire Hoctor (Tipperary North, Fianna Fail)
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That is not true.

Liam Twomey (Fine Gael)
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The Minister of State outlined the position during her contribution.

The need for the fair deal arose on foot of the events at Leas Cross, of which the public first became aware in 2005. We have been waiting for almost four years for many of the new standards to be introduced, which is too long. As far as I recall, the report into Leas Cross was referred to the Garda. Will the Minister of State indicate the information communicated to her office by the Garda in respect of the matter? One of the failures at Leas Cross was not that the standards were bad — which they were — but that what happened was reported up the line and nobody took action. It was made known to people that there was a problem with Leas Cross but nobody did anything about it. That is the problem the Minister might encounter. She might put a fantastic set of standards in place but if nobody does anything when a breach is reported, as happened with Leas Cross, we are back to the same position. What was the response of the Garda to the Leas Cross report? If the Minister considered it necessary to go to the trouble to refer the report to the Garda Síochána, she should at least have received a report back from the Garda.

Senator O'Toole is correct that we must be careful with our approach to standards in nursing homes. It will be a minefield trying to draw up a set of standards and obliging nursing home personnel, public health doctors and nurses and officials from the Health Service Executive to trip over themselves filling out reports. The standards must be user-friendly and workable. They must not have nursing home staff tied down ticking boxes when they should be looking after patients. That is the greatest danger. When there is a failure to protect elderly patients in nursing homes, there is an urge to over-correct, with the result that people spend their time ticking boxes and not looking after patients.

Senator O'Toole asked what we can do about this. The first way of getting around the problem is to ensure that when one is made aware of a problem in a nursing home, one sends in the heavy guns. One must pursue the problem. If it is reported that a nursing home is not doing its job, the authority must do something about it. There is no point having staff in 2,000 nursing homes throughout the country filling forms, ticking boxes and getting completely stressed when the small minority of nursing homes which clearly will not live up to their commitments are not inspected and followed up when a report is made. Much of what the Government has said about this relates to the financial impact it will have. That is very important but it is not the real reason for doing this, which is to protect elderly people.

Let us remove the mystery about nursing homes. I listened to the contributions on this issue and some of the comments were a little patronising. When I carry out house calls to nursing homes I have no problem bringing my children with me. Elderly people love to see young children running around the nursing home and bringing variety to their lives. They would be delighted to see more people bring their children.

We should not paint these nursing homes as some type of elderly care institutional prisons. They are not. My next door neighbour, whose only fault appears to be that he votes for Fianna Fáil, calls to nursing homes every Sunday to sing to the residents. He is not a professional singer. He is retired but is lucky enough to be in good health. These are the things that make nursing home living a little more enjoyable. Nursing homes should not be described as if they are horrible institutions. In the vast majority of cases they are not.

Paddy Burke (Fine Gael)
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I welcome the Minister of State, Deputy Hoctor, and wish her well with this document and her work with the aged. I have the greatest respect for people who take care of the elderly, especially the nurses, doctors and other staff who work in nursing homes. I have visited some nursing homes and they can be quite depressing places. There must be a better way, in some cases, of looking after the aged.

In the majority of nursing homes the elderly are getting the best care possible. However, at some stage we should devise a system whereby people can be given aid to return to their homes, either by way of a grant or assistance. With the fair deal system for the nursing homes, this could apply in some cases to private houses through, for example, the provision of an extension or paying somebody at home some form of assistance for looking after the person.

I have a number of questions on matters in the Minister of State's presentation. With regard to the calculation of the level of State support, is everybody entitled to get some level of support regardless of their means? Will any type of waiver scheme come into play with regard to the means test? What is the situation for a person who is on the threshold? Is there a buffer system or is one cut off straight away when one reaches the threshold? Is there room for manoeuvre in the calculations that will be made in the means test?

The Minister of State spoke about step three, which is the contribution to care. Does this apply to people who are in private nursing homes at present or will it only apply to new entrants to nursing homes? There are some doubts that it applies to people who are already in nursing homes, which the Minister might clarify. She said a charging order will be registered against the property, enabling the money to be recouped from the person's estate when it is settled. This is known as ancillary State support. Will an interest rate apply? The person could be in a nursing home for a considerable period but no more than 15% of the value of the private home can be taken. A loan will have to be provided but will an interest rate apply to it or will the 15% of the property be the only thing taken into account?

Obviously the other assets will be taken into account but no more than 15% of the value of the private dwelling house can be taken. Some people will have other assets so a loan might have to be arranged to take a portion of those as well. Will there be an interest rate across the board? Perhaps the Minister of State would clarify this important issue.

When will valuations be carried out? Obviously a valuation will be made at the beginning when the person first goes into the nursing home. However, if the person is in the nursing home for ten or 15 years, is a valuation of the property or house made every year? A house that might have been worth €1 million 12 months ago might only be worth half that amount today. On which valuation does one base the calculation? The person could be in the nursing home for many years. Is a valuation carried out every year or is it carried out when the person goes into the nursing home, with another being carried out when the person passes away or returns to the private residence? These matters should be clarified.

The different people who will assess the applicants will form different opinions. We have seen this happen too often with planning permission applications. I believe a range of different views will be taken in the different health areas.

Another matter the Minister of State might clarify relates to the care representative and how somebody can go to the Circuit Court to become a care representative. The Minister described the different people who can become a care representative. They can be a parent, brother, sister or relative. What about a neighbour? I have seen many cases where neighbours have done much more for older people than their relatives. I do not see any mechanism whereby a neighbour can become a care representative. If that option can be included, it should be because very often neighbours do more for older people than family members.

Máire Hoctor (Tipperary North, Fianna Fail)
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I listened with great interest to the contributions of Senators to this discussion. I am very grateful for the opportunity to address the Seanad on this issue and to respond to the queries raised by various Senators regarding this very welcome scheme.

I spoke today of the strides taken in developing the new nursing home support scheme and the standards for residential care settings. I would like to conclude by reflecting on the wider policy vista in which these strides are being taken.

The western world enjoys, as never before, the opportunity of ageing. Through our social, scientific and economic progress, human life has been strengthened and prolonged. In ancient Greece life expectancy at birth was 20 years of age. By the 1700s, life expectancy had only increased to 30 years of age. In 2007, just 300 years later, half of all baby girls born in Ireland were expected to live to 100 years of age and beyond.

Our longevity is something to be celebrated. The Government recognises this and is committed to supporting older people. This commitment is reflected in the current social partnership agreement, Towards 2016. In that agreement, the Government and the social partners have adopted a life cycle perspective, placing the person at the centre of social policy development. The vision for older people, as reinforced in Towards 2016, is to provide the support where necessary to enable older people to maintain their health and well-being, as well as to live active and full lives in an independent way in their own homes and communities for as long as possible. There are specific initiatives for older people in the partnership agreement, such as pension and income supports, housing and accommodation, community and residential health care, mobility and promoting education and employment opportunities. The high level objectives of these initiatives, individually and collectively, are intended to make a real and significant improvement in the quality of life of older people.

Of course, a comprehensive policy vision requires a comprehensive cross-departmental approach to policy development and delivery. The establishment of the Office for Older People in January of this year will bring coherence to Government planning, policy and service delivery for older people. The Office for Older People encompasses three Departments — as Minister of State with responsibility for older people, I also have responsibilities in the Departments of Social and Family Affairs and the Environment, Heritage and Local Government. I am also a member of the Cabinet committee on social inclusion, which ensures there is an integrated and coherent approach to issues relating to older people at Government level. This approach is crucial to delivering the Government's vision of improved integration of services, thereby further supporting older people into the future.

My office will also continue to develop health policy and will oversee and monitor the delivery of health and personal social services for older people and the running of the long-stay charges scheme. It will, in short, be the focal point for the development of a more comprehensive policy relating to older people. The resources of my office, which is staffed by officials from the Department of Health and Children, will shortly be strengthened by the addition of the staff of the National Council on Ageing and Older People. These new staff will significantly add to the research and overall capacity of my office.

The voluntary sector in general will also make a positive and essential contribution to the development of policy on older people. This will be done primarily through the establishment of a new national advisory council on older people. One of the main functions of this new council will be to advise me on all aspects of the lives of older people. The council will also suggest ways of improving the co-ordination and delivery of services for this section of society.

The establishment of the Office for Older People, the interdepartmental network and the advisory council will bring greater coherence to policy making for older people. These significant new measures will allow for a much greater degree of cross-cutting and will further develop the partnership approach that has featured so strongly in the planning and development of services for older people in recent years.

Within the EU member states, Ireland stands out as having a relatively youthful population. While we are undoubtedly on the same demographic path as our EU counterparts, we are still some way behind. The latest statistics indicate that 11% of people living in Ireland are aged 65 or over. It has been estimated that this figure will rise to 20% by 2036 and to 29% by 2056. Thus, an opportunity exists, while our nation is still young, to carefully plan ahead. This opportunity has been recognised by the Government and manifests itself in particular in two key commitments, namely, the development of a strategy for positive ageing and a future funding model for long-term care.

I am pleased that the key function of my office is to develop a strategy for positive ageing. This new strategy will be developed on a cross-departmental basis. My goal is to ensure that the strategy is meaningful and innovative and will result in real improvements in the lives of older people. The strategy will involve, for example, the development of operational plans by various Departments clearly setting out objectives relating to older people and joined-up thinking on initiatives serving this community. Other areas for consideration include ongoing mechanisms to monitor progress and identify challenges.

The policy vision outlined in Towards 2016 requires a comprehensive, cross-departmental approach. It also requires sustained and sustainable levels of funding. The very significant funding allocated by the Government to services for older people over the past three years is testament to its commitment to the principles in Towards 2016. In 2006 and 2007, just over €400 million was provided to enhance service developments across the sector. Over €165 million of this was for community-based services over the past two years. A further €25 million was provided in 2008 and in the recent budget the funding levels for community services were maintained.

To underpin the objectives in Towards 2016, older people have also been specifically highlighted in the social inclusion priority of the National Development Plan 2007-2013. Some €9.7 billion will be invested under the older people programme, with €4.7 billion allocated to the living at home sub-programme and €5 billion to be provided for the residential care sub-programme. In short, the Government is firmly committed to using the national development plan as a vehicle to translate policy into practice over the period of the plan.

The investment in services for older people in the past few years represents an important foundation on which to build. However, the development of infrastructure requires a sound blueprint and the development of infrastructure of care services responding to future demographic needs is no different. In the years ahead our nation's age profile will change and it is now, while our nation is still young, that we must consider the long-term care services needed to support us over the next half century and the funding model that, by virtue of financial sustainability, might ensure the long-term provision of such supports. That is why the Government and the social partners have agreed to identify a financially sustainable funding model which will support the future infrastructure of care services.

I hope time will allow me to specifically address some of the issues raised by Senators during the course of today's discussion. I was delighted with the interest expressed in the scheme and Senators made very valuable contributions. One of the questions raised related to the timeframe for the introduction of the legislation. It is my understanding that the Whips intend to bring the Nursing Home Support Scheme Bill before the Dáil within the next two weeks. Indeed, I hope the Second Stage debate can begin next week. I am sure much of what will be said in both Houses will be valuable in bringing in the best possible legislation to serve older people into the future.

Senators asked why there was such a delay in producing the legislation. The Bill was delayed due to its complexity. While there were no constitutional difficulties with the Bill, certain legalities had to be ironed out and it took quite some time to get it right. The Government wanted to bring forward legislation that, when enacted, would be user-friendly. To take the example of the care representative, we wanted to make that process as easy as possible. We wanted to ensure that a solicitor would not be required in order for a care representative to come forward and protect the best interests of residents of long-term care institutions. While the delays are regrettable, we believe we now have a very good blueprint from which to work. We hope Second Stage of the legislation will be taken in the Dáil in the next two weeks.

The question of standards and the timeframe for them was raised. The final date is not set, but the regulatory impact analysis will be completed this month and the standards and regulations will be finalised afterwards. We expect this to happen in the next couple of weeks.

Senators Joe O'Toole, Mary White and Larry Butler raised the important question of the experience of people in long-term residential care, which is no doubt varied. However, I believe there has been a genuine effort by public and private nursing home service providers to offer stimulating programmes for older people in long-term residential care. Some of these programmes have worked very successfully. For example, the Sonas programme helps residents suffering from dementia or Alzheimer's disease and has been of benefit to those who availed of it. I compliment county libraries throughout the country and I am especially mindful of Tipperary County Library which has opened up its doors as a long-term residential care setting for both private and public residential care. The library now visits residential care centres and people have access to books, can share and discuss them and promote the best books to read. Such experiences bring the outside world in and stimulates the mind which is important, especially as we get older.

Senators Frances Fitzgerald and Phil Prendergast mentioned the conditional registration of nursing homes under the standards scheme. HIQA will carry out the registration of nursing homes. It may grant conditional registration to allow a nursing home time to meet the appropriate standards. While one may set out with the best of intentions one must be realistic and give an opportunity to nursing homes to comply. A realistic and achievable timeframe must be put in place in this regard. This is why conditions will be laid down which will contain a timeframe in order that the nursing home must comply in time. During that period HIQA will carry out additional inspections and visits to monitor the progress in meeting these standards. Full registration will be granted to a nursing home at the end of that period only if HIQA is satisfied that the nursing home meets the standards. Senator McFadden asked a question about the cost of these standards. The cost benefit analysis is being carried out by independent consultants and will provide the relevant information and it will be part of the regulatory analysis. Work is underway and is expected to be completed by the end of this month and will then be published.

There was a question about those currently in nursing homes. Such people may wish to continue with existing arrangements and avail of the subvention. Subventions will continue to be available to those in nursing homes. However, when the Bill is passed, which we envisage by the middle of 2009, there will be a new scheme in operation. The subvention will not be increased once this scheme is introduced, but it will remain for those who wish to continue to avail of it. I emphasize this scheme is voluntary. People may choose to partake in it or opt to pay for their own care and not to be part of the scheme.

Senator Liam Twomey mentioned the report by the Garda on the Leas Cross nursing home and I do not have the answer to his question, but I will ensure he gets a response.

Liam Twomey (Fine Gael)
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I had a question about care assessment as opposed to means assessment. If a patient is considered to be suitable for a home, he or she may not be given an option. It is not always the case that a person in a nursing home has had a stroke or suffers from a disability or dementia. Sometimes people cannot cope with living alone at home. Will such people be excluded from the scheme if a care assessment concludes there is no physical necessity for such people to be in a nursing home?

Máire Hoctor (Tipperary North, Fianna Fail)
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I know of people, as I am sure does the Senator in his capacity as a general practitioner, who registered in nursing homes because they feared the winter and the cold, but who are very mobile. A nursing home is not the ideal place for such people. It is Government policy to provide support and keep people at home for as long as possible. There may be people who are dependent but who can avail of this support while remaining at home. I am aware the Senator was critical of the home care package scheme, but the experience has been very good throughout the country.

Liam Twomey (Fine Gael)
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Only if it is available.

Máire Hoctor (Tipperary North, Fianna Fail)
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In my area of the mid west and in County Kildare the scheme has proven to be very good. I cannot comment on County Wexford at this stage. However, significant funding has been invested and more than 11,000 people avail of the home care packages. The Minister, Deputy Mary Harney, announced the intention to set up more than 200 primary care teams. Professional medical colleagues of the Senator will be at the forefront of this initiative with other specialists and experts, such as physiotherapists and speech therapists, working with older people in local communities. We are working towards this objective. I am conscious we have not reached the objective yet and we must continue to bring people into the system. One should consider the €10 million allocated to my colleague, the Minister of State at the Department of Health and Children, Deputy John Moloney, to provide for services in speech therapy, physiotherapy and so on. We are working on a vision for the future and funding must be put in place to this end.

Liam Twomey (Fine Gael)
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If a patient fails the care assessment, is he or she excluded from the scheme?

Máire Hoctor (Tipperary North, Fianna Fail)
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We all agree a thorough care assessment will be carried out for an individual's needs. If such a person is deemed suitable for long-term residential care, a care needs plan is put in place——

Liam Twomey (Fine Gael)
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What if this is not done?

Máire Hoctor (Tipperary North, Fianna Fail)
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The assessment could be also carried out and might conclude such a person is more suitable for a home care package.

Liam Twomey (Fine Gael)
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There is no choice?

Máire Hoctor (Tipperary North, Fianna Fail)
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If a person wishes to enter a nursing home of his or her own accord no one will stop him or her.

Liam Twomey (Fine Gael)
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There are no benefits from the scheme.

Paddy Burke (Fine Gael)
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What about the interest and the valuations of homes?

Máire Hoctor (Tipperary North, Fianna Fail)
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On the financial side, some €55 million in the budget has been allocated for the nursing home scheme which, we anticipate, will start by the middle of next year. On the matter of interest charged, the assessment will be carried out on the value of the house. The charge will be 5% for a single person and 2.5% for a couple per year, up to a maximum of 15% for the first three years. We are aware the value of a house may fluctuate. The applicant will have an opportunity to request a review of the value of the house and this will form part of the arrangement. If a person wishes to enter the scheme and avail of nursing home care, he or she may start to pay his or her contribution of either 2.5% or 5% immediately. However, he or she may also opt to defer that payment. It could be the case that a loan is taken out by such a person and obviously that will be subject to interest rates.

Liam Twomey (Fine Gael)
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It is the Health Service Executive that has taken out the loan.

Máire Hoctor (Tipperary North, Fianna Fail)
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Is the Senator referring to people who take out a loan to pay their costs?

Paddy Burke (Fine Gael)
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The Health Service Executive is taking 15% of the value of the house. Will the HSE charge those people interest? The HSE will pay the nursing home.

Máire Hoctor (Tipperary North, Fianna Fail)
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I am not absolutely clear on that, but I might get back to the Senators on it.

Liam Twomey (Fine Gael)
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That is fine.

Paddy Burke (Fine Gael)
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Will the Health Service Executive keep the same value of the house from the first year? What happens if there is a fluctuation?

Máire Hoctor (Tipperary North, Fianna Fail)
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It is based on the first three years of residential care. The average stay in a nursing home in Ireland is currently four years. We know of people who remain much longer in those homes, so that may be part of the consideration.