Seanad debates

Tuesday, 13 July 2010

1:00 pm

Photo of Paddy BurkePaddy Burke (Fine Gael)
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I welcome the Minister of State and wish to be associated with the expressions of sympathy to the family of the late Nuala Fennell. I extend my sympathy to her husband, Brian, and family members who are here today.

2:00 pm

Photo of Áine BradyÁine Brady (Minister of State with special responsibility for Older People and Health Promotion, Department of Health and Children; Minister of State, Department of Environment, Heritage and Local Government; Minister of State, Department of Social and Family Affairs; Kildare North, Fianna Fail)
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I also wish to be associated with the tributes paid to the late Nuala Fennell and the expressions of sympathy to her husband, Brian, and all the family.

I welcome the opportunity to open the debate on behalf of the Government which has provided considerable and consistent support for carers during the past decade. Although carers may sometimes believe their work goes unnoticed by the State, their communities and even their families, the important and valuable role played by them in society has been increasingly recognised both at EU level and in Ireland in recent years. Caring for another person may have a very significant impact on carers and their families. This is especially true when care is provided on a full-time basis. Becoming a carer can be a very rewarding experience, but it often means people make great sacrifices, especially when it comes to availing of employment opportunities. Sometimes these sacrifices are made at the expense of the carer's own health.

The national partnership agreement, Towards 2016, included several commitments specifically related to carers. These include commitments to review social welfare payments, consult representative groups and develop training programmes. In addition, many of the commitments related to older people are relevant to carers such as to maximise the use of community and home-based care and deliver home care packages. The national action plan for social inclusion also recognises the valuable role played by carers in society, not only in the commitments specifically related to carers, but also in the sections on older people and people with disabilities.

Who is a carer?

Without being too legalistic, it is worth considering who we mean when we refer to carers. There are a variety of definitions of the word "carer". Current definitions in Ireland stretch from that used in the census, which records people who provide at least one hour of unpaid help per week as carers, to that used for the purposes of qualifying for a social welfare payment, which states that the carer must be providing full-time care and attention to a person in need of such care. Sometimes we use the terms "informal carer" or "family carer". The word "informal", rather than "family", reflects the fact that the relationship between the carer and the care recipient varies with people caring not only for their own family members but also for neighbours or friends.

Whatever we call them and however we define them, the one thing we all have in common is that at some stage in our lives almost all of us will either provide care for another person or receive care. Each Member will have a family member involved in caring. The issues surrounding carers and family care in Ireland are relevant to every one of us and are crucial to Ireland, as a nation, socially and economically. When someone becomes a carer, their circumstances can change dramatically, and often suddenly, and they can find it difficult to cope financially. The person in need of care is often the main wage earner in the family or the carer is elderly and relies on a pension or other State benefit. These and many other factors can put a strain on finances and make it difficult to pay even basic utility bills and living costs. Becoming a carer can have implications for all aspects of a person's life from taxation to transport and from social welfare payments to accessing health services. Reflecting this, services and supports for carers are delivered by a variety of Departments and bodies.

The Department of Social Protection and the Health Service Executive provide a range of supports for carers and it is worth highlighting them. Carer's allowance is the main social assistance payment to provide income support to people who provide older people or people with a disability with full-time care and attention and whose incomes fall below a specified limit. Persons in receipt of carer's allowance also receive the annual respite care grant, the household benefits package and the free travel pass. In the majority of cases, persons who are being cared for will be in receipt of a payment in their own right and will be entitled to a free travel pass. This includes anyone aged over 16 who qualifies for disability allowance.

The 2007 budget provided for new arrangements whereby people in receipt of a social welfare payment other than carer's allowance or benefit and who provide someone with full-time care and attention could retain their main welfare payment and receive a half-rate carer's allowance. Similarly, people in receipt of a carer's allowance who may have an underlying eligibility for another social welfare payment can transfer to that other payment and continue to receive up to a half-rate carer's allowance. As of December 2009, 48,223 people were in receipt of carer's allowance, an increase of approximately 11% on the previous year. Of these, 19,132 were in receipt of half-rate carer's allowance and another social welfare payment. Since March 2005, two carers providing care on a part-time basis in an established pattern have been accommodated on the carer's allowance scheme. This small change can be of significant benefit in helping families cope with the demands of caring.

Carer's benefit is a payment for people who have made social insurance contributions and who have recently left the workforce to look after someone in need of full-time care and attention. Recipients can get carer's benefit for up to two years for each person cared for. By the end of 2009, 1,917 people were in receipt of carer's benefit.

A domiciliary care allowance of €309.50 per month may be paid to the parent or guardian of a child aged under 16 requiring full-time care. This payment is not means tested and it provides for the additional costs involved in providing care and supervision that is substantially more than normally needed by a child of the same age. The parents may also be in receipt of the carer's allowance.

The respite care grant is an annual payment for full-time carers who look after certain people in need of full-time care and attention. The payment is made regardless of the carer's means but is subject to certain conditions. People in receipt of carer's allowance or carer's benefit receive the respite care grant each June. Others who provide full-time care but who are not eligible for carer's allowance or benefit may apply for the grant separately each June.

Free travel is available to people aged 66 or over and who are resident in the State and to people aged under 66 in receipt of certain disability-type social welfare payments or carer's allowance. It allows them to use public transport and a large number of private bus and ferry services free of charge. Free travel is provided to those providing care and satisfying the payment condition in recognition of the additional costs which may occur in assisting the care recipient. The main objective of the free travel scheme administered by the Department is to encourage older people, people with disabilities and carers to remain independent and active in the community. It is an important income support for carers but, more important, a support in helping them maintain their inclusion in the wider community. The scheme permits a recipient to travel for free on most CIE public transport services, Luas and a range of services offered by a large number of private operators in various parts of the country. A free travel customer can also travel for free on cross-Border journeys between the Republic of Ireland and Northern Ireland.

In addition to this scheme, the Department of Social Protection contributes €1.5 million every year to the rural transport programme, on top of the contribution by the Department of Transport, in recognition of the carriage of free travel customers. It is acknowledged that such customers benefit from the initiative, especially those who had no access to public transport prior to the setting up of the programme.

The household benefits package comprises the electricity or gas allowance, the telephone allowance, which may be paid in respect of either a land line or a mobile phone, and the free television licence. These allowances provide contributions towards an electricity or natural gas or bottled gas refill bill and telephone bill and cover the cost of the television licence each year. They are applied directly to bills, where applicable. The package is available to people aged over 70 who are resident in the State and to people aged under 70 in certain circumstances, including carers. Only one person in a household can qualify for the package at any time. In some cases, this will be the carer; in others, the person being cared for.

The Government is committed to ensuring that, in addition to the necessary income supports, carers receive a comprehensive range of services to assist in the caring role. Caring for a relative who has a disability, is frail or is chronically or terminally ill not only requires a wide range of skills but also requires patience and an ability to empathise at times when they may be feeling vulnerable, stressed and frustrated. The role of carer, while it may be rewarding, can be a 24-7 job and caring can extract a great cost, be it emotional, physical or financial, from the person providing that care.

I refer to the services provided by the Department of Health and Children and the HSE. Home care packages, HCPs, were introduced in 2006 and are tailored to the needs of individuals whose needs cannot be met by mainstream primary, community and continuing care, PCCC, services. They can range from therapy and nursing support for a few weeks after a hospital stay to ongoing daily visits from a home care assistant to help the client get out of bed, washed and dressed. HCPs can include a variety of services such as public health nursing, day care, occupational therapy, physiotherapy, home help, home care and respite care, which are shaped around each client's individual needs. The packages can be provided through a cash grant, which the recipient can use to purchase the care and support they need, or through the organisation of care services by the HSE. They can also be delivered in partnership between the HSE and certain voluntary providers and can often include a respite element at local level.

The packages are enhanced supports over and above existing mainstream community services, with the objective of maintaining older people at home and in their communities. They are also targeted at those at risk of inappropriate admission to long-term care or acute hospitals or those who require discharge home from acute hospitals. The HSE provides approximately €120 million per annum to cater for approximately 8,700 clients at any one time or approximately 11,500 during a full year. Last year, I published a report of an evaluation carried out by PA Consulting Group on the home care package initiative. The independent evaluation found that the HSE was successful in implementing the policy vision to make HCPs a viable option to support a highly dependent cohort. An additional €10 million was provided in the 2010 budget to expand the HCP initiative nationally.

Other supports are provided through programmes such as meals on wheels, day care or home help. Every effort is made to make each service as flexible as possible to meet individual needs. Total home help hours have increased by 25% from 9.1 million hours in 2005 to an estimated 12 million hours in 2010.

Respite services are an immensely important support for carers. These can take many different forms and can be a respite for the carer, the person being cared for or a combination of both. Through these services we are trying to ensure carers can continue to care in a way that benefits their own health and ensures the best quality of life for them and their dependants. Investment has been made by the provision of more than 21,300 day respite care places, benefiting in excess of an estimated 80,000 people, and more than 750 designated respite care beds, benefiting approximately 19,000 people over a full year.

However, when living at home is no longer possible, it is equally important that older people have access to the best possible residential care available. The Government is committed to ensuring that quality nursing home care is available to all who need it. It is worth mentioning, in passing, the nursing homes support scheme, A Fair Deal, which addresses issues of access and affordability, and the standards for residential care settings for older people which address the need to improve quality.

I recently completed a country-wide series of consultation meetings to hear face to face the views of older people, service providers and representative organisations, with a view to the development of a national positive ageing strategy. I am pleased to say we have received submissions from the Carer's Association, Care Alliance Ireland and Caring for Carers. Their views and the information they provide will help us in the formation of the strategy. At all of these meetings, I heard an immense amount of valuable information on a broad range of issues to be considered in the context of the new strategy. In due course, it is intended to publish a report on the consultation process to highlight the issues which older people and service providers have been bringing to my attention.

At the public consultation meetings, participants have suggested how services and programmes can be improved and have given views on what works well and on what could be done differently or in a better way. In particular, they highlighted how service delivery could be enhanced in the light of current resource constraints. While some localised issues have been raised, in general the themes that arose during the public consultation meetings are broadly consistent with those outlined in the written submissions received. The top five priority themes that emerged from the submissions were health and social care, 64%; transport, 40%; social inclusion, 36%; housing, 33%; and income and pensions, 27%. The national positive ageing strategy will set out a common framework for the development of operational plans by Departments. These will clearly set out their objectives relating to older people, as well as the development of ongoing mechanisms designed to monitor progress and identify challenges facing older people in future.

Carers can be any age, from an elderly person looking after his or her spouse, to a teenager caring for a parent or sibling. My colleague, the Minister for Social Protection, recently launched the carer of the year awards, which include a special award for a young carer. He was impressed on meeting the winner of last year's award, a young women who has looked after her mother since an accident left her disabled and needing to use a wheel-chair. Young carers have issues particular to them. I wish to refer to a recently published report on the lives of young carers in Ireland. The Study of Young Carers in the Irish Population, undertaken by the Child and Family Research Centre at the National University of Ireland, Galway, was launched at the Carers Association annual conference. The report found that children are involved in a broad continuum of caring in a wide variety of situations, such as helping with domestic chores and general care, including help with feeding, medication and mobility. It also found that some young carers also provided psychological or emotional support or provided intimate care, involving toileting, dressing and bathing. Young carers also find themselves helping to seek support from service providers, translating and interpreting information, helping with paying bills and with post or telephone calls.

This report is the first national qualitative study of young carers in Ireland and gives an insight into the lives of children and young people who provide care in the home and uncovers the reality of their situation. While the report is preliminary and exploratory, it marks an important milestone in improving our understanding of the positive and negative impacts for children who are involved in caring and makes a positive contribution to policy development and debate on this issue. The authors of the report also said they found it encouraging that many of the young carers or their households received supports from the State, whether in the form of home help or respite care, for example. Dr. Allyn Fives, a co-author of the report from NUIG, in presenting the study's key findings noted that while caring for a family member can have positive impacts for a young person such as greater maturity and compassion as well as closeness to the person cared for by the young person, it must also be recognised that there can be negative impacts, including absence from school, feelings of social isolation, impacts on health, and experiences of boredom, worry and resentment.

I have detailed for Members the various payments and supports available for carers. These indicate that the State and the Government are acutely aware and appreciative of the contribution made by carers. It was for that reason that when resources were available we invested heavily in improving social welfare rates and services for all those who are reliant on the State for income support. Over the past decade, weekly payment rates to carers have increased, qualifying conditions for carer's allowance have significantly eased, coverage of the scheme has been extended and new schemes such as carer's benefit, half-rate carer's allowance and the respite care grant have been introduced and extended. Where people are caring for more than one person they receive a higher payment. This equates to the personal rate for a person with the same means who is caring for one person plus 50% of the maximum personal rate. Recipients with children also receive a qualified child increase in respect of each child.

Since the introduction of the carer's allowance in 1990, payments to carers have been increased and expanded. Carer's allowance was increased in 2007, 2008 and 2009. As a result, even with the reductions announced in last year's budget for carers under 66, the weekly rate of payment for the carer's allowance is still almost 20% higher this year than in 2006 and more than 147% higher than in 1997. The means test for carer's allowance has been significantly eased over the years, and is now one of the most generous means tests in the social welfare system, most notably with regard to spouse's earnings. Since April 2008, the income disregard has been €332.50 per week for a single person and €665 per week for a couple. From June 2005, the annual respite care grant was extended to all carers who are providing full time care to a person who needs such care, regardless of their income. The rate of the respite care grant has also been increased to €1,700 per year in respect of each care recipient since June 2008. The free travel scheme, which I mentioned, has been significantly improved and enhanced in recent years, most notably following the abolition of peak time restrictions in late 2006.

Carers were identified as a priority theme under the economic and social disadvantage category in the dormant accounts allocation for 2007. The focus of the carers' measure is to provide training to assist carers in undertaking their caring role. The Department of Social Protection is the lead Department for this measure and the funding is being channelled through the Department's Vote. Pobal administers the measure on behalf of the Department and is responsible for the ongoing monitoring and evaluation of the programme. Applications were assessed by Pobal and 12 groups were approved for funding, in December 2008, totalling €1.48 million. The draw-down of funding takes place between 2009 and 2011. The training in most instances commenced in September 2009. The grants range in size, from the Carers Association grant of more than €500,000 and the Caring for Carers grant of almost €250,000, to smaller grants to groups such as the Rosses community development project in Donegal or the Ballinrobe family resource centre in Mayo.

I am very conscious of the needs of carers. I also fully understand that a wide range of other groups, such as unemployed people, parents, pensioners and people with disabilities, depend on the welfare budget for vital support. I want to assure the House that the Government, in the context of a very tough budgetary environment, will continue to do its utmost to protect the most vulnerable people in society.

The requirements of the Department of Social Protection highlight the importance of stable finances. Over the next five years, the Department of Social Protection will spend over €100 billion. All of this must be raised by taxation or by short-term borrowing. Obviously, any borrowing involved must be repaid by the taxpayer at some time in the future. It is clear that if the Government did not ensure that we had a sustainable financial situation, that as the largest single Vote, the Department of Social Protection and its clients would be the first to suffer. This Government will of course ensure we provide this money and this support. It is up to other parties to explain how their policies would maintain the same level of commitment to social welfare clients.

The Government is proud of its unrivalled record in increasing the level of social welfare payments. Over the past 12 years, we have increased pension rates by about 120%, unemployment benefits by almost 130% and child benefit payments by over 330%. The cost of living has increased by approximately 40% over the same period. We extended coverage, removed barriers and increased entitlements, such that the level and extent of social support payments has been transformed beyond recognition. Continuing to reflect the trend of recent years and re-affirming Government's commitment to all those in need of support, some €20.9 billion will be spent by Government in 2010 on social welfare provision, €500 million or 2.45% more than 2009.

On the economy, following eight consecutive quarters of contraction, the latest GDP data show an increase in economic activity during the first quarter of this year, signalling the beginning of Ireland's emergence from the deepest recession ever recorded here. More recent statistics, including soft data, point to a continuation of growth in the second quarter also, so the economic outlook for this year in GDP terms is somewhat better than projected last December. For the year as a whole, an average GDP growth rate of the order of 1% is now anticipated. The exporting sector, especially parts of the multinational sector, has been the driving force behind the recent expansion of activity. Excluding the profits generated from multinational exports means that GNP is likely to decline by around 0.75% per cent for 2010 as a whole. On the assumption that international activity gains momentum and that further competitiveness improvements are achieved, a strengthening of activity can reasonably be expected next year and beyond. The budget day forecast of GDP growth of 3% in 2011, remains achievable.

While there are challenges facing the entire economy, including controlling Government spending, there are significant challenges facing the Irish pension system. In particular, the task of financing increasing pension spending will fall to a diminishing share of the population. There are currently six workers for every pensioner, and this ratio is expected to decrease to less than 2:1 by 2050. Increasing State pension age is one of the ways in which we can sustain the pension system and also maintain the value of the State pension at 35% of average earnings. People are living longer and healthier lives with average life expectancy set to rise even further in the future, up to 89 years for women and 83 years for men. People will still, therefore, be spending at least the same amount of time in retirement as they are today, even with a later State pension age.

Therefore, as announced as part of the national pensions framework, the State pension age will be increased gradually to 68 years. This will begin in 2014 with the removal of the State pension - transition, thereby standardising State pension age at 66 years. This means that the last group of people to receive the State pension - transition will be those who reach 65 years of age in 2013. State pension age will be increased to 67 years in 2021 and to 68 years in 2028. The details and timeframes for these changes are set out in the national pensions framework, which was published on 3 March 2010. An implementation group chaired by the Department of Social Protection has been established to develop the legislative, regulatory and administrative infrastructure required to put the necessary reforms into operation.

In addition to the changes being made to State pensions, both employees and employers must be encouraged to change their attitudes to working longer. At the level of the workplace, employers must seek to retain older employees and create working conditions which will make working longer both attractive and feasible for the older worker. Where this is not possible and people leave paid employment before State pension age, they will be entitled to apply for another social welfare payment until they become eligible for a State pension, as is the current situation.

This framework will have an impact on carers. People who leave the workforce for periods spent caring can have gaps in their insurance records which can affect their entitlement to a State contributory pension at age 66. The homemaker's scheme, introduced in April 1994, allows for periods spent providing full-time care to children up to 12 years of age or an incapacitated person to be taken into account for pension purposes. It does not provide social welfare payments while homemaking. Persons in receipt of carer's allowance, carer's benefit and the respite care grant may engage in employment, self-employment, training or education outside the home for up to 15 hours per week and still be considered to be providing full-time care and attention for the purposes of the schemes. This means that where a carer remains in employment, he or she will continue to pay the appropriate social insurance contribution. Also, any person, including a carer, may pay voluntary contributions once they satisfy certain qualifying conditions. The social welfare pension rights of those who take time out of the workforce for caring duties are protected by the homemaker's scheme which was introduced in and took effect from 1994. The scheme allows up to 20 years spent caring for children or incapacitated adults to be disregarded when a person's social insurance record is being averaged for pension purposes.

However, the homemaker's scheme will not of itself qualify a person for a pension. The standard qualifying conditions, which require a person to enter insurance ten years before pension age, pay a minimum of 260 contributions at the correct rate and achieve a yearly average of at least ten contributions on his or her record from the time of entering insurance until pension age is reached, must also be satisfied.

People who qualify for payments such as carer's allowance or carer's benefit may, subject to conditions, qualify for credited contributions for the period they receive the payment. As part of the national pensions framework, homemaker's credits will be introduced for new pensioners from 2012, with backdating to 1994, to replace the current homemaker's disregard.

For many of us, especially as we get older, our first choice is to remain living at home in the communities we belong to and are familiar with. Government policy is to support people to live in dignity and independence in their homes and communities for as long as possible. Where appropriate, the health service also supports access to quality long-term residential care. This policy approach is renewed and developed in the partnership agreement, Towards 2016. I understand that people requiring care face particular challenges daily in their lives and that family carers have to make sacrifices to look after their loved ones. I have set out in the foregoing the very definite steps the Government has taken to ensure these vulnerable groups are protected to the greatest extent possible. This Government is well aware of and values the contribution made by carers. The actions of Government in enhancing provisions for carers in recent years reflect that fact.

Photo of Nicky McFaddenNicky McFadden (Fine Gael)
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I welcome the Minister of State. Carers are the unsung heroes and the poor relations in our health system. There are a total of 161,000 family carers, 40,000 of whom are providing full-time care for more than 400,000 people with disabilities. Last week we witnessed the very profound protest and lobbying by people who are disabled and their very strong carers. While the Minister of State has made a very understanding and sensitive contribution, I cannot agree with her that carers are being supported to the extent they require. The biggest worry for the carers on that protest to whom I spoke was that the half-rate carer's allowance or respite grant would be removed or cut. I ask the Minister of State to give a commitment that this allowance will not be interfered with in any way. The half-rate carer's allowance is a measly sum of €106 per week. Such carers provide up to 60 hours' care per week, which is almost full-time care in the home for people with disabilities. This is very good value for money. If this care were to be sourced in the private sector, €106 per week would provide five hours' full-time care.

I have had many conversations with the Carers Association which is appalled at the indignity inflicted on some of its members for the sake of saving a few euro. Community health and community care services are being cut left, right and centre and care-givers are experiencing anxiety in this regard.

I refer to the issue of incontinence pads because this is a grave worry. This was illustrated in an edition of "The Frontline" television programme where one could see the anxiety inflicted on carers. An incontinence manager is someone who rations the number of incontinence pads for use by elderly people. I know about this because people have come to me in my constituency about it. They have told me they are not allowed a sufficient number of incontinence pads for the use and comfort of elderly relatives. In an article in The Irish Times on 6 July there was a reference to incontinence managers who were asking carers to bring in wet nappies in order that they could be weighed to see if they were managing resources properly. I find that extraordinary. This problem was well documented on the programme "The Frontline" by carers who spoke about the lengths of time identified in the draft HSE guidelines which I hope will never be introduced. A stopwatch will be used to monitor the length of time it takes to get an elderly person up in the morning. A period of ten minutes is allocated for this task. What happens if the elderly person has had a bad night and is feeling vulnerable and unwell? A period of 15 minutes has been allocated for the taking of a shower. It takes a long time to get an elderly person from a wheelchair onto a shower chair. If he or she has brittle bones, we must consider the amount of time it takes to dry and dress him or her. It is nice that a person has ten minutes for breakfast, but it does not augur well if he or she must be fed. There is no allocation of time for housework such as taking out ashes and setting a fire. I know home helps who do this, but no time is allowed for it. There is no time to go to the shop if someone needs a litre of milk. The public health nurses association has come out against the draft guidelines and I hope the Minister of State listens to it. She is a caring person who is both practical and logical. We should remember that if people are kept in their homes, it will save the State billions of euro.

Trinity College commissioned a report entitled, No Place Like Home - Study of Domiciliary Care Services for Older People. It documents that it is nine times more expensive to keep a child with a severe disability in hospital or in an institution than at home. The Jack and Jill Children's Foundation funds its activities by recycling mobile phones. I have sent mobile phones to it. Some 35 children will reach the age of four years, the cut-off point, beyond which the organisation does not have enough funds to extend the service. These children are not sure if they will receive support. A gentleman in Roscommon spoke about his fears. He benefits from nursing care two nights a week, which means he and his wife can sleep for those two nights. They would not have this without the support of the Jack and Jill Children's Foundation. We know that if one does not get enough sleep, one cannot cope during the day. Many of the families affected are in terror and living in fear. They do not know how they will survive.

I referred to the half-rate carer's allowance. The Minister of State referred to 19,000 wonderful people. In 2007 the half-rate carer's allowance and respite care grants were allocated in recognition of the great work they do. They are a unique group which provides tremendous value. I ask the Minister of State to give us such a commitment. The biggest fear of the Carers Association is that the half-rate carer's allowance and the respite care grant will be cut.

The Minister of State referred to young carers. In that regard, I welcome the report of Dr. Allyn Fives. The young people concerned provide care before they go to school and are socially isolated. I warmly welcome the understanding of the Minister of State of the problems faced by this group and ask that she consider them.

I refer to respite care services. The Minister of State attended a public meeting in Athlone and witnessed our fabulous centre, Loughloe House, which will be closed. Now that it is to be closed, there will be no respite care services in the Athlone area. The Minister of State has said the only way to support those who provide care is to give them a break in order that their mental and physical health can recover and they can continue caring. Two private beds are being sought to meet demand in the entire Athlone area. Heretofore, there was a long waiting list to enter Loughloe House or St. Vincent's Hospital. Two beds are being sought in the Mullingar area, while the number of beds in St. Mary's Hospital is to be reduced from 190 to 50. I ask the Minister of State to put her money where her mouth is. If she is serious about acknowledging the valuable work done by carers, there must be respite care services available.

Photo of Maria CorriganMaria Corrigan (Fianna Fail)
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I wish to be associated with the tributes paid to the late Nuala Fennell.

It is appropriate that we are having a debate on a group of people who must fight very hard to have their voices heard. I welcome the many carers in the Visitors Gallery. I also welcome the Minister of State.

I wish to recount a story that sticks in my mind. It occurred during the general election campaign in 2007 when I called to the door of a house while out canvassing and spoke to a woman who told me she did not work outside the home anymore because her mother was ill. She had given up her job to care for her. She asked me to come in and meet her mother. She told me her mother did not receive many callers and would like to say hello to me. She brought me to a downstairs room that had been converted into a bedroom for her mother who was lying on the bed and not moving or speaking. She explained that her mother had become quite ill during the previous year and that there were many days when she did not say or move much. She took care of her mother to the best of her ability. I asked her if she ever got a break or received many visitors. She said no one called to the house. She told me I might think her mother could not hear me but if I said hello, she would tell her later that I had called. I left the house and walked down the driveway. I was profoundly moved by what I had seen and struck by the thought which has remained with me ever since that there were so many quiet heroes living in our communities. We do not often give sufficient time to or have sufficient regard for them, through no one's fault, as we all have busy lives to live and have to get on with other things. There are many competing demands on our time. While I am conscious the Minister of State has many demands on her time and budget, it struck me that these are the quiet heroes, about whom films are seldom made or books written, but society could not survive without them. The Government would not be able to deliver its care programme or develop the society it seeks to develop without the contribution of carers. It is important that we are having this debate in the Chamber, as it is important to highlight the role they play. We must make provision for them, as we could not survive without their contribution.

Many welcome changes have occurred in our society and Government policy in the past few years. What drives Government policy is the concept that people must be supported to remain in their homes for as long as possible. There are advantages to this, in that the benefits in respect of quality of life and of care are known. Similarly, it is known that it contributes in a meaningful way to the physical and psychological well-being of the person with disabilities. Moreover, one now can see how quickly hospitals try to get people back home as an infection control measure. One must be honest that in trying to keep people at home for as long as possible, economic advantages also accrue to the State.

In realising such a policy, the role of carers is essential and I wish to make the case briefly for maintaining, at a minimum, the supports that are in place for carers at present. Moreover, the future should be planned and provided for through the publication of the national carers strategy. I will repeat neither the issues raised by Senator McFadden nor the statistics she has provided. However, the commitment that was provided for in Towards 2016 to develop a national carers strategy gave great hope to that group of people and I regret it has not been possible to publish it.

Photo of David NorrisDavid Norris (Independent)
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Hear, hear.

Photo of Maria CorriganMaria Corrigan (Fianna Fail)
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I ask the Minister of State to reconsider this decision. I am aware of the economic constraints and one must be clear that publishing something does not mean that a commitment is being given to its immediate implementation. However, it would demonstrate the State's aspirations and ambitions for the future and that it is prepared to plan for and to carve out a path for that future. Such aspirations are something of which to be proud and not something to be worried or anxious about having out in the public domain. Consequently, I asked the Minister of State to give consideration to this point.

I am highly conscious that Fianna Fáil-led Governments in recent years have put in place terrific supports for carers and it will be important to build on and continue such efforts. The Minister of State spoke of the carer's allowance and in particular regarding the introduction of the half-rate carer's allowance. This was highly important and it also will be important to maintain both the carer's allowance and the half-rate carer's allowance, even though the State faces really tough economic times. I welcome the commitment given in the Chamber today by the Minister of State when she stated "I want to assure the House that the Government, in the context of a very tough budgetary environment, will continue to do its utmost to protect the most vulnerable people in Irish society."

While I am aware there are many demands, I ask the Minister of State to give particular regard to this group of people. I do not mean this in any disrespectful way to anyone else who is obliged to seek financial support from the State through other allowances but there is one clear difference between such assistance and the allowances received by carers. The latter make a contribution to the State in return for the allowance it provides to them. They make an economic contribution and this sets them apart from everyone else who receives an allowance. I do not mean this in any disrespectful way but it is important to make this point. Moreover, in return for the money the Government provides to carers for their contribution to the economy, the State makes savings of multiples of that amount.

I ask the Minister of State to reconsider the habitual residence condition, which is causing severe hardship. There are cases of well-meaning people who leave whatever lives they have established abroad to return home to provide care for their relatives. I repeat that it is extremely important to continue to provide respite and that the existing provisions be built on. Unless such supports are put in place, it will not be possible to maintain at home the people concerned. It therefore becomes a false economy whereby for the sake of saving a few euro for a couple of months, it will end up costing the State a great deal more further down the road. Moreover, it takes away from the quality of life of the person with a disability that it had been possible to put in place in the first place. Consequently, it is completely counter-productive, does not make sense economically and does not help to realise the underlying policy of assisting people to stay at home for as long as possible.

Concerns have arisen in respect of home care packages and my office has been contacted frequently by people who have become concerned on finding their needs are increasing and that they need a little additional support. Such people are afraid to make contact to ask for such support because they fear becoming the subject of a review at which their existing supports will be examined. The story that has come back to them is that rather than resulting in an increase or enhancement of the support, every review thus far has resulted in a diminution of that support.

Photo of Nicky McFaddenNicky McFadden (Fine Gael)
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That is right.

Photo of Maria CorriganMaria Corrigan (Fianna Fail)
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I again ask the Minister of State to take this point on board.

I greatly welcome the much-needed report on young carers, which raises serious issues for Members, not least with regard to child well-being issues. I am highly conscious that it also is very difficult for those people for whom young people are caring. Such people are conscious that they are asking their sons or daughters to do things they never dreamed they would be obliged to ask of them. They always had seen themselves in their roles as parents or as the people who would provide the care, rather than being its recipient. This brings its own difficulties. As society ages, an increasing number of older people are adopting the role of carers. It also is beginning to become evident that, for example, in the area of people with intellectual disability, some people with intellectual disability are becoming the carer for older parents, which brings with it its own issues.

Finally, I refer to practical supports, apart from financial or respite assistance, whereby a commitment was given to training. Carers are asked to undertake practices, procedures and aspects of care that no one who was employed to carry out such task would do without the requisite training, whether it be in respect of manual handling or safe lifting. I thank the Leas-Chathaoirleach for his indulgence.

Photo of David NorrisDavid Norris (Independent)
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Senator Corrigan anticipated my first remarks, which were to the effect that the tributes paid earlier to the late Nuala Fennell constitute a highly appropriate context in which to have this series of statements. I wish to front-load my acknowledgement that this Minister of State is decent and that the economy is bad. Having got that out of the way, I will review the present position. The Minister of State's speech contained some interesting stuff, as well as a certain amount of padding and public relations spin. As for free travel, everyone is entitled to it. I will be getting it at the end of this month and consequently, there is no need to congratulate anyone on that score. That is an old chestnut.

As for home care packages, there is much concern in this regard. They are available for the securing of the services of commercial companies and this often is unsatisfactory. The employees of such concerns may not be able to speak English properly or may not have an understanding of the condition and it is a monetary transaction which varies. I raised this serious question on the Order of Business in some detail on 19 November 2009. The Minister of State's advisers might look up this contribution because it was in the context of a particular case that was drawn to my attention. At that time, I noted that the National Economic and Social Forum had stated that care workers were sent into people's homes without being the subject of Garda checks and that the HSE had confirmed this was the case. Moreover, private companies had acknowledged that they had never been inspected and that there was poor or no supervision of staff. When I sent a copy of my contribution on the Order of Business to the woman who wrote to me, she replied by sending me details of how the situation had deteriorated further. She concluded by expressing her gratitude to me for taking up the matter but that she would appreciate if I were to avoid giving full details about her sister, as the family believed she would be boycotted by the agencies and that they were all getting older.

The Minister of State continued her contribution by discussing social services, meals on wheels, day care, home help and so on. However, these services are routinely removed and I wish to discuss this a little further. As for respite service, the Minister of State is aware of the demonstrations outside the gates of Leinster House in recent days. All Members heard the agonising stories of the impact on carers, for example, in Galway on foot of the additional €2 million that the HSE tried to slice off the budget of the Brothers of Charity and what this would do to both carers and the cared for. As I stated in respect of the Civil Partnership and Certain Rights and Obligations of Cohabitants Bill, Members ought to concern themselves with the children in such situations and that the welfare of the child should be paramount. In respect of policy on this area, the welfare of both the carer and cared for should be the primary concern. At the end of her speech the Minister of State said, "This Government is well aware of, and values, the contribution made by carers". While it is okay to say that, we ask her to demonstrate this, even in these difficult times. There are 161,000 carers in the State, 40,000 of whom are providing full-time care. Their impact is to save the State €2.8 billion per year. The Minister of State should compare the money paid to carers – it is paid quite grudgingly and every effort is made to restrict payments – with the awards made in legal cases where compensation is sought for devastating injury that might replicate some of the conditions of people being cared for.

Senator Corrigan mentioned, in a quite delicate and understanding way, the failure to publish the national carers strategy. Will the Minister of State commit to its publication and state the date on which it will be published? Will she retain the half-rate carer's payment and the respite care grant? The homemaker's scheme continues not to recognise time spent caring before 1994. Will the Minister of State retain the home care packages at their current value?

Let me consider the impact of the habitual residence condition on family carers. This condition does not recognise the unique position of family carers returning to Ireland to provide care and, therefore, it discriminates against them unfairly. I have been asked by the Carers Association to urge the Minister for Social Protection to waive the condition in respect of persons returning home from abroad to provide full-time care for a family member. Perhaps the Minister of State will be kind enough to pass on my request.

The provision of care is of real service to the State. The application of the habitual residence condition causes great and unnecessary difficulty. It also causes financial hardship for people who return from abroad. One should bear in mind that those affected have not chosen caring as a career. It is a task they have been forced to do by family circumstances. One ought to remember that the action of carers serves to take pressure off long-time respite facilities, hospital wards etc.

In 2009, 35 Irish people were denied grants on the basis of the habitual residence condition. The condition was put into effect to protect us against welfare tourism. I accept this but the condition does not always act as desired; it can act against the interests of Irish citizens. Consider the case of Paul, for example, who returned from the Untied States in 2009 to care for his elderly parents. His mother had Parkinson's disease while his father had Ménière's disease and both needed full-time care. Paul has a property in the United States and, for that reason, was denied any support. He has no income and is living on a small amount of savings. Since he is now living with his parents, the home help hours the parents had have been withdrawn. The authorities give with one hand and take away with another. This is wrong and unfair. The home help co-ordinators assured Paul some of the home help hours would be reinstated if he returned to the United States, in other words, if he broke up the family. Instead of paying, the Department is saying it will withdraw benefits unless Paul goes back to the United States. Paul now feels that coming back to Ireland to look after his elderly parents has militated against their interests and he is considering returning home. The welfare of those cared for should be paramount.

One's centre of interest has a bearing on one's eligibility for an allowance. This is a very complex matter given that so many people took properties abroad, for one reason or another, during the boom years of the Celtic tiger. Consider the case of Brendan, example. He returned from Spain early this year to give full-time care to his mother, who has Alzheimer's disease. She was refused the carer's allowance because his centre of interest was deemed to be in Spain, even though the property he owns there is a small holiday apartment and the business he leased there for five years has been wound up. The man lives at home with his mother and has no income. That is the reality.

One must consider the length of time it takes for the Department to make a decision or consider an appeal. Terry, for example, came back to Ireland from the United Kingdom because she was concerned about the level of care her elderly parents were receiving. When she did so, the HSE removed the home help hours and meals on wheels that her parents had been receiving. Thus, she felt bullied into becoming a full-time carer. These are the points to which the Minister of State referred to in her speech. I am pointing out that the impact on somebody who returns home to look after a parent in intuitive ways is such that benefits are taken away. That is the nonsense behind the Minister of State's fine words. The first reaction of the system seems to be to reward the altruism of the returning people by systematically stripping away all the benefits, which is appalling.

A carer living in County Cork returned from Egypt with her family in 2009 to care for her elderly parents, both of whom were extremely frail and could not live independently. The carer is not eligible for the carer's allowance because she is not considered habitually resident. The family is struggling to cope, has no income, and is without many basic services. The family is now considering putting both parents into a home. What would this cost the State? Would it not be more decent, prudent and economical to redress the case in the manner I have outlined?

The Carers Association has asked me to request the Department to apply a common-sense approach to the assessment of persons returning home. While I acknowledge that financial circumstances are poor, I urge the Minister of State, whom I know is intelligent and caring, to waive the habitual residence condition applying to those returning home from abroad. The Minister of State should do the decent thing. People should not be punished for returning home. Applying the condition to them is not even in the economic interest of the State.

Photo of Mary WhiteMary White (Fianna Fail)
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There is no doubt that carers, both young and old, play a critical role in society that often goes unnoticed. The recent publication of the first national qualitative study of young carers in Ireland uncovered startling realities concerning the circumstances of young carers. The study found that there are children as young as five years acting as carers through the provision of general care, emotional support and domestic help. They are providing care to siblings, grandparents and parents. The study highlighted that there is a lack of mentoring, therapy and financial support to meet the needs of young carers. There is no provision for them whatsoever. Drawing on some of these findings, it is clear the study has identified a vulnerable section of society that is being ignored in terms of recognistion and the provision of services thereto. In light of this, I call for an urgent response regarding the provision of support and protection to young carers.

Photo of John Paul PhelanJohn Paul Phelan (Fine Gael)
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Hear, hear.

3:00 pm

Photo of Mary WhiteMary White (Fianna Fail)
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Let us not forget adult carers, who also play an outstanding role in caring for the needs of their loved ones. Only recently, 73 year old Ms Carmel Devaney from Athlone won an All Ireland Inspirational Life Award, of which I am the chief driver, for her sterling work as part of the Athlone Carers' Support Group. Ms Devaney, who has an important role at the helm of the group, is supported by committee members Margaret Caulfield and Margaret Fallon. Ms Devaney says the members meet once a month and the goal of the group is to support all those in the region who are looking after their loved ones, for whatever reason.

The group invites speakers who talk on all sorts of subjects, from social and welfare issues to manual handling and stress. Every year, the committee organises a trip, usually abroad, so members can get a break, or respite, from their all-consuming caring work. Respite has been talked about so much in the past week.

On accepting her All Ireland Inspirational Life Award, Ms Carmel Devaney said there is a broad range of issues connected with caring practices that need attention. One is that the carer's allowance is still being means tested. She said: "If you've got a certain amount of income you won't get the allowance, yet we are saving the Government an awful lot of money." She is worried that not enough provision is being made for the elderly.

Ms Devaney, the 73 year old chairwoman of the Athlone carers support group, would like more Government-sponsored assisted living centres in which old people could get help while remaining independent. Private nursing homes are not an option for most because they are too expensive. Athlone is crying out for an assisted living facility. In the opinion of Ms Devaney, the Government would want to move on this matter.

Photo of John Paul PhelanJohn Paul Phelan (Fine Gael)
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I welcome the Minister of State, Deputy Áine Brady. For months this side of the House has been seeking a debate on care of the elderly.

I will make a couple of specific points at the end of my contribution, but first I will speak about carers and the undervalued role they play in society. I echo Senator Mary White's comments on young carers and the lack of support available to those who look after elderly relatives. A few years ago a girl in my area won the young carer of the year award for looking after her grandfather who has since died. Many other young people do the same and do not receive recognition for their role.

As Senator Norris stated, because of the work they do carers save the State a considerable amount of money. They do not do it for the money, but because they are looking after someone they love such as a family member. The State should do everything in its power to ensure elderly or ill patients and family members who can be looked after at home stay there for as long as possible. This requires the provision of support for carers.

We have made significant advances in recent years, but it seems as if the Government is considering making cutbacks. The an bord snip report which has not been implemented proposed a number of serious cuts which would affect carers. If the Minister of State does anything in her position, she should ensure the cuts, including the half allowance and so on recommended by Mr. McCarthy's committee, do not take effect. She should safeguard what is in place and work as hard as she can to ensure this. Her heart is in the right place so far as supporting the services provided for society by carers is concerned.

I am involved with the carers association in Kilkenny. My mother has been a carer for most of her life. She has never qualified for carer's allowance, despite the fact she has looked after my elderly grand-aunt, my uncle and, before he died, my father. She now minds my nephew, my godson, who is severely autistic.

The former Minister, the late Seamus Brennan, was a hard-nosed politician, but he did a great deal to recognise the role played by carers and women, in particular, in the social welfare system. He fully supported the payment of dependent adult allowance to who did not qualify for an old age pension. He also pioneered the introduction of pensions for spouses of the self-employed which were threatened by another former Minister, Deputy Hanafin, but I am glad the current Minister, Deputy Ó Cuív, recently stated they would not be abolished. Seamus Brennan is often overlooked in these debates, but he did a great deal of good work in this regard. While he was a combative politician, he had a good side. In my eight years in the House he was the most effective Minister with whom I had the pleasure of dealing.

The carers associations are looking for a number of measures, including a small increase in the number of hours carers are allowed to work outside their caring role. In their capacity as carers, most work much more than the number of hours in the average working week. It is good for them to be able to do other work, as stepping away from their difficult situation allows them to keep their minds in order. I support the request by the associations that the Government not treat the household benefits package as taxable income.

In recent weeks there has been a number of protests against the proposed cutbacks in respite services. Cutting the badly needed respite services for carers may result in a saving in the short term, but forcing people to place their loved ones in public or private institutions will cost the State much more in the long run.

The publication of the carers strategy has been delayed for a long time. Will the Government publish it as soon as possible?

I seek a debate on supported care homes and specifically on the Health Information and Quality Authority standards for nursing homes which are being applied to supported care homes which are not and never were intended to be nursing homes. They are to be found all over the country, but especially in County Kilkenny because Dr. Peter Birch who was Bishop of Ossory many years ago was a man ahead of his time and donated a great deal of church property to local parish communities to provide such facilities. Last Friday the Mount Carmel supported care home in Callan received a letter from HIQA indicating that the time available to subscribe to the standards was being reduced from three years to 12 months, which period will expire in one month's time when the home will face closure. It accommodates 20 people on a full-time basis, although they do not need full-time nursing care. Through supported living measures, they leave the premises during the day, go to the shops and meet their friends. They could not survive independently in the community, but they have a loving home in Mount Carmel and six or seven other facilities scattered throughout County Kilkenny. It is appalling that HIQA's standards will be used to close down such facilities or make them so expensive that most of their occupants will not be able to remain. If they become seriously ill, they will have to attend the acute services at St. Luke's General Hospital in Kilkenny, a private nursing home or one of the public nursing homes in Kilkenny. However, they are not nursing home patients. While they are incapable of living independently, they do not require 24-hour nursing care.

I am appealing to the Minister of State on a personal and political level. I am not asking that there be no standards. Some of the scandals in nursing home provision show that there must be standards. Those who run homes, many of whom do so voluntarily, do not want a situation where there would be no standards either, but neither do they want nursing home standards to be applied to their facilities which are not and never were intended to be nursing homes.

Photo of Jim WalshJim Walsh (Fianna Fail)
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The Senator has gone well over time.

Photo of John Paul PhelanJohn Paul Phelan (Fine Gael)
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Will the Minister of State address my points?

Photo of Niall Ó BrolcháinNiall Ó Brolcháin (Green Party)
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I welcome the Minister of State for one of the most important debates in which I have been involved. Although it is not possible, I would like the Minister for Finance to sit beside the Minister of State, given that we will soon be facing into a budgetary process that, irrespective of whether we like the idea, will place considerable pressure on front-line services. We need to ensure such services will remain untouched.

As a Green Party Member, I was critical of Fianna Fáil when the Green Party was not in government. During the Celtic tiger years considerable progress was made in the provision of support for carers. There is always a long way to go, however, and the measure of society is how well it treats the less well-off. As Governments changed, I watched as my wife became a carer. We have a young disabled son. It is quite extraordinary when one starts off with the whole process because literally one does not know what the hell is going on or what the supports are. It is not something people generally expect to happen in their lives, to become a carer. Not many people set out to be a carer in the community from a very young age. However, it happens to many people and they become carers. One in 25 in the population is an official carer according to the 2006 census, equivalent to 161,000 people. As many people have indicated in this debate, that level of caring is saving the State €2.8 billion, and the Government policy which states that community care is the right way to go is supported by all parties in this House, I believe, and in the country. I feel very strongly about that and believe absolutely it is the right way to go and that community care is the best way to care for our people. Obviously, the elderly prefer to live in their own homes and communities until the very last possible minute. In the case of any of our children, we certainly want them to be in their own homes, if at all possible. I understand there are many difficult situations and there is an enormous debate on the whole issue of child protection at the moment. It is not always that easy to achieve, but certainly in any case where a child or an adult can live within the community, they should be given the best possible support and services for that to happen. That is an excellent policy.

Provision of occupational therapy and speech therapy in schools is something that I have raised before on many occasions. It is very important that this should be upgraded. At a time when money is scarce, we need to up our game. I am delighted the Minister for Health and Children, Deputy Mary Harney, has pioneered speech therapy within a pilot school programme in Galway. I want to see how successful a completed pilot is because I believe this can lead to much cheaper and much better speech therapy services for children if implemented properly. We have to look at the best possible way of delivering services in the community and find innovative ways of doing that within society.

I want to mention form filling, which is not something many people would think about in relation to carers. When one becomes a carer, as my wife and I have, one wants to put every ounce of caring towards the person who needs it. One does not want to be trooping in and out of administrative centres, filling in forms and being treated as someone who is trying to defraud the State. I am not pulling any punches in saying this. At times one feels like that, rightly or wrongly. One is made to feel as if one is trying to defraud the State of money when one is simply looking for the best services for one's child. That is not the way it should be. Obviously, there may be people who try to get a carer's allowance when they are not entitled to it, but the default position should certainly be one of caring for people within the State.

I very much welcome the fact that I have received correspondence from the carers' association, Caring for Carers Ireland. We need support associations for carers. There has been much talk about respite care, home help and meals on wheels. I want to ask the Minister of State about training for carers. When one becomes a carer, one generally does not have training in that regard. Support and training in the home setting is something, certainly, that could be improved.

I do not believe we should use the monetary situation as an excuse for denigrating the gains we have got. We must hold on to those and make every effort in that regard. If we are going to cut in this budget it has to be from the higher end of things. I could speak all day on this particular subject, as the Cathaoirleach recognises. It is a very important debate, and I hope we can come back to it again. There have been a number of specific measures suggested in this debate. I hope the Minister for Health and Children and the other Ministers involved in the caring area will look carefully at today's Seanad debate and embrace many of the points that we have sought.

Photo of Áine BradyÁine Brady (Minister of State with special responsibility for Older People and Health Promotion, Department of Health and Children; Minister of State, Department of Environment, Heritage and Local Government; Minister of State, Department of Social and Family Affairs; Kildare North, Fianna Fail)
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Listening to the various contributions to the debate, I was reminded once again how close to home the issue of carers is. Each individual carer mentioned represents the thousands of carers from every corner of Ireland - every parish and every family - who receive no awards, often little recognition and sometimes not even the awareness of those for whom they care. People need help and support in doing this and this Government is committed to supporting family carers as much as we can.

In the changing circumstances over the past two years we have had to make difficult decisions and reassess priorities. In the face of enormous economic pressures the Government has chosen to continue supporting carers to the maximum extent possible. We have retained the half-rate carer's allowance, which I know is of great value to carers, both financially and in what it represents. We have retained the respite care grant, including for people who do not otherwise qualify for other income supports. I have taken all the issues on board and, as Senator Ó Brolcháin has indicated, it would be great to have another debate at another time of the year. As regards the home care packages, my focus last year was on the fair deal nursing home support Bill, and certainly now it is on home and security care. In my initial speech I mentioned the evaluation we had done of the home care packages, and we are now aiming to standardise access and delivery of these. They are working extraordinarily well in parts of the country and not so well in others. We are working very hard in my Department to standardise that access and delivery.

Several Senators raised the issue of the habitual residency requirement. There are five grounds to be considered based on the rulings of the European Court of Justice, and we can consider the balance of the grounds outside the five, which obviously cannot be changed. Thirty-five people have been refused out of 19,000 and an appeals process is in place.

I referred to the positive aging strategy and many Senators have mentioned the national carers strategy today as an issue. The Government took a decision in 2009 not to publish this strategy. In 2008 the economy experienced multiple shocks as an unparalleled combination of international and domestic developments impacted. Reflecting these developments the economy rapidly moved into recession and the pace of this deterioration has to be recalled now against a background of 6% GDP growth during 2007. The European Council and the European Commission considered Ireland to be at medium risk when it came to the long-run sustainability of the public finances. As a result, Ireland's stability programme update in October 2008 described safeguarding the public finances as requiring additional policy responses and potentially difficult choices, notwithstanding existing initiatives. That was the context in which the Government took the decision not to proceed with the carers strategy. Given the prevailing economic situation, it was not possible to set targets or timelines which could be achieved. Rather than publishing a document which did not include any significant plans for the future, the Government decided not to publish a strategy.

I refute any suggestion that the Government has no strategy or vision for carers. Government policy is to support older people, people with disabilities and people with mental health difficulties to allow them to live in dignity and independence in their own homes and communities for as long as possible and, where this is not possible, to support access to quality, long-term residential care. The report of the working group on long-term care recommended that a central principle of policy should be to support older people to remain in the community. This policy approach is renewed and developed in Towards 2016. It is reflected in the ongoing statements of strategy of the Department of Social Protection and the HSE.

The Government has a vision for carers, of an Ireland which recognises and respects the valuable role of carers in society by providing them with support, where necessary, to assist them in their caring role and to enable them to participate as fully as possible in economic and social life. That is our vision and it is what guides us.