Wednesday, 21 October 2015
United Nations Principles for Older Persons: Motion
That Seanad Éireann notes the ratification by Ireland in 1999 of the United Nations Principles for Older Persons which include:- Article 6: “Older persons should be able to reside at home for as long as possible”;and calls on the Minister for Health to:
- Article 12: “Older persons should have access to health care to help them to maintain or regain the optimum level of physical, mental and emotional well-being, and to prevent or delay the onset of illness”; and
- Article 16: “Older persons should have access to the educational, cultural, spiritual and recreational resources of society”;- outline how Ireland is upholding the United Nations Principles for Older Persons;
- maintain Government policy which is to facilitate older people to stay in their own homes and communities for as long as possible; and
- continue to develop alternatives to residential care, including enhanced home care, and to consider the potential of new residential models which would help older people to be more independent and to enjoy a better quality of life for longer.
I welcome the Minister of State, Deputy Kathleen Lynch, who I know is interested in this issue. A student at Oxford once told Albert Einstein that he had set the same examination questions as in the previous year. Einstein said the questions may have been the same but that physics had moved on and that, therefore, the answers would be "very different". It is how we answer things that may change.
We all know that it is an irreversible fact that we are going to get old. We need more creative and imaginative solutions to how our elders are treated. "We fail in clearness of vision or in boldness of heart or in singleness of purpose" - these are not my words but of Pádraig Pearse in The Murder Machine. The American writer Kurt Vonnegut wrote a book called A Man Without a Country. I do not subscribe to the premise, but in the book he speaks about how the most terrifying characters in history were the most enthralling and great guessers. The most profound and loud guessing is happening in parts of Europe and other countries. Our international leaders are sometimes completely unaware of solid information, research, scholarship, investigative reporting and downright common sense. The guessers know no more than the ordinary common man, but they give the illusion - I may be talking with the benefit of age - that we are in control of our destiny when we are not, especially when we get old.
My first point is that we cannot continue to guess our way around the profound topic of ageing, from a European or a national point of view. The topic of ageing is far more important than all of the shouting and roaring about water charges. The population has been getting older in the past 30 years, hence the rise in concern about hospital beds, including step-down beds, step-up beds and bed blockers, as well as nursing homes and primary care services. This problem has been coming for the past two or three decades; it did not just arise yesterday. How we plan for the future is becoming the big reality. As a nation we are very bad at planning; we write plans and give them a language and then shelve them. We rarely activate them. That is the reason 68% of us do not have a will. If ever Ireland or politics needed a more compassionate, imaginative and creative way forward it is on the issue of ageing, but we keep putting aside the big issues. If I was to leave a dog alone at home for three days, the ISPCA would be called and it would become an animal rights issue. An older person, however, can be left at home for three or four days, or die on their own. This is a human rights abuse and it happens all the time. It also happens all the time in institutions; people are unwillingly in institutions, without visits.
In 1999 Ireland signed up to the United Nations Principles for Older Persons, yet current policy is geared towards incubating and congregating older people in long-term care settings. Government policies must help them to live in an anti-fragile world. We should not accept that we will wither away in an unacceptable way because of financial and human costs.
When I was young, I was very interested in Greek drama, from which all great dramas rose. They always had a king or a young man, a princess or a young woman, or a group and no matter what happened in a society, be it through greed, jealousy or war, at the end the elders would always come on the stage and say, "You should have listened; we told you that you needed to be careful about what you did and the decisions you made." They always offered solace, wisdom and hope. We need to listen to our elders who have been ostracised and silenced. We know that they have been silenced in the financial sense, as poverty silences people, as does the old age pension. They might be frail and not have the language or the voice, but we have to listen to what they tell us about how they feel about their lives.
In much of the world average lifespan is past 80 years and rising. More than half of us live without a spouse and a partner. We are also having fewer children, which is another source of concern. Are the autumn days of our lives to be spent in institutions and nursing homes, with intensive care routines? I understand it is not always possible for people to live at home, but I argue the case for greater balance, in favour of staying at home. There are complicated medical needs, against which I do not argue. There is a great book in which all Senators might be interested, or the Minister of State may have read it. It is called Being Mortal by Atul Gawande. It is a brilliant book on ageing. Atul Gawande believes that in some way we have allowed our fate to be controlled by medicine, technology and strangers and he is right. There are those who may think it is a little extreme, but sometimes one needs to be extreme to find common ground.
I am not attacking nursing homes, as they are outstanding in the care they provide, but we need to look more at saving money by using the same ideas, polices and solutions within the home. We need to look at the phenomenon of ageing in other ways. For example, what about having a fair deal scheme package with appropriate care being provided in one's home? The person concerned could still pay at the rate of 7.5%, 14% or 21%. What about having a direct payment scheme for those to decide who they want to mind them in order that they will not always be looked after by people who can often change? My family and I are a living example. Every week, sometimes every day, the people concerned can change.Old age should be multi-generational but has become somewhat private. It is the private aspect which I am trying to twist and turn. We need to reverse this. Age is no longer rare. The wisdom of age is somewhat ignored. There was an example of this recently with the retirement of the great transplant surgeon, David Hickey, who was not allowed to stay on, even as a mentor, at 65 years of age. Senator John Crown has a Bill to allow those who are able and have the capacity to be allowed stay at work.
Google explains everything to us. The wisdom of experience is explained through Google, not through the experience of a human being’s age. Philip Roth, the novelist, said old age is not a battle but a massacre. The older I get, the more I know what he is talking about. The Government should not add to the massacre. Depression is rife among older people. We rarely hear about it because it is the preserve of another chronology. We are not educating enough doctors to study gerontology. It is the least sought after medical specialism in America.
Nursing homes cost five times more than independent living. This comes back to my point about the fair deal scheme. Did nursing homes really find their route in giving ageing people a better way of life, better than what they had in their other lives? No. They were created to clear out hospital beds. The place where we are most likely to spend some part of the frail last years of our lives was never really created for us. I fully accept we have quality and standards in nursing homes and that they are safe. However, it is not happy sometimes. A person might have left their apartment but is no longer allowed to do things because they are not safe. One might have made one’s own jewellery. Now, that person just plays bingo, watches a DVD and has passive entertainment but not purpose. Health and safety has closed down much of the creativity in nursing homes and what older people can do there. The elderly have less freedom than children.
What we forgot in all our protection in health and safety was how to make life worth living. The elderly are frail, weak and cannot argue for themselves. People like us are here to argue for them. Why have we not burned the nursing homes to the ground? There is one here in Dublin that I would burn to the ground. It is because we do not really believe that anything else is possible. We believe it is sort of possible under certain conditions. This comes back to Pádraig Pearse and the lack of clear vision.
We need to develop assisted living as the norm, building it in every village and town. I believe when one is away from home, one has lost one’s freedom, no matter what one’s age. I also believe older people should never disburse decision-making to their children. The Assisted Decision-Making (Capacity) Bill 2013 will be very helpful here. Children are not in charge of their parents. Neither are nursing homes. Elders are in charge of themselves, even when they lack capacity because there was a time when they did have capacity and they can make those decisions. In the lobby of Leinster House, the Proclamation stands. It talks about human rights. This is one.
Privatisation of home care means that one hour of home care costs €25 per hour. At 168 hours a week that comes to €4,200. In 2026, 16% of the population will be over 65. We now have what are termed young-old, people between 65 and 74 years of age, middle-old, 75 to 84, and old-old, 85 years up. That is how long we are living. If one buys into fair deal, one cannot reverse one’s decision.
There are 36,000 people in nursing homes, equivalent to the population of Sligo town. According to the ALONE report, some 12,000 of these people do not need to be there. Up to 12% of elders in nursing homes engage in passive suicide. I saw it myself. Up to 57% of the budget for older person services is being allocated to just 6% of the older population. The percentage of the elder population in nursing home care in Ireland is 35% greater than the EU average. In the past five years, there has been a significant decrease in supports for older people to age at home. The supports have been cut by €1.6 million and the housing adaptation grant by €30 million. I understand everything had to be cut but we must start reversing that. There is too much money going to 80% of stand-alone nursing homes. We need to parallel that money in the communities. We put people’s names down for nursing homes because we do not know or have not developed good home-care supports. The average length people stay in a nursing home is two and a half to three years. There is no incentive to reverse that pattern. Strategies are no guarantee of implementation.
We wait for occupational therapists to tell us what we already know. We are not acting like a smart economy but like the bad economy of bad health. I have just read the WHO report on ageing and health in which Dr. Margaret Chan, director-general of WHO, stated, "There is no “typical” older person ... older age does not imply dependence". We need less emphasis on congregated care and more on community care.
Almost 2,000 years ago St. John said, “When you are old, you will stretch out your hands, and others will dress you and take you where you do not want to go". I rest my case. I am delighted the Minister of State, Deputy Kathleen Lynch, is in the Chamber because she has a genuine interest in our elders. I would like to see policies reversed with fewer stand-alone nursing homes. Instead, I would like more care in the community where the elders deserve to be, in the core of what they built themselves in their lives and want to come back to.
I second the motion. I thank my colleague, Senator Marie-Louise O'Donnell, for tabling this motion and helping us understand the rationale behind it. We all know it instinctively but she has hit it home for us all. I have long been a believer in balancing our supports and the need to invest more in community services. We tend to put an overemphasis on the medicalisation of too many issues, when we actually need to look at the humanisation of those issues to ensure people can get the help where they need it.
I am delighted to second this motion. My own father is in a nursing home. I have nothing against nursing homes. He had a severe stroke and is high dependency but getting high-quality care. However, there was a period when he should have been getting care in the community but it was not there. That is why tonight I have chosen to drill down in one area to illustrate why I am so honoured to second the motion.
Four years ago the Government launched its strategy, National Policy and Strategy for the Provision of Neuro-Rehabilitation Services in Ireland 2011-2015. As the title suggests, the intended lifetime of this policy ends in two months’ time. Now is a good time to see what has been achieved. It will not take me long because there has been nothing, not even an implementation plan. As Senator Marie-Louise O’Donnell said, the difficulty has been with cutbacks, which have affected all services but particularly neuro-rehabilitation and older people services. In general, total community support hours have fallen, according to Age Action’s figures, from €11.97 million in 2009 to €10.29 million last year, despite an increase in the number of people who wish to access the services.
The Government rightly lauds the success of the Health Service Executive’s national stroke programme in transforming acute stroke services across the country. We have seen the death rate from the disease cut by 13%, against both demographic and international trends. This means that more people than ever are returning home after a stroke but the community rehabilitation services that enable survivors to maximise their recovery and their quality of life are as bad as ever, however. At the most vulnerable time of their lives, in the wake of a major brain injury, survivors are effectively abandoned at the hospital gates and left to face the future with no support or services. The Irish Heart Foundation "Cost of Stroke in Ireland" research illustrates just how badly stroke survivors are being failed. It should be underlined that the problem is not about how much money is being spent but where that money is being spent. The study estimates that the direct cost of stroke to the State is up to €557 million a year. Of that €557 million a year, €414 million goes towards nursing home care and less than €7 million goes on community rehabilitation. How does this fit into Government policy to keep people at home? We are saving more lives than ever from stroke due to improvements in hospital services and amazing staff. The system then waits until after it can help maximise the recovery and after it can help people return to and remain in their homes before it spends any money on them, instead of switching the focus to rehabilitation. We know that saves lives in instances of stroke, and saves the quality of life, which is core to the motion being put forward by Senator O'Donnell this evening.
I would like the Government to look at the issue of early-supported discharge programmes, which Senator O'Donnell called a fair deal for home. We need a way to ensure that we can care for people and that they can get the resources they need in their own homes. The ESRI and the Royal College of Surgeons in Ireland report last year concluded that over 3,000 stroke survivors could benefit from early-supported discharge. That would reduce hospital beds by 24,000 annually, freeing up vital space to ease the crisis. The data from the three early-supported discharge pilot programmes in the Mater, Tallaght and Galway University hospitals indicate bed savings of between eight and 14 days per patient, along with improvements in self-reported quality of life, which is absolutely core to what we are talking about here from 9.5% to 19.4%. Some people will say this is evidence from urban areas but, for example, Galway recorded the biggest bed day savings, even though the current programme only serves rural dwellers who make up to one third of its patient numbers.
I support this motion because it is about the quality of all our lives. If one looks at the UN principles for older people, one will see that they are about ensuring that people have the choices, that the services are there and that we do not needlessly put people into hospitals. We have to ask what the roles of the hospital and the community services are. I have experienced it with doctors on night call - all too often the easy option is to send a person to an accident and emergency department because the doctor is covered. We need to drill down and have supports at home.
My in-laws are Dutch and I see the amount of community support and the way the system is tailored around the home in the Netherlands. If people need those supports in their home they will be there - people ask for them when they want them. My father-in-law is quite ill and is able to ring and have a doctor within 20 minutes on every occasion. We should be striving to have support in the home when it is needed and as it is needed. We need to ensure that older people have access and the optimum level of physical, mental and emotional well-being. We also need to look at the other services. I have been discussing the medical services here this evening but there should also be educational, cultural, spiritual and recreational services. I am sure we can debate this further.
I second this motion wholeheartedly. This debate is part of a journey. Senator O'Donnell has done considerable work on this area. I hope this contributes to that debate but I really hope that it adds to action and a change in policy rather than platitudes.
I welcome the Minister of State to the House. I thank my colleagues for bringing forward this Private Members' motion. We face a major challenge in this country over the next number of years to how we develop policy in this area. Just because someone reaches a certain age does not mean that there is suddenly a dependency. One lady who lives in my area is 99 years of age and still drives a car. I have a connection with another person who is 91 years of age who is confined to a wheelchair and lives on her own. She wants to live on her own because she does not want to go into a nursing home. People can live on their own and can continue to live the life they want to live rather than being confined to a nursing home. We need to examine how we do that and how to bring about the necessary changes to make sure more and more people can stay in their own homes and live there for a longer period of time.
It is interesting to read the vision statement "Positive Ageing Starts Now" which sets out quite clearly:
Ireland will be a society for all ages that celebrates and prepares properly for individual and population ageing. It will enable and support all ages and older people to enjoy physical and mental health and wellbeing to their full potential. It will promote and respect older people's engagement in economic, social, cultural, community and family life, and foster better solidarity between generations. It will be a society in which the equality, independence, participation, care, self-fulfilment and dignity of older people are pursued at all times.
It is a very important vision statement and we need to make sure that every word of that vision statement is followed through on. I brought in a Private Members' Bill, the Health (Professional Home Care) Bill 2014, which set out quite clearly why we need to improve the monitoring of home care and to make sure that we plan for home care provision and that there is proper supervision and regulation of it. The whole issue of home care is about making sure there is proper planning, risk assessment, a care plan, and that it deals with issues such as the handling of money, which older people worry about, manual handling, training, and the cost of that. It is important to look at this.
The Law Reform Commission report set out that the guiding principles of the proposed legislative framework should be independent living, privacy and dignity, quality of care, and the protection of adults in receipt of professional home care. It is important to develop a proper structure to provide home care for people who want to remain at home - that is the vast majority of people. One of the things that has occurred over the last few years in the HSE is that a person who provided home care used to call two or three times a day for an hour each time, and suddenly that was cut back to half an hour. It is inadequate to expect someone to travel to a person's house, when it takes 20 minutes to travel there and 20 minutes to go home, to get paid for half an hour. We need to review that kind of approach and make sure that when people provide home care they are paid for an adequate period of time at the person's house so that they can actually properly look after the person.
When we reviewed the structure there was a greater demand for home care so there was a certain budget. It is a budget that needs to be increased over the next few years if we want to keep more and more people out of nursing homes. If one looks at the figures, one will see that there are 585,000 people over the age of 65. That will increase to 990,000 people between now and 2030. We could immediately respond and say we need to create more nursing home beds but there is a cost factor there, whereas for every person who goes into a nursing home we can at least look after four or five people at home for the same cost of a nursing home bed.
That is an important issue that needs to be looked at.I do not in any way criticise what has occurred, but in fairness, in recent years we have more debates and discussions on the matter and many positive things have been done. For example, we had the national positive ageing strategy, which was a plan for an ageing society from 2011 to 2016. The strategy is now up for review.
Other plans include the healthy and positive ageing initiative and the Irish national dementia strategy. Dementia is now a major challenge. Approximately 50,000 people in this country have dementia. The indications are that over the next 20 to 25 years the number will increase to well over 100,000 and we must plan for that as well. The dementia strategy implementation programme has been drawn up and €27.5 million has been made available for it. That amount includes private funding of €12 million, which is very helpful. We do not have much time available and we must start to work now to increase the availability of home care services and home care packages. We must ensure an adequate number of people are trained to provide home care. We must also ensure an adequate number of training places are available. There is a range of issues on which we need to work and we must follow through in that regard. I thank those responsible for tabling this motion for discussion. I look forward to hearing the Minister of State's response in due course.
I compliment Senators O’Donnell and van Turnhout for their initiative in tabling the motion. We are all great at talking in these debates and not so great at coming up with innovative solutions. I agree with much of what Senator Burke said. I am sure we will all agree with each other in the debate as there will be no contention.
As my favourite Minister of State, Deputy Kathleen Lynch, is aware, the problem is that she is the one who is left with too few resources for her entire portfolio which encompasses mental health, ageing and the elderly. Those are the people who are more vulnerable in society and their voice is not as loud as it ought to be. When we have debates such as this, we all agree and tomorrow, unfortunately, it is a case of business as usual once again.
We must push the boat out and think outside the box. I suggested previously in the House that a pilot scheme could be set up whereby the means test for the carer’s allowance would be abolished, with protocols to encourage the 12,000 people who do not need to be in care to go home with the assistance of an aunt, niece, first cousin, neighbour, brother or child. The Minister of State should ask the Minister for Finance, Deputy Michael Noonan, and the Tánaiste, Deputy Joan Burton, to consider that. In addition to the support outlined and the provision of the carer’s allowance of some hundreds of euro per week, those people should be given a medical card and, where necessary, a home care package to assist. Protocols could be put in place to ensure that people are not just on the make in terms of becoming a carer for someone who does not need a carer. No doubt there are enforcement measures and assessment criteria that would see through such applicants.
The cost per week for district nursing homes run by the HSE in Sligo and Leitrim ranges from €900 to €1,550 and various sums in between. It is not as simple as one being better at delivering the service than others; it is to do with the complexity of patients’ needs and the services that are provided. If one takes away the carer’s allowance, a number of home help hours, include the respite grant and a medical card, and take away the prescription charges, the per week charge would struggle to get to €800 as opposed to sums ranging from €900 to €1,550 to keep a person in a nursing home. I accept we are in an era where we are trying to reduce social welfare and we do not want social dependency but there is not an elderly person in a home in the country who does not have a relative capable of providing a level of support that might facilitate them in their home, who does not have a job and who would not be prepared to do this work. A carer provides flexibility that a person in a 9 a.m. to 5 p.m. job, five days a week, could not provide. That would be something worth doing. It could be done on a pilot basis, for example, in Sligo, or even for one nursing home or a group of nursing homes to see whether it would work, how much it costs and what could be saved. Given all the factors involved, such an approach must be worth trying. It is not the case that I am looking for any credit.
I would welcome a response from the Minister of State on the issue, not today, but after she speaks to her officials, the Department of Social Protection, the Taoiseach and the Tánaiste to see whether we could try such an approach. Perhaps we could get all parties to put it into their manifestos in advance of the election whether that is in February, March or whenever. It could be a real winner, not for votes but for older people. The votes would undoubtedly come but that is not the point.
None of us has covered ourselves in glory in recent Administrations. When the money was available we had one-upmanship and pensions and supports increased. It was never enough. When it came to cutting back there was too much of a focus on taking the money back. It was easy to do that and people just had to accept it.
I do not wish to be overly political but let us consider the savings made on prescription charges. Before the election the charges were to be abolished. The then Opposition spokesman on health, Deputy James Reilly, was most vociferous on the almost criminal aspect of the charge. It is difficult to disagree with that perspective. Then the charge was increased from 50 cent to €2.50. One could ask how much we collected. I suspect it was a negligible amount.
The same is true of the changes to the criteria for medical cards for those aged over 70. There were other small changes such as to the telephone allowance and the respite grant. We all welcome the return of the latter, as it was a key support to the 77,000 families that are in receipt of the carer’s allowance. Carers save the Government of the day €4 billion a year in terms of the care they provide. What divides me politically from perhaps the Minister for Social Protection or the Minister for Finance in recent years is that people who were earning more than €100,000 a year were expected to be hit by another 1% or 2% in the more difficult budgets of recent years. They would not have liked it, nor would they have wanted it and it would not have got anybody any votes but they were better heeled to sustain the hit rather than the few hundred million euro that was saved or gathered as a result of increases in such measures as the prescription charge increase or the cut to the bereavement grant, changes in criteria for the medical card and the drug payment scheme increasing from €120 to €144. They made a significant difference to people’s lives. As someone with a mortgage and everything else who has faced up to the recession as best I can, if asked whether I would have been prepared to pay a little bit more for the relative security of those older people, I think I would. I urge the Minister of State to please look at that as a possibility. By all means, she can come back and tell me I am crazy and why, but I think it is worth a try. Let us hope there is never a recession like this again, but if there is, next time I hope we can focus on taking that little bit more from the people better placed to sustain it, even though they will not like it.
There is a nursing crisis in this country that is caused by a number of different reasons. First, we are training one third fewer nurses per year since 2008. That is bearing out now. I read a press release from the INMO today which outlined that the number of nurses at the beginning of 2008 was 39,000 while today there are 34,200. There are approximately 4,800 fewer nurses in the system. Inevitably, that takes its toll on things such as home help. An aggressive recruitment policy is not paying off, largely because pay and conditions are being judged as insufficient by graduates themselves who want to go elsewhere. There is also competition from private nursing homes. That is another area on which the Minister of State must focus.
I have tried to be innovative and come up with suggestions. I hope the Minister of State can try to take them on board and come up with a response.I commend the Minister of State on her commitment to her job but I condemn the lack of foresight on the part of her colleagues in government to provide her with the resources she needs to look after the most vulnerable in society in terms of those with mental health issues and the elderly.
Sometimes old age is seen as a burden. Others think the accumulated benefits of aging, such as knowledge, experience and wisdom, mean it is not a burden but something that is welcome and necessary. As a society, as people and as policy makers, we must acknowledge our attitudes to aging and see where the fit into the dichotomy of views on aging. This takes on an increasing importance as our population ages. It is unhelpful to think of elderly people as a homogenous group. I know a man in Glanmire named Joe who celebrated his 90th birthday on Saturday night last. He still cuts grass using his ride-on mower. As a psychiatric nurse, I have spent a long time looking after elderly people and those who suffer with mental health issues. There are people in their early 60s who do not enjoy the benefits of good health. It is important, therefore, that we do not lump everyone together in a homogenous group and state that all of those who are elderly have the same needs.
There is no family in the country that does not experience the joy of living with a parent or a relative who is becoming increasingly elderly. In parallel to the aging process comes the decline in people's health, etc. It is important that we put the needs of elderly people at the top of our policy agenda. There has been a recent move in that direction. We see it in the Bill that was debated last week in the Dáil on increasing the age of retirement. The Minister of State has also placed the fair deal scheme at the top of the political agenda. She has made great moves in terms of delivering in this area and that fact must be acknowledged.
Many families, including my own, have required the assistance of the State. An elderly, widowed relative of mine was happily living alone until we started noticing some declines in her health. For example, she would forget to eat her dinner some days. In hindsight, these were signs of the onset of Alzheimer's disease. They were not recognised, of course, although one would think I, as a psychiatric nurse, would have been able to spot them. However, the onset of the disease can be insidious and slow and it can go unnoticed. The onset of the disease required that pathway of care for my relative be put in place. It is interesting that it was generally a good experience for us. The main initial concern of my elderly relative was terrible because it was loneliness. It was not a specific illness or disability but loneliness is debilitating. I know the Minister of State understands this point.
This relative came to live with us but we needed support. The voluntary sector offers fantastic support in this regard. The services offered by the Alzheimer Society of Ireland and the Carers Association are fantastic if, unfortunately, limited given the demands on their time and resources. We used the private sector extensively. I will mention one group called Home Instead. The service offered was wonderful and affordable because, although a private organisation, tax reliefs were available. This relative only had her pension but she could afford 20 hours a week of someone from Home Instead coming and sitting with her, minding her and chatting with her. At the end of the year, marginal rate tax relief was available which set us up nicely for the following year. We should consider extending the tax relief on such schemes or we should find some other mechanism. We were lucky that we could afford to do it. A large number of people cannot afford it, which is unfair. Is there some way it could be extended, be it by means of the tax system or otherwise? I am not saying we should replace the statutory and voluntary bodies but we should allow the private sector to complement what is being done. In doing so, we would relieve some of the burdens placed on the State's resources.
We had a negative experience when my elderly relative had to go to hospital. She fell one night and injured her shoulder. We had a very poor experience at the accident and emergency department. The accident and emergency services are always topical, but the service was very unsatisfactory. Once she was in the system, however, the service was fantastic. Access to the system was the problem. After she was patched up and came home, she was grand and decided, in consultation with us, that her needs would be best met in a nursing home. We applied for the fair deal scheme and got a place in a short space of time. It was a place here in Dublin which I will mention because I was so impressed with the level of care. It is called Kiltipper Woods and is located beyond Rathfarnham. The level of care was fantastic. I tell this story by way of illustrating the way the private and public sectors can complement each other. We should be looking at all opportunities to see what we can do to join seamlessly the public, private and voluntary sectors. There is huge scope. The Minister is active in this area herself and it is something she is sympathetic towards, for which I commend her, but it is such a difficulty for people facing the challenge of finding the best care for elderly relatives. Of course, we should not speak passively of the elderly because they have to be participants and partners in their care.
This is a really good motion which allows us a good opportunity to express many views. I thank the Senators for tabling the motion, which the Government will not be opposing.
Senators O'Donnell and van Turnhout. Go raibh maith, a Sheanadóir. I said it in Irish first. Senator O'Donnell is prickly about the issue but no personal offence whatsoever was intended.
I am glad this motion has been, fortuitously, tabled this week. Peter Sands, a Member of this House for a number of months in 2007, was a fiercely active man in the Irish Senior Citizens Parliament and various societies for the aged and retired people. He did tremendous work in his community and nationally and his service in that and many other regards was recognised in his appointment to the Seanad, albeit for a temporary period. I remember him as I speak today.
I hope that in our actions and, in particular, our words this evening we make sure the protection, welfare and health of older people is at the centre of our society.
Ireland can be the greatest little country in the world in which to do business but, as my party leader has asked on a number of occasions, is this the greatest little country in the world in which to grow old in? We all aspire to growing old in good shape and with good facilities and security available to us. The one thing the elderly need and demand from the political system is a sense of security and safety. They demand a safety net. They want to know that they will be okay and that if they get sick they will be looked after. If they live alone, they expect that they will be protected.If they do not have independent means, they expect the State to recall the sacrifices they made and the hard work they did throughout their years, whether in rearing children or contributing to their communities. At the end of their lives they hope this will be remembered and recognised and that practical support and actions flowing from the words of politicians will be available or carried out for their benefit.
Various issues affecting the elderly have been rehearsed in the debate. Like all Members, I speak to elderly people all the time. They tend to know the politicians in their constituency, much more so than young people. Perhaps that is due to a familiarity built up over many years, although some are very much part of a political tradition. Among the measures they point to as having a particularly harsh effect on their lives and lifestyles is the prescription charge. Senator Marc MacSharry said there was a promise to abolish it prior to the previous general election, but he is wrong. The then Fine Gael spokesperson on health, Deputy James Reilly, now Minister for Children and Youth Affairs, committed to abolishing it once he took office in March or April 2011. That gave false hope because it was not an election promise; it was, presumably, a commitment flowing from the programme for Government. Not only did he fail to abolish it but the charge has escalated. If this teaches us one thing, it is that whenever a charge or tax is brought in, it only goes one way. Taxes never reduce or disappear. A harsh lesson has been learned in that regard. A charge of 50 cent was applied with the best of intentions and with the support of many people to ensure medicines would be used for the purpose for which they had been provided and to ensure they would not be provided unnecessarily, but this sensible arrangement has simply morphed into a tax that is having an impact on the elderly who would love to have seen movement on this issue in the budget.
Another issue the elderly raise regularly is the loss of the telephone allowance, which has been much more than a financial loss. They had the security of knowing that they could stay in contact with their relatives, friends and the Garda, if necessary, but they now face the additional costs associated with having a monitoring device, which are considerable. This affects the security of the elderly and it is incumbent on us all to work to have the allowance restored.
While I appreciate that the Minister of State's Department is not responsible, I have received a number of complaints about the new system for monitoring alarms. The community groups that provide and supervise the systems for the elderly state Pobal is requiring them to do a great deal of work that ordinarily would have been done by public servants. The organisation is putting a great deal of bureaucracy in their way to maintain these community alert systems. This is scaring many of the groups involved and I hope it will not have a negative effect on the provision of such systems. Many groups were happy dealing with the Department of the Environment, Community and Local Government because they knew the officials involved. There was significant upset a few years ago when the telephone allowance was cut, on which there were various political debates. Generally, officials in that Department were helpful to community groups that administered these schemes. However, the changeover to Pobal has not gone smoothly, according some of those to whom I have spoken. Some changes are necessary, but the process of change needs to be explained better and improvements need to be made to bring the community groups along. This issue has been raised by genuine people who assist the elderly in the provision of monitored alarm systems. Many of them give of their time voluntarily to organise the schemes and often they are elderly themselves. More power to them that they are doing this.
If there was movement on the telephone allowance and the prescription charge, it would give a deeper sense of security to the elderly who need to feel secure. Respect for one's elders in an ancient tradition in this country. The extended families of fadó, with the elderly granny sitting in the corner being looked after, are no longer as prevalent and care homes tend to look after more of the elderly. That derives from our own traditions, while all of the practical actions derive from UN principles for older persons, of which previous speakers have, thankfully, reminded us.
I thank those who tabled the motion. I do not suppose anybody will vote against it. We all support it, but it is a question of how we put it into practice.
I welcome the Minister of State. I compliment Senator Marie-Louise O'Donnell on tabling the motion which was seconded by Senator Jillian van Turnhout. It is apt at this time. The proportion of over 65s increased by 21% between 2006 and 2013 and the number in this age group is projected to increase by approximately 20,000 each year in the next few years, rising to between 850,000 and 860,000 by 2021. The proportion of over 80s is set to increase even more dramatically. The Government has initiated a number of proposals and initiatives, including the national positive ageing strategy 2011 to 2016. The programme for Government committed to implementing the strategy in order that older people would be recognised, supported and enabled to live independent, full lives, which is the key point. The elderly population should be allowed to live in their own environment for as long as they can and all Governments should assist in every way possible to ensure they have the comfort and security of their own home, with the necessary supports to facilitate this. It is much cheaper to do what the people themselves want, which is to stay in their homes, with the necessary supports provided, rather than putting them in nursing homes under the fair deal scheme at a cost to the State of more than €1,000 a week. The scheme is an absolute necessity, as many people cannot live on their own and need the service, but others would love be in their own home, with the support of family or community and voluntary services. That is what we should aim to do in order that we help in any way possible.
Not so long ago the Minister of State visited a supportive care home in my city. The Holy Ghost residential home caters for 60 residents who do not require full-time medical and nursing care. They are provided with meals, entertainment and medicine, but they are ambulant. However, without this service, they would be availing of the fair deal scheme at a cost to the State of more than €1,000 a week. This care home which provides these facilities through charitable work, investments and so on receives €50 a week for each resident. This cannot and will not continue. The home will close eventually, unless it receives adequate State support in the interests of the elderly people concerned. The Minister of State has seen at first hand the work being done in the home. There are a number of other supportive care homes in the south east, in particular, which require support and they would save the State significant moneys in the process.
As well as supporting the elderly, we must think of ways to save money.However, money is not being saved by giving this group €50 per week to support elderly people while others are getting €1,000, albeit obviously for the increased nursing care and so on which one would get in a nursing home. This is not a nursing home; it is a supportive care home. While I do not often support Senator Byrne when he speaks in the House, I support his comments on the monitoring alarms and so on. They are crucial to people living alone in particular. My own mother had one and it was essential. These devices are a source of support for elderly people and give them a bit of confidence. If, as the Senator states, red tape is now preventing people from getting these alarms in a timely fashion, it should be eliminated. As I stated, they are a source of support for elderly people.
This House formed the Public Consultation Committee at the behest of the independent Taoiseach's nominees. One of the committee's first reports was on the elderly and it made a number of recommendations, many of which have been attended to, while others need to be. However, Members should not forget it was the committee's first report. It was initiated in this House and it is right and fitting that Senator O'Donnell has followed up on that report and that Members should review it, as well as the entire system of supports for elderly people, because it will not be too long before they are in that state themselves. Consequently, one must look after the elderly as best as one possibly can, as one is judged by how one can support elderly people.
The Minister of State is doing and has been doing everything possible, particularly during the first three years of this Government's term in office, when the cupboard was bare and there was not a penny to spend. However, now the Government has begun to get the country moving, some growth is being achieved in the economy and so on, money should flow prudently to those areas which need it most. I do not believe one ever can spend too much on the elderly population.
I say "well done" to Senator O'Donnell for bringing this excellent and relevant motion before the House this evening. It starts by stating "That Seanad Éireann notes the ratification by Ireland in 1999 of the United Nations Principles for Older Persons". While listening to the other speakers, I calculated that by the time I am 75 years old, there possibly will be in excess of 1 million people just like me who will be heading for 80. The Minister of State and I probably will be in a home together, having a chat about old times, but a tsunami will hit us in the form of the challenge as to how we will manage the needs and the dignity of older citizens.
As a mature and sophisticated worldwide web accelerates, evolving faster than anything people ever have experienced, the young and agile smartphone generation live in an instantly connected world. In comparison, the older generation gets left behind as their worlds become lonelier and disconnected. As we in Ireland strive to evolve into a sleek, efficient economy, over the past five years Members of the Oireachtas have cut the numbers of gardaí although, as Members have noted this evening, fear is one of the greatest enemies of older citizens who crave security and have the right to feel safe in their homes. Many local post offices have closed and telephone allowances have been cut. The giant supermarkets have closed many corner shops, thus culling the vital lines of human communications and friendships our elders love and need. I need not remind Members that loneliness is the greatest dread that cloaks older people. Rural public transport is pathetic in places and with online banking being the order of the day, the icing on the cake is the curse of modern technology, namely, the computerised answering service stating dial 1 for customer service, dial 2 for accounts-----
-----dial 3 for ALONE or dial 4 for credit card information. If one dials 4, one must enter one's account number and PIN and then wait and hope to goodness a human being may come on the line, and they rarely do for another 35 or 40 minutes. Members who have not seen the film "The Best Exotic Marigold Hotel", it is worth a look. After the death of her husband, Dame Judi Dench is on the telephone to a call centre in India and the call centre girl had never been trained emotionally on how to accommodate and deal with an older person who had just lost her husband and it is a serious business.
I want to take the Minister of State to somewhere close to where I live, namely, the McAuley centre in Naas, County Kildare. It is a world-class centre of excellence.
It is somewhere to "age in place" for older people who might not be able to manage a three or four-bedroom house or garden but could easily manage a one-bedroom apartment, were it located in the heart of a town. It is an alternative to institutional residential care for older persons and a model that creates a society for all ages. This development is within walking distance, not for an able-bodied individual but for a person with arthritis, bronchitis, angina or similar, of shops, services and public transport. It has on-site intergenerational facilities and emphasises what people can do rather than what they cannot do. It is about wellness rather than illness and 12 years after first being envisaged, McAuley Place, located in the former Mercy convent in the heart of Naas, consists of 53 apartments. I love its website and ask all Members to have a look at it. Indeed, they should all book in because Senator O'Donnell should note rent is only €85 per week with a service charge of €10 per week and tenants pay for their own electricity. It is about living an independent life but as part of a community. It is about being the boss of one's own life, having access to the arts and opportunities for lifelong learning. It is about living where one's age is not an issue. It is about where one is more aware of what one can do as opposed to what one cannot do. Residents have opportunities to volunteer, to make new friends and to maintain old friendships. They have easy access to shops and services and live 130 paces from a bus stop that gives one access to Dublin Airport and, therefore, to the entire world. Living there entails being challenged to go outside one's comfort zone and is about ensuring one can maintain or regain the optimal level of well-being. It is great not to need a car. It is about having enough stress to keep one challenged but taking away that stupid stress of being obliged to manage alone. Incidentally, speaking of stress for a moment, I could talk for hours with Senator O'Donnell on the subject but I have three people who are over 90 and to be honest, it is a stressful situation. As for somewhere like the McAuley centre, I sometimes think it would be great to be able to free up the three-bedroom houses for families. Older people could move in to be safer and in a collective and Senator O'Donnell and I could discuss the property tax and how we access it online to pay it because we have not a clue without help. It is about having choices about what one does every day and having the expectation of the unexpected. It is about being proud of where one lives. While it is not a home, it is home. A wonderful concert will be held there this evening which I would attend, were I not present in the Chamber. A total of 17 musicians have been gathered and everyone in the town of Naas will attend; it is not just for the elder people. One might think that is all very well for older able-bodied people but I ask the Minister of State to visit that centre with the Minister for Health, Deputy Varadkar. It is a piece of low-hanging fruit in that with planning and not too much cost, villages like that could be built throughout Ireland and the Minister of State and I could book in for later on. Believe it or not, this evening's debate is about planning for our future.
However, what about those who must enter nursing homes? Again, I have one such person who is in a nursing home. Luckily, my own experience is wonderful and I cannot express my admiration and awe for the carers I have encountered. However, Members must envisage nursing homes that provide much more than a television set on a wall. Nursing homes are needed that have sensory rooms and a screen showing lovely movies from the years when the guests themselves were young, to allow them to reminisce. Nursing homes are needed in which animal lovers are able to pet a lovely carefree dog. As Senator O'Donnell is aware, I adore dogs and bring two dogs into the nursing home every Saturday and for old people with serious dementia in particular, my blessed dogs give pleasure. The dogs do not care what age one is or what one looks like. They will sit on people's laps and stare at them adoringly. It is amazing what a care dog can do. Young actors, there are enough of them around, could read aloud to residents and teenagers should come in to perform classical dance. Personal instructors should come in to teach chair yoga, that is, gentle exercises and meditation.In some nursing homes, daytime television is the order of the day but daytime television is a way to disimprove one's mental health.
I have so much to say but my final word will be on practicalities. Only 50% of us have wills.
Only 10% of us have an enduring power of attorney, which shows there is a lot to be done. If it is legal by 2035, I would like to give a living care directive to my medical and legal team, which would mean that I do not have to take antibiotics to combat a chest infection when I am 85 years old and feel that I am no good to anyone and am a burden to myself and my family. In such circumstances, I want to be able to go.
I, too, would like to compliment the Senators who tabled this motion. We all agree that this is not a debate about charity but a debate about our obligation as a people to those who built up our country, worked, paid their taxes and reared their families. Sometimes the wrong perception goes out because at times we seem not to value the worth of people because they have reached a certain age. It is quite easy in a debate like this to advance a set of statistics to prove or disprove a particular point. I would not want, in any way, to say we cannot give consideration to those statistics, which are important, but there is an attitude of mind that must be considered. Very often that attitude of mind permeates a lot of our discussion and communications. At times we think only of younger people, how they must be served and provided for, and rightly so. It is also important to have equality because we talk about equality in a democracy.
I do not know how many Members have had the opportunity of visiting a community daycare centre. I strongly recommend everyone should do so, particularly in rural Ireland. I can think of one centre that I visited in Kilmalley in County Clare which is a model in every sense of the word. There are many messages to be learned from the centre. The people who go there once a week spend the whole week in anticipation because they love it so much. When they go to the centre, they meet their neighbours, they reminisce and they encourage each other. The ladies can get their hair done and everyone has lunch there. All of that is part of the service provided. The message that I have learned is that when one has the right model and the right personnel in charge of any project relating to older people, then it will work.
Some Members will have had what I would regard as a very distressing experience of seeing an older person being brought to a nursing home. There are times when one cannot do anything about that but there are many occasions when it happens simply because parts of the structure that would enable people to remain at home and mobile are missing. I urge Members to always try to remember that the old person who has been placed in a nursing home feels deserted and that nobody loves or cares for them anymore. We must keep that in mind. I know cases where people get just one hour of home help during the day which is sufficient to keep them at home. It gives them a sense of independence, a sense of worth and the respect, to which they are entitled. As I said, we could all advance statistics but I am not going to do so in this particular case. However, I will say that increasing home help from one hour to two hours could make all the difference. We are not talking about hundreds of cases but about thousands. When a loved one wants to look after a parent and his or her home needs to be adapted, the pace at which the decision is made is important. If it takes too long to reach a decision, then the operation may fall apart entirely. As a result, the adaptation will not take place and the parent will end up in a nursing home.
We must admit that family structures have changed and are not what they were and people are out working. We must be cognisant of all of those types of issues. We are not going to be able to set the clock back but we need to move a little faster in our understanding that in the same way as communication has changed. For example, there is now social media and many old people are outside of such technology. I have even heard of old people who were able to drive a car but when roundabouts came into existence, they would no longer drive their car. That is how simple a change in lifestyle can affect older people. We often make those changes for the better but in most cases, without considering the impact that remains behind.
The media can also play a role. We often hear of great achievements by people being presented in the media. However, they are achievements that do not always press a button or set off the lights. I refer to the achievements of older people in their communities which I have seen in various committees and organisations. The organisations also play an important role. The GAA, Comhaltas Ceoltóirí Éireann, the Irish Country Women's Association and farmers, etc. are the bodies that keep in contact with the older people. I always recall the time when President Mary McAleese appealed to organisations to look out for older people. I heard the comment made by Senator O'Donnell earlier and agree with her 100% that if one leaves an animal unattended for a few days at home, one is likely to have an official visit. Very often we do not look out for older people in the same way. There was the dreadful case in Tipperary, which was published in the newspapers recently and which was absolutely mind-boggling. We need to look out for older people and bring back the community spirit that existed in the past. I urge people to look out for people when the weather is not good, etc.
I said I would not quote statistics as I do not think this is the time for political point scoring. In terms of what has to be achieved, I wonder in what way will what we have said here inform change and a response to the problems which exist.
I hope that this is just the first debate that we will have here. It would be well worthwhile if we could come back in the near future and have a further discussion because this subject is important. The people concerned are assets to this country, so we need to look after them and fulfil our obligations.
I agree with all Members who have spoken so far. I also compliment Senators O'Donnell and van Turnhout for tabling the motion. We are all on the side of the elderly but will there be any action after all of this talk? I have worked with older people and know that we have made some good strides but a lot more needs to be done. I will outline one of the improvement that have been made. This time last year in order to qualify for the fair deal scheme, one had to wait between 14 and 16 weeks and pay upfront but now the wait is only two weeks. That is a massive improvement in waiting times, which is welcome.
However, there has been enough investment in home care packages and in the home help service. I know from talking to home helps, a fact which I have said over the past couple of years, in my county one is not talking about home help hours any more but home help minutes. Home helps have been asked to go into houses for 15 minutes to do whatever they can but that is nothing. Massive improvements need to take place there. More investment in home care packages and home helps will also save on the fair deal scheme.
An issue I raised in the Seanad some weeks ago is that there is no joined up thinking between Departments. Each Department has a budget and Departments do not talk to each other. For instance, I know a lady in my county who suffered a stroke some months ago. She is now in a bed in Galway, which costs the State €100,000 a year. All she wants is a grant from the local authority to adapt her home and make it suitable for her to leave her bed and be looked after by her family.The grant would be €35,000 but because she is a little bit over the limit, she does not qualify for it. If there was joined-up thinking between Departments, the Minister for Health would say to the Minister for the Environment, Community and Local Government that they could save €65,000 by just giving this woman the grant. The money is all coming out of the same pocket.
As has been said by other speakers, we all know elderly people who do not want to go to a nursing home. They want to be cared for at home. Michael Lambert, who was the oldest man in Ireland and who died last year at the age of 107, was a neighbour of mine. He never spent a day in a nursing home and was in great health up to his death. We should be doing more for the day care centres mentioned by Senator Ó Murchú. I visit the day care centre in my own town on a regular basis. It is a big part of keeping somebody in their home. It is vital for their sanity. I also visit the psychiatric day care centre. For some unknown reason, the psychiatric services in the past couple of years have all been about saving money. I got a call from two psychiatric patients who attend the day care centre in Ballaghaderreen. They were frightened by the threat of the bus service being withdrawn. Even though clinical decisions had been made by the chief psychiatrist that they should attend the day care centre in Ballaghaderreen rather than one in Castlerea, somebody in administration decided it cost too much and is threatening to remove it. We talk a lot about what we should be doing but we are not actually doing a lot about it.
My last point concerns how farmers are assessed for the fair deal scheme. There is a difference between the farmer I know in rural Ireland and the rancher in County Meath. Farmers have small farms that are not worth a lot. I do not think their farms should be assessed against them as a business once they go into a nursing home. A smart farmer who can think ahead and is clever enough to transfer his land to somebody else in excess of five years previously is fine because his land is not assessed against him when he goes into a nursing home. If somebody does not think ahead about the day they might have to go into a nursing home, and I know that the IFA is thinking about this issue, and their land is assessed against them when they go in for the duration of their stay there, it could mean that they could lose the entire farm. These people could be bachelors or they could have family. They might want to keep the farm in the family name. If somebody had transferred their property to somebody else four and a half years ago and they need to go into a nursing home today, one would think that in six months time when the five-year period is up, the land will no longer be assessable but no, if the five-year period is not up, it is assessable for the duration of their stay in a nursing home. I urge the Minister of State to look at the plight of farmers in respect of this issue. If the farm was assessed on the same basis as the house for a three-year period, that would be very acceptable to all concerned.
I totally agree with some of Senator Mary Ann O'Brien's remarks about elderly people or anybody trying to access services on the telephone and being told to dial one for this and two and three for the other. I made one such telephone call today and eventually gave up. I suggest that there be dedicated telephone lines for elderly people relating to the services they need. It can be clear that if one gives the Department of Social Protection one's PPS number, it knows what age you are. There should be dedicated telephone lines for people over the age of 66 where it is vital that somebody answers the telephone because what elderly people have to go through is a nonsense.
Not old age, I hope. I was surprised to learn that we actually had ratified the 1999 UN convention because we are certainly not complying with it and I am not even sure what efforts we are making to comply with it. Are we doing anything? Have we done anything over the past ten, 15 or 20 years to assist our elderly people to reside at home as long as possible? Absolutely not. Have we improved health care provision notwithstanding the economic meltdown? Absolutely not. What sort of provision is there for elderly people in cultural or educational services? It is minimalist. We have gone backwards rather than forwards.
Last week, the budget was well re-played in this House and elsewhere. The debate about the elderly in the budget revolved around the fair deal scheme - the nursing home subvention as I call it. There was a modest but welcome increase in old age pensions. However, if one asked elderly people throughout this country what the services and aspirations they were hoping for - not from a one-day budget but from Government - they would talk about security in their homes, certainty of health care and trying to remain in their homes as long as possible.
The Minister of State is doing her best to try make progress on the fair deal scheme. I raised the very lengthy waiting period for assessment many months ago in this House, as did my colleagues. We have become obsessed with this scheme as being somehow a solution to elderly care and we see the nursing home, the decent nursing home bed and decent nursing home provision as meeting the aspirations of the elderly. We must recognise that the vast majority of elderly people in this country do not want to be in nursing homes. They want to be at home with their families and communities. We have completely failed to respond to that aspiration.
Senator Kelly gave the figures about the individual case in Galway and we can all talk about such cases. We can all talk about cases where because of our very narrow definition of means for carer's allowance, we are refusing carer's allowance payments to family members and neighbours which would cost the State a maximum of €10,000 per annum. In many cases, those people who fail to get the assistance of a carer's allowance end up in residential care costing the State a multiplicity of those figures. Due to the economic meltdown, our changes to the public health nurse scheme and the home help scheme have resulted in people seeking long-term residential care rather than care in the community.
Our focus is wrong. We receive on a monthly basis lobbying calls or letters from the nursing home organisations. Of course, I would lobby if I was them because it is a profitable venture. This is not charity. It is a cold and clinical business. Insofar as the State can respond, we are responding to that business - perhaps not as sufficiently as they would wish - but we are not responding to the much broader issue of attempting to allow people to remain at home. I know that in the Minister of State's response, the Minister's response and the response of all politicians, we will claim that we aspire to allowing people to remain at home but we are failing to do so. Senator Kelly, as a former community welfare officer and former member of the council, and I can remind the Minister of State that there was a time when the very basic disabled person's grant scheme processed locally resulted in a modest grant of €1,500, €2,000 or €3,000 being paid to somebody to permit a minor improvement to their house from an accessibility perspective to allow them to stay at home. Now there is no point in approaching the council seeking a grant of €1,500. The job needs to cost €15,000 or €30,000 before the council will even consider it.We really have lost the run of ourselves and common sense has gone out the door. The schemes which existed and worked well, such as the home help, the disabled person’s grant and the carer’s allowance in its early days, were real solutions. We must go back to those practical solutions because they worked. No matter what progress the Minister of State makes with the fair deal scheme, there are all sorts of anomalies, a fact highlighted by Senator John Kelly. Even if we remove the assessment waiting lists, it will not solve the problem of those who want to stay at home. It must be a question of focusing on community, changing the carer’s allowance, providing sufficient home-help packages, freeing up the old disabled person’s grant and making them work.
I commend the Senators on moving this motion and causing us to reflect on this issue once again. We are failing the elderly. This country is facing a pensions crisis, along with an entirely new set of demographic problems. If we think progressing the fair deal scheme is the answer to it, we are sadly mistaken.
Senator Marie-Louise O’Donnell started off on a high note. I was fascinated by her description of those who have reached a certain point in their lives when they could dispense with wisdom. That is the type of later life experience I want and she wants too. Thankfully, there are still some people with some bit of joy in their hearts.
Having listened to the most recent speakers, however, I must admit I am not certain I want to get to that stage in life at all. If that is what people see as what it will be like in later life, it is quite worrying. We must deal in facts. Of course, when one looks to the future, one has to have aspirations. Facts are important as well, however. For example, there are 575,000 people over 65 in this country. Of those, 4%, 23,000 people, are in nursing homes. Up to 50,000 of them are in receipt of home help. It might not be 24-hour care but they are in receipt of it. Up to 13,600 people are in receipt of home-care packages, which is an enhanced home-care provision. Every time I talk about psychiatric units, psychiatrists tell me we are not there yet. I am never certain where there is. I am never certain that when we get there, should we be there at all. Surely, it will change and we should be open to change. Members know the majority of older people lead happy and fulfilled lives.
I have said many times that I am charged on three different fronts. In the context of mental health, I am charged with closing down big institutions and bringing people out of them. Senator Ó Murchú is involved in one area with me in this. When it comes to disabilities, I am also charged with ensuring people come out of institutions. However, when I addressed a conference on nursing homes, I made it clear that it would appear to me that I am charged with putting older people into nursing homes. I have no intention of doing that. Later life is about much more than dependency and so forth. We now have a single assessment tool which means it is quite difficult to qualify for the fair deal scheme to go into long-stay care. The evidence of that is that people used to live for three years in a nursing home setting. Now, they are living for half of that time and it tends to be more for end-of-life, high-dependency care. That is a good development.
I know I do not want to end my days in a nursing home. I most definitely do not want to end my days in a single room at the end of a corridor that lives up to HIQA standards. I want to live in circumstances that are appropriate to my needs. I am concerned the focus of this discussion is that it will all end in tears and we are all doomed. It is about more than that and we should aspire to more than that.
When I am calling for more resources to be put into this sector, we need to stop talking about age. Senator Marie-Louise O’Donnell gave the example of 99 year olds living independently, perfectly happy and with no supports. However, there are 40 year olds who need home help. It should be more about needs rather than age. That would change our vision. What would I do if I were a member of a new Government starting out and could determine what would happen in this area? I believe we should have a new ministry for primary and social care, separate and independent from health. If one looks at the list of what Members said older people need, I have very little responsibility for many of things included on it. The telephone allowance, safety at home, alarms, carer’s allowance, prescription charges, all have nothing to do with me. These are all delivered by other Departments in a different way and with a different focus. Accordingly, how can one have can have joined-up thinking, as Senator Paul Bradford demanded? Surely, it could be done if there was one Department with responsibility. We must start to think how we can do this better. The housing adaptation grants are the responsibility of the Department of the Environment, Community and Local Government. If I told the Minister for the Environment, Community and Local Government that the €22 million for the grant should be my responsibility, I can imagine the answer I would get. We must have a more co-ordinated, more cohesive and more visionary approach to dealing with our aging population.
For the past four years, the Government has been doing its very best to ensure the country did not go down the tubes. It was about maintaining the services as they were. We have a little more flexibility now, which is why we are putting more money into home helps and home-care packages. We should not assume, however, that we know what is best for other people. Senator Mary Ann O’Brien spoke about how she wants to be able to make decisions for herself when she reaches 85 years of age. Just today, the Dáil concluded its deliberations on the Report and Final Stages of the Assisted Decision-Making (Capacity) Bill 2013.
It will be taken in this House on 10 November. That legislation will ensure that Senator Mary Ann O’Brien will be able to make those decisions for herself. Bringing it through the Lower House taught me that one can never assume what someone else wants. By the way, I met the group Senator Mary Ann O’Brien referred to last week and some progress was made in enhancing the service it will be able to provide.Sometimes there are people in that circle who will not allow that movement to happen and the assisted decision-making (capacity) legislation will allow people to make those decisions for themselves because it will be an offence to coerce, or to put undue pressure on, someone to make a decision contrary to his or her own best interests.
I hope the future is bright but given debates such as this, it has to be bright. At least we are thinking about this. God knows we did not do that in the past. I agree we need to change our focus and we need to ensure that when people make a choice and outline their will and preference, we are able to support that. However, I am nervous that we would assume what people want. Some people will want the security of a nursing home and long-stay care and others will not. It is not what I would choose but we should ensure they are facilitated. I congratulate the Senator for tabling the motion. The debate is important and it is also important that we were open enough to have it because, at the end of the day, we are discussing our future and we should not assume that those who are described as "older people" are somehow some kind of alien species and the rest of us will not reach that stage when we know that with great good fortune we will. I read Being Mortal: Medicine and What Matters in the Endand I agree entirely with the opening sentence. Every morning one steps out of bed, it is a roll of dice as to whether one will make it back there safely that night. That changes one's view of the world.
The Minister of State is a formidable opponent. I am not surprised that more colleagues are absent. I do not mean this is an accusatory way but this is a profound issue and it will be the major issue of the decade. It is more profound than water charges or arguing about, or because of, territory. I know Margharita Solon who imagined and developed the McAuley centre in Naas, County Kildare. I read all her work and I spent time there during the year. When I spoke to her about older people, she said, "Who are you talking about?" I replied, "Well, the older people who live here." She asked, "What do you think you are?", and pointed out that they are human beings. I take the Minister of State's point in this regard. She referred to agelessness. We will all get old but that is life. I asked Ms Solon what the residents did when they needed a doctor. She said, "What do you do when you need a doctor? You ring a doctor." She was also interesting on cultural change and isolation, whether one is young, middle aged, old, married, single or whatever.
I thank the Minister of State for taking the motion and for standing up to much of my contribution because she is right. However, there does not have to be neglect or institutionalisation. We should put more imagination and creativity into caring for people at home and use templates from around the country, including the brilliant ones in Cork, that are working well. It does not always have to be one way. That is what I was talking about.
I was a member of the Seanad Public Consultation Committee, as was Senator van Turnhout, who seconded the motion. It was amazing. It was the first time that I realised that old people get depressed. That issue was highlighted in results produced by the Centre for Ageing in TCD. One thinks of loneliness but older people do not talk about their depression in the same way. It seems to be the preserve of a younger cohort. The Proclamation states that no one who serves the cause of the Republic "will dishonour it by cowardice, inhumanity...". I was arguing the case for humanity, as was the Minister of State.
The problem about being old is that people are never old, they are always young. We think of them as old. I oppose the fact that 80% of nursing homes are stand-alone businesses. The business template takes over and the residents are secondary to that. The homes have to look into the way they operate.
In response to Senator MacSharry, the Government should examine the possibility of providing the fair deal scheme within the home. It might work because the participants could perhaps hand over a higher percentage of the value of their home when they die. We do not pass on; we die. That is another myth.
Some Nordic countries have an adoption process for older people. I like that extraordinary idea. It works because many couples and individuals are lonely and they would be happy to have somebody to look after. They might not have had the privilege of parents or grandparents and they might love to adopt an older person. There are also crèches within nursing homes in these countries, which is a wonderful idea.
The issue is not money. We need to be creative and imaginative with our nursing home structure because we need nursing homes. I have met the most extraordinary people in care in nursing homes and caring for older people in them through my work outside the House. The arts, music and culture can be used imaginatively in these homes.
I do not want to end my days in a nursing home and neither does the Minister of State. If I was to write a paper as to why, or if she was to talk to me outside about this following the debate, we would outline what is wrong with them. By that, I mean when they do not work for the person and they work according to the business template.
The Minister of State made a good point about a Ministry for primary and social care. She made a massive case for it and she would be good as Minister. If I was in her position with her knowledge built up over the past four years, I might use that platform in the next election. She has been an amazingly communicative Minister and it would be interesting to marry the different responsibilities of Departments for older people into one central Department. They do not talk to each other and they affect people's lives through delays and so on. It is a good platform and the Minister of State should use it, given her knowledge. There is nobody better than her to bring this about.
I thank her for taking the motion. I will return to this issue. It is not going away because our lives are not going away. Time and tide stops for no man.