Denis O'Donovan (Fianna Fail)
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From one Roscommon person to another, I now call on Senator Swanick.

Keith Swanick (Fianna Fail)
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I thank the Minister of State for taking the debate. I am sure that as Minister of State, he has visited many nursing homes. As we know, they are fantastic institutions operated by dedicated individuals who selflessly work night and day to take care of our loved ones. Nursing homes play a key role in healthcare delivery in Ireland. It is never an easy decision for families or individuals to make to enter a nursing home. I have heard many fabulous stories of fantastic care received in nursing homes but my issue concerns people who are placed in these settings for no reason other than there is nowhere else for them to go. The case of Julia Thurmann was recently brought to my attention by Councillor Cormac Devlin. Ms Thurmann was 34 when she found herself moving into a nursing home in 2008. Ten years later, she is still there and her attempts to live independently have come up against repeated obstacles. Ms Thurmann resides in a nursing home in north County Dublin with 120 other residents, some of whom are suffering from dementia. While her placement in the nursing home costs the State more than €62,000 per year, independent living would cost the State significantly less. Her placement is inappropriate. We are trying to get away from congregated settings to community settings and we need integration, not segregation. I implore the Minister of State and the Government to redouble their efforts to support individuals with disabilities who are living in nursing homes, to bring to an end the congregated settings in which they are living at present and to afford them the opportunity to live in dignity.

Finian McGrath (Dublin Bay North, Independent)
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I thank Senator Swanick for raising this important issue. I acknowledge, from working with him over the past two years, that he is very supportive of all people with disabilities, as well as of the rights of the person with a disability who is in a nursing home and who I firmly believe should not be there. I will respond to that in detail. It is important that we have this discussion because I wish to make clear that my position, and the Government's ongoing priority, is the safeguarding of vulnerable people in the care of the health service. We are committed to providing service and support for people with disabilities, which will empower them to live independent lives. That is the plan and the vision.

The health service provides specialist disability services to enable each individual with a disability to achieve his or her full potential to maximise independence, including living as independently as possible. Services are provided in a wide variety of community residential services, in partnership with service users, their families and carers and a range of statutory and non-statutory voluntary and community groups. These services are provided within the available budget. Although most families would prefer to be able to care for their loved ones at home, for various reasons hospital or nursing home care is at times necessary to meet their care needs and therefore forms part of their continued care. In addressing the needs of adults with a disability, the full range of community services available are tailored to meet the needs of the individual. The health service works with local authorities, Departments where applicable and other public services, as well as the voluntary sector, in seeking to tier the services to best fit the needs of the individual. There are now fewer than 2,400 people living in a congregated setting and each year, more people are being supported to move into the community and independent living. This year, we expect another 170 people to move on. However, the Health Service Executive is aware that many people with disabilities reside in nursing homes. We accept that point of Senator Swanick's argument. In some cases, people may have enhanced support in respect of their disability support needs.The review of the nursing homes support scheme published in 2015 states that only 5% of long-term nursing home residents are aged under 65 years. However, it is recognised there are a small number of younger people who require full-time nursing home care, such as those who have had a stroke or perhaps an acquired brain injury. To establish which places are inappropriate and which are appropriate based on the primary needs of the individuals, an expert working group, led by the Disability Federation of Ireland, is currently carrying out a review of all those with disabilities aged less than 65 years of age that live in nursing homes.

The nursing home sector is used in developing options to meet the needs of some adults with a disability where no other alternatives are possible. We need to regularly review these individuals to see if, through their care plan, a more appropriate option might be available. In this particular case, it appears that one is. In the longer term, the policy is to develop a more tailored service suitable to meet the needs of these service users.

In 2018, funding of some €1.772 billion in total is being provided for health and personal social services for a wide and complex range of services and supports for those with disabilities, an increase of €1.9 million on last year. This year, through the HSE, we will provide over 8,300 residential places, as well as emergency supports for 385 persons. We will provide over 82,000 respite nights and 42,500 day respite sessions to families in need right across the country. I assure the House, as I have done on many occasions previously, that my ongoing priority is the safeguarding of vulnerable persons in the care of the health service.

As Senators will appreciate, I cannot comment specifically on an individual case. However, I can confirm that my office has been in weekly contact with the person to whom Senator Swanick refers in his question in an effort to help secure more suitable accommodation from that which the person is currently in. I can assure Senator Swanick and the House that we will continue to support the person concerned until such suitable accommodation is found. In addition, I am informed that the HSE has been engaging with the person concerned and the family, and will continue to do so.

Keith Swanick (Fianna Fail)
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I thank the Minister of State for his detailed response. It heartens me to hear that he is in contact with the individual concerned.

As the Minister of State will be aware, the population is getting older. In the next 30 years, the number of people over 65 will double and the number of people over 85 will quadruple. Of course, that will put extra pressures on the health system, especially residential units. I hope and pray that we will not be forcing people to live in inappropriate accommodation when that happens.

Finian McGrath (Dublin Bay North, Independent)
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I thank Senator Swanick for raising this particular case, but also the broader issue because we have to deal with that issue when it comes to institutional settings.

I emphasis that we have been dealing with the particular case the Senator raised. Two of the advisers in my office have been on to the Housing Agency and Fingal County Council. They have also been working closely with Senator Dolan on this issue to secure a specific house that would become available. We will continue pushing that issue.

On the issue of those with disabilities having the right to live in their own settings and in their own homes, it is an important right. When I took over as Minister of State nearly two years ago, at one of the first institutions I visited I remember a young man in a wheelchair coming up to me who had been in an institution all his life. He was very disabled physically but, intellectually, there was not a bother on him. He said to me that he would love to have his own place, his own telly and have his meals when he wanted and do it on his own terms, not to be staying in an institution where he had set times and set menus. I get the message strongly.

We will keep following up on this issue.