Pauline Tully (Sinn Fein)
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I wish to raise the issue of boarding-out regulations, that is, the service for older people. Not everyone is familiar with boarding-out services. This is a service for older people who are mobile and generally in good health and who do not require nursing home care but who cannot live on their own because they might not quite manage or they do not want to because of loneliness and so forth. Instead, they can live in a house in the community, which is arranged by the HSE. A family can take up to six residents to live with them in their home. The HSE pays a certain amount for each resident and then each resident also pays a percentage of his or her pension, determined by the HSE.

This was a common enough practice the Cavan. There were eight boarding-out houses at one time. We are now down to one. That one has given notice to the HSE that it is going to finish up at the end of July. The reason it is finishing up and many of the others have stopped operating, not just in Cavan, but in other counties as well, is that the regulations introduced in 1993 have not been updated since. There was a review carried out about 15 years ago, but it was a very basic review and little changed. The statutory instrument - SI 225 of 1993 - and its regulations need to be updated. Providers need to see an increase in the amount that the HSE pays. They need to see that standardised across CHO areas because different areas were paying different amounts. They also need to see an increase in the amount that the resident pays. They would like to see the number of residents per household be increased from six to nine. They have also asked that tax exemptions, similar to the rent-a-room exemption, be introduced to make the scheme more attractive.

I have been raising this issue since 2020. I have raised it with the former Minister for Health, Stephen Donnelly, and then with the Minister of State, Deputy Butler. I had many interactions with the latter about this. I submitted parliamentary questions, raised the matter on the floor of the Dáil and written to the Minister of State. At the time, she assured me that she was having her officials update the regulations, but nothing happened. I raised the matter with the current Minister of State, Kieran O'Donnell, and I have been hearing since March that he is going to do something about it, but nothing has happened.

It has come to crunch point now because the last provider is finishing up in just over a month. The residents living with her were in tears when they heard this because they have nowhere to go other than into a nursing home, which they do not want to go to. In terms of the cost to the State, the difference between putting them in a nursing home and keeping them boarded out is about €30,000 per year on average. It is huge. The HSE pays between €8,000 to €9,000 at the moment. In a nursing home, it would be paying a lot more than that. It could be anything up to €50,000 a year.

This scheme needs to be updated, revised, made more attractive and expanded because it is a very good scheme. I was talking to the residents living in the house the other day. Basically, they get their food and their board there, but they can come and go as they please. They can get a bus into Cavan town or Longford town. They can go to bingo. They can go to the pub for a drink. It is an independent life with just a little bit of support and so they are not living on their own. They are going to lose all of that now because successive Ministers have failed to update these regulations. The HSE has also failed to promote this scheme. It is a very good scheme that would suit a lot of people and keep them in their communities and out of nursing homes, able to live a supported but more or less independent life. That is what we need. It is something that is supported strongly by the charity ALONE as well.

Seán Canney (Galway East, Independent)
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I thank the Senator for raising this issue. It is something we all need to be aware exists. A lot of us do not know about it.

The boarding-out scheme offers an alternative care option for older people who are no longer able to live independently in their own homes and wish to remain in their communities where they may otherwise be accommodated in residential care. The boarding-out scheme currently operates across three former community health organisation areas, namely, CHO 1, CHO 2, and CHO 8. The HSE has reported that there are only eight service providers operating the scheme across the country, with approximately 39 people availing of this service.

The most recent review of the scheme was completed by the HSE in 2017, which concluded that there was merit to further review of the scheme and its utility and viability, in rural areas in particular. The HSE review also noted possible challenges to the expansion of the scheme, particularly the current funding model. The review also noted that consideration should be given to the impact on the welfare of residents that might arise from the lack of requirements in relation to specific training or qualifications needed to be able to deliver the scheme.

The Minister of State with responsibility for older people and housing has requested that officials in the Department of Health consider this model of care and the regulations for this scheme as well as the rate of pay.The Minister of State, Deputy O'Donnell, has also requested that they consider the implications of the rising costs for operations associated with running these types of accommodations. The Department is aware of the challenges being faced by operators currently providing boarding-out services and acknowledges the inflationary cost pressures associated with the service, particularly with regard to heating costs. Additionally, it is the Minister's view that consideration must be given to modernising the scheme. For some people with limited care needs, this scheme can represent a cost-effective alternative to residential care services, as the Senator said. A potential expansion of the scheme merits consideration and further exploration, particularly in rural communities.

Pauline Tully (Sinn Fein)
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The Minister of State, Deputy O'Donnell, told me that he was unable to be here because of questions to the Minister for rural affairs in the Dáil. What he is saying is really reassuring, but I have been hearing that for a number of years and nothing has been done. When I first raised this issue in 2021, 51 providers were involved. Now there are only eight. That tells you that people are leaving. It is not because they do not want to continue. It is because they cannot continue because of the cost pressures of inflation, with food, fuel and electricity having all gone up. The money to provide the service has not gone up in tandem with that. The provider I was talking to the other day said it was difficult for her to afford to pay staff. She is working round the clock and she is not even getting the minimum wage with the amount of money she is getting per hour. I hope something can be done on time before she exits this service, but I am not sure about that at this stage. If it can be looked at, updated and encouraged, more people might get involved if the scheme was more attractive.

Seán Canney (Galway East, Independent)
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As previously noted, the boarding-out scheme facilitates older people to remain in their communities, which is important, where their level of care or needs do not require them to enter residential care facilities. It is all about getting some support locally. While the use of the boarding-out scheme by the HSE has traditionally been small, the potential of the scheme merits consideration and further exploration. I acknowledge that it may benefit from measures to allow for greater flexibility in the payment mechanism too. The Government aims to provide and fund services that allow older people to remain independent and living in their own homes with dignity and independence for as long as possible. Where staying at home is no longer an option, the State supports individuals to access long-term residential care. This model provides an example of how we can support people with additional needs in the community so that they do not have to enter long-term care facilities.

We will continue to develop and improve health services in the regions to meet this objective and to ensure quality and patient safety. In this vein, the Minister of State, Deputy O'Donnell, has requested that his Department consider this model of care in the context of the Government's overall commitment to enhancing opportunities for older people to stay in their homes and communities longer. I will bring the Senator's issues back to the Minister of State.

Malcolm Noonan (Green Party)
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Gabhaim buíochas leis an Aire Stáit. Tá brón orm, a Sheanadóir Ní Chuilinn. Níl an freagra réidh fós so leanfaimid ar aghaidh go dtí Ní i dTosach Suíonna 4.