Fiona O'Loughlin (Fianna Fail)
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I welcome the Minister of State, Deputy O'Donnell, to the Chamber.

Kieran O'Donnell (Limerick City, Fine Gael)
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I welcome the opportunity to discuss nursing homes and the care of older people with Members of the Seanad.

I acknowledge the "RTÉ Investigates" programme that was broadcast on 4 June. This hard-hitting and harrowing programme highlighted a litany of poor care standards in two nursing homes, showing clear neglect and abuse of older people, namely, The Residence Portlaoise and Beneavin Manor in Glasnevin. The welfare of both the residents and their families was obviously at the forefront of my concerns following the RTÉ programme. I am very conscious of the impact this programme will have had on the residents, their families, and the staff in the nursing homes featured in the broadcast. I am also conscious of the impact of the programme on the nursing home sector more generally.

It is important to acknowledge the committed, compassionate, and dedicated providers and care staff operating in nursing homes across the country. Like everyone else watching the programme, I was shocked and deeply concerned at the level of non-compliance with care standards in evidence from the distressing footage that was aired. Nursing home residents deserve, and should expect, the highest standards of care at all times. Poor care, mistreatment, neglect, or any other form of abuse of any person living in a long-term residential care centre is completely unacceptable. I expect the highest standards of care to be upheld by providers for every resident in every nursing home in the country, and anything less than this standard will simply not be tolerated.

I welcome confirmation that referrals have been made to An Garda Síochána. Responsibility for the safety and care of residents ultimately rests with the individual provider of each nursing home and their staff. The governance and management of nursing homes is a critical aspect of ensuring the safety and welfare of all residents. Staff must be equipped with the tools and supports they need to provide those in residential care with person-centred care.

As the national independent regulator of nursing homes in Ireland, I expect HIQA and the office of the chief inspector to utilise all powers available to them to ensure rigorous oversight and accountability in nursing home care. HIQA's role is to ensure that the systems, structures and processes that have been put in place by nursing homes work to ensure safe and effective care and support for residents in residential care.

I, along with officials from the Department of Health, met with HIQA on 4 June to discuss regulatory activity relating to the nursing homes featured in the "RTÉ Investigates" programme. At this meeting, HIQA's chief inspector confirmed its continuous intensive engagements with the two nursing homes in question. As requested, on 13 June, HIQA furnished me with an interim report on its engagement with the two nursing homes in the previous two weeks, which was published on 17 June. This interim report details HIQA's inspection of these nursing homes since the "RTÉ Investigates" programme was broadcast and its ongoing work in this regard. It also provides a brief overview of the Emeis Ireland group.

The Minister, Deputy Carroll MacNeill, and I, along with officials from the Department of Health, met with HIQA on 17 June to discuss the interim report. It is critically important that residents of nursing homes reside in a caring and safe environment. I have had significant engagement with key stakeholders in the nursing home sector, as well as HIQA, plus the HSE and representative bodies from the sector. I am continuing this engagement with an immediate focus on delivering the highest quality of care to the residents of nursing homes in Ireland.

A review of safeguarding concerns raised about the two nursing homes is ongoing. The HSE has also confirmed that it will be engaging with all nursing homes in the Emeis group in the coming period. HIQA's chief inspector continues to intensively engage with the two nursing homes featured in the RTÉ programme. HIQA has completed a series of recent unannounced inspections of both nursing homes in the evening, the early hours of the morning and during the day to ascertain the level of care being provided at all times - day and night. Both providers were issued with an official warning of cancellation of registration by HIQA should they fail to implement significant improvements in the care of residents. I assure Members of the Seanad that the Minister for Health, Deputy Carroll MacNeill, and I and the Department of Health will continue to closely monitor developments regarding both nursing homes. The welfare of residents and their families will remain our highest priority.

Last Friday, as requested, I received a report from HIQA which provides a comprehensive overview of the Emeis group and its regulatory history, including, but not limited to, regulatory compliance, escalating enforcement actions, and any additional conditions of registration. The contents and findings of both reports are being considered, including the need for additional regulatory powers in respect of nursing homes, with actions in this regard to be taken as a matter of priority. HIQA has acknowledged the importance of examining its processes and methodology. It is essential that these are continually being looked at for ways to improve the inspection and regulation of nursing homes.

The Minister, Deputy Carroll MacNeill, and I are fully committed to introducing an adult safeguarding policy for the health and social care sector, including nursing homes. The policy will commit to the development of adult safeguarding legislation for the sector, including nursing homes, and will build on the range of existing legislation, policies, and procedures already in place in the sector for preventing, reporting and responding to abuse. The policy is at an advanced stage and our intention is to bring it to the Government as a matter of priority. The Government has included a health (adult safeguarding) Bill in its current legislative programme to facilitate this. It is recognised that this will be an important further development in preventing and protecting vulnerable adults from abuse.

I also advise the Seanad of ongoing work by the Department of Health to develop a framework for safe nurse staffing and skill mix for long-term residential care settings for older people. This work is being overseen by a task force. A research team from UCD and UCC have undertaken substantial research and testing of a methodology for determining safe staffing in the sector. The work is nearing completion and I expect to receive recommendations shortly on how it can be implemented.

The Government is committed to continued investment in healthcare infrastructure which supports the highest quality care for the older population. It is recognised that long-term residential care will continue to be a crucial part of the overall continuum of care. In this context, the Department of Health, alongside the HSE, is developing a new long-term public residential care additional capacity plan, which will be published in 2025. The programme for Government commits to building more public nursing home beds. This is an absolute priority for the Government.

People are living longer and the number of older people in the total population is growing. The success that has been achieved in improving health outcomes and extending life expectancy must be acknowledged and celebrated. However, we also recognise the challenges we will face in a range of areas in the coming years as our population ages. It is within this context that, in March 2024, the Government established an independent Commission on Care for Older People. The commission is charged with examining the provision of health and social care services and supports for older people and with making recommendations to the Government for their strategic development. Subsequently, a cross-departmental group will be established under the auspices of the commission to consider whether the supports for positive ageing across the life course are fit for purpose and to develop a costed implementation plan for options to optimise and implement these supports. The commission will publish its first report in due course.

The Government's strategic goal is to deliver a new model of integrated older persons' health and social care services across the care continuum, supporting older people to remain living independently in their own homes and communities for longer, in line with the Sláintecare vision for receiving the right care in the right place and at the right time. Engagement with the older population clearly indicates a preference to age in place, in their own homes, for as long as possible. As Minister of State with responsibility for older people, in conjunction with partners in the health sector and beyond, I am determined to support and facilitate this.

The 2025 programme for Government commits to a range of actions that will advance a social care model that supports older people to live full and independent lives, in their own homes and communities, with the appropriate wrap-around supports.Home support is an essential and highly valued service for thousands of people each day in the country. The programme for Government commits to design a statutory home care scheme, which is a key priority for me as Minister of State with responsibility for older people. That statutory home care scheme is something on which I am actively working and it is an priority for me and the Government. In my dual role as Minister of State with responsibility for older people and housing, I am also committed to a particular focus on housing options for our older population in the context of the new housing plan to follow Housing for All. It is absolutely vital we continue to increase the housing options and choices available to older people.

Across the country, nursing homes in the public, private and voluntary sectors play a vital role in the provision of long-term care and other services. It is important to acknowledge the committed, compassionate and dedicated providers and care staff operating in the sector. There are a lot of very good nursing homes. What we saw on the "RTÉ Investigates" programme was horrific and showed an absolute neglect and abuse of older people, but there are a lot of very good nursing homes out there with good and dedicated staff providing good care, and that is something that needs to be acknowledged as well.

It is clear that the scenes that were witnessed in the recent RTÉ programmes have highlighted clear deficiencies in the standards of care being provided in some long-term residential care settings. I want to firmly reiterate that poor care, mistreatment or any other form of abuse of any person living in a long-term residential care centre is wholly unacceptable and will not be tolerated. Every resident of a nursing home deserves dignity, respect and the highest standard of care. The Minister, Deputy Carroll MacNeill, the wider Government and I are committed to ensuring everything possible is done to ensure the distressing scenes we witnessed in the recent "RTÉ Investigates" and "Prime Time" programmes do not happen again in any nursing home across the country. Furthermore, I want to state clearly that I am committed to delivering a better future for older people in this country.

Maria Byrne (Fine Gael)
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I thank the Minister of State for coming to discuss this all-important issue. I am glad he acknowledged the fact that what we all saw on the RTÉ programme across two nursing homes was not reflective of all nursing homes. That is a really important message. When we think about the residents, the people who work there, their families and the greater community that watched that programme, it is horrific. It was frightening that people were so neglected. I am glad to hear from the Minister of State that the Government has taken steps, along with HIQA, to address those issues and ensure that this will not happen again. There are thousands of staff right across Ireland who dedicate themselves to the care of older people.

Here in Ireland, we are all living longer. Who is to say that any of us might not end up in a nursing home down the road? So much good work is going on but to then see the neglect on the other side was harrowing, especially for the families of the residents. We have to move to a model where we show that there is better quality of life for people, people are well-looked after and they can have trust in the level of care they are receiving. Whether it is a private or a public nursing home, it does not make a difference.

I know the Government is committed to more public nursing homes but the queues for the public nursing homes are unbelievable. As he is, the same as myself, from Limerick, the Minister of State will know that the number of people every week who send representations to get into St. Camillus’ community nursing unit and other public nursing homes is unbelievable. There are obviously not enough beds in the public system, so without the private healthcare system, we would be really stuck in terms of long-term care for our people. Private nursing homes are the backbone of healthcare in Ireland. Without them, access to care would be significantly reduced. We have to be very grateful that we have a balance of both. Sometimes, people say nursing homes are out to make a profit but we have to work with both systems and ensure there is a level playing field across them so that people have access to a nursing home and are treated the same regardless of whether they are in the public or private system.

Recently, I was speaking to a family who were looking for a nursing home in the Limerick area. There are waiting lists for all the nursing homes. This just shows that nursing home beds are crucial. Since 2018, 77 nursing homes have closed down across Ireland. That was up to the end of 2024. I am not sure if any have closed in 2025. This represents a loss of 2,800 beds. It is a huge difference and has led to there being waiting lists.

I have had engagement with Nursing Homes Ireland, which represents the different nursing homes around the country. I am not here to advocate for it but I believe it does a very good job in representing the nursing homes. It held a round-table discussion in February and the key recommendation was that a rights-based, resident-led nursing home policy, fully embedded in the continuum of older persons' care, was essential to safeguarding quality, dignity and long-term sustainability. It was recommended that residents should have equal access to primary care therapies and diagnostics regardless of where they lived. If we take the private versus the public, private is across all areas of health. It is in pharmacies, primary care and GP practices. That balance is quite good and will be needed for sustaining nursing home care into the future.

The Minister of State mentioned how the Government was committed to working with the different organisations to provide not only that high-quality level of care but a good quality of life as well. One thing that should be looked at relates to the Department of education or that whole side. Many of the nursing homes run classes, be they art classes or different group therapies, and they should possibly be able to access funding from the Department for the provision of a tutor.

Kieran O'Donnell (Limerick City, Fine Gael)
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Yes.

Maria Byrne (Fine Gael)
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One last thing I wish to discuss is the fair deal system. While it works for many, Nursing Homes Ireland found from surveying its members that their costs had gone up 36% but their income levels had only increased by a small amount, some by less than half of that. While I am not saying prices should go up, we have to try to support nursing homes to keep them accessible to all so that people can afford to go to them, given how we do not have enough public beds. We need to move to a model of nursing home care where every person can live with dignity and autonomy and where they and their families can be assured of a great quality of life into the future.

Teresa Costello (Fianna Fail)
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A recent "RTÉ Investigates" documentary exposed substandard care in nursing homes operated by Ireland's largest private provider. What we saw was a litany of repeated failings, chronic staff shortages and residents left unsupervised, denied basic care and, in some cases, subjected to outright neglect. The most disturbing part was the complete lack of dignity shown to vulnerable people in their final years.

Deciding to move a loved one into a nursing home is never easy. For most families, it is a last resort and something that is done only when a person's needs become too complex to manage at home. I do not know a single person who has not struggled with that decision and who has not felt guilt and worry. Now, those fears have been confirmed. That documentary showed families that their worst nightmares could be a reality. As I watched, my blood boiled. What I found particularly sickening was how staff told families that their loved ones were taking part in activities, giving them a false sense of comfort. Families believed their loved ones were being cared for and engaged with.In reality, they were being neglected. That level of deception is cruel. It was not just cruel to the residents. It was also humiliating for their families. We have all heard the argument that staff are under pressure. We know about the understaffing and that there were supply issues but none of that justifies what we saw. It does not excuse mishandling an elderly person, ignoring someone calling for help or lying to families. If someone is in a caring role, that person's core values should be respect, empathy and honesty, none of which were displayed in that footage.

HIQA appeared before the Oireachtas Joint Committee on Health last week. I listened as it referred to the testimonies of residents and their families and, honestly, I was baffled. How can we refer to testimonies from people who, as we saw on camera, were being lied to? How can we trust the word of dementia patients who say they are happy when footage clearly shows them being neglected? What we saw on camera was the testimony. It was the truth unfiltered.

Beneavin Manor can cater for up to 115 residents and charges roughly €1,400 per week under the fair deal scheme. Despite the company being paid well, staff constantly face shortages of basic supplies such as incontinence products, towels, bed sheets, sanitary wipes and gloves. At the committee meeting, I asked witnesses about the billing process in these homes. I would bet everything I own that these homes are extremely efficient when it comes to collecting payment but ordering incontinence pads is apparently too much to ask. I would think it reasonable to expect that, when HIQA carries out inspections, one of the very first things to be checked would be stock levels of basic care items. If that is not happening now, it needs to be added as a priority.

We also heard that HIQA could not conduct undercover investigations. One of the witnesses told us that HIQA had to declare its right of entry. Unlike RTÉ, the authority cannot undertake undercover surveillance. It cannot turn up in the middle of the night or observe staff in action without warning. How can we get an accurate picture of what is happening if inspections are announced ahead of time or are even just suspected? Issues can easily be hidden. If this is what it looks like with warning, I dread to think what it is like when nobody is watching.

These companies were paid very well for a service they did not deliver. We need to talk seriously about financial penalties because providers should not be allowed to keep money for delivering care when what they were delivering was neglect, humiliation and cruelty. What financial consequences will they face?

While preparing for the committee meeting, I came across a book written by a French investigative journalist who had spent three years investigating Orpea, which has rebranded as Emeis, the company that owns two of these homes. The book revealed a strategy of cost-cutting at these expensive care homes, underpaid staff, illegal use of temporary contracts and the rationing of food and hygiene products. In France, that scandal hit so hard that the company's share price dropped by 90%, and rightly so. Back home, two of our leading geriatric doctors called what we saw in the documentary exactly what it was, namely, abuse. This was abuse in a place that was meant to be safe and neglect in a place that was supposed to be called "Home". Families placed their trust in these homes and, for many, that trust has been eroded, if not completely destroyed. A constituent of mine, a healthy independent man in his 70s, rang me after the documentary aired. He was furious but he was also terrified. He said "God help me if the day comes that I need to go into one of those places." Can you blame him?

I acknowledge that HIQA referred the matter to An Garda Síochána. I welcome that but I would like to know whether there has been any update on that investigation. I am open to correction on this but I understand there are approximately 95 nursing homes under review based on concerns raised. Have the families of the residents been contacted? Have they been told their loved ones live in homes that are under scrutiny?

The governance we saw in some of these facilities was nothing short of disastrous. If we are going to change that, we need to look at how HIQA inspects homes and whether legislative change is needed to allow for undercover investigations because, until homes do not know who is watching or when, we will not see real accountability.

While my speech today has focused on failings in the sector, there are many committed, compassionate and hard-working carers and providers out there. I have met them. They care deeply about the residents and do the work for the right reasons in very tough circumstances. We cannot lose sight of that.

At the same time, these revelations have shone a light on systemic issues in nursing home care and, while the Government's response to date is welcome, we need to go much further to ensure this never happens again. This Government is committed to strengthening protections and will shortly publish the first ever national adult safeguarding policy and develop legislation that builds on what is already in place. The adult safeguarding Bill included in our legislative programme is a critical next step and must ensure robust prevention, reporting and enforcement.

In the end, it is all about dignity. It is about how we, as a society, treat our older people, those who built this country, raised families, paid taxes and contributed so much. They deserve to live their final years with dignity, respect and the highest standard of care.

Nicole Ryan (Sinn Fein)
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In his opening statement, the Minister of State said there were a lot of nursing homes and care homes that did great work, and I agree with him. We cannot tar every single nursing home with the same brush because there are really hardworking people out there doing good work. However, last week, the Oireachtas health committee was presented with a deeply unsettling picture of how the State treated its older people and how little we had learned from the shame of the Leas Cross scandal 20 years ago. We were told that 95 nursing homes were under review by HIQA after serious concerns were raised. Of these, 52 were HSE-run centres, one was a stand-alone home funded by the HSE and 42 were private facilities, 23 of which were stand-alone homes. These numbers are not just statistics. They represent residents at risk, families living in fear and staff under pressure in a system that is failing from the top down. Despite this, we continue down the path of privatising care, handing over the welfare of our most vulnerable citizens to private operators, many of which are driven by profit and not by care. How can the State genuinely claim to exercise meaningful oversight when it has outsourced the majority of this responsibility to the private sector?

How can HIQA hold providers accountable when it is constrained by limited powers and its inspections are often focused more on compliance checklists than on the residents and their lived experience? Last week, the Minister of State appeared before the health committee and stated that HIQA had powers through the courts system. However, HIQA is advocating for more powers to enforce rules. Which is it? Is the Minister of State seriously saying that the only way families can get justice or for care homes to be closed is to drag people through the courts? We heard about homes where staffing shortages were so severe that residents were left without timely care and basic hygiene was not maintained. I reiterate that provision was not made for the basic hygiene of these residents. Safeguarding concerns were raised but they were not acted upon swiftly and families were stonewalled when they tried to raise the alarm. What does the State think of the older generation if they cannot even have their basic needs met or a dignified way to live in their remaining years?

The privatisation of nursing home care has led to a patchwork system in which the standard of care is often determined by your postcode, your provider or your ability to pay. This is not a care system but a market, and markets do not protect people. Regulation does protect people but only if it is robust, independent and backed by political will. The State is funding private care but failing to hold it properly accountable. In HIQA, we have a regulator that is supposed to be a safety net but last week we saw that there clearly were many holes in that net. After Leas Cross, we were told "Never again". That was 20 years ago but here we are again.

This about more than just governance; it is about values. Do we value our older people enough to protect them with strong public services, proper staffing ratios and real accountability? Do we believe that the private market should be the default for elder care or that dignity in later life should be guaranteed publicly? As a State, we have a moral and legal obligation to those in care. At present, we are failing on both. We cannot continue to speak about dignity and compassion while outsourcing care to underregulated, profit-driven providers. The time for reviews and reports is over. Action is long overdue.

Maria Byrne (Fine Gael)
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I welcome the guests of Deputy Aidan Farrelly from St. Seton's Secondary School in Ballyfermot. I hope they enjoy their visit here today.

Patricia Stephenson (Social Democrats)
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I thank the Minister of State and the other contributors. We were all appalled and disgusted by the "RTÉ Investigates" programme, which made for really disturbing viewing. It showed how older people in our communities are being neglected and failed by those responsible for their care. I worry about the reactionary response we take when we see a documentary or TV show that precipitates discussion. It makes us take action and have statements. While I understand the drive for that, my concern is that it means we are reacting and not being proactive. It comes from all the things we have heard from Senators Costello and Nicole Ryan about the challenges with HIQA, in that we are reacting to a documentary instead of having a system in place to catch these things in the first place. It has already been referenced that we have had scandal after scandal in Ireland involving the care of a lot of vulnerable people. We spoke earlier this week about the Farrelly commission. There does seem to be a pattern involving vulnerable people and older people in communities.

HIQA was set up in response to previous scandals. It is ostensibly responsible for inspection and monitoring of conditions in these homes, yet the operating model of HIQA's inspections are not meaningful and do not have credibility. The inspections must be reviewed as they are not effective or meaningful in their current form. We heard that not all homes even come under its remit. HIQA is also incredibly understaffed and under-resourced. Senator Costello spoke powerfully about those matters in her intervention.

We have a reliance in Ireland on the private sector for the delivery of many different services, but especially for the care of older persons. That is a big issue here. Outsourcing the care of our loved ones to for-profit companies is a deeply problematic model. As soon as we outsource the care of any vulnerable person, be it an older person or a vulnerable younger person or adult, to the private sector, which involves the concept of profit, we then look at margins and how we can make the most money. That is often how we see the private sector working. I accept that is not the case with all homes. Senator Ryan made that point as well. However, when we have a model based on private care, this is an inevitability. For that reason I would like to see an expansion of the public model to all nursing homes. Research has shown that the quality of care delivered by private systems compared with public ones is systemically worse. The majority of nursing homes are run for profit – 81% in 2023, which indicates the vast majority of them. The reality is that private models lead to worse outcomes for people. We in Ireland have the most privatised care of older people in communities of anywhere in Europe.

Senator Costello referred also to another key issue, which is the lack of adult safeguarding legislation. We spoke about this at length since I became a Senator. I know there are plans to introduce legislation. Senator Clonan, for example, has plans to do so. It is also a commitment in the programme for Government. This is urgent. It is something that needs to be fast-tracked. It is not something on which we can sit on our laurels any more. It has come up again and again in this Chamber, as it relates to various scandals, which reinforces the need for adult safeguarding legislation. The gap in that regard is leading to systemic failures for the most vulnerable in society. We are in contravention of the UN Convention on the Rights of Persons with Disabilities. Linked to that is the idea of mandatory reporting when abuses of vulnerable adults are encountered, much like the system we have for mandatory reporting of abuse against children. I question why it has taken this long for the Government to take action because we have had scandal after scandal. I hope we are not sitting here in six months still calling for adult safeguarding legislation when some other horrific case arises. We must see this as a precipice and that we choose to take this action and put the systems in place.

I accept the HSE has a safeguarding policy, but it does not necessarily have a remit over the private sector. We have a public sector model with a safeguarding policy. I hope all of the private sector organisations are obligated to have their own safeguarding policy. Perhaps the Minister of State could respond to me on that in regard to how it links in in terms of compliance with the HSE policy. While we might expect HSE nursing homes to have a safeguarding policy, it would be interesting to know if the same level of compliance is expected of the private sector nursing homes. Does it really matter if inspections are not taking place?

The Minister of State could correct me if I am wrong, but it is a glaring gap if HSE social workers cannot meet residents in private nursing homes in that they do not have the right to enter them. The whole point of a social worker is to examine the conditions in a nursing home, and if they cannot do that, it is incredibly problematic if it takes a documentary film maker to go in and investigate the situation.

We should take a rights-based approach to these conversations. We should take a rights-based approach to all of these various issues. That should be at the core of our legislation. Given that 81% of nursing homes are in the private sector and are being run for profit, we are not focusing on a rights-based approach. If we take a rights-based approach to the care of older people in society, we will have better outcomes for them. That is my request. I urge the Minister of State and the Department to make progress in that regard so that we are not sitting here in six months' time or in a year's time having the same conversations about adult safeguarding. We can look back at debates from previous Dáileanna and Seanaid where this has been discussed. On that basis, I question the urgency of the Government's commitment to doing that.

Frances Black (Independent)
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The Minister of State is very welcome to the Chamber today. I thank him for being here to discuss this very important issue. We have a collective responsibility to safeguard the safety, dignity and well-being of older citizens, particularly those in nursing homes and care settings across Ireland. It is a matter of profound importance. As recent events have laid bare, we all know there is an urgent need for reform. It is a moral imperative that we respond decisively.

Most of us have seen and spoken about the recent "RTÉ Investigates" programme, which exposed distressing safeguarding failures within private nursing homes. These revelations echo the tragic failures we saw at Leas Cross in 2005. As a previous speaker said, here we are again, 20 years on. It is outrageous. Other speakers have spoken about the very good care some providers deliver - we must give credit where it is due - but these reports reveal systemic issues of abuse, neglect and human rights violations that are entirely unacceptable. They serve as a stark reminder that, despite progress, significant gaps remain in how we protect our most vulnerable.

Ireland's ageing population is growing rapidly. In 2011, 11.4% of our population was over 65. By 2022, this had risen to just over 15%. Most older people live at home, but many more reside in residential care. As people age, their needs change and their dependence increases. This is where we must get it right.

It is shocking to think that our system for supporting older persons is fundamentally flawed. While inspections can help to standardise care quality, they are snapshots in time and reactive rather than preventative. Complaints are often delayed and investigations sometimes require ministerial requests, creating gaps in timely responses. Systemic abuse, as uncovered in recent investigations, reveals failures not only in direct care but also in governance and oversight.

As other colleagues have said, the landscape of nursing home ownership has shifted dramatically over the years. Since the introduction of tax incentives in 1998, private providers now run about 80% of nursing homes, with a growing presence of large international companies. While this has increased capacity, it also raises questions about regulation, quality and the prioritisation of profit over person-centred care.

Furthermore, the community-based options for ageing in place remain limited. The fair deal scheme, designed to assist with care costs, inadvertently favours statutory support in residential placements, leaving many vulnerable older persons without sufficient options for independent living or affordable community supports. What is the timetable for the delivery of appropriately funded home care or community care? This should be a priority.

In response to these challenges, I support the urgent implementation of the framework for adult safeguarding published by the Law Reform Commission in April 2024. This comprehensive blueprint offers legislative and policy reforms, such as safeguarding orders, warrants for access and transfer orders, that are crucial for protecting adults from abuse. However, progress remains slow. We must accelerate the establishment of an interdepartmental and interagency working group tasked with implementing these recommendations. I note that the adult safeguarding Bill is not on the priority list for the Government's summer legislative programme. It should be prioritised. Equally important is the establishment of a fully independent national safeguarding authority, empowered by legislation, with the resources and leadership necessary to oversee safeguarding across sectors - health, justice, social protection and community safety. It is important that this is cross-sectoral approach. It is vital. We also need to strengthen the regulation of healthcare staff to ensure consistent standards of care. Many support staff remain unregulated, which is unacceptable given the vulnerable populations they serve.

Some immediate actions can be taken without delay, such as legislating for better information sharing across agencies when safeguarding concerns arise and broadening the offence of coercive control to better protect vulnerable adults in all relationship contexts. The Department of Social Protection must also step up its role in preventing financial abuse, especially in cases involving third-party agents, as highlighted by recent cases.

A simple yet vital measure is the establishment of a national register of advance health directives. This would empower individuals to specify their healthcare wishes, ensuring these are accessible when needed. The infrastructure already exists through the Decision Support Service. A legislative order could implement this swiftly. That is something the Minister of State might consider.

Safeguarding our older citizens is not just a policy issue, it is a moral obligation. They have built this country. They are our mothers, fathers, brothers, sisters, aunts, uncles and grandparents. They deserve to live their later years free from fear of abuse or neglect. I often think about myself and what is ahead. We all have to think about that as well. We must move beyond debate and take concrete, co-ordinated action to protect their rights and dignity. We must do this work across all sectors and Departments to support these urgent reforms. That is one of the most important things I want to say today. It has to be done across all sectors and all Departments. Let us act decisively, implement these recommendations and finally ensure that our system of care truly upholds the human rights and happiness of the older population in this country. The time for talk is over. Now is the time for real action.

Tom Clonan (Independent)
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Apologies as I was at committee with Senator Kyne and unable to attend. I am just going through the Minister of State’s statement.

Regarding the abuse that “RTÉ Investigates” uncovered, not everybody will agree with me on this but I believe that was a predictable and foreseeable set of circumstances given the model of nursing care provision and the model for care provision in general that we have in the Republic. Last night, when speaking on my Private Members’ Bill on personalised budgets, I spoke at length about the lack of choice we have in the provision of care and the models of care provision.

When care is provided in Ireland, no matter at what stage of life, whether you are a disabled citizen, teenager or young adult who needs personal assistance supports or care in the home, right up to people who acquire brain injuries through road traffic collisions or by other means, or through reason of stroke, right up to and including elderly people who become infirm by way of age, families all over the country will find themselves pushed into that space of trying to find care supports. It is a very difficult environment to find oneself in. Much of it comes down to the fact that, as a jurisdiction, we have chosen in many cases to, if you like, subcontract care. I do not mean that in the pejorative sense, rather I mean it just purely in a descriptive sense. It leads to suboptimal outcomes, as set out in the “RTÉ Investigates” programme.

The Minister, Deputy Foley, has promised to work with me on the personalised budgets model, which is directly related to how people source and access care. There needs to be more choice and a more holistic environment where people can choose. Care in a nursing home should be a last resort. We should all have the dignity to be able to live at home and administer a budget either ourselves or through our assisted decision-maker or person who will support our decisions. We are a generation that is expected – well, maybe you guys – to live to 100. We would like to think we could live at home with dignity with the minimum of supports which, while expensive, would be a fraction of the cost of nursing home care. We have to try to evolve a model. The Minister, Deputy Foley, will work on it but I hope I get the opportunity to work with her on it.

I have two final points to make. While we have the opportunity, thousands of young adults are inappropriately placed in nursing homes in the wider Dublin metropolitan region alone. Many of these young people are disabled and go into crisis when their parents pass away. I do not like to use the phrase “end up”, but that is where they end up. They are warehoused in nursing homes throughout the wider Dublin metropolitan region. That is a consequence of a lack of alternative methods of providing care and support for people. That in and of itself is an abuse of those younger people. It is systemic abuse.

The “RTÉ Investigates” programme gives us an opportunity not just to discuss the care of older persons but also that of any one of us who, by a simple twist of fate, might end up requiring care.

Maria Byrne (Fine Gael)
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Before I move to the next speaker, I welcome Senator Evanne Ní Chuilinn and her guests from Dublin South-Central, as well as Jamie Malone and some of his family members from Louth. They are all very welcome. I hope they enjoy their visit here.

Seán Kyne (Fine Gael)
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I acknowledge public service broadcasting and the role of RTÉ in showing this footage and going undercover. When you query paying a television licence fee, this is public service broadcasting at its best, unpalatable as it may be to watch and as uncomfortable as it may be for family members, I am sure. I understand from talking to colleagues in the Portlaoise area that there were other family members who did not consent to the footage being shown, even blurred and obscured, because they did not want their loved ones to be shown in that fashion. I can understand that.

As Senator Black touched on, none of us know what our future will be. In the case of my own father, Lord have mercy on him, we were able to keep him at home, but he was nearly totally immobile at the end and non-verbal. These are difficult things. I do not have children and I am unlikely to at this stage of my life, and you worry who is there to look after you if you were in a situation in a nursing home. That is why we should aspire to statutory home care. Having the opportunity to be cared for in your own home rather than a nursing home should be the norm. That is not to say there are not great and wonderful nursing homes. I understand there were nursing homes that were small family units that were closed down and residents moved to other nursing homes, at least one of them being the one in question in Portlaoise. There needs to be a sea-change in all of this area, as well as the adult safeguarding that goes with all of this.

HIQA obviously has a board. What engagement has the board had on these issues with regard to its responsibilities? The delay from notification by HIQA was not good enough. That is an absolute shortcoming. If information is being provided, it should be in there rapidly – as immediately as possible – to investigate. Staffing has been an issue and I understand that. I refer to the basics of incontinence pads. A man was told there were no staff to bring him to the toilet, so he should use his pad and not wet the sheets. How absolutely degrading is that in this day and age? HIQA needs to do a lot of work to improve its processes because it is the guardian. If I end up in a nursing home, who do I call? HIQA is the one that is there to oversee what goes on in nursing homes as regards the care of loved ones, particularly those who may not have immediate family members or who may have very loving family members who might live in another part of the country or the world and who rely on the care of the staff and management of a nursing home. I appreciate there are very good staff, but that is what we expect and demand - that there be a good staff, that there be sufficient staff, that the basics be there, that the processes be there and that if there are problems, they be identified, reported and dealt with quickly.

There is an important job of work ahead for the Minister of State and the Government and I wish him well. It is important we get good delivery for all our citizens, not just for now, but into the future.

Anne Rabbitte (Fianna Fail)
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I thank the Leader of the House for ensuring we are having statements on this today. They are timely. I thank the Minister of State for taking the time to appear before us to allow us the opportunity to speak about what we witnessed on "RTÉ Investigates". It is unfortunate that we have to rely on a television programme to do the job of HIQA. If we are to talk about the elephant in the room here, it is HIQA. It is the statutory body. It is the eyes and ears that protect the most vulnerable, the staff, the residents and their loved ones. As far as I am concerned, it failed in its job and has questions to answer. Why did it allow admissions to continue? That has to be the question. Is the private sector too big to fail? I asked that the last day and ask it again today. Are we afraid, because over 80% of all nursing homes are now in the private sector, that it is too big to fail? It should never be too big to fail. We are funding it. We can take it over. We took over nursing homes during Covid. We should be able to take them over again.

We should at all times ensure that the rights of the individual come first and be front and centre and never come second. A person's rights should never be a compromise. I completely agree with Senator Kyne, and everybody else, when he asked "How absolutely degrading". How degrading for a grown man to arrive at 80 years of age and to be told to - I will not repeat the word because I find it horrific - go to the toilet in his bed. How dare they? That goes down to management but it also goes down to the failure of the watchdog. We as politicians do not work nine to five and I do not expect our statutory agencies to do so either, but they have an obligation in terms of compliance and regulation. As for this idea of making a phone call to call in, it is not a cup of tea, nor do I take lightly their job. I feel, however, that they have shown leniency or tolerance towards certain groups.

At the same time, it is very important to be balanced in what I say. I want to be balanced about a lot of our family-run nursing homes. We have seen a loss in our county of Galway where it has not been sustainable for the family-run nursing home of 30 or 37 beds. The average to be sustainable now is 70. I talk about Portumna Retirement Village, the Holy Family Nursing Home in Killimor and Rosemount Nursing Home in Gort, which provide 100% care and diligence. It is a family relationship when a family member goes in. The whole staff get to know the individual. I therefore want to be balanced in my contribution but I also know the coals HIQA hauled these homes over to achieve that standard and I do not feel that the same standard was applied uniformly across all providers.

I welcome the Minister of State's remarks about the statutory home care scheme. I will support him in all he wishes to do in that regard but I also think the cases that are presenting to family nursing homes are getting more complex because of our discharge policies. We do not have that transitional space to be able to support people either to return home or to find their way into rehabilitation. Our disability providers have more of a social model than a medical model for intervention. Maybe we are putting pressure on some nursing homes to support more disability discharges into nursing homes, which is inappropriate. More than 1,350 under-65s are in nursing homes because we do not have that transitional care pathway. We have been a long time talking about it. There is a road back again to the HSE as to how it is managing to support that transitional care pathway. With the complex cases, it is no longer a question of people going in because they just do not have loved ones. Maybe the care and support are very expensive to provide, but we should ensure they are delivered in a person-centred way in the people's own houses.

I thank you for your leniency, a Leas-Chathaoirligh. A lot of good work has gone into nursing homes and older persons when we look at the meals on wheels scheme and see the home supports. With an ageing population, though, I think the Minister of State has the biggest job of work to do in these Houses because we are all getting older and I think not one of us ever wants to find ourselves or a loved one in this position. We are getting closer to that age bracket. We need to ensure we have more space.

Today is the last day for submissions to the NDP. If I were to appeal to the Minister of State, I would say we need to double our community nursing homes' capacity immediately. We should not build them with 40 beds or 60 beds. They do not need to be campuses or institutional settings but we need to build more of them. At the same time, we need to balance that with supporting our family-run nursing homes where when someone rings the doorbell, he or she knows that the manager answering is a local person.

Maria Byrne (Fine Gael)
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Before I move to the Minister of State, I welcome Deputy James O'Connor and his guest, Mr. John Lundy from Cork. I hope you enjoy your visit here to Leinster House today and to the Seanad especially.

Kieran O'Donnell (Limerick City, Fine Gael)
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I am grateful for the very good contributions of Senators. I probably will not get to every point but I want to deal with the points as raised.

Senator Byrne was first up and said we had a balance in the model. Regulation is key to that, and that is why I want to strengthen the regulation in terms of HIQA to give that reassurance. She asked if funding could be provided to ensure activities for people in nursing homes. We can certainly look at that.

Virtually everyone brought up safeguarding. I will give the House the context. It is correct that the legislation is there. It is being prioritised, to answer Senator Black. The programme for Government commits to bringing forward a national safeguarding policy. Within that will be the provision of legislation. The Law Reform Commission has done a huge body of work on this. We are very much looking at that in this context. It is a priority for me, the Minister, Deputy Carroll MacNeill, and the rest of the Government. I have been in this role a relatively short time, but it is something I take very seriously.

Senator Costello made a couple of points. HIQA has a power to go in unannounced to any nursing home, whether public or private. It regulates all nursing homes, regardless of whether they are public, private or voluntary, in the same way across all sectors.Senator Nicole Ryan referred to its powers. HIQA has the power to go to the District Court to enforce any aspect, including asking the court to impose fines. HIQA cannot impose fines directly. We are very open to giving HIQA the power to fine nursing homes directly.

Financial penalties were mentioned. Senator Costello referred to safeguarding, which is hugely important. I covered all the points raised by Senator Ryan. At the moment, HIQA carries out inspections and publishes reports after inspections. These reports deal with the day of the inspection. I want the reports to provide an update as to when there has been compliance with any conditions. It is a logical thing to do. It means that when reports are published, we will not only learn about the inspection, we will also learn about nursing homes that have complied with conditions or requirements imposed by HIQA. This is a positive thing. It would allow people looking at a nursing home on the HIQA website to see it in real time.

Fines constitute the other area we will look at and, if there were to be a significant shift in staffing levels in a nursing home, it would be obliged to inform HIQA. This was a key issue regarding Beneavin Manor and is something we need to look at. There is a lacuna where HIQA carries out inspections of individual nursing homes but does not have power regarding an audit of the parent company of that group. We are going to change that. I would like to see these companies audited and that any change in ownership of a nursing home, whatever form that takes, would necessitate re-registration. It makes sense that when a sole trader who owns a nursing home sells it, anyone who buys that nursing home would have to apply to re-register it. At the moment, anyone who buys the shareholding in a nursing home takes on what is the existing regulatory history of the nursing home and does not have to reapply. It has to inform regarding a change of directors. In terms of consistency, these are things we can do.

Senator Stephenson asked about the changes that will be made. It is a valid point. A body of work is under way with HIQA on processes in which it is engaged. The two nursing homes are key along with the overall Emeis group. There is safeguarding legislation coming in. The Senator asked about safeguarding. The HSE has set up a national safeguarding office. It does not have the powers to enter a nursing home uninvited but most nursing homes will allow it to come in. We will be looking at that in terms of overall safeguarding. There are regulations from 2013 and HIQA publishes standards on safeguarding with which nursing homes must comply. We will strengthen safeguarding.

We want to provide safe nursing homes for older people. We are all working collectively in that regard. Senator Clonan made reference to the collective. I note the work he is doing with the Minister for Children, Disability and Equality. It is something I want to keep an eye on in terms of its general application. As Minister of State for older people, I am in two Departments - the Department of Health and the Department of Housing, Local Government and Heritage - so I look at health and housing. I want to provide statutory home care. The first step in doing this is regulating home care providers, which are unregulated at the moment. I hope to bring legislation on that to Government very soon. Once that is up and running, we have to define what statutory home care is. What do we want to see? We then need to bring in a system that gives people the choice to stay at home for as long as they wish. There will always be a requirement for long-term residential care because people's needs may be so great, so we need to make sure people feel safe in that environment. It is already there in that local authorities are working in the area of independent living, but I want to do that in a more structured way. The Department of Housing, Local Government and Heritage is looking at policies in this area. The programme for Government commits to local authorities looking at suitable sites for the provision of independent living. We also want to assist AHBs in that area by looking at a multitude of areas from the cradle to the grave in order that people can stay at home, go to work, etc. It might be independent living but light independent living, and the next step is more supported independent living. It is about the degrees so that people have that choice. It is something I feel very strongly about.

HIQA has acknowledged that there is a need for an ongoing review of procedures, which is something we will strengthen. In response to Senator Rabbitte, we will look at transitional schemes. Senator Clonan referred to the younger cohort. It does not come under my direct remit but nursing homes do. However, it is something I will look at with the Senator.

I thank Members for a very constructive engagement. We are all looking to ensure that nursing homes are safe for older people. We have a responsibility. It is all about that for me. Nursing homes have the ultimate responsibility but it is how we can enhance regulation in this area so that if older people choose to go into a nursing home, they feel safe and have good care.