Wednesday, 14 December 2005
Seanad Eireann Debate
It is important in the lifetime of this, or any, Government that due recognition be given to the people who have been the pillars of this State, those who have put the State where it is today. The measures announced in the budget give that recognition. The additional funding will have a number of effects. Coming on top of the additional funding for disability, mental health and primary care in the Estimates for 2006, this is part of a Government policy to develop the general community and primary care programme so that acute hospitals and residential care will not dominate extra health care investment as they have previously.
Most old people like to live in their own communities and homes where they have friends and neighbours. As a person with over 30 years experience in long care institutions I have raised the fact that many people in nursing homes are never visited. This was brought up by the recent nursing home charges controversy. It is imperative that people remain in their own homes and environments for as long as possible.
The home care support packages deliver a wide range of services and have been piloted successfully in several regions in recent years. These include the services of nurses, home care attendants, home helps, etc., and in some cases therapists including physiotherapists and occupational therapists. Home care packages vary with the needs of the person, for example, one package might emphasise home care assistance while other packages might have a greater level of home care and nursing. It is not possible to have a text book example of the care levels required for each person so this varying package is important and the flexibility necessary to give a broad based service has been incorporated by the Tánaiste and Minister for Health and Children, Deputy Harney.
The priority will be for older people living in the community or who are in-patients in acute hospitals and who are at risk of admission to long-term care. The home care packages will also be available to older people who are in long-term care and who wish to return to the community. In addition, these packages will be offered to people who are already using existing services such as home helps but need more assistance to continue to live in their communities.
I need not tell anybody in this House what happened when we did not have properly developed community care services. We saw what happened in the psychiatric services 30 years ago. St. Loman’s Hospital had 1,200 to 1,300 patients but today has fewer than 300. While many of those people have gone to their eternal reward, a number of people who were in the care of the psychiatric or geriatric services are now in the community and successfully living their lives as they were meant to, in their own homes and environments.
The packages are delivered to the HSE by a range of providers including the HSE, voluntary groups and the private sector. It would be remiss of me not to say a special word about the voluntary sector, which provides a tremendous level of backup service. Often the only face a long-term psychiatric patient sees, except for the ward staff, is that of the Society of St. Vincent de Paul volunteer who has taken responsibility for visiting him or her. It would be remiss of us not to underline that.
The scheme will be as flexible as possible and highly responsive to the real needs of the individual so that if family or friends wish to provide these services they will be encouraged to do so with support and linking with the HSE, voluntary and private sectors. Approximately 1,100 care packages are now being provided to people and by the end of 2006 a total of 2,000 additional home care packages will have been provided. This will constitute a trebling of the current services provision. These 2,000 packages will support more than 2,000 persons, for example, some people need a care package temporarily. The major thrust of this initiative will be directed at older people but there will be flexibility so that a person under 65 years will not be rejected automatically but may receive home care as appropriate. That is to be welcomed.
Home helps have provided pivotal support and are an essential part of supporting old people at home thus delaying or preventing admissions to long-stay residential care. They also help keep people out of acute hospitals or help their early discharge. Given the increased number of older people there is an increasing demand for home helps. We live longer and as a consequence the age profile of the general population is on the increase. That can be explained by better lifestyles and people taking greater responsibility for their own health. Females in particular have a greater inclination to seek medical advice and assistance when it is required.
An additional €33 million has been allocated for this programme, €30 million of which will be for 2006, a significant increase over the Estimates provision for 2005. The additional funding will provide 1.75 million additional home help hours. If we are concentrating on community services and the pivotal role home helps play, it is axiomatic that additional home help hours of the scale suggested and proposed here would be the case. As with home care packages, it is expected that these additional resources will be implemented in a flexible way by the HSE, particularly for those vulnerable individuals who need a home help but who are under 65 years of age. They can now access the service.
The day care respite service is important. It may include a midday meal, a bath, occupational therapy and physiotherapy, chiropody, laundry and hair dressing, social contact for older people, respite for family members and/or carers and social stimulation in a safe environment for older people with mild forms of dementia. The provision of €9 million in a full year will allow for an additional 1,325 places per week in such centres. The number of older people who will benefit from these new places will be substantially more than 1,325 since, over the whole year, one place can provide a service for more than one person.
The investment of €9 million will allow for additional programmes for specific needs such as activity therapy. It will also mean that many day care centres will be able to open five or seven days a week, rather than just two or three days as is often the case at present. I have often argued this point, it is not rocket science, it is common sense; the needs of our elder citizens and the care needs of any person do not end on a Friday evening and begin on a Monday morning. Someone who needs care needs it seven days a week. There will be an investment of €7 million in 2006, with the balance of €2 million to be provided in the following year.
There is also a proposal for specialist palliative care, with €9 million being provided, including home care and community initiatives in 2006. A further €4 million is being provided in 2007 to develop the service, giving a full year cost of €13 million. This funding will provide €1.9 million to open six palliative care services at Blackrock Hospice under the management of Our Lady’s Hospice in Harold’s Cross. Some 24 extended beds will also be provided at Our Lady’s Hospice. That is tremendous news for those who have people in need of palliative care. There will be ten new palliative care beds in Milford Hospice at a cost of €1.9 million, St. Francis’s Hospice in Raheny will receive €1 million in increased funding and €2 million is being made available for the development of palliative home care services. Development of palliative care services in the midlands, western and south-east areas will continue, thus building capacity.
Meals on wheels has played a pivotal role in community care. There will be a significant increase in the resources available to the service. An estimated €10 million was spent on the service in 2004 and an additional €2.5 will be provided next year, together with a further €2.5 million the following year, a total increase of 50%. Sheltered housing and action on elderly abuse are also being addressed.
Last Wednesday I said in this House that for 20 years the Progressive Democrats have determinedly pursued economic and social policies aimed at maintaining full employment, strengthening the competitive position of the economy, keeping taxes on labour low and, most importantly, focusing on the low-paid, elderly and the vulnerable. The budget reflected this approach clearly. On income tax, social welfare, pensions, child care and care of the elderly, there can be no doubt that the Government is delivering the right policies and on the commitments outlined in the programme for Government.
Last week’s budget gave us the big picture account of how sensible economic policy has allowed us to provide for the most vulnerable. This evening’s motion brings us down to a micro level, the specifics of our view that the fruits of economic prosperity must be used to provide and improve care for those who need it most, in this case the elderly.
The approach adopted by the last two Governments has rightly been to promote and support economic development and prosperity. It is not prosperity for its own sake; the more people are encouraged to work hard and prosper, the more revenue is generated for the vulnerable in society. The changes in social welfare and pensions included in the budget are evidence of the wisdom of the Government’s approach.
The details of the wide-ranging new services for older people announced by the Tánaiste and the Minister of State on Thursday confirmed two things. We are pursuing the right policies and we are committed to delivering the best services. Of the measures announced in the budget many people, politicians and commentators alike, focused on the measures relating to the care of children. They said these were the most important aspects but I do not agree. I have worked closely on child care policy in recent years but the wide-ranging services for older people that have been announced are the most important development in last week’s budget.
The Progressive Democrats have set out in successive policy documents and manifestos that care of older people is a basic social duty. We have worked on improving the quality of life of older citizens. This Government and the Progressive Democrats campaigned for and delivered on a €200 per week pension. The old age pension is now running at €193.30, up from €99 eight years ago and the Progressive Democrats will deliver, with our Fianna Fáil colleagues, by the end of the Government the target of the €200 per week pension.
On budget day I mentioned that we are concerned not just with ensuring the best quality of life for older people, we were also determined to deliver the most appropriate type of care. That often means allowing for care in the most appropriate setting. International research has shown that a person’s life expectancy can be extended by up to two years if delivered in his or her own home. Policy is this area is not just about ensuring the best quality of life but can play a part in prolonging lives. That is why for me this initiative is the single most important announcement of last week. This is about delivering the same home and community-based support for older people that can prolong lives, ensure the most appropriate care in the most appropriate setting and improve their quality of life.
I congratulate the Tánaiste and the Minister of State for the initiative in this area. When it comes to policy makers, the Tánaiste has worked to deliver the best care for older people, has proven herself to be both the most determined and most effective in this area and I thank her for ensuring these measures were included in last week’s budget.
Much is being made of the fact that this is the largest ever budget package for services for the elderly, involving €150 million. However, I do not want to get hung up on the superlatives. I am more interested in what this money can do. These millions of euro mean thousands of older people needing care will receive new services and supports in the next 12 months. It is the largest ever increase in funding for services for older people. This money will make a significant difference to thousands of people, their families and carers. It goes without saying that we will continue to support appropriate residential care. However, this investment package is focused on caring for people in their homes. As the Tánaiste has stated, that is where most of them want to be.
We are all aware of the growing independence of older people. We must respond to the desire of the many who wish to remain in their communities. The initiatives outlined in today’s motion underline the Government’s commitment to putting older people at the centre of health policy. This is to be commended. Furthermore, the initiatives pursued by the Tánaiste are in line with international trends. Older people deserve, as a right, to have these services delivered. They deserve to be listened to and consulted. Age Action Ireland has said:
We listened day after day, inside the House and without, to Opposition claims that the Government neglects the vulnerable and protects various interests. The reality is that we take seriously our obligation to promote development and prosperity. The services prosperity can deliver in this area are almost too extensive to discuss. They include the following: some 3,000 home care packages, including the service of nurses, home care attendants, home help and various therapists; €30 million for home help in 2006, providing 1.7 million more hours of assistance; an additional 1,325 places in day and respite care centres; €9 million for additional programmes for specific needs such as activity therapy; €9 million for specialist palliative care, including home care and community initiatives; €12.5 million for meals on wheels services; the development of sheltered housing accommodation for older people; and €4 million for initiatives in primary and community care. One could go on. This is probably utterly depressing for the Opposition but it is utterly encouraging for the deserving older people of this State. I gladly second the motion.
—introduce proposals to ensure clarity on rights and entitlements to services for the elderly, including funding proposals for long-term care of the elderly, despite the fact that the Government promised to introduce legislation for both of these matters since the publication of the national health strategy in 2001;
Although we welcome the package announced by the Minister, the first point I make is that the allocation is not €150 million but €110 million, because €40 million is allocated for 2007. This is typical Government spin whereby a package is announced but one then discovers it applies to more than one year.
Mr. Browne: Based on the results of recent local and by-elections, Fine Gael will be in power next year. This figure should be considered in comparison with the moneys spent on PPARS, which has cost the taxpayer more than €200 million to date. The provision for the carer’s allowance is comparable to the reduction in betting tax. It is important to put matters in context to get an overall impression.
The Government’s record on the elderly is shocking. This time last year, legislation on the nursing home charges which were later found to be unconstitutional was rushed through this House. The Government should hang its head in shame on this issue. On the one hand, it is prepared to rush through legislation. When it came to repaying the money after the fees were deemed in breach of the Constitution by the Supreme Court, however, it adapted a different attitude and announced the money will be reimbursed in the course of two or three years. Only today we hear that the heads of the relevant Bills are being prepared and will go before Cabinet shortly. It will be well into next year before the legislation is brought forward and one cannot say when it will be enacted.
The Government’s attitude in this matter is shocking, especially when one considers that it affects the most elderly in society. We can get into the argument about who will benefit from the refund. Ultimately, however, that is not our job. The bottom line is that the highest court in the land found the Government had behaved incorrectly and ordered it to repay the money. These moneys should be returned immediately and it is up to the recipients how they are spent. In some cases, the families will get the money rather than the elderly themselves. Unfortunately, some of them do not have six, eight to ten months to wait. Many will be deceased by then and others have already died while awaiting repayment.
I urge the Minister to fast-track the legislation and repay the money as soon as possible. A suggestion was made at a meeting of the Joint Committee on Health and Children that staged payments could be made. If the full amount cannot be paid immediately, there should be a minimum payment to every family. I am aware of some families who are keen to bring elderly relatives abroad to such places as Medjugorje or Lourdes, perhaps for the last time. That option would be available to them if the repayment was made.
The amendment notes that legislation was due in autumn 2005 in regard to an independent inspectorate for nursing homes. It is now the last week of this term and there is no indication of when that legislation will be brought forward. Even after the public outcry following the Leas Cross nursing home scandal, the Government remains tardy rather than proactive in terms of the promotion of an independent inspectorate. Such a body would ensure the rights of the elderly are upheld. The opposite was clearly the case in Leas Cross.
Another important element of the amendment is the call for an extension of the national hygiene audit which took place recently in the acute hospitals to all public and private nursing homes. Through my involvement with a group called MRSA and Families, I hear on a regular basis about patients being transferred from acute hospitals into nursing homes, some of which are disgraceful in terms of hygiene. There is a further problem in that acute hospitals do not always inform nursing home authorities when elderly patients have MRSA. It is a major scandal that MRSA is being introduced into nursing homes in this way. A system should be in place where before a patient who is known to have MRSA is transferred to a nursing home, the latter should be made aware so that appropriate steps can be taken, for the sake of that patient, existing patients and staff. It is unbelievable that this is not happening.
I welcome the aspect of the Government’s plan relating to sheltered housing. It is very vague, however. I attended a meeting recently with the housing officer of Carlow County Council and a group in Tullow called Cheshire Homes. The latter pointed out that very few houses are being built for people with special needs. There is great scope within Part V of the Planning and Development Act for a system whereby, with some extra encouragement from the Department of the Environment, Heritage and Local Government and local authorities, developers could be encouraged to bring home modifications to such a level as to accommodate persons with special needs. There has been much advancement in this area in recent years in that new homes must now have downstairs doors that are wheelchair accessible and light switches are placed low on the walls. In order for a house to be fully accessible, it would take only a small additional effort. This is not happening but is something that can be done at little cost. Part V allows for a certain percentage of housing to be ring-fenced for social and affordable housing. Changes could be made in this way but they should not be left only to developers. We should take a proactive line on the issue.
Will the Minister of State clarify the number of extra nursing home beds to be introduced? The Irish Times reported last week that €8 million is to be provided for 250 more nursing homes beds, comprising 200 in Dublin and 50 in Cork. Is this the entire sum of nursing home beds to be provided? The Minister of State will accept there are elderly people not only in Cork and Dublin but throughout the country. There must be a major increase in the number of nursing home beds.
I welcome the Tánaiste’s statement concerning the conclusion of the special savings incentive scheme, SSIA, and the possibility that the allocation for this will be used to fund the plan for the elderly. There is one weakness in the SSIA scheme. There should have been three or four SSIA accounts, one for transport, one for education and one for pensions. Senator Terry has referred to the pensions time bomb on numerous occasions in the past. I welcome the initiative that we should extend the SSIA scheme to fund specific projects.
I am puzzled by the suggestion that 28% of patients currently in nursing homes will be able to move back home. I do not accept that suggestion. The people to whom I spoke who work in nursing homes did not agree with that point. It is not as clear-cut as taking patients out of nursing homes and moving them back home. First, there are many lone-parent families and families where both parents are working, unlike a generation ago when one person was at home full time and could care for an elderly relative.
There is also a growing commercialisation of Sunday and Saturday. Sunday is now like an ordinary weekday because all the shops are open. This means people are at work and cannot afford to look after their elderly relative. If one listened to “Liveline” yesterday, one would have heard the woeful tales of family members who were very upset because they clearly wanted to look after a family member but could not do so because of lack of resources. I do not think it is as easy as just moving elderly people back home.
Ms Terry: I second the amendment. I welcome the Minister of State to the House. The amendment is worthy of debate because it highlights a number of failures on the part of the Government on delivering services to the elderly.
Of course, I welcome any funding which will help our elderly. It would be very small-minded of us if we did not do so. However, it is a drop in the ocean. Given the economic climate in which we live, much more money should have been allocated. One could do much more if additional funding was provided. Much more is needed, because as we sit here, elderly people are sitting in a chair in their home since they were put on it this morning, waiting for their home help to arrive and put them to bed this evening. This is the reality for many elderly people in the city and throughout the country. I do not believe anyone can be proud of this service. Neither do I believe the home care package will address the needs of thousands of people who need help.
Some 26% of older people live alone in this country, compared with some other European countries where 40% of elderly people live alone. We could look at these figures in a number of ways. First, we do not support sufficient people to enable them to live at home. Other countries give greater supports to elderly people who live at home. If additional hours of home help are required to allow an individual to stay at home, this should be provided. Providing home help for one hour per day to an elderly person makes a mockery of elderly people. In many instances, this is all that is provided, even though we know they need much more help.
Some 36.4% of older people’s households are at risk of poverty compared with 23% of all households. As many older people are at risk of poverty, they need a lot of help, particularly when they are much older or if they have disabilities or are unwell. I agree with Senator Minihan that older people should be cared for at home for as long as possible if it is their wish. Older people do much better when cared for at home. Studies have found that older people’s hearing, vision, dexterity and attention do better in the home environment when they must do things for themselves, rather than being put into a institution like a nursing home where everything is done for them. As many people like the comfort and surroundings of their own home, we need to put in place the funding to enable them to remain at home for as long as possible. The money which was made available in the budget will not do so. I know the Minister of State will say that he will work on this aspect in the coming years, but what has been done in the past number of years while he has been in Government?
Older people have been neglected. Home help is one of the crucial pillars of looking after the elderly in their homes. Home help in the North of Ireland is provided to 17% of older people. That figure is 7% in the South. Meals on wheels in the North of Ireland is provided to 26% of older people, while it is provided to 18% here. This indicates where the priorities are. Our people need these services.
I looked up the website of the National Council on Ageing and Older People. During the week of the campaign Saying No to Ageism, the results of a study on older people were announced. These indicated that many older people felt ignored or let down by the health services when they sought information. The study found that the health service was guilty of discrimination against older people. This discrimination was evident among upper age limits for breast screening and also for certain referrals for specialist treatments.
There was also evidence of prejudicial attitudes by staff to older people. I do not know how the funding which has been provided will address these issues, but I would like the Minister of State to take on board the points made by the National Council on Ageing and Older People. I believe there is discrimination against older people. We must change our attitudes and ensure that frontline staff are specially trained to ensure older people receive the answers and information they require in a caring way, and not be brushed off.
My final point relates to older people dying in hospitals. Many older people die without respect or dignity in many hospitals because they are dying in public wards. There is no dedicated room in most hospitals in which an older person can die. There are no facilities for families to get together to talk and grieve. This aspect must be addressed. When a person is dying he or she should be afforded some respect and dignity. We must ensure that every hospital has such facilities adjacent to the wards. It is the least we can offer older people.
While I welcome the funding that has been provided, it is a drop in the ocean. I hope it will be increased significantly on the next occasion. The money the Government has wasted in so many areas could be well spent in this area. The small amount of funding provided will not do much to help the plight of many older people.
I, too, welcome the Minister of State, Deputy Seán Power, to the House. I am pleased to be able to speak on this motion. Some €150 million was announced in last week’s budget by the Minister, Deputy Cowen, to provide care for the elderly.
To take up Senator Terry’s final comment that people should be allowed die with dignity in a hospital and that does not happen, I do not know where that does not happen. Sadly I have buried three family members, my mother, father and an aunt in Tullamore, County Offaly, in recent years. The dignity and respect they were afforded in a hospital before they died was such that if we had staged their deaths we could not have had it any better. Perhaps the experience in that respect in rural areas is different from that in urban areas. My experience of the dignity afforded by medical and nursing staff to loved ones dying has been fantastic and of their allowing my family to be with them. I could not fault them in any way.
When I hear Fine Gael Senators say that the €150 million allocation will not go too far in addressing needs in this area, I want to laugh, but this is not a place where one would laugh out loud. Fine Gael has been out of office for too long and has lost the knack of formulating good policy. It is back in the mindset of the old days when it was in power and everything was doom and gloom. Fine Gael Senators are still preaching doom and gloom.
Ms Feeney: The people to whom I speak talk about the Government’s commitment to older people, the wonderful pensions they receive and the great supports they have in their homes. I do not know from where the Senators are pulling the people to whom they have spoken who are complaining. We should not politicise this issue.
Ms Feeney: I sit on the National Economic and Social Forum and I, together with Senator Kate Walsh, am a member of the committee that drafted a report which has gone to Government. I am aware that the €150 million allocated will cover many of the measures we sought in that report. Given that allocation, if this is not a caring Government looking after the elderly in our society, I do not know what is.
Senator Browne called for the appointment of a nursing homes inspector. I am sure an inspector will be appointed in time. The most important point is to announce that €8 million is being spent on the provision of 250 extra beds. A total of €2 million will be allocated to dealing with abuse of the elderly, which is an important issue to address.
Mr. Daly: I thank Senator Feeney for sharing her time with me. I welcome the Minister of State to the House. The measure of the success of a Minister is in determining what budgetary allocation he or she can secure for his or her area of responsibility. The Minister of State has had great success in this regard, and this is a welcome allocation.
I wish to focus on and ask the Minister of State to direct attention to people suffering from Alzheimer’s disease. Recent studies indicate that 35,000 people in Ireland suffer from Alzheimer’s disease. This is an increasing challenge to policymakers and service providers. In my constituency in Clare it is estimated that approximately 1,000 people suffer from the disease. Based on current statistics it is reckoned that approximately 500 more people will be at risk of developing it in the next number of years. This is a serious challenge for the Department, the community at large and the service providers.
To date, existing services have not been successful in providing what is required in this area. Current services are fragmented, underdeveloped and in many cases that leads to crisis because people do not obtain the service they require until such time as they are in a crisis. This issue needs to be dealt because it poses a challenge for the services and their providers.
I want to pay tribute to people who have worked in providing a voluntary service in some of the day care centres and institutions. I mention in particular the service provided by Clarecastle day care centre in my constituency. It has a development plan which will provide additional places for approximately 50 people on a day-care basis. This will greatly alleviate the pressure on the institutions because the latter do not have the necessary bed capacity or the facilities to deal with people with Alzheimer’s disease.
In so far as it is possible to do so, it is imperative that people who suffer from Alzheimer’s disease should be cared for outside the long-stay institutions. Supporting and funding plans of community groups such as the Clarecastle day care centre will relieve pressure on institutions such as St. Joseph’s in Ennis, which has only 12 long-stay beds for people with Alzheimer’s disease. It is estimated that in County Clare, 50 such beds are required, some of them being long-stay beds. In some of the other institutions such as Carrigoran where there are 25 such places. Fees must be paid for those places and they are expensive.
This issue was raised by Senator Browne. I endorse what he said about the number of people and families in particular who find it extremely difficult not only to meet the cost of providing care for people with Alzheimer’s disease but to find places to accommodate them. This is an increasingly serious problem. In the programme to which the Senator referred, one woman was in such a desperate state she spoke about bringing her mother to the accident and emergency department in one of the hospitals because she could not care for her any longer. This issue needs urgent attention.
I draw the attention of the Minister of State to the needs of those suffering from Alzheimer’s disease. I spoke to some people about the need to establish an Alzheimer’s disease foundation similar to the Hospice Foundation where resources in the private sector could be utilised to complement and support what the Minister can do in this area. This is an urgent and pressing demand for such services.
Mr. Finucane: I welcome the Minister of State to the House. I listened to the debate on the monitor and while €150 million seems a considerable allocation, it is not an amount to crow about in the context of the length of time the Minister of State has been in office. Following the passing of the budget, an advertisement on behalf of ALONE appeared in a newspaper last week, which the Minister of State might have seen, requesting people to send letters to the Minister outlining their concern about the amount of funding being allocated to the elderly.
The heading of a newspaper article was “We were proud to be young in our new republic now we are at the mercy of the rip-off state”. The article referred to people in 1949 in the new Republic and their excitement at that time. That is worth bearing in mind in the context of what we are talking about in this debate, namely, the elderly, home help and carers. The level of home help service here is 3% compared with 16% in Sweden and 14% in Northern Ireland according to the statistics available. Since 2003, the home help service for the elderly has been cut by 22%. In this allocation, is the Government trying to make up for lost time?
Politicians are approached regularly on behalf of the elderly. I am saddened by the level of service in this area and I will outline a classic example. A man of 82 years of age contacted me recently. He is in reasonably good health, living in a rural location and all he wanted was a home help for one hour a day. The home help organisers said they would like to help him out but they are unable to do so, unfortunately, under the existing means testing arrangements. The circumstances of the man in question are typical of many people in the locality. Home help organisers should have the flexibility to use their discretion. The ceilings used in such instances may preclude a person with two pensions from benefitting under the home help scheme. I often wonder whether we pay lip service to the idea of looking after people in their home environments, rather than encouraging them to stay in private or State nursing homes.
There has been a surreptitious erosion of the number of beds available for elderly people in public health facilities. Tax incentives have been made available to encourage the development of more private nursing homes, which perform a useful function, on the basis that more beds are needed to deal with our aging population. When the Cathaoirleach, who is familiar with the circumstances in this regard in County Limerick, and I were young, people often used to say that they would not like to finish up in St. Ita’s Hospital in Newcastle West, which was known as “the home”. There has been an amazing change in that regard, however, as many people now say they would like to finish up in St. Ita’s Hospital. Many people have asked me for help in trying to secure a bed for a member of their family or extended family in the hospital because they recognise that a high level of care is offered there.
The Minister of State, Deputy Seán Power, and many other Ministers have visited St. Ita’s Hospital over the last seven years, since it was first suggested that an Alzheimer’s disease care unit would be developed in Newcastle West. On the Order of Business this morning and again as part of this debate some moments ago, Senator Daly quite rightly highlighted the need to provide accommodation for elderly people suffering from Alzheimer’s disease. Private nursing homes do not necessarily cater for such people. The development of an Alzheimer’s disease care unit in Newcastle West is absolutely essential. I am optimistic that such a unit is likely to be developed in the near future, after seven years of waiting. Although a great deal of time has passed, not a block has been laid.
I acknowledge the work that is done by the staff of St. Ita’s Hospital. The Minister of State has seen the hospital’s facilities. We need to give positive encouragement to the staff, who work in a building that was constructed in Famine times. Newer buildings have been developed at the hospital site, but the facilities which are available in the older structures are not compatible with modern needs. If we want to do a proper job, we need to build a completely new hospital for elderly people in Newcastle West. It is probably not possible to improve the facilities in the existing structure because that building is so old. The standards which are being tolerated in public hospitals would not be accepted in private hospitals. I refer to the distances between beds, for example.
I am concerned about the elderly. All Senators agree it is preferable to keep such people in their home environments. A great deal of comfort is offered to elderly people living in rural areas, who often feel isolated, when home help staff come to their homes to perform basic functions, even for just one hour each day. We can offer elderly people a type of lifeline by allowing them to have discussions with home help personnel, for example. The efforts of such workers over short periods of time are particularly valuable when one considers the relatively small amount of money that is spent.
I recently read a breakdown of the cost of the services which are offered to elderly people in County Limerick by various bodies, such as the rural community care network. The former Mid-Western Health Board used to provide a home help service. If three people are living in a house, one of whom is handicapped, another is elderly and another has a further problem, it could be the case that three different units of the health service call to the house, each within its parameters of responsibility. It is time for us to dovetail the facilities so that we provide a proper care package to the elderly population.
We have a great deal to do. It is easy to appeal to elderly people in monetary terms by pointing out that the old age pension has been increased over recent years. It is quite right that such improvements have taken place, in light of the buoyancy of the economy during the Celtic tiger years. If we are unable to look after the people who helped to build this country in difficult times, we should shed some tears.
It is not enough to cater for elderly people financially, however; we have to do a little more than increase the pension. We have to help to look after elderly people in their home environments. I do not think the funding which has been made available —€110 million in 2006 and €40 million in 2007 — will meet the deficiencies in that regard. We need to compare that provision of €150 million with the overall level of expenditure in the health service. The almost €200 million that was spent on the PPARS project, for example, exceeded the provision in question by €50 million. The Government needs to consider what it is doing for the elderly in that context and recognise the work it has yet to do.
I would like certain aspects of the home help service, such as the means tests and the eligibility criteria, to be examined. Home help organisers should be responsible for making decisions on the basis of an analysis of medical matters, the need for care and the person’s rural location, rather than on the basis of means tests. Such people have to try to dispose of the limited number of hours available to them as part of the depleted home help resource. As far as elderly people are concerned, the Minister of State and his Government have “a lot done, more to do”. Action needs to be taken in respect of home help services in particular.
Minister of State at the Department of Health and Children (Mr. S. Power): I thank Senators for tabling this motion, thereby giving me an opportunity to outline the improvements in services for older people which will result from the unprecedented additional funding that has been made available in this year’s budget. I remind Senator Finucane that the allocation of €150 million is in addition to the money that is already being spent on services for older people. The new developmental investment package is intended to develop further the services which improve the lot of older people who wish to remain at home in their communities in dignity and independence. It demonstrates the Government’s commitment to older people by putting them at the heart of future health policy.
As Senators are aware, most older people wish to remain in their communities for as long as possible. That may necessitate additional home help or more developed home support, including various therapy services. There is evidence to demonstrate that families caring for elderly relatives can continue to provide care in partnership with the support services which have been put in place for those who require them. It is estimated that approximately 28% of nursing home residents have a low to moderate dependency level. Many such people could have continued to live at home if appropriate supports had been made available to them at the appropriate time.
The Government’s investment package is evidence of its determination to provide an important form of health care to a generation that contributed significantly to the prosperity we enjoy today. The package involves the provision of additional resources of €150 million in a full year —€110 million in 2006 and a further €40 million the following year. As a reflection of the new emphasis on home and day care, some €109 million, or almost three quarters of a full year’s expenditure, is being committed to community care supports. It should be borne in mind that such funding is in addition to the extra funding that is being made available for disability, mental and primary care services in the 2006 Estimates. It is part of the Government’s policy of developing the general and community care programmes. The funding will be allocated to home care packages, the home help service, day and respite care centres, specialist palliative care, meals on wheels, sheltered housing, elder abuse prevention, the development of the nursing home subvention scheme and additional bed capacity for those requiring residential care.
Home care packages, which deliver a wide range of services, have been piloted successfully in several HSE regions over recent years. The packages involve the services of nurses, home care attendants, home helps and various therapists, including physiotherapists and occupational therapists. They vary according to the care needs of the people in question. Some packages place an emphasis on home care assistants while other packages require a greater level of therapy and nursing. I assure Senator Finucane, who called for home care packages to be made more flexible, that there will be much greater flexibility in the operation of the scheme.
Older people living in the community, or those who are inpatients in an acute hospital and are at risk of admission to long-term care, will be prioritised. Home care packages will be made available to older people who have been admitted to long-term care and now wish to return to the community. They will also be offered to people who are using existing core services, such as the home help service, but need more assistance to continue to live in the community. Home care packages are delivered through the Health Service Executive by a range of providers, including the executive itself, voluntary groups and the private sector. The scheme, which will be as flexible as possible, will be highly responsive to the real needs of individuals. If family members or friends of an older person wish to provide such services, they will be encouraged and supported to do so, in conjunction with the HSE, voluntary groups and the private sector.
Approximately 1,100 home care packages are provided to people at present. By the end of next year a total of 2,000 additional home care packages will have been provided. This will amount to almost a trebling of the current service provision. The additional 2,000 packages will support more than 2,000 persons as, for example, individuals could in some cases need a care package on a temporary basis. The major thrust of this initiative is to be directed at older people. However, there will be some flexibility, so that a person who is under 65 and may need home care may receive it, as appropriate.
Home helps are an essential part of supporting older people at home and thereby delaying or preventing admission to long-stay residential care. They also help to keep people out of acute hospitals or help their early discharge from hospitals. There is a continuing demand for home helps because of the increased number of older people in our country. An additional €33 million in a full year is being allocated for this programme, €30 million of which will be for 2006. This represents a significant increase over the 2005 allocation. The additional funding of €30 million will provide 1.75 million more home help hours. As with home care packages, it is expected that these additional resources will be implemented in a flexible way by the HSE so that particularly vulnerable individuals, who need a home help, but who are under 65 years of age, can access the service. We have had a couple of pilot schemes throughout the country providing home care packages which have made a real difference to people. Often it is only something small that makes the difference between a person being allowed to remain in his or her own home or having to go to long-term care. That is the area in which we are going to invest the money. When one is in Opposition the amount is never enough. We would have no difficulty spending more money on older people if we got it. I am happy with the increased funding being made available and I am confident it will make a real difference to the lives of many of our older people throughout the country.
Day care and respite care are an integral part of delivering a comprehensive community service for older people. The service provided may include the following: a mid-day meal, a bath, physiotherapy, occupational therapy, chiropody, laundry and hairdressing; social contact amongst older people; respite for family members and-or carers; and social stimulation in a safe environment for older people with mild forms of dementia.
The provision of €9 million in a full year will allow for an additional 1,325 places per week in such centres. The number of older people who will benefit from these new places will be substantially more than 1,325, since, over the whole year, one place can provide a service for more than one person. While we speak about the importance of investing money, we also have to change attitudes. We have had cases where a person’s circumstances changed and the first thought of others was what hospital or home they could get the person into. We have to change that attitude. Nursing homes and hospitals should be a last option rather than the first. Our investment will be geared towards changing that attitude and making it possible for people to remain in the comfort of their own homes for as long as that is possible.
The sum of €9 million is being allocated to specialist palliative care, including home care and community initiatives in 2006. A further €4 million is being allocated in 2007 to develop the service, giving a full year cost of €13 million. While recipients of specialist palliative care are not necessarily older people, this nonetheless shows the commitment to develop community based programmes.
There will be a significant increase in the resources available to the meals on wheels service to develop the service. An estimated €10 million was spent on the service in 2004 and additional funding of €2.5 million will be provided next year together with a further €2.5 million in the following year making for an increase of approximately 50% on the 2004 level. The meals on wheels service is a crucial part of the range of services which help support older people to continue living in their own homes. I had the pleasure of attending an awards’ function recently where there was a man who was involved in a number of voluntary organisations, one of which was meals on wheels. In saying his few words, he mentioned one case where he delivers a meal to a man whose nearest neighbour lives more than half a mile away. Often when leaving that home he asks himself the question, which is more important: his visit or the meal he was delivering. Apart from the meal it is a great contact. One does not necessarily have to live in rural Ireland to be lonely. One could live in O’Connell Street and be the loneliest person in Ireland.
Mr. S. Power: It is wonderful that we have this type of service and that many people give of their time voluntarily to assist others. We commend and express our appreciation of people throughout the country who are involved in that service.
The Department strongly supports the development of sheltered housing accommodation for older people, as it provides a real alternative to residential care and reflects the desire of older people to live with as much independence as possible. To support the development of sheltered housing, a full year commitment of €l million will be allocated, split evenly between 2006 and 2007, to provide front-line health service support, such as therapists and public health nurses or for sheltered housing.
The HSE is developing proposals in the primary and community care areas in 2006 which are new ways of delivering service and which reflect best practise elsewhere. The proposals should reflect the very significant emphasis on home care and involve non-statutory agencies working in partnership with the HSE. A total of €4 million, €2 million in each of the next two years, is being made available to the Health Service Executive for such initiatives to improve and increase services delivered to older people. A total of €2 million is being allocated to address the important issue of elder abuse, again split evenly between 2006 and 2007. This level of funding will facilitate the implementation of the full range of recommendations contained in the report Protecting Our Future. Approximately €2.5 million has already been made available in recent years towards implementing the report, and this funding shows our commitment to this issue. It will also provide for the development of a research function in this area.
Inevitably, there are those who because of their level of dependency will require residential care. It is this Government’s intention to facilitate and support these people and to do so in a meaningful way. A total of €20 million is being allocated to the nursing home subvention scheme for residents of private nursing homes. This represents an increase of 14% over 2005, which has an estimated spend of €140 million. The €20 million is a 2006 full year cost and will go towards both basic nursing home subvention and enhanced subvention and reducing waiting lists for enhanced subventions.
The sum of €8 million is being provided to cover the cost of 250 extra nursing home beds which the HSE is already in the process of sourcing from private nursing homes. The Department is updating the subvention scheme for payments to people in nursing homes. The purpose of this change is to make the assessment criteria for subventions, which have not been updated since 1993, reflect the major changes in property values.
Mr. S. Power: These changes were announced last year and make a great deal of sense. The criteria being used based on 1993 values bore no reflection of the changes that have taken place in property prices, particularly, in the capital but throughout the country. It is a change that all people will welcome.
Members will be aware that the Tánaiste and Minister for Health and Children, Deputy Harney, and the Minister for Social and Family Affairs, Deputy Brennan, earlier this year established an interdepartmental group for the purpose of reporting on the future financing of long-term care. The initiatives I have outlined have been informed by the work of this group. It is intended to bring the report of the group to Government shortly. In putting these measures in place we are rising to the challenge set by all civilised societies of providing services and facilities of the highest standard for the more vulnerable among us. More important, I believe that the provision of choice is an even greater contribution to the well-being of our older population. It demonstrates the respect with which we hold them and also respects their wishes by providing care alternatives of the highest quality.
This Government, through these measures, recognises the contribution of older people to our society and will continue its momentum to improve their lives in as many ways as possible, particularly assisting them to retain their independence and their place in the wider community. As politicians and journalists have stated, we have had a booming economy here for the past few years and it is only fitting and right that older people should share in the fruits of that boom. Small changes can make a real difference to the lives of older people. When one is talking in millions, one can often get lost in the figures and the zeros after them. I have tried to explain as clearly as possible the number of areas we are tackling and the extra services that will be provided. This is an investment that I am confident will make a major change to the quality of life of thousands of older people throughout the country and is money well spent.
I thank the Senators for their contributions and I know others will contribute later in the debate. In general, they were constructive in what they said and were very appreciative of the money that is being spent and the difference it will make.
Senator Browne raised the specific issue of legislation and the repaying of moneys for long-stay care. It was our intention to have that legislation ready. It is almost finalised but it has proved to be a difficult task, with a lot of work involved. However, it has been a priority. As we announced earlier this year, this will be the biggest repayment scheme ever undertaken in the State and it was decided that we would seek the assistance of an outside company or body. We had to go through a selection process in that regard, which has now been done. A sum of €400 million was provided in the Estimates for next year.
We are trying to put a scheme in place which will not necessitate any legal involvement, as far as the older people affected are concerned. Last year the Government introduced legislation and Senator Browne was one of those who criticised us for rushing it through. The Government thought it was the right thing to do but the courts decided otherwise. We then had to take stock of the entire issue. The legislation that was introduced before Christmas last year made provision for an ex gratia payment, so money has already been paid to a number of people. All Governments try to introduce the best possible legislation but in this instance, because in many cases the people who are owed money are vulnerable, it is important to put safeguards in place to ensure those who are owed money actually receive it. It is very easy to say that, but devising legislation to ensure it is so is not so easy. We are treating the issue as a priority and will make an announcement on the matter in the near future. The same is the case with the setting up of the inspectorate.
Earlier in the year, a television programme highlighted treatment of people in a nursing home which left an awful lot to be desired. It frightened a lot of people, particularly families who had loved ones in nursing homes. In my experience, having visited many nursing homes, in the vast majority of cases, older people are treated very well. However, a bad experience in one nursing home or hospital is one too many. The Government is committed to putting an inspectorate in place that will prevent the type of happenings that went on in Leas Cross from being repeated anywhere else. We will put in place an inspectorate that has teeth and will prevent a repetition of what we saw on our television screens earlier in the year.
The sum of €150 million is money we have secured, in addition to what we have spent this year. It is money that will be well spent and will make a major difference. One Senator referred to it as being a drop in the ocean but in anyone’s terms, €150 million is serious money.
Mr. S. Power: It is nice, now and again, to hear positive contributions from Members. This money was one of the great successes of last week, announced by the Minister for Finance, Deputy Cowen, and will make a real and meaningful difference to the lives of older people. The Government is committed, and has shown itself to be over a number of budgets, to improving pensions and services to older people. This is part of that process and the Government will continue to fund such services because it is nothing more than older people deserve.
I have a problem when the Government tables a motion congratulating itself and equally when Members on the Opposition benches table a motion condemning the Government. The people in general have a problem with us because of this kind of scenario. I do not see why the Government needs to be congratulated for spending the money it has to spend, that it raised to spend. It is required to spend the money. It cannot put the money in the bank but must spend it, so it is not a matter of congratulations. Neither is it a matter of condemnation. This is the kind of thing that brings the House into disrepute with people generally.
I have listened to the Minister of State and cannot disagree with a word he said, except perhaps his point that for members of the Opposition, enough is never enough. I would have thought that it is the same for those on the Government benches, for whom enough is never enough either. I have heard numerous Ministers say they wish they had more money and that they have not got enough. Every time they come to this House to speak they claim they only have X amount and have to make do with it. There is no difference in that regard. The same applies on both sides of the House.
It is important that we determine how we can make things work well and how we bring the situation forward. I wish to focus on a number of points, the first of which is the independent inspectorate. I can guarantee that within a few years of its establishment, a motion will be tabled in this House. The matter of who is in Government at that point is totally irrelevant; Senator Bannon might be on that side of the House or he might be on the Government side in the other House, and I wish him well in his campaign. The reality is that someone will ask if the inspectorate was a mistake, if it was a waste of money. He or she will point to the costs and argue that inspectorates did not cost so much in the past.
I have a suggestion, though I know there is not a snowball’s chance in hell that it will be taken up — that is always the problem with sensible suggestions. Setting up a nursing home inspectorate is a very good idea but there are other areas that also need to be inspected. This inspectorate will be set up on an ad hoc basis and will only examine a certain area. The Minister of State should analyse the various areas the Government will have to examine over the next few years. In fact, there are areas within his Department that are relevant.
Two weeks ago, we discussed the issue of early childhood care, which is the other side of the spectrum. The same question arose with speaker after speaker, namely, how do we know when a parent is dropping his or her child to a care facility in the morning the child is going into a safe place that is well run? The question is exactly the same for elderly people, namely, how can we be absolutely sure they are in a safe, well-run facility that complies with all of the relevant regulations? We most certainly need an inspectorate but it should not be on an ad hoc basis, dealing only with the elderly. We should, however, investigate what is happening in buildings which the Government is subventing. There is no reason an inspectorate or other body cannot look after children under six as well as elderly people at the other end of the spectrum. It will eventually be governed by health and safety because that is what we are trying to achieve.
To create synergies I ask the Minister of State to inspect the various institutions in which citizens of this State of any age are being looked after. This will avoid setting up something and regretting it two years later as we argue about whether to extend its area of responsibility.
I welcome the constant theme of flexibility in the Minister of State’s proposals. He is correct about the number of people who would prefer to stay at home and the number of extended families and communities who favour that option. I would like to have heard what the Minister of State means by flexibility, not to hold him down to it because these proposals must go through a process. If an extended family has three elderly relatives being looked after in three different houses and all three decide to move into one of the elderly persons’ homes, it becomes easier for the extended family and economies of scale make it easier for everyone. As things stand two people in such a situation cannot get the same level of support, though I am open to correction on that. Extended families often have more than one person to deal with.
I also welcome the Minister of State’s point that a certain number of places could cater for twice that number of people, because people do not need to be present all the time. The idea that people can move in and out of a home as and when they need support is welcome.
The Minister of State said the subvention rate was increased last year but that does not appear to be the case. Is that increase down to the number of people who qualify, rather than an increase in levels? Will the levels be increased? The Fine Gael amendment states that subvention levels have remained static since 2001. If that is correct it is almost as nonsensical as retaining the 1993 levels, as the Minister of State said. Inflation since 2001 must amount to at least 10%.
How will this work? Will the Minister of State recognise that we cannot do these things without a sense of care in the community? I am worried by the greed in Irish society at the moment. The more we can do for families who want to look after their elderly relatives themselves, with a little support from the State, the better.
I would like to see the formula showing how we can save money. I can see the figures the Minister of State has provided but what does it cost, per person, in a nursing home for a year and what is the subvention level available for each? What does it take to give such people a Rolls Royce level of support at home, involving somebody staying with them at night or visiting them for a few hours during the week? The State might have difficulty organising an hour here and an hour there. The home care service works very well but extended families can sometimes do it equally well. I have seen it happen in my own community.
The flexibility proposed by the Minister of State could give a better quality of service and also save money — it is a win win situation. We need to increase funding levels because the point made in the amendment is important.
The motion, “recognises that this package will mean a major improvement in home and community-based support for older people.” I remain to be convinced and I do not see how it will happen. The money will make a difference but we need to see it working and how flexibility will be built into it, because that is the most difficult task. Every home, community and family are different. Some live close to each other but others live far away. A family member may be based in Dublin but a relative might live 150 miles away and it is costly to visit them every weekend. If somebody put that to the Minister of State would he take it on board?
Mr. Norris: I agree with Senator O’Toole that it is regrettable these matters become a subject of contention on partisan lines and I will vote with the Government this evening. It praises itself too much but we need to encourage it because good work has been done in this budget. The Minister of State is decent and caring, which is obvious from his comment that the visits of meals on wheels providers were as important as the meals.
I spoke to members of Age Action Ireland and they were positive about the budget. They were pleased that old age pensioners were now allowed to earn up to €100 per week without coming into the tax bracket or it affecting their pension, in contrast to the €7 at present. I welcome that significant improvement. The pension increases were in line with what Age Action Ireland asked for so it must and will congratulate the Minister.
Irish pensions, however, are only 32% of gross average earnings, less than the target of 34%. In comparison with other European countries we are not living up to our obligations to older people. The OECD average is 57% and in Luxembourg it is 102%. That is a wonderful figure though I wonder if it is correct. It suggests there is a premium for moving into the pension bracket which is a wonderful idea, and becomes even more wonderful the older I get.
The Harney package of €150 million over 2006 and 2007 for home care is very welcome and indicates a welcome change in attitude. I listened to an RTE radio programme today on a facility in which old people were given physiotherapy and training for living alone. I recognised the voice of a decent old fellow who was the father of a man I was in school with and explained how the facility enabled him to continue living alone. He had got to a point where he had difficulty dressing himself but they taught him how to do so and showed him exercises to make it physically easier. Socialisation was also a major feature of the facility and anything like that represents money well invested.
At a time when the health services are described by the Minister and others as having systemic problems and are in the middle of a re-organisation, can the Minister of State reassure us that there is sufficient bureaucratic capacity to implement these measures? I encountered a wonderful misprint at a meeting of the Joint Committee on Transport calling the Competition Authority the “Completion Authority”. That would be very useful in this State. Like an implementation board it would have the completion authority and could be sent in to complete these valuable programmes.
We have heard nothing about the creation of further public nursing homes. I want to raise an issue of particular concern in this area. The Leas Cross nursing home was a private nursing home, and such homes are inspected on a fairly regular basis. I do not believe there is the same supervision of public nursing homes. There should be because of simple and avoidable things, such as bedsores, which we need to know about and address.
I welcome what the Minister of State said. Further research is needed. A very good report on health and social services for older people found, for example, that there were discrepancies between different health board areas. We need to know why people are not taking up the services or getting the same service they did. It would be useful to look into this and I hope the Minister of State can facilitate research in this area.
I support the motion and welcome the Minister of State to the House. I am delighted to have close experience and evidence of the determination of the Tánaiste and Minister of State to provide the best services for elderly people. Recent examples of this determination and of what it can deliver in my own area of Limerick include approval under the capital programme scheme for a dementia unit in Newcastle West and for a hospice unit. I thank the Minister and Minister of State who visited those facilities in the past. I was fortunate enough to be able to arrange a number of meetings at Newcastle West and I am very supportive of the projects. I appreciate the support of the Minister of State.
Today’s motion provides more evidence, if it were needed, that this Government and the Tánaiste in particular, put care of the elderly at the heart of budgetary and policy decisions. That must be commended. In Limerick there are some 20,000 persons aged 65 and over, about 11% of the population of the city and county. Like so many other industrialised countries, Ireland will experience a significant ageing of its general population over the coming decades. However, a word of caution is needed. Using statistics can lead us to think of a particular group in society as a uniform group with the same circumstances and needs, which is not the case. We have a duty to provide the most appropriate services for particular cases.
As has been mentioned earlier, the State will, rightly, still support appropriate residential care. That option may be the most appropriate and desirable in some cases but there are a significant number of older people who do not need that level of care. They might need some home help, perhaps a midday meal, help with a bath, physiotherapy or occupational therapy. Social contact is another aspect that should not be underestimated.
Perhaps the most important aspect is choice. A lot of ink is given to issues of respecting the elderly, equality and rights. The true evidence that a society really values any group, but especially the vulnerable, lies in providing them with real choices. Many elderly people wish to stay for as long as possible in their own homes. A state and a government may provide a single safety net for a vulnerable group. That may be adequate but to me it does not seem enough. In this month’s edition of Ageing Matters, the Tánaiste writes that care for older people is a top priority for her. She wants our country to fully respect and care for older people and wants this to be a legacy of her time as Minister for Health and Children.
I will conclude with three short comments on what she said. First, the Government parties share the Tánaiste’s top prioritisation of care of the elderly. Second, I hope the House joins me in expressing support for the tremendous work being carried out by the Government and by the medical staff in the HSE in this area. Finally, the wide-ranging new services being funded, involving an additional €110 million in 2006 and €150 million in a full year, will go a significant way towards ensuring that full respect and care for older people will be the legacy of the Government.
I especially welcome the €9 million provision for respite care. That is in recognition of the tremendous services being provided, often in a voluntary capacity, throughout the country. That money will allow for an additional 1,300 positions for care in centres, which is to be welcomed. This is the first time a special heading has been inserted in the budget for this area, which is also true for voluntary housing.
Many comments have been made about the great work in voluntary housing across the country, but the €1 million provided under this heading is additional money for therapists and nursing care at these facilities. It is in everyone’s interests to keep people in their own communities for as long as possible. This is a tremendous success story carried out by voluntary housing, and I commend the Minister of State for the funding, and wish him well for the future.
Mr. Lydon: There is no need for me to go over the items noted by other speakers. I welcome the motion, and the provisions made by the Minister for Finance. It is a good package and will help the elderly.
I have always said that if one finds a child or baby outside one’s door in the morning, one takes it in and cares for it, but if one finds an elderly person, one might not be inclined to do so. Having dealt with elderly people a lot over the years, I have great empathy with them, especially those who are abandoned. Many elderly people have families who do not visit them, have nothing to do with them and do not look after them. That is very sad. There is a major problem in this country with people living alone, and with the increasing numbers of people suffering from Alzheimer’s disease. I understand some 35,000 or 40,000 people currently suffering from that illness, and the numbers are rising.
Any nation which cannot care for its elderly population is not worth its salt. Such care is very important. When people have given their lives for the State, have worked and done the best they could with their lives, it behoves the rest of us to support them.
I compliment the Society of St. Vincent de Paul on its great work. I support some of the comments made on the various financial packages provided, including that for respite care, palliative care and home help. Home help personnel are not always what they are cracked up to be. They come to a home for a short time and cannot stay all day, but they help. However, elderly people on their own are very vulnerable and as the Minister of State said, it is a good idea to help them to stay in their own environments as long as they can. Elderly people do not like to be shifted around and moved from where they are used to living all their lives. Home help is very useful in this respect and is to be praised.
I would like to see the Government concentrate on the area involving people before they become elderly. I do not see any reason on God’s earth why people have to retire at 65 if they do not want to. Many people might be engineers, for example, or company directors or postmen, on the day they reach the age of 65. The following day they have no job. All the knowledge and the accumulation of experience developed over a lifetime is lost to the community. Other countries such as America — or so I understand — make use of the great knowledge such people have in order to train young people, to help them, to inculcate values and even look after children. We should follow such examples.
There is a lot that elderly people can do, and should be encouraged to do up to the end. That is why I like to see emphasis on primary rather than tertiary care. I like to see emphasis on exercise programmes and on proper dieting. I do not mean merely physical exercising, but mental exercising, people using their minds up to the end. One can recall people who have remained on in office, such as Seán MacBride. Many such people work into their 80s or 90s, because they believe they can do so and are given some encouragement. I have met many elderly people who had so much to offer the community but were landed in a psychiatric hospital or a nursing home — particularly in bad nursing homes, of which there are many. I have no hesitation in saying the best nursing home in the country is in Crinken, Shankill, run by the St. John of God Order. It is spotlessly clean. A great programme is provided as are good food and individual rooms. Great care is also provided as well as respite care.
I welcome the increases in old age pensions but they should be around €1,000 per week and should be means tested. If one tried to live on €10,000 per year, one would know what it was like. Elderly people should have enough money and if they do not, they should be helped. I know we cannot afford to give €1,000 per week but we must aim towards it. The Government’s ambition of moving towards €200 per week is laudable. Nobody thought it could be achieved but it will be shortly. The Government should be complimented on that.
Mr. Ryan: I gently take issue with Senator Lydon. The Minister of State would probably agree with me that perhaps as good a model of an excellent centre of care for the elderly is St. Vincent’s Hospital in my home town of Athy, which happens to be where my mother resides. It would be remiss of me not to put on the record the extraordinary quality of care available which I am sure is replicated in many public facilities for older people throughout the country. It is a remarkably good humoured, cheerful place and it provides high-quality personal and medical services. Families are integrated and it is easy to get access. It provides an extremely good service.
I am a little worried that the Tánaiste and Minister for Health and Children may be allowing her preference for the private sector to direct her funds in the direction of private nursing homes rather than towards the expansion of public sector care for the elderly. If one wants a model of how good public provision can be, many of the public services provided for elderly people provide such a model.
What was announced in the budget is a considerable improvement but it is, to a degree, symptomatic of something which seems to be a particular blind spot with the Government, that is, the realisation that there are costs associated with prosperity. We have moved from a situation where there were 1 million people at work in 1996 to one where there are 2 million at work now. The population has not increased by anything like that number and it is also ageing. Many services were provided by volunteers or by the considerable number of people who were underemployed or who were not employed and who were often women. As I have said 100 times here, I would rather have the problems we now face than those we had in the past.
However, there was a great need for a strategic realisation that as our labour force expanded and as people’s free time, therefore, contracted, gaps would appear all over the place in the network of community support which used to exist. I noted a reference to the increased funding for meals on wheels in the Minister of State’s contribution, which I welcome. However, a problem about which people doing meals on wheels in Cork have told me is that the providers of the service are ageing and the number of volunteers is declining because people who used to volunteer — very often married women whose children were in school — are working, and who would begrudge them that. It is beginning to leave gaps all over the place in services. That is an issue which we, as a society, and the Government, as the lead player in society, will have to address, that is, it is no longer possible to do the things we could do through voluntary service in the past. I am not suggesting the goodwill has changed but people have changed and opportunities have presented themselves. We are in a completely new environment.
The fundamental fact in all of this is that as a percentage of GDP, our expenditure on protection of the elderly is low by international standards. We must realise that with prosperity of the scale this country has achieved, we are beginning to be forced into choices. I refer to the famous comparison the Tánaiste said she never really made between Boston and Berlin but which has become part of our political mythology. We are liable, by default, to make the choice of the Boston rather than the Berlin model which leaves people to provide for themselves out of their own resources and creates a profoundly unequal society. If we do not strategically decide to direct public resources to reduce those inequalities, we will end up with an impoverished older population which is in considerable danger of poverty. Some 7% of old people live in conditions of consistent poverty, according to the most recent Central Statistics Office figures.
We are creating a network, or a patchwork, of gaps which will impoverish older people. What happens to an old person on an non-contributory old age pension if his or her waste service is provided by a private operator and for whom there is no waiver, as happens in many parts of the country? If an old age pensioner moves from inside to outside the city boundary in Cork, he or she suddenly discovers the waiver he or she had is gone. I am sure the Minister of State can usually manage the payment of waste charges, whatever about myself. However, for an old person on an income of €200 or €250 per week, the annual charge for waste disposal is the equivalent of one week’s income. That is a hole in anyone’s budget.
The Government must see old people as in need of a variety of services, the most fundamental being that they have an adequate income which they can spend on the things they need and which is not extracted from them by increased local authority rents, the imposition of privatised waste collection charges or by a sudden increase in energy costs. I am glad the Government has decided to increase the fuel allowance for the first time in I do not know how many years.
Some 31% of our elderly people suffer from a disability, that is 135,000 people. Have we a strategy in place? I know we have the beginnings of something. Again, I do not want to play a silly negative game. Everything done in the budget is welcome and is better than nothing. However, one would have a greater sense that there was a strategic plan if there was not the slippage in respect of the nursing homes inspectorate. The legislation was supposed to have been introduced in the autumn. As we approach 2006, it has still not emerged and we do not know when it will.
The same applies to the repayments of the illegal charges. A cynic would say people are waiting for as many as possible of those charged illegally to die because it is probably more difficult for the dead to sue than for the living. It is also probably more difficult for the beneficiaries of a will to sue than for a living individual to do so. I cannot understand the slowness of this, whatever about the merits or demerits of it because I did not have a serious problem with people paying a reasonable fee towards good quality care. This is a strategic failure on the part of a number of Governments, including some in which my own party participated. I support the Fine Gael amendment because it identifies the need for a strategy. What we have here is an indication of what may be a strategy but I would like to see it in its entirety not just little examples of it. Then we could believe there was a coming together of all the agents of the State to provide the type of quality of life to which our older people are entitled.
Ms White: I compliment the Minister of State on his endeavours in getting the €150 million package for older people which will include the new home care scheme, increased home help, and more day care and palliative care. This is a significant investment by the Government. I wish to catch the Minister of State’s eye to compliment him on his achievement and endeavours.
Ms White: I am now working on a new document on the elderly. As I stated previously, the Taoiseach informed me prior to the budget that I could take credit for the child care provisions in the budget.
Ms White: I hope that my next endeavour on a new approach to ageing and ageism will have as much impact on the next budget and over Government policy in the coming year. One can well ask why a new approach to ageing is required. The number of people over 65 is increasing dramatically. They are a growing proportion of our population and are living longer than any previous generation. Society must reassess how it views older people, how it will respond to their needs, their role in the community and how to tackle ageism.
Currently, people over 65 comprise 11% of the population. In 2006, that number will rise to 11.16% and it will be 13.3% in 2016. It is interesting to note that not only is the number of older people growing but they are also much healthier and getting healthier. The population is living longer and is generally more healthy. In future it is likely that most Members will probably be very healthy when they are 75. People think that when one reaches 65 one becomes old and enters an older state of mind yet there is a major difference between a person of 65 and a person of 90. It is a whole generation. One cannot take the same policy approach to people of 65, 75 and 85. A blanket homogenous policy to people of these differing ages does not work and different policies should be in place for different age groups.
The most exciting aspect of my research to date is that we will all be much healthier. I am fascinated by this. I am sure Senator Henry is familiar with this research but it was news to me. As people get older those who have a genetic tendency to high blood pressure or strokes take medication so when they reach 65 they are capable of enjoying a full, healthy and active life.
Ms White: Yes, especially the white ones. Councillor Evelyn Byrne, the chairwoman of the National Council for Ageing and Older People was here last week and she pointed out that in three generations the role of Irish women has changed. We should think about that. However, the role of older people has not. When one reaches 65 one is put in a certain slot. We must examine why that is the case.
In 1994, when the former Taoiseach, Albert Reynolds, was leader of Fianna Fáil, I got involved in the peace process in the North. As we all know, language is critical. My key to understanding the problem centred around the phrase, “parity of esteem”. It was based on the concept that both sides of the community were entitled to equality. In my new approach to ageing and ageism I am putting the issue of equality and parity of esteem for older people on the political agenda.
A perfect example was the introduction of BreastCheck for women under 65 only. It seems unbelievable that anyone would dare take that approach. A woman over 65 is not entitled to get a free breast check in the same way as a woman under 65. How dare anybody decide that somebody over 65 is less entitled to a breast check?
I have spoken to Professor Kathleen Lynch from the equality department in UCD. She would like to see a commission on ageing. She pointed out that it was only when the commission on disability was set up ten years ago that the attitude to disability began to change. From an academic point of view she would suggest a commission on ageing. That approach would take longer to produce results but it is a very good idea.
From my research to date, older people are neither organised nor mobilised. They are too complacent and patient. Why should people have to retire at 65? Many people want to stay in the workplace after the age of 65. I propose that people would be allowed to retire on a phased basis at 67 or 68. Sixty eight may be the optimum age. It should not be the case that one would have a job to go to one day and no job the next. Most Members are active people and we would not like the idea of having to give up work at 65 if we were in perfect health unless it was to pursue another interest.
We have many role models. If Senator John McCain decides to be the Republican candidate for the presidential election in the United States in 2008 he will be 72. President Reagan was 76 during his second presidential term. Brian Friel is 76. Senator Maurice Hayes is a perfect example of a robust individual over the age of 65.
Ms White: Yes, he is 21. As I stated, 11% of the population is over 65, yet there are only five Deputies over 65 in Dáil Éireann. This means only 3% of Dáil seats are given to those over 65 while they comprise 11% of the population.
It will take a few months for me to produce a finely honed document. Older people are too polite and passive. They need to assert themselves and make their voices heard politically. I again compliment the Minister of State on his endeavours on the significant investment for older people in the budget.
Mr. Bannon: In welcoming the Minister of State to the House, I wish to condemn this motion in the strongest possible terms as nothing more than the self-congratulatory spin we have come to expect from this lame-duck Government over the past year or so. While the Government’s new-found mantra emphasises care of the elderly and keeping them within their communities and their homes, a new report by the National Council on Ageing and Older People provides evidence of ageism within our health and social services. The research uncovered concrete examples of discriminatory practices experienced by older people or witnessed by health or social care providers in every part of the country. Last week’s budget announcement will do nothing to help the more than 40 people awaiting admission to nursing home care in my constituency of Longford-Westmeath.
The Minister of State mentioned an additional 250 beds but told us that 200 of those will be provided in Dublin and a further 50 in Cork. That will leave none for the people of rural Ireland, who have already been grossly neglected in terms of community services and accommodation in nursing homes. That is a shame on this Government. Two weeks ago, I raised the issue of home help in rural Ireland with regard to neglect and the hours that were cut. This budget has not addressed that issue.
Dr. Henry: It is all very well to say that the services are there for people but the question arises of whether they are available. While I applaud, for example, the Government’s efforts with regard to improving home help, I have asked at the top of the HSE what happens when a home help is on holidays and have been told that the elderly person is entitled to a locum if one is available. It is no good to require that someone must be available.
I was dismayed to learn yesterday of the intrusive questions people are asked before they are given incontinence pads. I will not describe them here but they are outrageous. Questions of a personal nature should not be asked by non-medical staff. For the sake of personal dignity, we should ensure that such situations do not arise.
Mr. Glynn: I am proud to have moved this motion, which is indicative of the Government’s commitment to services for the elderly. As I said in my opening remarks, older people have been the architects of this society and it is only right that proper services are provided for them.
There are many facets to the budget and a range of proposals were outlined in this debate by the Minister of State. I concur with Senator Lydon that further consideration should be given to the issue of experienced people from all walks of life who have a job one day but lose it the next. A certain degree of flexibility should be permitted with regard to retirement because they do not become lesser people simply by turning 65. There have been many examples of brain drains in Ireland, such as the one from the public to the private sector. Where a person is physically and mentally fit, a case could and should be made for him or her to continue. Time will be required to roll out all the provisions set out in this document.
There are many different models of care for the elderly. Some years ago, I encountered an excellent example in London when I visited my sister’s mother-in-law. It included a flat, a resident caretaker and a selected group of people who kept an eye on the elderly citizens. I understand a similar model exists in Ireland but, if that is not the case, the example in London deserves investigation.
Regardless of the type of medical or nursing discipline, community service is better than hospital care. However, it is also a more expensive service. I have read a number of reports by the Inspector of Mental Hospitals and Places of Detention on the elderly in long-stay institutions and the word “visit” does not take pride of place in terms of the number of visits residents of institutions receive from relatives. Of course, plenty of relatives came out of the woodwork when a few pounds were made available. On the other hand, I know a number of people who make efforts to visit their relatives and I commend members of voluntary organisations such as the Society of St. Vincent de Paul. If it was not for them, residents would never see any face other than those of ward staff. I commend the motion to the House and hope it receives unanimous support.
|Bannon, James.||Bradford, Paul.|
|Browne, Fergal.||Burke, Paddy.|
|Burke, Ulick.||Coghlan, Paul.|
|Cummins, Maurice.||Feighan, Frank.|
|Finucane, Michael.||Hayes, Brian.|
|Henry, Mary.||McHugh, Joe.|
|O’Meara, Kathleen.||O’Toole, Joe.|
|Phelan, John.||Ryan, Brendan.|
|Terry, Sheila.||Tuffy, Joanna.|
|Brady, Cyprian.||Brennan, Michael.|
|Callanan, Peter.||Cox, Margaret.|
|Daly, Brendan.||Dardis, John.|
|Dooley, Timmy.||Feeney, Geraldine.|
|Fitzgerald, Liam.||Glynn, Camillus.|
|Kenneally, Brendan.||Kett, Tony.|
|Kitt, Michael P.||Leyden, Terry.|
|Lydon, Donal J.||MacSharry, Marc.|
|Minihan, John.||Morrissey, Tom.|
|Moylan, Pat.||Norris, David.|
|Ó Murchú, Labhrás.||O’Brien, Francis.|
|O’Rourke, Mary.||Ormonde, Ann.|
|Phelan, Kieran.||Ross, Shane.|
|Scanlon, Eamon.||Walsh, Jim.|
|Walsh, Kate.||White, Mary M.|
|Brady, Cyprian.||Brennan, Michael.|
|Callanan, Peter.||Cox, Margaret.|
|Daly, Brendan.||Dardis, John.|
|Dooley, Timmy.||Feeney, Geraldine.|
|Fitzgerald, Liam.||Glynn, Camillus.|
|Kenneally, Brendan.||Kett, Tony.|
|Kitt, Michael P.||Leyden, Terry.|
|Lydon, Donal J.||MacSharry, Marc.|
|Minihan, John.||Morrissey, Tom.|
|Moylan, Pat.||Norris, David.|
|Ó Murchú, Labhrás.||O’Brien, Francis.|
|O’Rourke, Mary.||Ormonde, Ann.|
|Phelan, Kieran.||Ross, Shane.|
|Scanlon, Eamon.||Walsh, Jim.|
|Walsh, Kate.||White, Mary M.|
|Bannon, James.||Bradford, Paul.|
|Browne, Fergal.||Burke, Paddy.|
|Burke, Ulick.||Coghlan, Paul.|
|Cummins, Maurice.||Feighan, Frank.|
|Finucane, Michael.||Hayes, Brian.|
|Henry, Mary.||McHugh, Joe.|
|O’Meara, Kathleen.||O’Toole, Joe.|
|Phelan, John.||Ryan, Brendan.|
|Terry, Sheila.||Tuffy, Joanna.|
|Last Updated: 08/09/2010 05:33:39||Page of 11|