I compliment the Minister for introducing this Bill and express the hope that it will eliminate some of the difficulties experienced over the years. We have identified them by virtue of our experiences in the institutions run by the existing hospitals and health boards. The general purpose of the Bill is to set out the structures in relation to the buildings and care which we proposed to give to the elderly. There is no ground in society today more vulnerable and subject to the whims of economic pressure than the elderly. There are many instances where elderly people, having been admitted to general hospitals, are then discharged and shunted from post to pillar, as it were, in an unceremonious and undignified fashion that ill befits them.
Let us examine what happens at present. When an elderly person — for instance, a stroke patient — is admitted to a general hospital he is likely to be there for a week or two at the most and then he is referred elsewhere. When alternative accommodation is available, either in another hospital specialising in geriatric care or in a health board institution of a minor nature, that is all right but in many instances there is no such accommodation available. Over the years we have had an opportunity to evaluate the suitability of some of the accommodation that was available, both in the private and public sectors. I have no hesitation whatever in going on record and saying that up to a few years ago some of the accommodation which was available in the public sector left an awful lot to be desired. Old, decrepit buildings were being utilised to accommodate the elderly and this, to my mind, was a complete reversal of the manner in which we should have been dealing with the matter. Obviously the elderly are much more subject to climatic changes than any other sector, with the possible exception of babies. Some of the old buildings in which our elderly were housed over the years were, to say the least, totally and absolutely unsuitable and it was impossible for staff to operate and give a proper degree of service in them.
It does not really matter who provides accommodation as long as it is there and a good standard of care is available. Good solid buildings should be made available wherein that accommodation could be provided. In the great majority of cases, in recent years in particular, where private accommodation has been provided, the regulations laid down by the Department of Health, the health boards and the fire departments of the various local authorities are sufficient to ensure that the standard of those buildings is equal to if not better than many of the older State-run establishments. That may well reflect on ourselves as legislators and as members of various boards. I see nothing bad in allowing the private sector provide this much needed service provided of course that we never lose sight of the main objective which is to ensure that the right degree of care is provided.
In that regard I would like to dwell for a few moments on the categories of patients being referred to institutions at present. We should remember that the extended family is not as available as it used to be to cater for an elderly person within a family. In recent years, and I am not making a political point, there has been large-scale emigration with the result that in many cases the extended family is not available to the extent it was some years ago to care for an elderly person. That elderly person is faced with three options. The first is to enter a welfare home. This is acceptable where the person is not immobilised and does not require regular medical treatment provided that the patients are categorised and are placed in that kind of environment in the knowledge that they will not have to have recourse to the kind of medical attention provided in a geriatric hospital. As I see it, we will have to make sure that patients are categorised properly and ensure that we do not have in welfare homes a patient or patients who require regular visits from a doctor or specialist.
We now come to the person whom nobody wants, the immobilised patient or the patient who requires what is described by the health boards as heavy nursing. It is not good economics for a private nursing home to take on too many immobilised patients for very obvious reasons. One reason is that they require a very high degree of medical attention. It is important that a good proportion of those who require heavy nursing are spread between the public and private sectors, otherwise we will end up with those institutions in the public sector which are already overburdened carrying the weight of the problem, the most seriously affected and those most in need of attention. It is of vital importance that in each community care area there are two to three private institutions and a similar number of public institutions. In placing patients we should have regard for the degree of medical attention required at all times and ensure a similar number is placed in both the public and private sectors, thereby ensuring that everybody carries their fair share of responsibility.
I am sure that most Members of this House have had access to private institutions in recent years and I must say that the degree of service and attention available is absolutely amazing. In many cases patients are not being maintained in subvented beds but rather the cost is being picked up by their families. It is not possible to do this in all cases but in a countless number of cases the extended family have clubbed together to pay for the upkeep of an elderly relative in a private institution. Let me also add that many of these patients have been holders of medical cards for quite a long time. It is particularly ironic that after a lifetime of work, be it in the public or private sector, and holding a medical card they find it is of no benefit to them whatsoever and they have to go to their relatives and friends to ensure that they get the attention they need at that stage.
Sheltered housing has been referred to by many Deputies, including Deputy Mattie Brennan who referred to it a few moments ago. It has an important role to play in the context of this Bill in this sense. It is not necessary to place all patients who require care and attention in an institution, be it private or public. It is possible, and desirable from the point of view of the State and the patient, to provide sheltered housing where regular medical supervision can be provided, where meals can be prepared in a central commune and where, at the same time, the individual patient would have a degree of privacy not available in a nursing home, hospital or welfare home. I am thinking here of small blocks of custom-built houses adjacent to a hospital to which medical staff would have ready access and where patients would have a degree of privacy which many elderly people desire and have striven for all their lives. We should attempt to give them that at this stage of their lives.
I would now like to refer to what I would describe as the in-between patient. I referred earlier to the role played by welfare homes. Incidentally, there are very few welfare homes providing this kind of service. I can see us arriving at the point where it would be much more economical to provide a service in a welfare home than in a nursing home or in a hospital for a patient who does not require that service at this stage. We would have no reason to put that person into a hospital. If it is possible for them to gain access to sheltered housing where they can be supervised and looked after without being totally dependent on either the public or private system then this should be done. Unfortunately, an insufficient amount of this type of accommodation is available at present with the result that more and more pressure is being put on our general and geriatric hospitals.
I do not want to be parochial but, for instance, in north Kildare where I live the main geriatric hospital is St. Vincent's in Athy which provides a very acceptable standard of accommodation and which has long since been a leader in providing that service. All credit is due to the sisters and staff of the hospital for the work they have done during the years. In fact, this was the only institution providing that service in County Kildare for a long time.
In recent years we have witnessed the advent of private nursing homes and the subvented bed. In north Kildare, from the point of view of family visits it is a long way, almost 50 miles, to Athy and it is virtually impossible to expect relatives to travel that distance on a regular basis either to the satisfaction of the patients or the relatives. There is an on-going problem in endeavouring to achieve that sort of accommodation within a radius of about 20 miles. Twenty miles in Dublin city would seem a long distance but in the country it would be quite acceptable. However, we do not have that service within 20 miles. The point at issue is that the subvented beds available in north Kildare do not nearly meet existing requirements. I know that in the context of this Bill there are proposals for a means test so that subvented beds would be available to a wider section of the community. That would be all right provided it met the problem which is that poor people who do not have the means at present have to go to relatives to try to get sufficient money to place an elderly relative in a private institution since they cannot gain access to the public one which has reached capacity. The availability of subvented beds is of major importance and this problem has been discussed at every health board meeting and certainly at EHB meetings in recent times.
While people may say that there have been cutbacks and that the number of beds have been curtailed, the essential problem is that the need is now greater, that more elderly people need accommodation. With each year that passes more and more elderly people have to be catered for. We do not have the resources within any of our health boards to go even half way towards meeting the requirements. Different areas may have different problems and in some counties the problem may not be as bad as it is in Kildare. Will the Minister carefully consider how this Bill will deal with the existing problem — and deal with it it must, because we cannot go on as we are. I have about ten different patients on my files at the moment who were referred to me by local GPs looking for accommodation for them with geriatric care. I am only one public representative and I am sure every other public representative is in the same boat. We have a long waiting list for subvented beds and unfortunately the only way in which a bed becomes vacant is when somebody dies.
That is not dealing with the problem at all. The patients trying to gain access to the beds know the situation. The problem results in old people being shifted from one institution to the next. A person might be in a Dublin hospital today and back down in a hospital in County Kildare next week and back in Dublin the following week. That is a most unfair and undignified way in which to treat the elderly.
There is a debate whether or not nursing homes could or should provide the kind of service we are talking about. They should and they can. In many cases they are doing so more economically than the State. That is another irony we would need to address. It is rather peculiar if a bed in a private nursing home turns out to be cheaper than maintaining a patient in a bed in a public institution. One of the reasons given why that should be is that there is a higher level of expertise in medical attention available in public institutions. That may or may not be the case and the reverse may be the case in some instances. We have an opportunity within the context of this Bill to provide a service for which there is an urgent need and at the same time save money. We need a certain amount of loosening up in relation to providing money for subvented beds. We could build new public institutions but they would cost a lot of money. We would not have to involve ourselves in such a large capital outlay if we used the private institutions. The only resolution to the problem that I can see in the short-term is to use private institutions provided proper medical attention is available to the patients.
Like every other Member in the House I have had correspondence from nursing homes. Without exception a most impressive degree of care and attention is provided by the people running those nursing homes. Far from it being a business, it is more a vocation because the people who set up these homes generally have a long experience in the nursing or medical professions or in caring for the aged. This experience stood them in good stead when they set up the nursing homes.
A few years ago I advised somebody who was in the process of setting up a private nursing home for the elderly. This person had a large old house which he proposed to adapt. At that time, and now in hindsight I can honestly say that I gave him good advice, I advised him to forget about adapting the old house and to operate from a green field site and provide new buildings. After some consideration he did so and it was the right step. He provided very high quality accommodation for the patients and the old house is now more valuable because it has never been interfered with. The quality of the buildings provided adjacent to the old house were complementary from an architectural point of view. There was a happy blending of the two types of development, the private residence and the nursing home, with the effect that medical attention was readily available to people living in a chalet-type accommodation with a high degree of privacy.
I hope that the Bill will deal with the problem about which we have all spoken. One could speak for hours outlining the problems that all public representatives have encountered in dealing with the elderly. If there is one group in society that we owe something to it must be the elderly who have worked long and hard for this economy. When they retire and require care and medical attention or housing we should be in a position to give it to them. It is unfortunate that up to the present we have not been able to give them the degree of attention they require.
There is a system of assessment for elderly people. The degree of assessment that some elderly people have to go through is outrageous; by the time many get through that assessment they can no longer be catered for in a nursing home or in a geriatric hospital. I would ask the Minister to streamline things so that it will not be necessary to bring a patient anything up to 100 miles to a central location to be assessed, kept there for two or three days, sent back to wherever they came from and told they might have to wait six months or a year, or until accommodation becomes available. It must be soul destroying for the unfortunate individual in such circumstances. Let us not forget that the elderly depend on those around them. The more immobilised they become the more dependent and, therefore, the more irritable they become. Anybody who is dependent on others is subject to the whims of those around them and knowing that is a big problem.
We are all getting older. Because of the age structure in our population there will be more demands on those providing care for the aged as time goes on. I hope that in this Bill we will set out a resolution to the problem by providing the care and attention that the aged deserve and desire without much more ado.
I would like to compliment the Minister on bringing in the Bill. We will have more to say on Committee Stage. I deliberately refrained from referring to the sections of the Bill at this stage but will do so at a later stage. Hopefully a degree of agreement will be reached within the House as to how best to deal with the problem because this issue should not be dealt with as a political issue but on the basis of delivering the best possible standard of service for those for whom it is intended.
