Private Members' Business. - Care of the Elderly: Motion (Resumed). – Dáil Éireann (27th Dáil) – Wednesday, 8 Dec 1993

Private Members' Business. - Care of the Elderly: Motion (Resumed).

The following motion was moved by Deputy Flanagan on Tuesday, 7 December 1993:

That Dáil Éireann, mindful of the importance of carers in the provision of care to the elderly, deplores the recent comments of Deputy Emmet Stagg, Minister of State at the Department of the Environment, wherein he described nursing homes as "corrals of death" and calls on the Government to recognise, encourage and support the carer and the dependent in this, the European Year of Older People, by reforming the carer's allowance and introducing a charter for carers to ensure appropriate assistance to the dependent and by guaranteeing institutionalised care where families can no longer cope.

Debate resumed on amendment No. 1:

To delete all words after "That" and substitute the following:

"Dáil Éireann commends the Government for the broad range of activities which were initiated to mark the European Year of Older People and Solidarity between Generations; in particular, commends the Minister for Health for the introduction, on 1 September 1993, of the Health (Nursing Homes) Act, 1990, which provides a framework for the registration of nursing homes and a new system of subvention towards the cost of nursing home care for those who need such care and cannot afford the cost and for his commitment to introduce a Health Charter for the Elderly; and further commends the Government and the Minister for Social Welfare for their continued support of the carer's allowance, for the commitment in the Programme for a Partnership Government to maintaining the real value of social welfare payments and to protect the income of pensioners and for their support of the elderly generally."

—(Minister of State at the Department of the Environment.)

Mr. Bradford

I am glad the Minister of State at the Department of the Environment, Deputy Stagg, is present in the House to listen to the rest of the music, so to speak. I am sorry he did not avail of the opportunity afforded him last night to withdraw the strong and very unfair attack he launched on private nursing homes and the concept of private nursing homes. If he had been willing to climb down from his high horse last night and admit that his remarks were somewhat too strong, we would have looked differently on the matter. However, the fact that he used the opportunity afforded him last night to defend his earlier remarks is unforgivable. The silence of the Minister of State's Fianna Fáil colleagues in Government on this matter is quite deafening. I hope this is not an indication that they support the Minister of State's comments but rather that they are ashamed of what he said. Hopefully, some Fianna Fáil Deputies will clarify tonight their party's views on the Minister of State's comments.

The point must be made that private nursing homes have more than filled the very wide gap created by the lack of State funding for people who need care. Private nursing homes, their proprietors and staffs have gone beyond the call of duty in this respect. They have provided much needed care and attention to many thousands of elderly people in a very dignified way and should be congratulated on their record in this regard.

I welcome the assistance which has been given to private nursing homes by way of the subsidy which has been put in place. Unfortunately, the amount of the subsidy is not always sufficient and the regulations governing payment are formulated in such a fashion that it is very difficult for many needy people to obtain it. I hope the Minister for Health will look at the regulations governing this subsidy in 1994 and at the gap which needs to be filled. As I said, the private nursing homes have made a major contribution in this area.

I wish to refer briefly to the carer's allowance. This issue has been debated ad nauseam with various Ministers at Question Time. Nevertheless, the point has to be made that when the carer's allowance scheme was first announced amid a fanfare of trumpets the then Minister put it on record that the allowance would help up to 28,000 people. On the most conservative estimate 3,000 to 3,500 people — if one was being a bit more generous one could say up to 5,000 people — have benefited under the scheme. This is not good enough and the regulations governing the scheme need to be changed. It should be remembered that all those receiving a carer's allowance are helping the State in the long run: by looking after elderly people in their homes they are saving the State money. I appeal to the Minister in the European Year of Older People to amend the carer's allowance scheme so as to make it more meaningful for people.

Mr. Finucane

The Minister of State's description of private nursing homes as "corrals of death" led to a debate last night which was like the film "Gunfight at the OK Corral". The Minister of State said that he wanted to provoke discussion on the issue, but I would regard his comments as most unwise.

I wish to refer to my experience of nursing homes. My brother-in-law contracted multiple sclerosis and were it not for the kindness of the local nursing home and its staff I shudder to think what would have happened to him. He could not be catered for within our health care system. There are long waiting lists for the Cheshire Homes including the home in my constituency, which do tremendous work. However, these homes cannot cater for the number of people who want to gain access to them. I was very upset when I read the Minister's comments.

I know most of the nursing home proprietors in County Limerick and on several occasions I have tried to garner information for them. Even though the Health (Nursing Homes) Act was passed in 1990, I see from literature that it could take the Minister another few months to put in place regulations governing nursing homes. It is very unfortunate that all these aspects were not teased out before the legislation was passed. Nevertheless, the nursing homes appreciate the subvention now being paid in respect of patients. I would like to add a caveat to my remarks, that is, that the maximum payment of £120 is insufficient as the cost of keeping a patient in a nursing home is in excess of £200 per week. This deficit needs to be made up.

Nursing homes have played a very useful role in our health system in the past and will do so in the future. Hospitals which cater for the elderly — I do not like to use the word "geriatric" because of the improper connotations which have been attached to that word in recent times — have long waiting lists. The best possible solution to this problem is to pay people to look after the elderly at home. In many cases people who provide home help work for a very small income and work considerably longer hours than the number of hours for which they are compensated. These people, who are normally paid £2 per hour and who make great sacrifices, are the true champions of our system of care for the elderly. I have tremendous admiration for the women who carry out this work. In a recent television debate a woman who provides home help said she wanted to unite all the people working in this area in calling for a proper hourly rate for their work. These people should be properly compensated for the care they provide for the elderly.

One can see many examples of neglect of the elderly by the Government. Unfortunately, the only thing many people will remember about the European Year of Older People are the Minister of State's comments. Even though he may have made his comments in an overall context, they have been remarked upon by people throughout the country. Many people running nursing homes around the country have told me that they regarded the Minister's statement as very disrespectful.

Dr. O'Hanlon

With your permission, a Leas-Cheann Comhairle, I wish to share my time with Deputy Flood, Deputy Noel Ahern and Deputy Brendan Smith.

An Leas-Cheann Comhairle

Is that agreed? Agreed. The Deputy has 30 minutes.

Dr. O'Hanlon

I want to support the Government's amendment. Of course, any member of Fianna Fáil would be proud of the contribution that our party has made to the development of services for the elderly going right back to the time when we first came into Government in 1932. It is no harm to refer to those innovations which were unique in Europe such as the free electricity scheme, free television licence, free travel and free telephone rental, in addition to the housing that was provided and the range of services.

While I believe that the remarks attributed to the Minister of State, Deputy Stagg, were insensitive to the patients, to the staff who look after the patients and to their relatives, nevertheless, I am glad he is in the House because as Deputy Finucane has said, the ideal for the elderly is that they should be able to live in their own homes and in their own communities.

There are a number of excellent schemes in operation to improve the housing for the elderly but the time has come to streamline them. These include the essential repairs grant, the disabled person's reconstruction grant, the scheme for the elderly operated by the health boards and the new scheme introduced in recent years under a Fianna Fáil Government, the £10,000 grant in lieu of local authority housing. While I believe that these schemes are worthy, they are implemented in far too rigid a manner and there must be more flexibility. There is great variation from one county to another in how they are implemented. A scheme such as the disabled person's reconstruction grant should be applied liberally to any family who wish to build a room to house an elderly relative. Apart from the fact that the elderly like to live with their own families in their own communities, it is much more economical to provide a grant of £5,000 than to pay £10,000 a year to maintain a person in an institution.

Special dwellings for elderly people have been provided and these have been very beneficial in helping people to live in the community. There are also excellent support systems for people living in the community. Some people say they are insufficient but there would be no reason for us to be here if we were satisfied that everything was right and that nothing new needed to be done. There is the excellent home help scheme, the public health nursing scheme, day care facilities and day hostels. When I was Minister for Health in 1987 I was very anxious that more respite beds would be available for people who perhaps were confined to a wheelchair and indeed for the carers who needed to get away for a holiday, because of illness or whatever. Provision was made for the elderly to be maintained for a short period of time and I am glad to say that more beds have been provided for respite care.

We must recognise in Ireland that the great carers are the families and it is significant that less than 10 per cent of the elderly are maintained in institutional care. In other words, over 90 per cent are still maintained in the community. Reference was made to the carer's allowance by Deputy Bradford. It is important to look at what Deputy Woods did as Minister for Social Welfare. Under the prescribed relative's allowance the maximum payable was £28 per week and one had to be an immediate relative in order to qualify for that scheme.

I am aware of a woman in her eighties who was suffering from arthritis, who could not leave her chair and who had her adopted son looking after her. He did not qualify for that allowance because he was adopted even though it was essential that he be there with her. When Deputy Woods introduced the carer's allowance not only did the rate of payment increase from £28 to £50 at the time — it is now £60 — but the range of people who qualified as carers was considerably extended to the advantage of many people in this country. We would all like those who look after an elderly person to receive a carer's allowance but I am sure every Deputy recognises that that is not practical and that the cost of it would be prohibitive. However, where the person being looked after is totally dependent, the means test should be waived so that those who are caring for elderly, or younger people who are totally dependent, would receive a carer's allowance. That would not be very costly.

In the few minutes remaining to me I wish to refer to the Health (Nursing Homes) Act which I, as Minister for Health, piloted through this House in 1990. That Act had two objectives: the first was to ensure a high standard of accommodation for the elderly, including adequate staffing and a high quality of staff, and the second was to financially assist dependent persons in paying their nursing home bill. In addition, under that legislation people were assessed both in terms of their own means and also on the degree of dependency and a larger allocation could be paid by the health board where the person was more dependent. Nursing homes are obliged to register with the health board and my experience has been that there is a very high standard of care in nursing homes in Ireland. That is something of which we should be very proud.

I would like to pay tribute to the carers. We are very fortunate in Ireland that we are a caring people and that the elderly are well looked after both by the State and by the voluntary organisations. We should always recognise the contribution that they make but even if the State was in a position to provide the necessary funding for all the care that people needed, it would be unfortunate if we did not have the voluntary organisations who assist community development and make such an important contribution to the care of those in need.

Finally, I wish to compliment all those who care for the elderly and I can assure the House that Fianna Fáil, as they did in the past, will continue in the future to ensure that our services are developed to meet the needs of the elderly.

Mr. Flood

I want to thank Deputy O'Hanlon for sharing his time with me tonight and giving me an opportunity to participate in this very important debate.

The whole question of caring for the elderly is one that will increase in importance in the years ahead as our elderly population, in line with European Union trends, continues to grow. Therefore, we should try in so far as we can to put in place services and facilities to meet the needs of the elderly.

The growth in the number of elderly people places certain demands on the finances available and we must ensure that we utilise those resources which are always scarce. When it comes to matters close to our hearts we must ensure that we get the best possible value for money as well as providing the best possible service. The role of carers in relation to dependent elderly people obviously comes very much into focus in this regard.

I support the comments of Deputy O'Hanlon, a former Minister for Health, who has great experience, a person who, in his time was very committed to the elderly in his region. My aim is to ensure that elderly people are allowed to live an active, independent life, in so far as possible, within their own community and the services we put in place should have that objective in mind. Of course, there will be circumstances in which an elderly person will become dependent and find it difficult to continue to live alone within the community, which is when the role of the carer comes into play. The role of the carer has not been acknowledged although there have been debates and studies undertaken, particularly an excellent report published in 1988 for the National Council for the Aged by Professor Joyce O'Connor, which spelled out very clearly for the first time the role and work undertaken by carers and the difficulties they experience.

We can improve support for carers by putting in place a number of facilities which, until fairly recently, had not been afforded very high priority. These would include, for example, respite care since we must remember that a substantial number of carers are on call 24 hours a day, which places a tremendous strain on them. Therefore, we must provide respite care to give carers an annual break as some of them do not get away from year to year, which can place enormous stress on them and lead to circumstances touched on by the Minister of State at the Department of the Environment, Deputy Stagg. While we might not agree with the manner in which he made those comments, I am glad there has been some attempt to focus on the overall issue of elderly people and their movement towards either institutional or private nursing home care.

Many Members of this House in their clinics will have come across elderly people saying they are thinking of disposing of their family home and moving in with a son or daughter. I am becoming increasingly concerned at that trend. Frequently the same elderly people return to the clinic seeking independent, local authority housing because relationships broke down when they moved in with the relative. That highlights the difficulties for elderly people when problems arise within their families and they need to find alternative accommodation. There may well be a trend emerging that too many elderly people who could, with support, survive and lead independent lives in the community, for family reasons, are directed towards institutional care. That may well be an unfortunate development in our society which we will have to face if we are to genuinely meet the needs of the elderly within our community.

I am particularly pleased that the Minister for Health has now brought into effect the provisions of the Health (Nursing Homes) Act, 1990, which, for the first time, laid down the procedure for the registration of nursing homes and the level of care and accommodation which must be maintained in nursing homes with two or more elderly people.

There is also an onus on the respective health boards, through their public health nurses, to monitor the operation of the provisions of that Act with regard to nursing homes, something for which all sides of this House had been calling for some time. I predict the provisions of that Act will constitute a major contribution in terms of maintaining the standards of nursing homes at levels acceptable to elderly persons and their families when they cannot remain in their former abode. It is important that, in so far as possible, we give health boards nationwide the necessary resources to ensure that the highest standards are maintained in nursing homes. In addition, the provisions of that Act give the health boards discretion with regard to the payment of a subvention, a problem in the past which placed great difficulties on individuals and families with regard to the costs of maintaining an elderly person in a private nursing home. Now the relevant health boards have some discretion up to an optimum figure which is much more realistic. In this Year of the Elderly it is important that the provisions of that Act are implemented. I am delighted that has been the case.

The physical work undertaken by carers is very substantial and has often gone unrecognised. Many of them are on 24-hour call which, as I said, places an enormous strain on them and may well lead to circumstances in which a carer will be unable to continue to provide the type of service he or she would wish.

If, in developing services for the elderly, we provide more respite care places, that would be a help to those who wish to continue to care for an elderly relative. In addition, we need to expand the home help service, a good service, but probably a Cinderella one in terms of resources because, most certainly, we get tremendous value for money. More resources should be allocated to that service because the people working as a home help are at the coalface and provide an enormous service for those with whom they come in contact.

We can vastly improve the lives of elderly people by the provision of additional day care services. Carers need training or counselling when difficulties arise in relation to care of the elderly.

There is a whole range of issues to be tackled in so far as improving the lot of carers is concerned. If we tackle them on a progressive basis, identifying weaknesses in the system, then the lives of our carers will be improved, thereby encouraging more people to support the elderly in our community, and ensuring that they do not need institutional care.

Acting Chairman (Mr. McGrath)

I might remind Deputy Flood that he expressed the wish to allocate time to some of his colleagues and that he has now taken the lion's share.

Mr. Flood

I have made my points and will now give way to Deputy Noel Ahern.

Mr. N. Ahern

I support the Government amendment to this motion. The Year of the Elderly, an initiative of the European Parliament rather than the Commission, helped to highlight the problems of the elderly, getting people focusing on and thinking about the extra care and attention the elderly should be given.

The Government took a number of measures during the year in respect of the elderly. Certainly, the Minister for Health, with the co-ordinating body, made almost £500,000 available, ensuring that the statutory authorities, voluntary bodies and various other groups would work together to highlight the positive contribution the elderly make to society. I believe there were up to 5,000 events held nationwide focusing on that very issue.

The original motion referred to the fact that only 4,000 people are in receipt of the carer's allowance. We know where we want to go in that respect. As many other Members said, we all meet people who provide round the clock care for elderly people. We would like to be able to give them some financial reward in recognition of what they do since, at present, under the means test, they do not even qualify for a sum of £20 or £25 per week. I hope that in coming years matters generally will improve and that such people will be given recognition.

In the past year the Minister for Social Welfare announced a respite care fund which will be of tremendous benefit to people who look after the elderly, some of whom are constantly tied to the house. This fund has allowed various groups to spring up around the country. Volunteers can move in and give a carer an occasional day, week or month off so that carers are now able to take the odd holiday. Things are moving in the right direction. The Minister contributed last night and I am sure he did his best to defend the comments he had made previously. I can well understand the reason some people took offence at them. Some elderly people have a certain fear of institutional care which goes back to the old workhouse or county home mentality. Any comments in that regard help to worsen their fears.

There are a few points I should like to make in relation to the elderly. At a certain age people should get the medical card as of right. I had a case of a husband, aged 91, and his wife, aged 92. He was an ex-civil servant and he was in receipt of a pension of £180 or £190 a week. At a certain stage I would like to hear a Government say: "Unless you are a millionaire, you would get a medical card as of right". I realise that if a person has a letter stating that they are suffering from a terminal disease they qualify for a medical card.

The issue of nursing homes has been mentioned. Progress in this area is very slow, but I hope it speeds up. There appears to be a delay in my constituency regarding registration of some of the homes. Perhaps I had better give way to Deputy Brendan Smith.

Acting Chairman

Just to clarify, the Deputy has until 7.40 p.m.

Mr. N. Ahern

In relation to the Health (Nursing Homes) Act, 1990, the subventions are of great assistance but the registration process appears to be working slowly. I know there are many homes to be registered and that much work remains to be done. Since September progress has been slow. I am surprised at the terms of three stages of subvention, but I am aware it rests with medical opinion. I have been amazed at some of the people who were allocated the lower subvention of £70. I do not know how bad one's condition must be to obtain the higher subvention. Certainly, some of those who have got the £70 subvention need full-time institutional care. Nevertheless, it is a great improvement from what obtained previously and we are moving in the right direction.

Regarding the elderly, as Deputy O'Hanlon said, Fianna Fáil is always very proud of what it has done for old people. The value of the pension in recent years has maintained its real value. The campaign ten or 15 years ago to boost the old age pension succeeded, but perhaps it needs another campaign to give it a further boost. In recent years it has maintained its value and most years they have obtained a real increase.

I read an article in a newspaper the other day concerning the Christmas bonus in England, which is £10 and £15. In that context what we do for the elderly, together with the free schemes, is tremendous and means a great deal to many people. Indeed, some ex-local authority staff or ex-civil servants, who traditionally may have been in receipt of a good pension, would now dearly love to qualify for even 10p of a social welfare pension so that the door would open to all the free schemes. The free schemes have made an enormous difference to the elderly. This is a reflection of the care and concern which Irish people have for their old folk.

Mr. B. Smith

I thank previous speakers for sharing their time with me. At the outset I wish to compliment Deputy O'Hanlon on his initiative, while Minister for Health, in introducing the Health (Nursing Homes) Act, 1990. I know from speaking with people in the nursing homes association and health board officials, particularly in my own health board area, that he was most amenable to their proposals and suggestions.

I am delighted to have the opportunity to speak on this motion tabled by the Minister for Health. It is opportune as the European Year of Older People and Solidarity between Generations draws to a close. It is appropriate for this House to look back on the series of special initiatives which the Government has taken during the past 12 months, particularly in the area of social welfare. We in Ireland have gained a reputation throughout Europe for the imaginative and caring way in which we look after our old folk. Their position and status in our community stems directly from the respect which Irish people have always held for older and retired people. In particular, Fianna Fáil has always recognised their immeasurable contribution to the economic and social life of this country. In Government Fianna Fáil will continue to combine imagination with concern to ensure that our policies meet their needs. We have done so in the firm belief that after a lifetime of service to the nation, elderly people should be able to retire with the dignity they deserve. Fianna Fáil is firmly committed in the Programme for a Partnership Government to at least maintain the real value of social welfare payments and to protect the position of pensioners. I am confident that this Government will honour that commitment and improve the situation where possible.

I would like to refer specifically to the carer's allowance. This is one of the most important initiatives taken and Deputy Dr. Woods, as Minister for Social Welfare, over a number of years is worthy of commendation for his work in introducing this scheme. There are thousands of people all over the country, many of whom are women, who are looking after elderly and incapacitated relatives at home. That scheme was introduced by the Minister for Social Welfare, to provide a secure income for those carers who have no independent income of their own. I know the Minister would like to see more flexibility with regard to the income criteria and the time conditions of the scheme.

We all hope it will be possible during the coming years to improve that scheme. However, we must realise that some £10 million is being provided for the scheme and about 5,000 carers are in receipt of a regular weekly payment. I am disappointed that some politicians in this House and outside have tried continuously to undermine the carer's allowance since it was first launched. The reality is that £10 million per year is being provided where it was not provided previously. Almost 5,000 carers throughout the country are receiving a payment which they did not receive previously. We are giving tangible financial recognition to the work of carers on low incomes, who unselfishly, day in and day out, care for elderly and incapacitated social welfare pensioners. The reality is that the Government this year increased that allowance by almost 12 per cent, bringing the maximum payment to £59.20 per week.

Earlier in the year the Minister for Social Welare, introduced the respite care trust fund. I would hope that that fund can be increased and more scope given to it. Nobody can doubt the commitment of this Government and particularly the commitment of the Minister for the Environment, Deputy Michael Smith, and the Minister of State at the Department of the Environment, Deputy Stagg, or their determination to improve housing conditions throughout the country. The improvements mentioned by the Minister of State last night are worthwhile, but much more is needed.

I appeal to the Minister for Health, Deputy Howlin, and to the Minister for the Environment to plan more effectively and to provide a better spread of housing units for the elderly. Those units should be provided in all our villages. There should be a mix of housing to ensure that all age groups are caterd for within the schemes. I appeal to the Minister for Health to ensure that more beds are made available in what may be termed district hospitals for people who no longer need an acute hospital bed but have no relative to return home to. The establishment of proper day care units and district hospitals would be very important in rural parts.

The essential message from the Minister of State is that regardless of one's circumstances and whether one has the physical, emotional, mental or financial capacity one must keep one's elderly relatives at home.

Old age is not a question of death but a question of degeneration, the degeneration of cognitive faculties, of the intellect, sight, hearing, taste and smell as well as the reduction of independence and the loss of mobility. Incontinence is a major feature in relation to the elderly. It is estimated that 40 per cent of elderly people suffer from incontinence and carers have to provide for that particular need. The Minister of State, Deputy Stagg should know this; if for no other reason, he should know it having displayed such incontinence of language. I wonder how much experience of incontinence he has had in his life; and how many incontinence pads he has changed and, in particular, how many double incontinence pads he has changed. There are many thousands of carers who have had that experience on a daily basis and I would trust their views on the care of the elderly more quickly than those of the Minister of State. These are the unsung heroes and heroines of Ireland. Their role in society is one of anonymity and it has never been given full recognition. It has a low status and will continue to have unless there is a radical transformation in the way the State acknowledges their job and the important role they play.

At a personal level, we hold the elderly in high regard but at public level we do not and those who care for the elderly are not regarded as important people. The work is very often carried out by women alone at home, for whom the provision of a carer's allowance is denied or, when granted, so minimal as to reinforce the view that their job is unimportant. These people are vital to the good of society and to the health of families.

Ministers and Ministers of State are cared for. Their needs are met by a whole range of carers, be it the driver, the secretary, the person who cooks the meals or answers the telephone, the adviser, the civil servant. These people all bolster and reinforce the message that Ministers and Ministers of State are important people. Who provides that message for the carer? Who supports them when they fall ill or are at the end of their tether? Who provides them with the ego massage that Ministers enjoy? An individual may spend years caring for an elderly relative who may be cranky, disoriented, physically strong yet mentally feeble and who requires constant daily attention, but who cares for the carers?

Many elderly people do not experience problems in old age and live full and active lives right up to the end. There are many families who, when the health of an elderly relative starts to degenerate, take on the role of caring in a willing, able and loving way. Obviously, the ideal for everybody concerned is that the elderly person should live out his or her days being well looked after and in familiar surroundings in the family home if possible and surrounded by those who love them. That is the best of all possible worlds and Irish people have shown that they are in accord with it. At a personal level, families have shown a tremendous sense of responsibility towards the elderly but unfortunately this respect is not matched in the public arena. However, that kind of arrangement is not always possible as it is not always possible to keep an elderly person at home.

There are many needs that must be met including the frailty of the elderly. Some persons require special nursing care that simply does not exist in the home. We are talking about a group in society who are subject to all the chronic diseases of the heart, the circulatory system, strokes, which are extremely incapacitating, arthritis, brain damage, digestive conditions, Parkinson's disease and, in particular, Alzheimer's disease. Alzheimer's disease is now a major factor in old age. In America, the number of people over 85 years of age with Alzheimer's disease is now 50 per cent of this category. This has major implications for future health care. Our elderly population is growing and requires professional services that can be provided in nursing homes along with the care that can be provided by relatives. This growth in the elderly population is a phenomenon that has to be faced up to. It is a feature that should be included in the national health strategy. Goals need to be set. The care of the elderly requires a whole range of services which must dovetail with one another, from the general practitioner to the public health nurses to the home help service and the district units of meals on wheels. The objective of the care must be to maintain the independence, dignity, health and happiness of elderly people in familiar and loving surroundings, wherever they be.

What was so shocking about the Minister of State's comments was his depth of ignorance about the whole question of the care for the elderly. He represents a Government who, with such fanfare, introduced the year of the elderly, that mouths aspirations about solidarity across the ages but when the mask slipped we heard the views expressed by the new found Right as represented by Deputy Stagg which is sending out the message to keep your elderly at home, this is a private solution to a private problem and people should not lean on the State.

Let me tell the Minister that the reaction of nursing home owners — I live in Bray where there are a great many nursing homes — is one of sheer and unadulterated rage that the Minister should display such ignorance and such arrogance. He complains that nursing homes operate by making a profit but I would like him to show me a nursing home that could operate by making a loss and still continue to provide a decent service for its residents. The Nursing Homes Act is beginning to make a difference. I, for one, would never defend the rogue nursing homes that have created a bad reputation for nursing homes throughout the country. However, they are a minority and the Nursing Homes Act is making a difference. The majority of nursing homes are providing good quality care and the better ones, which unfortunately are more expensive, are providing an extremely high quality of life for their residents.

The Minister also ignores the fact that many residents in nursing homes choose to live in them. They do so out of choice rather than out of compulsion. He prefers to feed the understandable guilt that many families have about choosing a nursing home option. He has also stirred up fears among the elderly. I do not believe that Irish people need to be told how to care for their elderly and they certainly do not need lectures from the Minister of State about their responsibilities. The evidence is that people willingly and lovingly take up that responsibility but they need support in making the right decision. Indeed, the elderly themselves need support in making the right decision. The misinformation and the unjustified attack that the Minister indulged himself in is an example of how far we are from a decent service that supports the elderly and is based on essential principles that are in tune with the needs of people, both the elderly and the carers, and are also appropriate to the demand that will continue to grow into the next millennium.

We have a carer's allowance, a pittance which is offered to people who spend many long hours caring for relatives, sometimes even up to 24 hours a day, watching over relatives who are in need of care. Yet, not all carers get their allowance. In 1992 the number of people who applied for the allowance and were refused was almost as high as the number who were granted it. We have only to look at the home help service to observe the low status this kind of work has, where grown women caring for elderly people in their own homes are being paid less than a 14 year-old baby-sitter.

An ESRI report in 1992 described the reality, not the sentimental sludge I heard from the Minister last night, of caring for the elderly. The care is almost always provided by one individual, usually a woman who is found to work on average 46 hours a week and as the age of the elderly person rises the number of hours worked rises to 85 hours a week and even more. The carers were found to suffer physical stress and physical and emotional strain. The level of stress was found to be so high in many of them that they required medical attention. This reality is what led the authors of the report to recommend that health policy should ensure that the elderly are not institutionalised because of lack of community support. They also recommended that a carer should not be obliged to undertake the caring role, that it should be a question of choice.

Last night Deputy Cullen gave the impression that health spending here was high compared with other European countries, but that is not the case. We are cost effective considering our population profile. Our problem has to do with equality rather than overspending. Equality also relates to nursing homes. Our problem is not with the nursing homes but with the cost of keeping patients in nursing homes and the fact that many people cannot afford the cost of good quality nursing home care particularly as many families are caring for their young as well as caring for their elderly at the same time.

At the end of the day the elderly, and their families, have the right to choose what kind of care they wish to have without feeling guilty or fearful. That right must be protected by the Minister for Health. This right was undermined in a most despicable way by the Minister of State, Deputy Stagg, and the Government should disown his statements in relation to carers and nursing homes. The Minister for Health carries a particular responsibility to disown those statements. The dignity and peace of mind of the elderly and their carers demands nothing less.

It is unfortunate that the Minister in his contribution last night engaged in a mock and feeble attack on Fine Gael Deputies and has continued tonight to interrupt Opposition Deputies with snide remarks. The Minister should simply have had the good grace to withdraw the remark made by him and accept that it was utterly inappropriate. In future when the Minister's utterances run ahead of his thought processes he should think of the people at the end of the sound bite sitting in nursing homes perhaps because there is no other way they can be cared for as their health requires 24 hours a day care. The Minister should think about how they might feel when they hear him referring to the place in which they are living as a corral of death and think about what that does to their quality of life.

Mrs. T. Ahearn

The Minister of State has hurled an unparalleled blow and an appalling insult at those excellent nursing homes where the most caring and dedicated people in society work by describing them in the cruel term of corrals of death. All politicians are embarrassed that a Minister should stoop so low, displaying not only his ignorance of the excellent care and support provided for elderly patients but scant regard for those in need of nursing home care. His remarks have caused anxiety and stress for the many families who unfortunately cannot care for their elderly at home and have no choice but to opt for nursing home care. His remark has caused justifiable anger and bitterness among those involved in the provision of nursing home care, the owners of nursing homes and the nurses who provide this invaluable service without adequate resources or support from the Government. The Minister's remarks shattered the confidence of the patients who at the most sensitive period of their lives need encouragement and support and need to have confidence in the quality of life provided for them in the nursing homes.

I consider how hollow and insensitive are the Minister's remarks when I recall the excellent care my mother received for eight years in a nursing home. I consider how ignorant and blatantly unfair are the Minister's remarks when I think of the excellent nursing homes in my constituency of South Tipperary. Despite the viciousness of the Minister's remarks there was not a murmur of criticism from Deputy Stagg's colleagues in the Labour Party or from his partners in Government. If they were honest they would have to admit that they share our anger and embarrassment.

Last night Deputy Stagg compounded his blunder by trying to justify his remarks as being to provoke debate. Is the Minister serious? He says he is justified in ridiculing nursing homes to open up a debate. Would the Minister ridicule the Garda if he wanted a debate on crime or ridicule teachers if he wanted a debate on education?

I support this motion tonight because it calls for a better deal for carers of the ill and the elderly. I support it because it calls for justice and fairness for the numerous women who are the unsung heroines in our society and who provide care, love and affection for their elderly parents or handicapped relatives. Their work is, unfortunately, unappreciated, unrecognised, undervalued and, above all, underpaid. In fact, they carry the can for the Government who willingly allows them continue their work. We must remember that their contributions are given at immense personal cost in terms of their physical and mental health. Therefore, it is unacceptable that they should also shoulder the financial strain caused by having an elderly parent in their home.

It is to our shame that a mere 1,500 people qualify for the carer's allowance, which in no way pays them for their work, but it is at least a symbol of recognition for their contribution. That should not only be estimated in terms of financial cost; we should recognise also the comfort they give to elderly people while allowing them end their twilight years in the comfort of their homes and surrounded by family. The statement by the Minister of State, Deputy Stagg, that nursing homes are "corrals of death" was unfortunate. He would serve everybody better by having the courage and humility to apologise for making such an appalling remark.

The elderly are the most vulnerable group in our society and the Minister and his Government should hasten the registration of nursing homes so that many people at present in dire need of beds in nursing homes can at least qualify for subvention. That will not be possible until nursing homes are registered. The Minister of State should devote his energies to that rather than making outlandish statements which are hurtful to those involved.

Mr. McCormack

The motivation behind the Fine Gael decision to table this motion was the unfortunate remarks of the Minister of State, Deputy Stagg, when he referred to nursing homes as "corrals of death". The Minister of State made a vicious attack on Fine Gael last night for tabling this motion and stated that we were only stirring up the matter. I have news for the Minister of State. At a Western Health Board meeting on Monday — this is in the area in which the Minister of State made those remarks — a sustained attack was made on the Minister, not by the Fine Gael members of the health board, but by Deputy Leyden, a former Minister of State, who was appointed to the Western Health Board by the Minister for Health, Deputy Howlin. He engaged in a sustained attack on the Minister of State for his remarks at Knock and was supported by most Government members of that board. Therefore, the Minister of State cannot single out Fine Gael for the attack on him.

The Fine Gael motion, which I support, calls on the Government to recognise, encourage and support the carer and the dependant in this, the European Year of the Elderly. I hope some good will come from this debate. If we continue to highlight the great work being done by carers in their homes, the Minister for Social Welfare may eventually take heed of what we are saying and make the carer's allowance available to people doing that very necessary work.

When the Minister for Social Welfare introduced the carer's allowance in the Social Welfare Bill, 1990, I welcomed its introduction and stated that I hoped the majority of the 66,000 carers would qualify for the allowance and that over-conscientious social welfare officers would not debar carers from receiving it. At that time the Minister informed the Dáil that he believed more than 8,000 carers would qualify in the first year. However, three years later, with a much increased budget, a far fewer number have qualified. Deputy Ahearn stated that out of an estimated 66,000 carers approximately 2,000 have qualified for the full carer's allowance and 2,200 for part of the allowance. Unfortunately, the high hopes created by the Minister for Social Welfare at that time were dashed and many were disappointed. At that time, and on many occasions since when I raised the matter at Question Time and on other occasions, the Minister asked us to bring to his attention cases of hardship where people do not qualify for the allowance. I have brought a number of such cases to the Minister's attention without success and without response in some cases.

I will cite one or two cases for the Minister's information. A small farmer's wife in the east Galway area cares for her mother-in-law who is confined to bed and incontinent. She cares for her 24 hours a day, 365 days of the year. She was refused the carer's allowance because her husband's farming income from 12 cattle and 40 sheep was considered to be 9p over the stated guidelines. Her reference number is 245687580B. It took six months and three visits from a social welfare officer to deal with that case. What did it cost the Department of Social Welfare to discover that her husband's income was 9p over the guidelines? A woman in south Galway cares for her husband's two elderly aunts, one of whom has been confined to bed for ten years and the other for 12. She applied for the carer's allowance when it was introduced. A social welfare officer visited her home on two occasions and, instead of giving her the carer's allowance, succeeded in reducing one of the elderly ladies old age pension by £3. One of the aunts is now deceased. Thankfully, because of the commitment of those two ladies, they have continued to care for their relatives.

I will draw the Minister's attention to another case raised at Question Time during the past month. I hope the Minister for Social Welfare is listening to the debate. A person from the Oughterard area of Galway came home from America to mind her father when her mother died. She received about £25 per week in carer's allowance. Approximately six months ago that person married a small farmer living some 25 miles from her home and her carer's allowance was discontinued despite the fact that she travels 25 miles every day in a 1978 Morris Minor car to care for her father. The carer's allowance should not disqualify people. Social welfare officers should use their common sense to allow people qualify for the allowance. It would lessen the demand for beds in the nursing homes about which the Minister of State, Deputy Stagg, has such a bad opinion.

Minister of State at the Department of Social Welfare (Ms Burton)

I am pleased to speak on the Government's behalf in support of this counter motion tonight. First, I apologise for the absence of the Minister of Health, Deputy Howlin, who is representing us at a ceremony to mark the end of the European Year of the Elderly in Brussels. I would like also to convey the apologies of the Minister of State at the Department of Health, Deputy O'Dea, who is indisposed.

The Minister went on to say that by all means institutional care should be provided for older people, when necessary and as a last resort, but that many elderly people on entering a home quickly lose heart and rapidly become institutionalised and that no one should enter a nursing home until all other options have been exhausted.

I listened to what Deputy Ahearn had to say. Like many other Members, I have personal experience of many nursing homes in the sense that some of my relatives need full-time nursing care. I have no wish to criticise the work done in nursing homes. Indeed, the first nursing home to be registered is located in my constituency and it is a splendid home; but there other nursing homes which do not meet acceptable standards and the Government is doing everything it can to ensure that proper standards prevail. Those Deputies who have personal experience of nursing homes will be aware that unfortunately one tends to find a line of chairs along the wall and that there is a lack of stimulation in some nursing homes. They also referred to the many excellent homes around the country.

There has been a discussion about carers. Again, I wish to pay tribute to the 60,000 carers around the country who look after elderly and incapacitated people in their own homes. These play a vital and essential role in society whether for a few hours a day on a part-time basis or on a full-time around the clock basis. In turn, society owes them an enormous debt. This can never be adequately recognised, but the weekly carer's allowance payable by my Department goes some way towards helping carers. In response to Deputy Ahearn, there are currently over 4,700 people in receipt of the carer's allowance at a cost of almost £11 million in a full year.

Mrs. T. Ahearn

The full allowance?

Mr. McCormack

They are getting £2 a week.

Mr. Allen

The Minister of State is misrepresenting the facts again.