Dáil Éireann debate -
Thursday, 25 Oct 2001

Vol. 543 No. 1

Other Questions. - Care of the Elderly.

Breeda Moynihan-Cronin

Question:

10 Mrs. B. Moynihan-Cronin asked the Minister for Health and Children if his attention has been drawn to the report, Health and Social Services for Older People, which found that the vast majority of older people would prefer to be cared for in their own homes rather than in a nursing home; the steps he is taking to facilitate the greater care of elderly people in their own homes, especially having regard to the escalating cost of nursing home care; and if he will make a statement on the matter. [25609/01]

Mr. Martin

I compliment Professor Hannah McGee and her colleagues at the Health Services Research Centre, Department of Psychology, Royal College of Surgeons, Dublin, for their in-depth evaluation of health and social services for older people from the perspective of older people themselves. My colleague, the Minister of State at the Department of Health and Children, Deputy Moffatt, spoke at the launch of this comprehensive report on 20 June and confirmed that my Department was happy to reaffirm that the policy is to maintain older people in dignity and independence at home in accordance with their wishes, to restore to independence at home those older people who become ill or dependent, to encourage and support the care of older people in their own community by family, neighbours and voluntary bodies and to provide a high quality of hospital and residential care for older people when they can no longer be maintained in dignity and independence at home.

The Government's commitment to this philosophy of care is proven by the considerable injection of funding into the services which are at the heart of care in the community, for example, expansion of the home help service, specific assistance to carers, additional community support services, such as public health nurses, care assistants, physiotherapists, occupational therapists and dieticians together with the provision of new day care centres. While I acknowledge that the report highlights shortfalls in the provision of community-based services, a problem we have tackled by the injection of substantial additional resources in recent years, I was encouraged by the many positive aspects in the report, including the following: some 75% of those surveyed are self-sufficient in the tasks of daily living; the majority had no functional disability; a very high percentage viewed their quality of life as being good or very good; a high percentage scored high on morale; the majority said that they were never, or not often, bothered by loneliness; and 85% said that they had a high level of emotional and social support. I assure the Deputy that the importance of care in the community will continue to be a major priority in the development of services for older people and will again receive special emphasis in the forthcoming health strategy.

Ms McManus

The Minister is being a little disingenuous. Surely the point is that where older people are healthy and independent they are able to get on with life. We do not need a report to tell us that. Would he accept that this report confirms very serious problems and deficiencies in services for older people? One third of those with severe difficulties have no home services and a great number feel their views are not taken into account by health professionals.

Would the Minister not accept that there is very little support when efforts are made to encourage elderly people to continue to live independently in their homes? Does he accept that the lack of assistance for carers is a problem? He has indicated he is looking at this need but he might like to comment on it. Does he agree that the lack of assessment of the needs of elderly people is also a problem? Is he aware of the lengthy delays elderly people can experience, for example, in waiting for an occupational therapist to assess their needs to provide them with the aids they desperately need when they are living at home?

Mr. Martin

I am aware of the difficulties and delays occasioned by the shortage of occupational therapists and of their heavy workload in the regions in terms of progressing applications for aids and appliances. There has been a significant increase in the budget for these, especially last year. This is creating extra work for all concerned. We must look at streamlining the way things are done to get the aids and appliances quickly to older people in homes.

From a philosophical and policy viewpoint we must move towards increased home supports and increased incentives to families to have older people kept at home. Over the last decade, since the introduction of the nursing home subvention scheme, the direction has been towards the institutionalisation of the elderly. In the early 1990s, when we were strapped for resources, that was the way forward and in many ways it filled the gap left by the failure of the public sector to provide community care beds or facilities under the aegis of health boards and so on.

However, there is a grave danger that if we do not shift policy away from an almost total dependence on the institutional model, that is, nursing home subventions, our basic philosophy of retaining and supporting people in the home will be undermined. That has always been the policy but it has not been acted on since the late 1980s. Extra investment has been made since 1997 but because of decisions made in the 1980s and 1990s it has not been acted on and the nursing home subvention was the result.

Ms McManus

The scheme for the elderly operated through the health boards, which also comes under the remit of the Department of the Environment and Local Government and which provides for the upgrading of facilities for elderly people, including improving the standard of their housing, is very slow to deliver. Will the Minister take account of this and will he ensure that health boards are providing for some elderly people who, even today, do not have full sanitary facilities? That basic need must be met in this day and age.

Mr. Ring

In the past year the Minister and his Department announced grant aid for elderly people to provide heating in their homes. Does the Minister accept that the scheme has not taken off because the health boards have not had sufficient manpower? Thousands of people are awaiting assessment.

Deputy McManus was right about a matter which concerns me in my County Mayo constituency where 1,300 people do not have basic sanitation. I have been waiting six months for the Western Health Board to apply for planning permission for a septic tank for a woman who has to go out to the fields to go to the toilet in the year 2001. Does the Minister think that is acceptable?

Mr. Martin

I do not. Clearly, cases like that should be prioritised and people should intervene to make the provisions.

Mr. Ring

They should be made immediately.

Mr. Martin

I pay tribute to my colleague, the Minister of State at the Department of Health and Children, Deputy Moffatt, who originated the idea of improved heating services for older people. It has been a major theme of his time in office to provide additional supports to older people.

Mr. Kenny

The Minister is defending him very strongly.

Mr. Martin

He deserves to be credited. Deputy McManus raised the issue of housing aid for the elderly. Due to the fact that we have expanded housing services so much, thereby increasing demand, logistic and personnel difficulties have been created. We will be looking at these issues because they have been raised on an ongoing basis, to see if we need to change procedures and practices to facilitate the faster delivery of the increased resources that have been made available.