Dáil Éireann debate -
Thursday, 14 Feb 2002

Vol. 548 No. 4

Adjournment Debate. - Care of the Elderly.

Mr. Healy

The Ombudsman's report of January 2001 set out the legal situation regarding in-patient care for elderly patients in nursing homes. In the report the Ombudsman stated:

The legal position in relation to hospital inpatient services both in 1990 and at present was and is relatively straightforward. Everybody resident in the State is eligible to be provided with inpatient services where necessary by the relevant health board. The service may be provided directly by the health board in one of its own hospitals or in another publicly funded hospital or by way of a contracting out arrangement between the health board and private institutions such as nursing homes.

Since that is the legal situation regarding in-patient care for elderly patients in nursing homes, why are elderly patients still paying huge nursing home bills? Why is the Government standing over what is in effect an illegality, implemented by the Department of Health and Children and the health boards? There is no discretion in this matter. It is the law of the land and must be implemented. Why has the Ombudsman's report not been implemented 13 months later?

Does the Government intend to introduce legislation which withdraws this legal entitlement to free nursing home care? The section of the Finance Bill dealing with tax deductible nursing home fees would appear to be a straw in the wind. There are indications that the Government intends to withdraw this benefit from the elderly in nursing homes.

The situation on the ground is that it costs at least €200 to keep a patient in a nursing home over and above the subvention being paid by the health boards and social welfare payments. That is approximately £160 per week. That means the elderly person's savings are drained away over a very short period and I know many elderly people who do not have enough savings left for burial expenses. It also means sons and daughters must fund the shortfall. In effect, these sons and daughters are paying what amounts to a second mortgage.

Worse still, elderly people are being pressurised to sell the family home to meet nursing home fees. What is happening is that health boards are deducting what they term a notional rent based on the value of the family home. That is being deducted from subventions payable by health boards to patients in nursing homes. This is outrageous. These elderly people have given years to building up the country and now they are under severe pressure to sell their own homes to pay for nursing home care. Will the Minister instruct health boards immediately to stop this latter day eviction, which is what I call it? It is a policy of eviction. The family home should be sacrosanct, at least as it is in social welfare legislation.

There is huge public anger with this issue. The Minister would do well to take what I have said seriously and to implement the law which entitles the elderly to free nursing home care.

Minister of State at the Department of Health and Children (Dr. Moffatt)

I thank the Deputy for giving me the opportunity to address this issue on behalf of my colleague, the Minister for Health and Children. The report of the Ombudsman on the nursing home subvention scheme raised certain questions about older persons' entitlement to services. The Ombudsman outlined his interpretation of the Health Act, 1970, which is that any person in need of nursing home care has a statutory entitlement to the provision of that service by a health board. My Department's position, based on legal advice, is at variance with the view expressed by the Ombudsman. What is clear is that the uncertainty that undoubtedly exists in relation to eligibility and entitlement should be resolved. I am glad to record that the new health strategy acknowledges this.

The position in relation to eligibility will be reviewed and legislative proposals aimed at bringing clarity to the situation will be brought forward in 2002. The application of the terms of the nursing home subvention scheme, which was introduced in 1993, was the subject of critical comment by the Ombudsman in his report. In addition, an expenditure review of the scheme conducted by Professor Eamon O'Shea outlined certain principles which should be brought to bear on the working of the scheme. Professor O'Shea's report will be published in the coming weeks, but one key area which he addressed was the paying of a home subvention payment as an alternative to the nursing home subvention. Proposals for the introduction of such a payment on a pilot basis, will be developed in 2002, in consultation with the Department of Social, Community and Family Affairs, taking into account the need to integrate such an arrangement with the existing carer's allowance.

Government policy in relation to health services for older people was outlined in the report The Years Ahead and reaffirmed in the review of that report which was published in 1997. This pol icy has now been given a further impetus in the health strategy.

We value our older people and, therefore, will place particular emphasis on an approach which aims at maintaining them in dignity and independence at home, in restoring to independence at home those older people who become ill or dependent, in encouraging and supporting the care of older people in their own community by family, neighbours and voluntary bodies, and in providing a high quality of hospital and residential care for older people when they can no longer be maintained in dignity and independence at home.

Our commitment to these principles is clearly demonstrated by the additional resources allocated to services for older people since the Government came to power. In 1997, an additional £10 million was provided, increasing to £36 million in 2000, £57.42 million in 2001 and £69 million or €87 million in 2002. This is by any standard an impressive list of developments. Nevertheless, the Government is only too well aware that much remains to be done if we are to get the level of developments which we are intent on reaching.

The health strategy acknowledges that the Irish population is ageing at a rapid rate. Estimates suggest that by the year 2011 our population aged 65 years and over will have grown by 25%. Each year our over 65 population increases by 6,000 and the number of people aged 80 and over goes up by 1,500. To continue to cope with the anticipated demand it will be necessary to expand significantly our current range of services. The new strategy recognises this and, therefore, commits us to a number of very specific but key developments over the next seven years.

The strategy emphasises again the need to support older people in their own homes in independence and dignity for as long as possible, to restore them to that state where this is required and to provide a high standard of extended care when they need it. These aspirations are expressed in concrete terms: the continued development of community based services, such as community nursing, home help services and community supports, including the provision of 7,000 additional day care centre places; a respite care grant to those caring for older people; the provision of 1,370 additional geriatric assessment and rehabilitation places in or associated with acute medical units and the provision of an additional 800 extended care beds per annum, including beds for those with dementia.

The Government places a high value on the contribution that older people have made to the development of the State and is committed to the implementation of the health strategy, including its specific proposals for older people.

The Dáil adjourned at 7.05 p.m. until 2.30 p.m. on Tuesday, 19 February 2002.