Dáil Éireann debate -
Thursday, 23 Mar 2006

Vol. 616 No. 6

Care of the Elderly: Statements.

Minister of State at the Department of Health and Children (Mr. S. Power)

I welcome the opportunity to address the House on the provision of services for older people and to outline what the Government is doing to meet the needs of this group. The significant growth in funding available for this sector in recent years is indicative of the Government's commitment to the ongoing development of health funded services for older people.

Advances in medicine and health care, more in-depth knowledge of health and of how to lead a healthy lifestyle and an increase in environmental standards have all contributed to people living longer. The increase in life expectancy is one of the great achievements of western societies in the 20th century. However, as our population ages, the number of new challenges in health care, housing, transportation and quality of life increases. One in five of the population of the European Union is an older citizen and the ratio is set to rise to one in four quite rapidly. The Central Statistics Office estimates that there will be more than 1 million people over the age of 65 living in Ireland by 2036.

The Government has made services for older people a priority. This means supporting older people in dignity to live in their own communities, for as long as possible. Studies have shown that older people are happier living among family and friends and that they lead healthier lives if they are allowed remain in their community. It is for that reason most of our funding is directed towards community care and allowing older people make that choice.

Since 1997, spending on health care services for older people has increased by more than €302 million. Additional funding for services for older people, amounting to €150 million, was allocated to these services in the December budget. This was the largest ever increase in funding for services for older people and reflects the new emphasis on home and day care. Almost three quarters of the additional funding, €109 million of the full year costs, is being committed to community care supports.

The investment package is focused on caring for people at home in accordance with their expressed wishes. The budget day package provides for a number of community and home-based initiatives, including home care packages, the home help service, day and respite centres, meals-on-wheels, sheltered housing, etc.

It is important to have a high quality of residential care available for those who require it and additional funding was made available in the 2006 budget for the subvention scheme. However, many older people in residential care have a low to moderate dependency level and they might very well have continued to live at home if the right supports had been made available to them. The budget package focuses on providing care for people at home, rather than in residential care, as a first option. Often it only takes a little extra to enable people stay in their homes rather than have to go to a hospital or nursing home.

Home care packages have been piloted successfully in several regions in recent years, with 1,100 provided by the end of 2005. In the 2006 budget a further €55 million in full year cost was allocated for this area, €30 million of which will be spent in 2006 and €25 million of which will be spent in 2007. This will allow for the phased introduction of a further 2,000 packages by the end of this year, almost trebling the service previously provided. The Health Service Executive has advised that 249 such packages have been commenced since 1 January this year. I acknowledge the role of the HSE and its commitment to rolling out these packages that make such a difference to patients and their families. We intend to almost treble the number of home care packages provided last year.

Home care packages are delivered through the HSE by a range of providers, including the Health Service Executive, voluntary groups and the private sector. The scheme is intended to be as flexible as possible and highly responsive to the real needs of the individual in order that where a family or friends of an older person wish to provide these services, they will be encouraged to do so with support and through linking in with the HSE or the voluntary or private sector.

Home care packages are multidisciplinary and may include services such as nurses, home care attendants, home helps and various therapists such as physiotherapists and occupational therapists. These packages will be targeted at those persons who have maximised their use of existing core community services and who might otherwise require long-term residential care.

The home help service also plays an important role in keeping people at home for as long as possible. An additional €33 million was allocated to this service in the 2006 budget, €30 million of which was for 2006. This will provide a further 1.75 million home help hours this year.

A comprehensive collective agreement between health employers and SIPTU was finalised in 2000 regarding the terms and conditions for the employment of home helps. This agreement provided for a significant improvement in the pay and conditions of home helps with the result that they now receive the same benefits as all other staff in the health services, including premia pay, paid annual and sick leave, etc. It was agreed with SIPTU in February 2006 to establish a high level group with an independent chairman to address issues pertaining to the standardisation of home help services, including clarification on the nature of the service and standard criteria for entitlements.

Home helps make a significant difference and provide good value for the substantial investment in them. In many cases they make the difference between existing and living. The difference in quality of life for people receiving home help is significant and they appreciate the help they get.

Day and respite care can give a much needed break to carers. Additional funding of €9 million has been allocated for this, €7 million of which is for 2006. This will allow for an additional 1,325 places per week in respite centres.

Meals-on-wheels are another area where there is increased investment. Additional funding of €2.5 million will be provided in 2006 with a further €2.5 million in 2007. This service is important and I acknowledge the role played by volunteers in the implementation of the scheme. Apart from the provision of a meal, the social contact involved is important. The service is a means of keeping in contact with older people, many of whom live in isolated areas or suffer from loneliness.

Sheltered housing for older people provides an 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 €1 million was allocated in the budget day package, split evenly between 2006 and 2007, to provide frontline health service support, such as therapists and public health nurses, in this area.

As outlined, additional funding was allocated in the 2006 budget to the nursing home subvention scheme for residents of private nursing homes. This additional funding amounted to a €20 million full year cost. The aim is to standardise means tests and bring greater consistency to the different levels of enhanced subvention support throughout the country. When the scheme was first introduced in 1993 it had a budget of €5 million. This year we will spend approximately €160 million on it. A sum of €8 million has also been provided to cover the cost of 250 extra nursing home beds which the HSE has already sourced. The HSE is now in the process of acquiring a further 250 beds to relieve the delayed discharges situation in acute hospitals.

The Health (Nursing Homes) (Amendment) Bill 2006 was published yesterday. The purpose of the Bill is to ensure that the existing subvention scheme for private nursing home care is grounded in primary legislation. This will help the HSE to implement the scheme on a standardised basis. There is some concern about the implementation of the scheme because it lacks uniformity. I hope we will deal with the Bill in the near future and, with the support of the Opposition, the legislation will pass through the House quickly and the scheme will be put on a sound footing. We will then see a standardised implementation of the scheme.

With regard to the repayment of nursing home fees, the Health (Amendment) (No.2) Bill 2004 was published on 16 March. It governs the repayment of long-stay charges for fully eligible people in an in patient setting. The Bill will allow for the full repayment of long-stay fees to 20,000 people who are still alive and to the families of 40,000 to 50,000 others who have died since December 1998. Priority will be given to those who are still alive.

The scheme will cost approximately €1 billion and repayments are expected to commence in June. The Health Service Executive will appoint an outside agency with experience in making mass repayments to administer the scheme. This year we have provided €400 million towards the repayments. I emphasise to those who are owed money that it is not necessary for them to appoint legal teams to collect the repayments on their behalf. They will be paid automatically. The Government introduced legislation more than 12 months ago, which provided for an ex gratia payment. We have most of the names and details of those who are currently alive on file and the money will be paid without any need for recourse to legal professionals. We had intended to pass the legislation before December 2005 but a number of issues had to be dealt with, including putting safeguards in place to ensure that the money is paid to those who deserve it and from whom it was taken. The Government made a commitment to repay the money and will do so.

Legislation is being prepared in the Department to provide for the establishment of the Health Information and Quality Authority, HIQA, and the social services inspectorate function, as part of HIQA, on a statutory basis. The social services inspectorate function will be vested in a new statutory office to be known as the office of the chief inspector of social services. The legislation will also provide for the establishment of a registration system in respect of residential services for children, for older people and people with disabilities to replace existing registration procedures detailed in the Health (Nursing Homes) Act and the Child Care Act. A working group to examine the standards in long-term care settings has been established and is currently examining minimum standards of care in both public and private settings.

The Tánaiste and Minister for Health and Children, Deputy Harney, and the Minister for Social and Family Affairs, Deputy Brennan, established a working group to identify the policy options for a financially sustainable system of long-term care, including improvements in community care and home care packages. The report of the working group on the future financing of long-term care has been presented to Government, where it is under consideration.

We are embarking on an era where future policies must reflect the needs of an aging society and when care in the home will be a first option. This is in line with people's preference to grow old in the homes and communities where they have lived for most of their lives. Older people must be given every opportunity to remain in their homes and, where possible, as active members of the wider community.

The recent budget package gives some indication of the Government's commitment to looking after older people. Having said that, I am conscious that many of the services for which we have now provided extra funding have been under-funded for a long time. In many respects we are playing catch-up. I acknowledge the important role the voluntary sector has played and from the Government's point of view, we have been highly dependent on that sector for the provision of a number of services for older people. It is vital that the investment made last December is continued and built upon. However, while money is very important in the provision of any service, attitudes in society must also change. For far too long, barriers have been placed before older people, preventing them from participating fully in our society. That must change. Just because a person has retired from employment does not mean he or she is any less valuable to society or is not in a position to play a contributory role. Very often, retirement can mean that people can play a more rewarding or fulfilling role. In any organisation one needs the enthusiasm of youth as well as the wisdom of age. Older people are often portrayed as being a burden on society but that attitude will have to change. I am delighted with the investment in, and priority attached to, older people by the Government and hope that will continue.

Last year media reports on a particular nursing home frightened many older people. The ill-treatment they saw some of their colleagues receiving in that nursing home upset them. However, having visited many nursing homes, my experience suggests that the care given to older people is exceptionally good in most instances. Nevertheless, we must ensure that safeguards are in place to prevent mistreatment of older people.

I am grateful for the opportunity to speak on this issue and emphasise the commitment of the Government to providing services for older people and building on the investment we announced last December.

Dr. Twomey

I wish to share my time with Deputy McCormack.

There is no commitment from the Government to care of the elderly. What the Government has been doing in terms of elderly care is seriously lacking, particularly given that it has been in power for the past nine years. There is a growing sense that the Government suffers from inertia, complacency or does not know what it is doing, as far as care of the elderly is concerned. The Government lacks focus and direction and this is reflected in its record in the health service.

One of the first reports I ever read about political involvement in the health services was entitled, Quality and Fairness — A Health System for You, published in November 2001. That report is similar to many others that have been published about the health services. The health strategy made numerous references to care of the elderly, as did the primary care strategy. The national task force on medical staffing seems to have disappeared. The Prospectus report examined the financial systems within the health services, but very little has happened in that area. The author of the Brennan report criticised the Government for not implementing her recommendations. We also had the radiation oncology report on the delivery of cancer services to the people of Ireland but again, very little has been done.

If one looks at the reports published in more recent years, one gets a good picture of where the Government is going. In the Travers report, the former Minister for Health and Children, Deputy Martin, clearly stated he felt he had no responsibility for the health service. It is some indictment of the Government that a Minister would say that he had no responsibility for what was happening on his watch. The Ferns Report showed shocking abuse of children in our society. Bearing in mind that the Government has been in office for nine years, when representatives of the One in Four group appeared before the Joint Committee on Health and Children, they stated clearly that there are still enormous deficits with regard to the protection of children in our society. The Madden inquiry examined the issue of organ retention. The hygiene audit report highlighted the filthy condition of some of our hospitals. The litany of negative reports has now been crowned off with the Lourdes Hospital inquiry. Almost every report from the Department of Health and Children in the past two or three years highlights what has gone wrong with our health services. We have moved on from the days when Deputy Martin published 150 reports on how he would make the health services better. Now the Government is publishing reports highlighting the problems in the health service. The last report published by the Government on mental health services, A Vision for Change, not only highlights the Government's idealistic nonsense of what it will do for the health service, it also highlights the diabolical state of mental health services. There is no commitment from the Government for care for the elderly, a lack of commitment mirrored across the health service.

The social services inspectorate was to be introduced as part of the 2001 health strategy. Today, however, the Government informs us that it will be part of the forthcoming Health Information and Quality Authority legislation. I hope we will see it, as much has been promised in the legislation, apart from its actual publication. Long before the disclosure of Leas Cross and hiring experts to examine what went wrong with care for the elderly, a policy for funding care for the elderly was promised. Today, the Government informs us that it is still under consideration after nine years. It is unbelievable how slow the Government is when making a decision on any important issue.

Is the Government aware that the elderly population will increase every year from now on? Only when care for the elderly becomes a crisis might it dawn on someone in Fianna Fáil or the Progressive Democrats what is happening. Legislation was promised in the 2001 health strategy for people to learn about their entitlements in the system, yet it is still not crystal clear with a few million euro here and a few million euro there. Usually it is taken from one service for another with no funding being actually given. The Government has no focus or plan for the health service, especially for care for the elderly. It is as if Ministers pick up the newspapers in the morning, see where the latest crisis is and throw a few million euro at it.

Cancer rates will increase, yet elderly people are discriminated against in the treatment they receive for cancer. Is there a sense that the service must be rationed because it is not freely available? Will more orthopaedic consultants be recruited to replace broken hips because the Government has not realised osteoporosis, brittle bone disease, is a preventable illness? With health promotion and proper screening, those orthopaedic consultants may not be needed. The Government always waits for the crisis to occur before thinking what to do. A person who fractures a hip, not only loses his or her independence and self confidence but invariably ends up in a nursing home at an even greater cost to the State.

The home care packages are simply a repackaging of home help hours because the Government was exposed to the fact it had cut home help hours. It is not a suitable alternative, particularly with the problems concerning VAT. The process is too slow. Why does the Government not move on and sort out these problems?

Heart disease is a growing problem. Again, there is discrimination in how elderly people are treated for the disease. No proper screening policies are in place. Heartwatch, a secondary prevention programme run by the Government in an ad hoc manner, is not really satisfactory because it is not properly resourced. Diabetes is increasing, yet there is no national strategy in place. Nothing but waffle comes from the Government. It is irritating for Members on this side of the House listening to Ministers rehashing old statements. Why does the Government not publish reports and inform us how it will implement them?

Telling old people that they have a medical card when they are over 70 years or that they might receive €200 a week in the pension is simply a softener for the next general election. That is not good enough anymore. The problems faced by the elderly are too large for that approach. The Government must show where it is going. A small percentage of elderly people will need long-term nursing home care. The majority live well and have reasonably good qualities of life in their own homes. However, if we are to help the small percentage with a poor quality of life, we must begin planning for it now and not massage figures. Last year's budget gave €150 million for care for the elderly. It has been reduced to €110 million this year. The Government is splitting its funding figures each month. I am beginning to have déjà vu with what happened with the doctor-only medical cards and the ten-point plan for accident and emergency services. It will be the same for the care for the elderly.

Mr. McCormack

I am disappointed the Tánaiste and the Minister for Health and Children, who was in the Chamber for the Order of Business, is not present to take this debate. It is obvious she does not want to answer any questions in the Dáil on the health service because she is ashamed of it. The Minister of State claimed elderly people want to remain in their own homes as long as possible. All Members agree that the majority of residents in public or private nursing homes should be still living at home. On 8 December 2005, the Tánaiste and Minister for Health and Children stated in a press release:

28% of nursing home residents have a low to moderate dependency and many of these residents might very well have continued to live at home if the right supports had been available to them at the appropriate time.

I call on her to provide the proper resources for elderly people to live in their own homes. Despite the praise from the Minister of State at the Department of Health and Children for the Health Service Executive, HSE, at both local and national level, it has proved it does not have the will to tackle the problem of better home care help.

To illustrate this, I will give an example of a case in the Galway West constituency. In the Connemara area a woman suffering from Alzheimer's disease was being cared for in her own home by her son. Up to August 2005, she had eight hours' home help care, three hours with the registered general nurse and some hours from the Alzheimer Society Ireland. Last September, owing to the retirement of the home help, the aged woman lost the benefit of the eight hours home help for August and September. Four hours were restored in October but ever since, the woman cannot get back the lost four hours.

In early December 2005, I contacted the personnel section in the Health Service Executive western area to inform it of a woman in the area who would take up the remaining four hours home help. I was informed no budget was in place to recruit anyone. I wrote for confirmation and received a reply on 16 December 2005. It stated there was an embargo on the recruitment of staff. It continued: "There are some people in the area who would work evenings, but we have an embargo on recruitment at present as we have our full complement of whole-time staff".

I then tabled a parliamentary question on 25 January 2006 on the matter. The reply stated there was no embargo on the recruitment of staff and €30 million had been allocated to the HSE western area budget which would provide 1.6 million extra hours. When I rang the HSE western area, it knew nothing of the extra €30 million or extra home help hours.

To ensure I received the right reply the next time, I tabled three parliamentary questions on 8 February 2006. One reply stated: "Public sector pay and employment policies do not prevent the Health Service Executive from appointing home helps or staff at any other grade". It also stated 1.75 million extra home help hours would be provided.

On Wednesday 15 February I raised the matter on the Adjournment. The Minister of State at the Department of Health and Children, Deputy Seán Power, informed me:

There is no embargo on the recruitment of staff in the health service ... Accordingly, public sector pay and employment policies do not prevent the executive from appointing home helps or any other grades to provide health and social services to the public.

I sent this response to the HSE western area which returned it to me highlighting a line on public sector pay.

Since I was making no progress, I rang the national offices of the HSE. I could not get through to Professor Drumm but instead got his personal assistant. I left my telephone number but never received a return call. I was then informed to contact Ms Mo Flynn, the national care group manager of service for older people. However, I could not contact her and she did not return my call. I wrote to Ms Flynn outlining the case on 3 February and received an acknowledgement but no subsequent reply to my letter. l rang her office three weeks ago and was informed that a reply was being drafted but I did not receive it. I wrote again but have still not received any reply. In the meantime, this 88-year-old woman in Connemara, who is suffering from Alzheimer's, cannot get the four hours' home help that would benefit her son who is struggling to mind his mother in her own home to keep her out of institutional care. The Minister is preaching all the time that such people would like to live in their own communities but no help is being given to them. In his reply, the Minister of State will no doubt read out details of all the extra money provided for various services. He should tell the Health Service Executive that money is available, however, because the HSE tells me that it has heard nothing about it.

In February, I wrote to the Tánaiste and Minister for Health and Children but received a reply stating that my letter had been forwarded to the chief executive of the HSE. She might as well have thrown my letter in the bin for all I have heard about it since then. I wrote to the Tánaiste again on 6 March and received a two-line acknowledgment on 13 March but no subsequent reply. Last Friday, I spoke to a person in the Health Service Executive, western area, and pointed out the written reply concerning the €30 million and the 1.75 million extra hours. I was informed that the executive had not received any word of this. The idea of announcing financial allocations in the Budget Statement and throwing money at the problem is a complete and utter sham as far as the public are concerned.

In December and again last week, I supplied the name of a person in the area to the health executive. I was informed that if the person's son got someone who could do the extra four hours' home help, he or she could be employed. I have discovered today, however, that the request must go through somebody else because the health executive cannot deal with it. The situation is a complete and utter sham and the Minister of State is paying lip service to the problem. He should ask the advice of those who are seeking the disabled person's grant and the care of the elderly grant in order to be cared for at home for the rest of their lives.

I dealt with a case in Galway concerning a disabled brother and sister who applied for a downstairs bathroom. Their request took three years to deal with and both of them were in the graveyard at Bohermore before the grant was sanctioned. The way the Government is acting is scandalous. I do not fault the Minister of State because he is only reading out the script that was supplied to him. The Minister should be here to answer the debate. The purpose of the debate was to elicit answers from the Minister to our queries arising from the problems with which we have to deal. The message is not getting through to the Government that pretending to throw money at the problem is certainly not solving it.

Dr. Twomey

It might help if the Minister set up a website.

Mr. F. McGrath

A one-stop-shop.

Mr. O’Shea

Ba maith liom mo chuid ama a roinnt leis an Teachta Wall. Tá an díospóireacht seo tábhachtach, agus tá athas orm a bheith páirteach inti.

The Central Statistics Office has predicted that the population cohort aged 65 and over will double by 2031, from approximately 11% of the total population to 22%. This projection indicates the extent of the provision that will be required for our aging population. Service provision for the elderly falls well short of what is needed. This underlines the scale of the challenge facing us. First and foremost, as the Minister of State has said, it must be the objective of society to keep our older people in dignity and independence in the community for as long as possible. Unfortunately, however, as our society becomes more violent we must add security to the aforementioned objectives of independence and dignity.

I was recently informed about a senior citizens' Christmas party in Waterford city, which was attended mostly by widows. These elderly ladies used to play bridge and bingo but no longer do so because they fear for their security if they go out at night. There are health implications involved when such people find themselves confined to their own homes. They are unable to take part in leisure activities due to the fact that they are living in fear. I accept that this is not a health issue per se but in examining services for the elderly we must consider a range of such services. The issue of security for older people requires attention. It is appalling that Ireland is no longer as pleasant a place to grow old in, as it once was. While the scourge of crime and anti-social behaviour is a growing crisis for society generally, and must be combated, we have a special duty to look after our senior citizens.

I also wish to deal with the issue of equity release by senior citizens on their homes to supplement their retirement income. Arising from the fact that interest rates on equity release products aimed at the over 60s are substantially higher than market rates, the Irish Financial Services Regulatory Authority expressed concern about equity release, particularly home reversion. With residential reversion, a 65-year-old owner of a house worth €600,000 can expect to get €114,961 for a 50% share. This rises to €158,773 for a 75 year old. These figures are alarming as regards the return to senior citizens. Age Action sees equity release as an option but the elderly need to consider their situation in the context of longer lifespan and ongoing care needs.

The chairman of the conveyancing committee of the Law Society, Mr. William B. Devine, has stated that equity release is a complicated area and there is a great deal of responsibility on solicitors to ensure that clients are in full possession of the facts.

The post-retirement market in Ireland is predicted by some to grow to €150 million by 2007. The Government must take all measures to ensure that senior citizens are not ripped off by greedy financial institutions.

I wish to focus on a couple of other care issues. The north-western part of county Waterford is in the south Tipperary community care area. The residential care centre for people in that region is in Cashel, County Tipperary, which is a very long way from their families. There are provisions for public patients both in Dungarvan and Waterford city but the rules are such that those patients will be referred to Cashel. This causes grave concern for families of senior citizens who go into residential care a long way from home. While they will obviously have fewer visitors, they will also be much further away from their own communities. Such links are so important to elderly people.

Deputy Twomey spoke about radiotherapy treatment services. The Waterford council of trade unions has tabled a resolution for the Irish Senior Citizens Parliament backing the provision of radiotherapy services in the local area. In some areas, radiotherapy services can be therapeutic for senior citizens, while in other areas they can be part of a palliative care product which gives older people a quality of life in their declining years.

I seek the Minister of State's assurance that in no circumstances will a senior citizen be passed over for treatment or put further back down the queue because they are older and thus not given priority for treatment on age grounds alone. I would be very concerned if that practice was happening anywhere in the health service.

Issues raised regarding the care and provision for older people range across a number of Departments. A SIPTU motion will go to the Irish Senior Citizens Parliament this year seeking that the recommended pension provision for the old age pension be increased from 34% of average industrial earnings to 40%. That is a reasonable request in our modern society where the cost of living is increasing for all sorts of reasons, such as the cold weather this winter and increasing fuel costs.

The issue of ageism is often raised. I am glad the Minister of State's Department allows new entrants to continue to work until the age of 70. However, that only applies to people who entered the service since 1 April 2004. On an incremental basis we should provide for all those who work in the health services to continue working until the age of 70 if that is their wish.

Mr. Wall

While some speakers are not that happy the Minister of State is present, I am delighted because many of the issues I will mention involve his constituency as well as mine. Perhaps by mentioning them we can move towards resolving them. One of the major problems we have regarding care for the elderly is the cut in home help hours. One must be careful when discussing the figures used regarding the Progressive Democrats aspect of the Government. However, replies received from the Minister for Health and Children on a number of occasions state that the cut in home help hours in Kildare is approximately 27%.

In many cases the only human contact the person in receipt of home help has from one end of the week to the other is with the home help provider. If we further decrease those visiting hours, we will put the recipients under greater stress and strain and the demand for care in nursing homes and geriatric hospitals will increase. I cannot figure out how on the one hand we state we can reduce the hours because of the greater efficiency of the system, while on the other hand we state there is a greater demand for hours.

In the system, a person is allocated one or two hours of home help per day. The people in receipt of the service value it greatly as they love to see someone visiting and relating to them what went on during the day. If we concentrate on the business aspect of this, instead of providing two hours' home help and allowing people to get involved in the local community through home help, we will reduce it to an allocation of one hour and the home help provider will leave after that time regardless of the situation.

I supported the SIPTU demonstrations on this matter. It must be addressed if we are serious about keeping senior citizens in their homes. The way society is evolving means a major decrease in the number of senior citizens who have a loved one at home. In almost all cases, the person who used to care for them is now out working. Those senior citizens are isolated. We are fooling ourselves unless we decide to take action instead of decreasing home help and creating a greater demand for nursing homes, geriatric hospitals and accident and emergency departments.

For some time I have argued for the need to re-evaluate the nursing home subvention. There is no way a person's home should be used in the means test for enhanced subvention. It is against the ethos in this country of owing a home to pass on to one's loved ones after spending 30 or 40 years obtaining it. This is the only means test in which I am aware that the home is used. It is a disgrace that we allow it to happen. I ask the Minister of State to remove this measure in the new legislation to come before the House in order that we return the family home to senior citizens and that we do not say to them that we will put them into a nursing home and that their homes will no longer be their kingdoms. It is a disgrace that after a lifetime of hard work and putting the country and their families together, the one possession they have is effectively no longer their own because we use it as a charge against enhanced subvention.

It would be better to provide more wards in geriatric hospitals such as St. Vincent's Hospital in Athy. It is a wonderful facility and campus. If we examine the figures, the centre built in Maynooth cost approximately €5.5 million while the Department of Health and Children returned to the Exchequer €136 million that was not used last year. Consider what that money would do for the provision of extra wards in places such as Athy, Maynooth and Leixlip. Such facilities would allow people to enter for respite care and return home knowing there was a place they could go, while all the time they would be safe in the knowledge that their homes were still their kingdoms and would not be taken from them. If the home is not removed from the means test, the Minister of State will meet major opposition to this Bill, certainly from me. In all other social welfare means tests, the first line is that the home is not rated as means.

Will the Minister of State examine the home help situation and review the forthcoming legislation to allow the family home to be protected? We can made some dramatic improvements to ensure senior citizens are still a priority and valued in the community. If we take away their homes and contact, we isolate them and leave them at the mercy of those who prey upon such people living in rural communities.

Caoimhghín Ó Caoláin

I wish to share my time with Deputies McGrath and Gormley.

I welcome the opportunity to address the issue of care for older people. This issue has come to the fore in the media and public life generally in recent times. The issue always existed. Older people have always needed the care of their families, their communities and the State.

Many in the House will recall the dedicated work of the late Willie Bermingham who founded the organisation ALONE and who almost single-handedly exposed the scandal of older people living and dying alone and forgotten in our midst. That was happening at a time when older traditions of large families and wide family support systems were breaking down. Care for older people has greatly improved since, but there are still far too many older people on the margins in our society, often living alone, with inadequate fixed incomes, without proper support and isolated in their final years. Many are long-stay patients in hospitals not because of illness but because the State does not provide the appropriate residential facilities to accommodate them.

The Leas Cross scandal exposed not only the abuse of older people in that nursing home but, equally scandalously, the failure of the State properly to regulate nursing homes. We are still waiting for legislation and a regulatory framework with adequate numbers of inspectors and enforcement. Most old people want to live their lives as close to their families and friends as they can, in their own homes preferably and with the best supports the State can offer. They deserve no less and every effort by the State should be geared towards this end.

One of the main State-provided supports is the home help service. This month, however, home help workers had to demonstrate to demand proper pay. The service is inadequate from the points of view of service users and the home help workers. These services should be expanded and developed along proper lines with decent pay and conditions for home help workers and the provision of the hours of service that older people need.

Many fear that the only way they can be cared for as they grow older is through selling their homes and using the proceeds to finance long-term nursing home care. In many cases that is the sad reality because there is no family support and State supports are inadequate. The Government needs to look long and hard at its own policies which are driving this process and pushing many older people into nursing home care who neither want nor need to be there.

The spiralling price of property creates a pressure on older people to sell their homes. This arises directly out of the Government's fundamentally flawed market-driven approach to housing. At the other end of the process this Government heavily subsidises the private nursing home sector through tax breaks as exposed by the recent review of tax reliefs. These reliefs are driven not by the needs of older people but by the profit motive of the private operators in the nursing home sector. In this sector, as in the wider health system, two-tier provision operates.

Those older people who can afford it can avail of the best care and accommodation while others are left behind. Instead of subsidising such a flawed approach the Government should use public money for direct provision for older people, including care and support for people in their homes and the development of local authority housing for the elderly. Our local authorities need to be funded to provide more accommodation for older people, including places where they can remain independent while availing of on-site facilities in a community setting.

A recent ESRI survey has shown that 60% of people oppose equity release schemes whereby older people are encouraged to sell their homes to provide themselves with long-term care. There are serious concerns about these schemes. Speaking at the Oireachtas Joint Committee on Finance and the Public Service, Mr. Liam O'Reilly, chief executive of the Irish Financial Services Regulatory Authority stated that the authority was concerned about the potential mis-selling of home reversion products on the market because they are unregulated. He said it would support the introduction of legislative amendments that would require these products and their providers to be regulated.

Everyone in this society has a responsibility to ensure that older people are empowered to live their lives to the fullness of their ability. If we are spared, we will all be there eventually. Individuals in paid employment have a responsibility to ensure that they provide for the future as best they can. Employers and Government have an equal obligation to facilitate this provision through proper pension arrangements.

Mr. F. McGrath

I welcome this important debate on the elderly. I also welcome any extra spending and funding used to provide services for the elderly. We should acknowledge any step forward. I wish to support the elderly in a practical way and to put forward a few ideas on how to assist them in their communities and ensure they have maximum support.

Approximately 440,000 people, 11% of the population are over 65 years of age. Many do not regard 65 as old. People who reach that age want to continue working, contributing to, and being directly involved in society. We should do away with the idea that at the age of 65 people should pack their bags and go fishing when they want to do many other things. The elderly should have choice.

Of these 440,000, approximately 266,000 are over 70 years of age and one third live alone. There are 25,000 elderly people in long-stay beds or nursing homes and a further 13,000 who need high to maximum dependency care continue to live at home. This should be the focus of the Minister of State's investment. The supports should be in place for these 13,000 people as priority cases.

We should also respect the rights of the elderly, most of whom wish to receive care in their homes and local communities. We should never take that right away from them. Providing those services where possible should be a key issue for us, as a State, as taxpayers and funders of local services. We should assist the many families of the elderly who make sacrifices to provide the best possible care for them. This topic should be discussed in this debate. We have already made a start on it.

I demand that the Government immediately provide adequate resources and a comprehensive infrastructure for care for the elderly. I also demand a guarantee of dignity through income support, a priority in health care, back-up support when the elderly are ill or convalescing, and information about entitlements as a right. These are core issues. I also demand accountability from decision makers which our society lacks. Too many people fudge, hedge and dodge decisions and responsibility. The Minister of State should get on with the job of looking after the elderly, put the funding in place and give them maximum support. If the Minister of State does not or cannot deliver he should be accountable to the people and the Dáil.

The Tánaiste spoke this morning about the 400 people in hospitals who need extra supports in their homes or other residential units. This should be an immediate priority too because these people need the support services. Many of them ring my office regularly. They do not want to be in hospital. They want to be in a home with proper support services or in a different type of community. There are many creative ideas in circulation for looking after the elderly. We need to be flexible and consider these issues.

On many occasions the Tánaiste and Minister for Health and Children and the Minister of State at the Department of Health and Children, Deputy Seán Power, have acknowledged that the home help service is crucial to Government policy because it allows elderly people live with dignity in their own homes and communities. It helps reduce the demand for expensive hospital and nursing home care.

For years the service provided personal and social care for many of the most vulnerable in our society and it is often the only daily personal contact an elderly person may have with the outside world. Notwithstanding the public acknowledgement of the importance of the service, the Department of Health and Children and its associated agencies continue to deny fair and reasonable treatment to the home helps who provide the service on the ground. This is unacceptable because the humanity and decency that they unselfishly provide in the care of their clients is denied to them. I support SIPTU's national campaign, Be Fair to Those who Care, to ensure that those who work in the home services are treated with respect and dignity. It is important to respect the rights of the elderly as citizens and provide the services they deserve.

Mr. Gormley

By the middle of the century, it is projected that one quarter of the population will be aged 65 and over. This demographic trend presents challenges and opportunities for the State and for society. Ireland is in a good position to deal with these challenges and opportunities. As a relatively late developer in demographic terms, we can learn from experiences in other EU countries. Moreover, we can harness our recent economic development to help provide a future in which older persons are treated as equal citizens. This presents us with great challenges in regard to our health service and nursing homes. We have an ageing population and people are living longer. We now have the technology and the medicine in our hospitals to help people live longer. That takes extra money, but we should not deal with that in terms of equity release, which was referred to by previous speakers.

The Government is again going down the Progressive Democrats neoliberal line, allowing the party to dictate policy in this area. It is quite scandalous that the Government will force people——

Mr. S. Power

The Deputy should wait until that is decided.

Mr. Gormley

I am hoping the Minister of State is listening to what we are saying, will take account of it and will not decide to take this route. It is heartless and ill-considered. The Government is clearly going to force people to sell their homes. This has repercussions not just for the older person but also for the children. So many people now can afford to buy a home in Ireland only if they get some money from their parents. Through the equity release process, that will all be gone. The Minister of State should think before going down that route. I know he is very good at keeping his finger on the pulse and probably realises equity release is not a particularly good idea.

Older persons make significant contributions to society as citizens, as workers, paid and unpaid, as family members and as members of the wider community. In their varied roles and as individual human beings, older persons have rights. Successive Governments have failed to respect, protect, promote and fulfil these rights. Older persons have become increasingly marginalised and are not benefiting from the economic development they helped create.

Recognising demographic trends and in response to the manner in which older persons' affairs have been mishandled by successive Governments, the Green Party has adopted Citizenship, Equality, Respect: A Policy on Ageing and Older Persons. This document is an attempt to identify the needs of older persons and Ireland's ageing society, and to make positive and innovative policy proposals to address those needs. The issues faced by older people are diverse and this is reflected in the structure of this document. I cannot go into detail in the time allowed but will give some flavour, because it impacts on the role of the Minister of State in Government.

The Green Party is calling for changes in the political system in order that opportunities for older persons are secured and their rights can be protected. We are looking first for a national positive ageing strategy. Successive Governments have failed to deliver effective, joined-up, holistic policy or action on ageing and older persons. The Government should initiate the drafting of a national positive ageing strategy. This strategy should identify the responsibilities of each Department and agency and establish deadlines by which specific reforms should be achieved. The strategy's targets should be integrated into the work plans of relevant Departments.

At the time of writing of this document, older people in Ireland are represented by what is effectively a half of the Minister of State at the Department of Health and Children with responsibility for services for older people and health promotion. It is generally acknowledged that this has not produced satisfactory results for older people. The Green Party believes that older people would be better served by a Minister of State responsible solely for older persons' affairs. This Minister of State should be given a greater role in co-ordinating Government policy in this area. His or her position should recognise that ageing is a growing issue for Ireland and that issues surrounding ageing and older persons' needs are not simply health related. To this end, the Minister of State should be placed at the Department of the Taoiseach rather than the Department of Health and Children.

We would like to discuss these proposals in this House. The issue before us is undoubtedly one of the most important the House and society must face. I hope we will get the opportunity for a discussion at a later stage, particularly on Committee Stage. That is where we can tease out these important issues.

Mr. O’Connor

I welcome the opportunity to make a brief contribution to this important business. As other colleagues noted, we must all be committed to care of the elderly.

I congratulate my colleague, the Minister of State, Deputy Seán Power, on the efforts he is making. I was delighted with his promotion, not just because he freed up an office which I was then able to get, but because it was well deserved. The Minister of State has shown to all colleagues that he is doing a great job.

I have said before that I try to bring to my politics, especially my work in Leinster House, my life experience. Deputy Gormley mentioned the Oireachtas Joint Committee on Health and Children, and we had a meaningful discussion this morning with consultants from St. Vincent's and St. James's hospitals about tuberculosis. I pointed out that I came from a Dublin of a different era. In that environment I noted as a child that my paternal and maternal grandmothers were always very anxious to remain at home, even when they were ailing and becoming very sick. They both died at home, surrounded by the family. I often cite that as an example when people talk of the different levels of care we need nowadays, and of nursing home care and subventions.

As I go about my business in my constituency and elsewhere in the Dublin region, I still get a clear sense that people recall the days of which I speak when older people had no choice but to stay at home. It was good for them to stay there, and I saw my grandparents staying. Even as a small child I recall they were anxious to do so. My parents unfortunately died in hospitals, but I remain committed to the idea that we should look after our elderly as far as possible in their home environment.

The Minister of State knows my views on home help. I am very supportive of the Tallaght home help agency which does a great deal of work. I am on the board of the Tallaght welfare council and I try to support the service in a practical way. That is the way forward — looking after the elderly at home. The welfare council faces other challenges, including helping young handicapped people, and it does a very good and meaningful job for the elderly. I know such work is done throughout the country.

The Government must understand the needs of the elderly and consider the issue of carers. As a member of the Joint Oireachtas Committee on Social and Family Affairs I have often made the point that we must continue, as the Government has done, to look after carers and home help needs. We all acknowledge the great contribution made by the elderly over the decades in the development of the Celtic tiger economy. That is not patronising, and it has been recognised by successive Governments. I am proud that Fianna Fáil, in Government with the Progressive Democrats, has honoured the commitments made, certainly with regard to pensions. Other schemes have also been improved. The Minister for Social and Family Affairs, Deputy Brennan, has done a great deal of good in that regard.

We should ensure that more schemes are developed to look after our elderly, such as free passports. Last week we saw the development whereby the elderly can now use their free travel passes at different times. The free transport scheme is important and we must work towards ensuring the elderly can travel free all day and every day on the buses, the DART and the Luas.

In my Dáil speeches I always refer to my constituency. I spend much time every day, week and month dealing with issues relating to the elderly. I spend as much time as possible going to places such as Glenview Lodge in Tallaght where they gather on a daily basis, in the south Dublin senior citizens group in Kiltipper and the various groups in the constituency not only in Tallaght but in my parish, St. Mark's, in the Tallaght west estates in Firhouse, Templeogue and Greenhills. It is important to do that because the elderly often have different problems and different needs. All of us as public representatives find that people come to us when they have particular needs and the systems are not working. I am always keen to stress — this falls within the remit of a number of Departments — that we should always continue to ensure services are easily accessible and known to people. In our clinics and offices every week all of us will get queries from people who, if the system was working, would have no difficulty in accessing services. There is a need to continue to stress that we must have information systems in place and public awareness campaigns on a regular basis so people, particularly the elderly, know what is available to them and how their needs can be fulfilled.

The citizen information centres, of which there is one in Tallaght village, do a great job in that regard but there are still gaps. On a daily basis I get queries from the elderly, or on their behalf, who say they did not know such a thing and ask how it can be done. It is important we continue to do what we can to improve that system as much as possible.

Any contribution on this subject would obviously have to include nursing homes and that whole system. In the Tallaght area many of the elderly have had to access services outside the area where they live. That happened in my family where an elderly uncle died in a lovely nursing home in Bray. He had to be taken from his home environment because he got to the stage where he was very elderly and needed the service but there were no beds available locally. In recent years much progress has been made in that area. In Tallaght there is Crooksling and there is a fine facility at Kiltipper Woods Care Centre. We must continue to look at the needs of the elderly.

We are all aging. On the way here when I told one of my sisters I was going to speak about the care of the elderly, she said I would be able to speak about my future. It is the future of us all.

I live in a town which has a young population. We are aging fast and we have to understand the particular challenges that will hold for future generations. It is important we continue to look at those needs and I expect the Minister of State will continue to do that.

I wish the Minister of State well. He has an important job and an important remit and has another 400 days at least before the general election and I know he will continue to look at these issues. As the general election momentum carries on, I am knocking on many doors these days and I get the sense that people do not want us to knock on doors for another year but that is the nature of the business. Many issues will be raised on doorsteps in a short time. It is important the business we are dealing with today gets the priority it deserves. All kinds of issues, including issues in the health area, that people regard as pertinent to gaining or losing votes will be raised. The care of the elderly is a matter to which we should pay attention. One has to do things for politics but also one has to do things for one's soul. I do not mean that in a virtuous or patronising way. It is right that we look after the elderly and their care. It is right that the Government would understand this issue is as important as any other.

My colleague, Deputy Neville, will be aware that Deputy Gormley said the Joint Committee on Health and Children has a role in this regard. We have a huge programme over the next year but we have to understand that what we are talking about today is just as important. I look forward to continuing to support the Minister of State at the Department of Health and Children, Deputy Seán Power. It is good that he is in House listening to the various contributions. He will always have my support. Despite what colleagues on the other side have said he has a particularly demanding and challenging job to do and I look forward to him being successful.

Mr. Neville

I wish to share time with Deputy Kehoe.

An Ceann Comhairle

Is that agreed? Agreed.

Mr. Neville

I welcome this timely debate on services for the elderly. We have already discussed the home help service, nursing home services, assistants in the community and assistance for carers, all of which are important in terms of the State's duty of care to the elderly.

I wish to deal specifically with one of the most neglected areas of service for older people, namely, mental health services. As life expectancy grows it is increasingly important to consider the mental health needs of people in later life and to provide a comprehensive range of services appropriate to their needs. While all users of mental health services are entitled to know their rights, what services are available and to access those services it is crucial for older people who have mental health problems. In addressing services for older people the Health Service Executive must subscribe to their inherent worth, respect and dignity and care for them on the basis of equity, fairness and accessibility. This is not only for those who are accessing mental health services but all services. We make decisions for elderly people. I see this all the time especially in discharging from general hospitals. We assume they do not have a view, a concern or a choice in regard to services. Of prime consideration is that the mental health services for older people should be person-centred and promote self-determination.

The role of carers in the older person's life should be considered in every aspect of the service provided for them. It is essential that carers be given support and education on the complex and challenging mental health problems experienced by those in care, especially the elderly in care. People of advancing years are faced with a number of stresses and challenges resulting from a loss of close attachments, their partner and friends, changes in their vocational and social role, retirement, being unable to have the social life they previously enjoyed and the depletion of their health and physical capacities.

The main conditions that come within the remit of the mental health services area are functional disorders of which depression is the most prominent in older people, organic brain disorder, particularly dementia and Alzheimer's, anxiety, substance abuse, mainly alcohol, and to a lesser extent psychosis which they experience for the first time. We assume that psychosis, like schizophrenia, occurs at a younger age but it also occurs for the first time in the elderly.

The gaps in the existing mental health services for older people include the following: an absence of mental health services in many catchment areas, incomplete multi-disciplinary representation in almost all mental health services for older people teams, a lack of specialised assessment and treatment in most acute admission settings, inadequate accommodation and continuing care facilities under mental health legislation, a lack of dedicated day hospital facilities in almost all services, a lack of emphasis on recovery and positive coping skills in existing service provision. In other words, many of the elderly, if they receive psychiatric treatment and are emotionally assisted, recover.

Primary care should be a critical component in preserving and promoting good physical and mental health in older adults. They should have regular contact with these services. That offers the possibility of identifying problems arising from social isolation, unsatisfactory living conditions and physical health problems. Given that most mental health problems in older persons will first present in the setting I have just outlined, it is important that the awareness level of primary care personnel is honed by education, through formal and informal means, to detect and intervene appropriately.

Mr. Kehoe

I am delighted to have an opportunity to speak in this debate on care for the elderly. Care for the elderly in our society must become an immediate priority for the Members of this House and, in particular, the Government. To date, it has a shameful record in terms of its attitude to the elderly. The elderly selflessly contributed to the development of this country at a time when life was much tougher and the rewards for their efforts were more difficult to obtain. It is incumbent upon us to ensure that the elderly in our society are no longer left at the bottom of the pile and that they receive the care and support they rightly deserve.

Dignity at any stage in one's life is essential. We must ensure that the citizens of this country maintain their dignity and have access to basic services. Those entitlements should be afforded to all but they are even more important for the elderly who should be able to live with dignity, have an adequate income, access to professional and timely health services and support to allow them live longer lives in the manner they wish.

Care for the elderly must be provided on many levels depending on the needs and wishes of the individual involved. This will range from low levels of dependency where individuals require little intervention, starting with weekly visits and monitored alarm systems, to the full-time dependency of nursing home care. In between those two scales are people being cared for by relatives, those requiring rehabilitative care and many more cases to be tailored for. The people caring for elderly relatives in their own homes must be commended in the way they provide that care with little or no financial assistance from Government.

The key to implementing any system, however, is to ensure that the needs of each individual at the opposing ends of the scale, as well as those in between, are met in a caring and compassionate manner. Many elderly people are keen to maintain their independence. Last week, I visited the Emergency Response social monitoring service in my constituency in Bunclody. Having seen the service provided by that organisation for elderly people living alone throughout the country, I was very impressed with the way it carries out the service and has a huge impact on the lives of many elderly people. I intend to contact the Minister, Deputy Ó Cuív, directly in regard to that service to ask him to consider improving the level of grant aid and facilitating improved grant application processes for community groups throughout the country who are interested in accessing the service for elderly people in their neighbourhoods. Initiatives such as this are invaluable and life-changing for many elderly people and we must do everything to ensure the service can be accessed without difficulty and without being hampered by bureaucracy by those who need it the most.

As we move up the dependency scale, there are people who require more intensive care. I have been very involved in the development of services through my work with St. John's Hospital in Enniscorthy and am very aware of the positive impact of the two 32-bed extended care wards built recently in which patients are now living. They are fortunate to have that facility. The proposed 20-bed unit for the elderly and mentally infirm under phase 2 is awaiting the go-ahead. That is of critical importance and funding for those types of services must be provided. The CSO figures have shown an 11% increase in the population of those over 65 years of age living in County Wexford. Assuming other counties have experienced similar increases, the figures underlie the need to ensure that services for the elderly are put in place without delay.

Another element of the care package about which I feel strongly is the role played by carers. Whether they are family members, relatives or home help carers, the work they provide is of immense value to this country. Certain families and individuals literally devote their lives to the care of loved ones and the time has come to ensure they are given proper recognition and support. We must back up that support in terms of assistance, advice, guidance and, most importantly, respite care.

I cannot emphasis enough the need for the completion of phase 2 of St. John's Hospital. I am disappointed that the Tánaiste is not in the House to hear Members' views on care of the elderly. I ask the Minister of State, Deputy Seán Power, to convey to the Department the importance of the provision of funding for phase 2 of St. John's Hospital in Enniscorthy.

Mr. McGuinness

I preface my remarks by acknowledging the huge amount of work and funding the Government has put into the health services and in particular into the general area of care of the elderly. I acknowledge also that when the Minister was appointed I was of the view, and to a degree I remain of the view, that there is need for political goodwill on all sides to ensure she fulfils the policies that are vital to improving health services throughout the country. Without that, through constant political debate and sniping we may undermine her position and prevent a speedy delivery of the health services that could otherwise be achieved.

I am deeply disappointed with the progress being made to date, particularly by the Health Service Executive in the way it is dealing with the development of health services and in particular the responses given to questions from Members of this Parliament. The replies are inadequate, inefficient and, at best, inaccurate. That is not good enough because if we do not have the information we cannot go back to the constituents we represent and help them deal with their problems.

On the "Late Late Show" last Friday night Brendan Gleeson made some direct comments and was very passionate in the way he delivered those comments. I share his view. The treatment of our elderly citizens in terms of some services is shameful, despite the amount of money being allocated. We are not doing enough. For example, home care and home attendant hours are being cut and changed. In some cases the elderly person being looked after, who has built up confidence in the person coming into their homes, finds that person has been replaced or has left the scene altogether.

I am aware that over €3.8 million is being expended in my area in respect of that service but it is not enough. Much of that money is being used up by bureaucracy. I do not know the difference between home attendant and home care hours but I know that both services provide great comfort to the elderly person at home and much support to the family concerned. However, home care attendants and home carers draw their funding from different pots of money and are being pushed from pillar to post in their effort to provide that service. I ask the Minister to examine that specific area and ensure these hours do not continue to be cut and that the necessary funding is put in place to ensure a sufficient number of hours' help are available to the people who need it in our constituencies.

The disabled person's housing grant was referred to throughout the debate. It is a shameful position for any of us to be in to have to tell the family caring for an elderly person that the funding for the stair lift, the extra accommodation downstairs or whatever will probably come through in 18 months' time. Telling that to a person in their late 70s or early 80s who is ill is not good enough because all the family and the person want is a quality of life for the remaining time they have on this earth. It is unforgivable that the HSE and the Government would state this to any person who has made that application. It is not how the elderly should be treated.

While EPG grants are there to comfort people in their later years and while the projects involved are of great assistance, coming up with the balance of the money owed is often an insurmountable problem for the people concerned. Some other imaginative scheme will have to be put into place to ensure that these necessary aids are obtained almost immediately. That can now be achieved because of the amount of money in the system. Subvention of hospital care is also of great concern. Charges have risen to €600 or €700 per week, far beyond the reach of most families. Families have met financial hardship in attempting to support a family member in such a setting. The Government and the HSE do not do enough to help people being cared for in these private homes. There is a need for more funding in this area and a review of the bureaucratic system that administers the service. There is a need to look at the person and the family involved to ensure that the greatest amount of support is given. The family should not be put through further stress and strain in coming up with the money, sometimes having to borrow it.

I put down a parliamentary question asking when the Minister would approve the €2.6 million necessary for a 30 bed unit for the care of the elderly in Kilkenny city. The paperwork on the project has not been submitted to the Department for approval. I got a reply stating that it is a matter for the HSE, but that is not the case as the Department must approve it. I cannot understand why we must go around in this bureaucratic circle. If half of the bureaucracy was removed and the cost savings were put to projects such as this, it would allow greater efficiency in the service and provide money for projects needed in almost every constituency.

Will that project be examined again? Will the €2.6 million be made available? The issue has been debated politically for the past 30 years in Kilkenny and a resolution has been found, if only the money was invested in the project. When the Minister looked at the project several years ago following a visit to Kilkenny, there was a cost of €2 million to care for people in the psychiatric services who were elderly and needed care and for those from the broader community who needed general care. In excess of €1 million has already been spent to fulfil the first part of that project and €2.6 million is needed to complete the project. I ask the Minister of State to take note of this.

I know the Minister of State, Deputy Power, will visit Kilkenny and the hospital in Castlecomer, which has four long-stay beds and is the only hospital in that part of north Kilkenny. The aged population has increased significantly, as has the demand on services. When he visits the area, he will discover that the community has contributed much money to ensure that the project is continued. The people are asking for more long-stay beds for the care of the elderly in that north Kilkenny community. I ask the Minister of State to look favourably on their request.

Many elderly people in my constituency live at home and have no alarm system. Greater funds need to be awarded to the different projects led by groups that provide alarms, as it is absolutely necessary. I urge the Minister of State to ensure that the home heating fund operated by the local authorities is increased substantially so that elderly people's homes are heated.

Mr. Crawford

I welcome the opportunity to speak on this very important subject. It is very dear to my heart and it needs much more attention than it has got. I know the Minister of State means well and I pay tribute to him as he made the first move to get a day care home for the elderly in Cootehill opened by next June. It was promised in June 2002, but even though it took four years to get it, I thank the Minister of State for it.

The care of the elderly and of the disabled is in serious difficulty. I recently received a phone call from the friend of an Alzheimer's patient. I was advised to call early in the morning or I would be unable to speak to the patient's wife. The patient is aware of what is going on, but he is too ill to be left alone. A very able person from the Alzheimer's Society of Ireland is currently on maternity leave and there is nobody to replace her in the area. The patient's wife is now only getting very limited help. An octogenarian man from Cavan with a handicapped son was only recently granted two and a half hours of home help per week, which works out at over 45 minutes a day for three days a week. Anything less than one hour per week is absolutely useless.

I am worried about the different service provided in different areas. An elderly lady in a wheelchair in Donegal received 12 hours of home help although her husband is still alive. They are now living in County Monaghan where she only gets two hours. This is just not on. Someone in County Cavan has waited for two years for an EPG grant because of difficulties between the HSE and the council. They cannot get the OT's report sorted out. If someone needs an EPG grant, he or she is either aged or sick. I put down a question on this and I was told that the Minister has no responsibility. Who has responsibility for issues such as this? I have heard of another case where an engineer from the county council told a family he could not look at their house for four months. There must be some degree of sympathy for people in such cases.

An elderly person was in hospital in Dublin and his wife had to stay in a bed and breakfast while visiting him. She was told by the health officer that there was no possibility of her getting any allowance for her stay. However, if that person had received treatment via the national treatment purchase fund in England, they would have been put up in a four-star hotel. We must be serious about health care for the elderly. I recently received a phone call from a neighbour whose mother has been seriously ill for some years with depression. The last time I raised this issue in the House, she had been speaking to me on the phone a few days before and I could hear her mother crying like a child in the background. Yet those in Cavan General Hospital psychiatric section do not see that as a problem. We must take this seriously and ensure that the elderly and those who care for them are looked after properly.

I could continue at length on the home help situation and the trials through which people are put to secure their entitlements. We were told in this House at the last budget but one that 9,000 people would receive a subvention for summer respite care, but I believe that the actual figure was only approximately 5,600. Not enough effort was put into it to ensure that those entitled to it received it. The subvention is also a joke — I raised the matter in the Dáil yesterday and will not return to it — in that there is totally different financing in the north east from that in other parts of the country.

Mr. G. Murphy

We are constantly reminded by the Government of continual increases in the old age pension. Only pensioners realise the proportion of their weekly money that they return to the Government in stealth taxes and charges for essential living requirements. The cost of waste disposal, rent, heating and gas has increased enormously in recent years and the amount of disposable income available to old age pensioners is extremely limited.

It is well established that indirect taxation affects the most vulnerable in society, especially the elderly. People are on fixed incomes and no amount of propaganda that the Government puts out can disguise the fact that the basic costs of running a pensioner household for a week eat substantially into a pension that I accept has increased to some extent. Owing to indirect taxation and stealth taxes, pensioners are no better off today than they were ten years ago.

Public spending on pensions as a percentage of GDP is projected to increase from 4.7% in 2004, the lowest in the EU, to 11.1% in 2050. That figure will still be one of the lowest in the EU. Public spending on long-term care will rise from a low of 0.6% in 2004 to 1.2% in 2050, approximately 4% less than that spent in a country such as Sweden, despite our economy being among the strongest in Europe. Despite all the promises and announcements, the Government is not prepared to spend the amounts required for essential services. In addition, there is the constant element of fear in old people's lives. How much longer will they be capable of independent living? How many hours more will be cut from their home help? Every elderly person has experienced cutbacks in home help in recent years.

The Minister points out the increased allocation in each health board area, either failing to realise or choosing to ignore that the cost of home help has risen substantially and that the number of elderly people seeking it has also risen. There are many other issues with which I would like to deal that have already been covered, but the most critical is home help. When it is not properly catered for, enhanced subvention becomes a necessity for those in long-term care. The other two issues that have been addressed today and require immediate attention are the disabled person's grant and the essential repairs grant. If we can get those three matters right, we will save the Exchequer substantial sums in long-term care.

Mr. Hayes

I thank the other Deputies for sharing time.

I am pleased at the opportunity to speak on this vitally important topic. Care of the elderly often seems to come bottom of the list of people's priorities. The elderly are very vulnerable for several reasons, and one of the areas in which that vulnerability manifests itself is their capacity to achieve the type of care and accommodation that they want and need to see out their lives. Often they find that they are not listened to. The dominant factors determining where and how they live their lives become convenience and cost-effectiveness.

The Ombudsman's report on the elderly highlights a large number of issues, several of which I would like to cover. However, I specifically bring to the Minister's attention a situation in my constituency concerning St. Patrick's Hospital in Cashel, which is among the finest of such institutions and has provided a wonderful service over many years. Its future is threatened, and I want the Minister to deal with that. It is a great worry for many in my constituency.

If an elderly person wishes to remain in his or her home, the State must endeavour to facilitate that. A key plank of that approach would be to accord the important role of carers its proper value in society. In that context, a more flexible approach to the habitual residency clause is needed. I know of the case of a constituent who left her job and family home in America to return to Ireland and care for her sick mother in south Tipperary. She does not qualify for carer's benefit, despite being an extremely deserving case. Carers' rights are often inextricably linked to those of the elderly and the Government must bear that in mind. I ask the Minister to examine that issue, which is one of the most important. A person has come from the United States and has been denied carer's allowance and that should not happen because that person is saving the State a substantial amount.

Mr. Carey

I welcome the opportunity to speak on this important matter. Most Deputies and public representatives have a fair amount of involvement and engagement with the elderly and it is right that we discuss their needs here. Before moving on to my substantive points, I want to say one thing. Mention has been made of the disabled person's grant and the essential repairs grant, including delays in processing. Those are within the remit of local authorities. Those opposite who criticise the Government should contact their colleagues on local authorities up and down the country and persuade them to vote money for such grants in the Estimates, which will then be matched by the Government.

I take pride in the fact that in Dublin we decided several years ago to accord priority to the essential repairs grant and the disabled person's grant. I almost collapsed the other day when an applicant came to my office and thanked the staff for encouraging Dublin City Council to turn an application, including occupational therapy assessment, around in three weeks. That does not happen often, but it happens.

I have a criticism regarding occupational therapy reports. People awaiting such a report from the public sector in the city very often have to wait up to a year or even longer. However, if they pay €150 for a private report, in most cases carried out by the same people, they can have that report in three weeks. That ought to be examined. The cost of the occupational therapy report should be recoupable by the applicant, especially if he or she holds a medical card, as is usually the case.

It is estimated that the number of elderly households in Ireland will increase from approximately 440,000 in 2002 to almost 800,000 by 2025. By 2030, more than a quarter of the population will be aged over 65 and, if today's predictions are true, the figure will be even greater. Furthermore, with improvements in health and lifestyle, life expectancy will also increase, with the proportion aged over 75 estimated to increase significantly. With that comes a reduction in informal family care, principally owing to participation in the workforce.

In that context, the Government is working towards a co-ordinated approach of integrated primary care, community health and rehabilitation services. We can pick and choose. Of course, not everything is perfect, but a great deal that is right and good is being done, something that the elderly acknowledge. I will not dwell on social welfare increases as they are only a small part of the picture. However, over the past 12 months there have been reports by such organisations as the Mercer Institute on care of the elderly, especially regarding the long-term funding of continuing care. There has been the O'Shea report and the National Economic and Social Forum has also reported. All these have stressed that well funded services must be delivered in partnership with the elderly, their families and carers, as well as through a range of statutory and non-statutory voluntary and community groups. They have supported the Government's aim to maintain older people in dignity and independence in their homes in accordance with their wishes for as long as possible. They have also highlighted the continuing need for high quality long-term residential care for older people when living at home is no longer possible.

I wish to highlight the Odin's Wood day care centre as a model of good practice. I understand the Minister has had the opportunity to see it for himself. It is a centre which has been developed at Kildonan Road in Finglas with the co-operation of the then Northern Area Health Board and Dublin City Council. It is a good example of a centre to which people with community support needs can come once, twice or thrice a week to have their hair done, engage in some physical and mental exercises, avail of the chiropody services provided or have a meal. We should try to replicate this centre throughout the country.

The voluntary housing organisation, Respond, has developed a centre, again in Finglas, which contains a number of residential units. The level of dependency is stepped, ranging from some people who are completely independent and are able to live on their own to those who are required to live in semi-nursing home care. They share a common room in which caring and medical facilities are provided as well as someone who is available to help them.

The initiatives set out by the Government show its commitment to older people and to putting them at the centre of health policy now and in the future. It is entirely proper that we should devote substantial additional resources to services for older people. They have made an enormous contribution to society and need recognition and reward. Sheltered housing is an extremely important part of any strategy to deal with the care of the elderly. Most older people prefer to live in their own homes and consequently, the fixtures mentioned by Deputy McGuinness, such as alarms for the elderly, grab-rails, stair lifts and so on, should be made available without all the fuss and bother that many people are obliged to endure at present.

However, when the elderly are no longer able to remain at home, it is important that the option of sheltered housing is available. Many local authorities have gone down that route with the help of the Department of the Environment, Heritage and Local Government, and much pioneering work has been done by Dublin City Council. For example, older people who own their homes are able to sell them to the council and to make a contribution of between a third and a fifth, depending on their age, towards getting high quality accommodation in which they can live with the support of many other community agencies. I have seen some very good models of practice in Belfast and other parts of Northern Ireland and I urge other local authorities to go down the road taken by Dublin City Council, whereby services like general practitioner support and meals are available.

Some years ago, I saw a good centre of excellence for the elderly in Summerhill, County Meath, and copied the idea. A report which was drawn up by the Finglas-Cabra partnership on the needs of older people in the Finglas area identified the need for a centre of excellence for older people in which there would be a mix of residential, social and medical facilities available in a single site. The centre will accommodate 45 units in a residential setting with some units having more than one person living in them. When its services are integrated with those available from the Odin's Wood day care centre across the road, it will become an important driver of services for the elderly in the Finglas area.

Advocacy by older people is very important and a number of significant groups are active. I will mention two of them. I draw attention to the Senior Help Line for which an 1850 number is available, although I cannot remember the exact number. This useful service is delivered by a woman in Summerhill, County Meath, and is available in different parts of the country. I compliment groups such as Age Action Ireland. I also have a soft spot for the Irish Senior Citizens Parliament. We need such groups and it is important that they form part of the advocacy process. I am glad to see that the Irish Senior Citizens Parliament, Age Action Ireland and a number of other organisations are participating as part of the voluntary and community pillar at the partnership talks which are under way at Government Buildings at present. Our policies must reflect the desires of organisations such as the Irish Senior Citizens Parliament.

Minister of State at the Department of Health and Children (Mr. S. Power)

I thank Members for their contributions to this informative debate. It is obvious that Members are in touch with older people and the various organisations representing them and are aware of their needs.

Many contributions mentioned the issue of home help. There have been some difficulties with regard to the qualifying criteria for home help. Moreover, in some cases people may have felt that the hours they received did not match what was required. This year, the Government will provide an additional €30 million for home help which will facilitate the provision of 1.75 million extra home help hours. This has been put in place and should have a significant and positive impact.

The Government acknowledges that it must continue to develop services to meet growing need and that it cannot be complacent in this respect. Its budget investment has demonstrated its commitment to the wishes expressed by older people, by focusing on community care, to which almost three quarters of the additional funding from this year's budget has been allocated.

Earlier, I outlined the additional €150 million which was allocated in the budget and the different areas in which it will be spent, which include home care, support packages, home help, daily respite care, meals on wheels, sheltered housing, elder abuse, nursing home subvention and delayed discharges. I also outlined the legislation which will be brought forward to give some indication as to the priority which older people receive.

While I am proud of this investment and the priority the Government has assigned to it, I do not state that all is well. I am as aware as Opposition Members of the shortcomings and gaps in the services as well as the need for new services in some respects. Some criticism was levelled at the subvention. I appreciate Members' concerns and acknowledge the need to streamline and clarify the scheme and to have greater uniformity in the manner in which it is administered. However, I hope that the budget increase of €150 million will signal the start of a new era in which older people and services to older people will receive greater priority and that Members can work together to eliminate ageism and to promote a much more positive attitude towards aging. It is also vital that people's entitlements to services be clarified and that people have greater access to those services when they qualify for them.

I again thank Members for their contributions. Their compliments and criticisms were appreciated. There is room for improvements in a number of areas and the Government will work to make them.