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Dáil Éireann debate -
Thursday, 11 May 2006

Vol. 619 No. 3

Health (Nursing Homes) (Amendment) Bill 2006: Second Stage.

I move: "That the Bill be now read a Second Time."

I am pleased to have the opportunity to introduce the legislation. Government policy on older people has long since been to support them to live in dignity and independence in their own homes and communities for as long as possible and to support appropriate long-term care where this is no longer possible. It was for this reason that the nursing homes subvention scheme was introduced in 1993. The aim of this scheme is to provide financial assistance to older people towards the cost of maintenance in a private nursing home. The Bill is designed to ensure the existing subvention scheme for private nursing home care is grounded in primary legislation and it will also help the Health Service Executive to implement the scheme on a standardised basis across the country.

I will outline the major developments the Government is pursuing to improve services for older people before getting into the detail of the Bill. It has been the policy of successive Governments to endeavour to help older people maintain themselves in the community while, at the same time, providing for appropriate residential care, where living in the community is no longer possible. The policy of this Government in the development and delivery of services for older people is to maintain them in dignity and independence at home for as long as possible, in accordance with their wishes.

The focus on services for older people has increased over the past 18 months, particularly in the area of long-term care, whether residential or community-based. Additional funding for services for older people and palliative care amounting to €150 million was allocated by the Government in the 2006 budget — an additional €110 million for 2006 and an additional €40 million for 2007. This is the largest ever annual increase in funding for older people and palliative care and clearly demonstrates the Government's commitment to improving the quality of service provided to our older citizens. Approximately two thirds of this money was allocated to community support for older people. This is in line with the focus on keeping people in their own homes in independence and dignity, with proper health and social support systems in place in the form of, among other supports, home care packages, increased home help hours and increased day and respite care places. A full year cost of €55 million was allocated to home care packages, €30 million of which is for 2006. An additional 2,000 packages are to be delivered by the end of 2006, with the majority being implemented in the second half of this year. The latest HSE figures indicate 1,366 packages in place, 249 of which have been commenced since 1 January 2006. The delivery of the 249 packages means that the executive has met its targets for the first quarter.

Not every older person can, or wishes to, remain in his or her own home. Of the budget investment, €20 million has been allocated to the further development of the subvention scheme in 2006. This is a full year cost aimed at standardising means tests and bringing greater consistency to the different levels of enhanced subvention support throughout the country. A sum of €8 million of the budget package was also provided to cover the cost of 250 extra nursing home beds, which the HSE has sourced from private nursing homes. The HSE is in the process of sourcing 250 extra beds from private nursing homes to accommodate older people requiring such care.

The nursing homes subvention scheme was introduced in 1993 following the Health (Nursing Homes) Act 1990 and the subsequent Nursing Homes (Subvention) Regulations 1993 which were made under the Act. The purpose of the subvention scheme is to provide financial assistance to older people towards the cost of maintenance in a private nursing home. The scheme does not cover, nor was it ever intended to cover, the full cost of private nursing home care. The 1993 regulations provide that a subvention can be paid to an applicant qualifying on both dependency and means grounds. Dependency is assessed according to an applicant's ability to carry out the tasks of daily living, such as washing and dressing. There are three levels of dependency set out in the regulations, maximum, high and medium, which are referred to in the Bill ascategories I, II and III.

The maximum rate of subvention that may be payable to a person is determined in the first instance by their level of dependency, and the current maximum rates of subvention, as set out in the regulations, are €114.30 per week for a person of medium dependency, €152.40 per week for a person of high dependency and €190.50 per week for a person at the maximum rate of dependency. Once a person's rate of dependency has been determined, the HSE carries out a financial assessment of the applicant which takes into account the value of the applicant's income and assets, subject to certain exclusions outlined in the regulations. The appropriate level of subvention to be paid is then determined, based on the level of dependency and the outcome of the financial assessment of the applicant. This may result in the payment of the maximum level, a reduced level of subvention or no subvention at all, as appropriate to the determined dependency level. Where a person is married or cohabiting, the means assessment is based on half of the combined means of the couple. In certain cases, the Health Service Executive has the discretion to pay an enhanced rate of subvention over and above the rates outlined, such as where personal funds are exhausted. This discretion regarding individual cases is a matter for the HSE.

Provided it has the money.

The average rate of subvention paid by the HSE generally exceeds the current approved basic rates. The subvention scheme is currently provided for in the Nursing Homes (Subvention) Regulations 1993. These regulations, made under section 7 of the Health (Nursing Homes) Act 1990, outline the scheme in detail, including such matters as how an application should be made, how an application is to be determined, how to appeal a decision made under the scheme and so on.

Legal advice received from the Attorney General has indicated that new primary legislation is needed to sufficiently underpin the principles and policies of the scheme. Sections 6 and 7 of the Health (Nursing Homes) Act 1990 were amended by section 3 of the Health (Miscellaneous Provisions) Act 2001. The purpose of this amendment was to incorporate principles and policies into the 1990 Act which would facilitate the making of new subvention regulations under the Act. However, the legal advice available indicates that section 3 of the 2001 Act does not adequately provide for the making of regulations under that Act. Therefore, section 3 of the 2001 Act has not been commenced and this section will fall on the enactment of this Bill.

The Tánaiste and the Minister for Social and Family Affairs established an interdepartmental group last year to examine the whole area of long-term care for older people. The group included senior officials from the Department of the Taoiseach, the Department of Health and Children, the Department of Social and Family Affairs and the Department of Finance. The group was chaired by the Department of the Taoiseach. The group had a number of reports available to it, including the Mercer report on the future financing of long-term care in Ireland, commissioned by the Department of Social and Family Affairs. The group also considered Professor Eamon O'Shea's report, Expenditure Review of the Nursing Home Subvention Scheme, commissioned by the Department of Health and Children. These reports were published in 2003. The group's report was recently discussed at Cabinet and it was agreed that a number of principles contained in the report should be discussed with the social partners in the context of the current round of partnership talks with a view to bringing the report back to Cabinet once these discussions have taken place.

The issue of funding long-term care needs for older people, both residential and in the community, is amongst the most difficult and complex areas in the health sector. The demographic challenges which are facing all countries must be tackled and sustainable programmes put in place, but while there are many different approaches taken by governments in addressing these challenges, there are no easy or simple answers. Nevertheless, the pace of change from a demographic, social and clinical aspect requires a coherent response from Government and from society generally so appropriate funding and service delivery programmes can be implemented. Although the report of the working group on long-term care is still being considered by Cabinet, the Attorney General has advised that immediate steps should be taken to incorporate the principles and policies of the 1993 subvention regulations into primary legislation, which is the purpose of this Bill.

Consultation has taken place on this Bill with the Department of Finance, the Department of Social and Family Affairs, the Office of the Attorney General, the Office of the Taoiseach and the Health Service Executive regarding its provisions. There will be ongoing discussion with the relevant Departments on any developments or changes made in the area of services for older people, including any regulations to be made under this Bill. Discussions have taken place with the Health Service Executive, which has responsibility for the implementation of the subvention scheme, throughout the drafting of the Bill.

Section 1 contains a minor drafting provision and simply inserts a heading into the Health (Nursing Homes) Act 1990. Section 2 of the Bill amends section 2 of the Health (Nursing Homes) Act 1990 to specify that subventions shall only be paid to a person maintained in a premises in which a majority of its residents are members of a religious order or priests of any religion if the premises is a registered nursing home. Section 3 is the main section of the Bill. This section replaces section 7 of the Health (Nursing Homes) Act 1990 and inserts the provisions of the Nursing Homes (Subvention) Regulations 1993 into primary legislation. These regulations are then revoked in this Bill. Given the length of this section, and the amount of detail contained in it, I will go through it subsection by subsection.

Section 7 defines the various terms used in the Bill. Subsection 7A outlines that all dependent persons may make an application to the HSE for a subvention. It outlines that an application must be made to the HSE and the manner in which it must be made. It also provides for an offence where false or misleading material is provided in a subvention application. Subsection 7B provides that once the HSE receives an application for subvention, it shall arrange for an assessment to be carried out on the degree of dependency and the means of the applicant. The assessment to be carried out on the degree of dependency of the applicant will be based on the applicant's ability to carry out the activities of daily living, such as walking and dressing. Other factors affecting the applicant's ability to care for himself or herself will also be taken into account, such as medical services and the receipt of family support. The subsection provides that the person carrying out the assessment must be suitably qualified to do so in the opinion of the HSE, and may or may not be an employee of the HSE. This allows the HSE to arrange for suitably medically qualified professionals to carry out such assessments, such as physiotherapists not employed directly by the HSE.

Subsection 7B also provides that the HSE shall arrange for the means of an applicant to be assessed, either by an employee of the HSE or a person nominated in writing by the HSE. It provides that the financial assessment shall take into account all of the applicant's assets and sources of income, such as salary, pension, savings etc. It also provides that certain assets and income shall not be taken into account, including the applicant's principal private residence, where occupied by certain relatives, as prescribed in the subsection, as well as the first €11,000 of the applicant's assets. Where an applicant is married or cohabiting, the means assessment will be based on half of the combined means of the couple. Where an applicant's principal residence is not continuously occupied by a relative as prescribed in the subsection, such as a relative whose sole income is the old age pension or a spouse, the HSE shall exclude 95% of the estimated market value of the principal residence from the financial assessment of the applicant. This means that an imputed income of 5% of the market value of the principal residence shall be taken into account.

That is disgraceful.

The subsection further provides that the principal residence of the applicant will not be taken into account if that could give rise to destitution or homelessness of a person with a close connection to the applicant. This provision is to allow for exceptional circumstances and would generally apply in the case of a relative who does not fall into the categories prescribed in the subsection.

Subsection 7C outlines the basis on which the HSE determines subvention applications, the amount of subvention payable and grounds on which they may refuse to pay a subvention. The rates of subvention, as outlined in the regulations, are not outlined in this Bill. It is intended to put down an amendment on Committee Stage to insert the rates of subvention into the Bill in order to ensure consistency with other aspects of the scheme contained in the Bill, such as the thresholds used when assessing a subvention. This subsection provides that the HSE may pay an enhanced rate of subvention, which is referred to in the Bill as an "alternative subvention", where a person cannot meet the costs of care without undue hardship. The amount of alternative subvention will be decided after taking available resources into account. The section provides the HSE with discretion to refuse to pay a subvention if the value of the applicant's assets or principal residence exceeds a certain threshold and his or her income is above a certain level. These thresholds were recently increased by way of the Health (Nursing Home) (Amendment) Regulations 2005. The threshold for assets to be disregarded for the purpose of subvention assessment is €11,000, the asset threshold above which subvention may be refused is €36,000, the income threshold above which a subvention may be refused is also €36,000 and the threshold of principal residence value above which subvention may be refused is €500,000 if the residence is located in the Dublin area or €300,000 if the residence is located outside the Dublin area and where the income of the applicant is above the threshold of €9,000. The Dublin area is defined as Dublin city and county. The threshold on income was not included in previous regulations but has been added to this Bill for the purpose of consistency. This section also provides that the HSE can, at its discretion, pay a subvention to the proprietor of the nursing home in question instead of directly to the applicant.

Under subsection 7D, the HSE can arrange for a review to be carried out of the level of dependency or means of a person in receipt of a subvention. If the HSE is satisfied that a person no longer qualifies for subvention or qualifies for a different rate of subvention, it can arrange for the payment to stop or be altered appropriately and for notice of same to be sent to the applicant and the nursing home proprietor, if appropriate. Where a person's subvention payment is discontinued or decreased, the HSE will not implement this decision for 60 days in order to give the person time to get their affairs in order.

Subsection 7E allows for an appeals mechanism against decisions made by the HSE in respect of the level of subvention paid or where applications were not considered because a condition of the application was not met. The HSE must appoint a person to consider the appeal, who may but does not have to be an employee of the HSE. The person appointed must consider the appeal based on guidelines issued by the HSE, make a decision as soon as he or she reasonably can and send a copy of the decision in writing, together with the reasons for making the decision, to the appellant. A further appeal is possible to the High Court, the decision of which is final, except where a further appeal is made to the Supreme Court on a specific point of law.

Subsection 7F states that a nursing home owner must inform the HSE in writing of the death, discharge or permanent departure of a resident within 48 hours. This is to ensure that subventions do not continue to be paid in respect of persons who no longer reside in the home. Where the nursing home proposes to discharge a person, the proprietor must inform the HSE in writing 14 days in advance and must outline his or her reasons for doing so. The Bill provides for an offence where a nursing home proprietor does not fulfil his or her obligations with regard to either of these situations. This subsection also provides that, where a person in a nursing home starts or ceases to be paid a subvention, the HSE shall inform the nursing home proprietor of this fact as soon as possible.

Subsection 7G provides that the HSE may recover all or part of any payment or overpayment if it is satisfied that an overpayment occurred or that the payment was procured through fraud or misrepresentation.

Subsection 7H allows the Minister to make regulations, with the consent of the Minister for Finance, on rates of payable subvention, the amount of assets to be disregarded when assessing a person for subvention, the thresholds above which subvention may be refused, the percentage of the family home to be disregarded and the percentage of the spousal income to be assessed, as required. It provides that the Minister will take into account the cost of living and nursing home care in the State and the rate of inflation when making regulations. This section provides that the Minister will only make regulations on the rates of subvention after taking into account available resources and the prevailing cost of nursing home care for persons falling under various dependency categories. It also provides that the maximum rate of subvention payable to a person based on his or her level of dependency is reduced by the amount by which the person's means exceed the weekly rate of the old age non-contributory pension payable at the time of assessment. This represents no change from current practice. The section also outlines the basis on which it is decided whether a person falls under category I, II or III dependency, otherwise known as maximum, high and medium dependency, according to such factors as the degree of mobility and the extent to which the person is confused or disturbed.

Subsection 7I provides that, where a person is in receipt of subvention immediately before the passing of this Bill, he or she will continue to receive a level of subvention equivalent to the payment received prior to the Bill's enactment. However, the HSE may still carry out a review of the degree of dependency and means of any person in receipt of subvention at any time and may discontinue paying subvention or pay a different level of subvention if the review shows that the correct level of subvention is not being paid.

Section 7J provides for guidelines to be issued by the HSE to provide practical guidance in respect of the provisions of the Bill and the working of the subvention scheme, for example, the process to be followed when deciding the amount of subvention to be paid to an applicant.

Sections 4 and 5, like section 1, are minor technical provisions which insert a heading into the Health (Nursing Homes) Act 1990.

Section 6 replaces section 14 of the Health (Nursing Homes) Act 1990 with a new section which provides that regulations will only be made after a resolution approving the regulations has been passed by both Houses of the Oireachtas. At present, regulations are made before being laid before both Houses of the Oireachtas and can subsequently be annulled by them.

Sections 7 to 10 also contain minor drafting and technical provisions. Section 7 repeals section 3 of the Health (Miscellaneous Provisions) Act 2001. Section 8 amends Schedule 7 of the Health Act 2004 by deleting subsection (6) in Part 4, as this subsection updates a section of the 1990 Act which is being replaced under section 3 of this Bill. Section 9 revokes the Nursing Homes (Subvention) Regulations 1993 because the provisions contained in those regulations are now contained in the Bill. Section 10 cites the Short Title of the Bill and cites the Health Acts of 1947 to 2006, collectively, as the Health Acts 1947 to 2006. Section 10 also contains a provision relating to commencement.

I want to briefly discuss the Health (Nursing Homes) (Amendment) Bill in the context of other developments and legislation pertaining to services for older people. The Second Stage reading of the Health (Repayment Scheme) Bill 2006 commenced in the Dáil recently and the Bill will continue its passage through the Oireachtas over the coming weeks. This Bill provides a legal framework for making repayments to those wrongly charged for inpatient services in publicly funded long-term residential care. It is currently envisaged that repayments will commence shortly after the Bill is approved and signed into law and an outside company has been appointed to make the repayments. The HSE is currently undertaking a procurement process for the selection of a company to administer the scheme. The final steps in the process are being completed and an announcement in this matter is expected in the week commencing 22 May. The Tánaiste has requested the HSE to proactively determine the details of repayments due to living persons so that prompt repayments can be made following the appointment of the company to administer the scheme. The key elements of that Bill include making the repayment process as user friendly as possible while also providing appropriate safeguards to prevent the fraud and exploitation of recipients who are not in a position to manage their own financial affairs.

The provisions of the Health (Repayments Scheme) Bill include exempting repayments to those who are still alive from income tax, allowing for repayments to take account of inflation by means of the consumer price index, allowing repayments to living persons and their spouses to be disregarded in means assessment for health and social welfare benefits and allowing for a streamlined process where an application is made on behalf of a deceased person. An independent, transparent appeals process will also be established.

The Bill will regulate patient private property accounts by introducing a statutory framework to protect patient interests, particularly in the context of large repayments which may be placed in these accounts. There has been extensive consultation with the oversight committee appointed by the Tánaiste to provide an independent input into the design and monitoring of the scheme. The committee has been fully briefed on all aspects of the scheme and has provided valuable input into the drafting of the legislation. The governance of the scheme allows the Minister to request and receive reports on the operation of the scheme, the appeals process and the donation fund to be established under the scheme. These reports will be laid before the Oireachtas. The Comptroller and Auditor General will be able to audit all funds and accounts associated with this scheme.

A draft general scheme and heads of Bill which provides for the establishment of the Health Information and Quality Authority, HIQA, incorporating the office of the chief inspector of social services within HIQA, has been prepared by my Department. Public consultation on the legislative proposals contained in the draft heads of the Bill is currently under way. Under the proposals in the draft heads, HIQA will set standards on safety and quality of services provided by or on behalf of the HSE. It will monitor and advise the Minister and the HSE on the level of compliance with those standards. We are making provision to give HIQA the power to investigate, at the request of the Minister or the HSE, the safety, quality and standards of any such service, and make any recommendations it deems necessary. It will also have a role in accrediting services and will be able to provide an accreditation service for the private sector, should that sector wish to avail of it.

The chief inspector of social services will be required to monitor against standards set by HIQA.

This has been promised for years.

The Deputy will have his opportunity to contribute to the debate.

It has been promised for years and I am delighted we are to deliver it. The chief inspector will be required to establish a register or registers of residential services, including residential services provided to any dependent person in respect of that dependency and services provided in accordance with the Health (Nursing Homes) Act 1990.

As I already indicated, the Department has initiated a public consultation on the legislative proposals in the draft heads. The background paper outlining the proposals and the draft general scheme and heads of the Bill are available on the Department's website. The closing date for receipt of submissions is Friday, 26 May. The draft heads will be reviewed in light of the views expressed during the consultation process and the Tánaiste intends to submit revised heads to Government in June seeking approval to have the Bill drafted and published as soon as possible thereafter.

In the context of the Health Bill 2006, the process has begun to review the current inspection system with a view to strengthening the powers available to those involved in inspecting facilities and to extend a strengthened inspection system to public facilities. To this end, a working group has been established and is chaired by the Department to develop the standards for residential care settings for older people. Members include representatives from the Department of Health and Children, the HSE, the Social Services Inspectorate and the Irish Health Service Accreditation Board. The standards are being developed in line with best international practice. These standards will put the resident at the centre of care and aim to ensure that the older person's needs are central to the philosophy of the residential care setting. The national standards will be the level which all residential care settings, both public and private, will be required to meet. It is intended that these standards will be ready in draft form in July and a three-month consultation process will follow enabling all interested parties to give their views.

The Department is preparing legislation to update and clarify the current legislation on eligibility for services. The main aim is to make the system clearer and to bring it up to date with developments in service delivery and technology that have occurred since the Health Act 1970. The legislation will define specific health and personal services more clearly, define who should be eligible for what services, set out clear eligibility criteria, including for older people, and establish when and in what circumstances charges may be made. It will also deal with an appeals framework. The Tánaiste briefed the Cabinet committee on health in November on the progress so far, and aims to bring legislative proposals to Government by the middle of this year. Her intention is to publish a new eligibility Bill by the end of 2006.

I wish to conclude by reiterating that this Government has made services for older people a priority, by supporting older people to live in dignity and independence in their own homes and communities for as long as possible, and by supporting the provision of quality long-term care where it is no longer possible. The significant progress that has been made in terms of the growth in funding available for this sector in recent years, and in particular the investment package put in place in the 2006 budget, is indicative of the Government's commitment to the ongoing development of health funded services for older people. This Bill will ensure the existing subvention scheme for private nursing home care is grounded in primary legislation and the Bill will also go a long way towards helping the Health Service Executive to implement the scheme on a standardised basis across the country. I commend this Bill to the House.

May I give way to the Minister during my speech to answer some questions on this legislation? The Minister has brought up this 2006 amendment to the Health Bill and has referred to other legislation such as the health repayments scheme, HIQA, eligibility and standards in residential care.

It is acceptable for Deputy Twomey to give way to the Minister.

My first question is on the standards in residential care.

Is this a Second Stage speech?

It is. I will focus on what the Minister said. He said he is developing a set of standards through the Irish Health Services Accreditation Board. I have been made aware that those standards, as put together by the IHSAB, were received by the Minister last November and that all they require is for the Minister to sign off on them rather than to discuss them in July. I am surprised to read that the Minister says they will be ready in July followed by a three-month consultation process with interested parties to give their views. I am told these draft standards have been in the Department since last November. The Minister seems to be postponing again the recommendations by a group, the IHSAB, which was established by the Tánaiste to put forward a set of recommendations on standards of care in public institutions where elderly people are being looked after. In light of the Leas Cross scandal and other scandals raised in pubic and private nursing homes, one would think the Minister for Health and Children would publish these recommendations as soon as they fell on her desk and not tell us this process will not start until July, six months later. I would like to give way to Deputy Seán Power, the Minister of State responsible for this. Does he have those recommendations on his desk and has he had them since last November, or do I have the wrong information?

The usual format is that the Minister replies to questions raised in Second Stage speeches during his reply to Second Stage if he wishes.

I will leave that question open to the Minister to answer. I hope we receive the answer sooner because the Minister might not come back to reply for another four or five weeks. I ask the Minister for a reply to this as it is serious. We are prioritising the issue of standards in public and private nursing homes in light of what we heard from Leas Cross. If it transpires that a body established by the Tánaiste gave recommendations last November which the Minister this morning says he will publish in July followed by a three-month public consultation process, we may not expect these recommendations to be implemented to any reasonable degree until next November. That will be 12 months after they fell on the Tánaiste's desk and is too far away for my liking. I ask that the Minister examine that more seriously.

I will now examine the legislation. I have a difficulty with the legislation on the question of assessing the degree of dependency. The only people who can assess the degree of dependency of patients who might require nursing home subventions are occupational therapists. A GP should fill out a pro forma letter regarding what he or she knows about the patient, but we cannot have nurses, doctors, occupational therapists and whoever is available assessing who should get nursing home subvention, either category 1, 2 or 3. It must be the duty of one category of people and currently, the most suitable are occupational therapists. We are talking of putting a uniform system in place for the entire country, so we should first ensure that the assessors have the same standards and training, and will reach the same conclusions. As the Minister of State knows, it is occupational therapists who assess people for disability grants, for extensions to their houses, which are paid for by county councils, and the health boards also have occupational therapists who assess people’s means and ability to look after themselves, and their needs for nursing aids and appliances to help them stay living at home. Accordingly, this would be simply an extension of the jobs of occupational therapists. The problem is that we have not got sufficient occupational therapists employed in the health service and they are almost seen as the financial controllers for the county councils and the health services. It is so hard to get occupational therapists out to assess patients that when they do so, and make their recommendations, the councils are almost buying themselves time before they have to pay out for the grants.

The Minister of State should tighten up this area. Occupational therapists must be given a proper role in regard to these assessments, and all that should be sought from doctors or public health nurses is a pro forma letter which is easy to follow to make the decision. That would be good governance in the system and banish the bureaucracy involving four or five different people giving an opinion with variable standards. How I might assess a patient’s mobility might be quite different from how the public health nurse or the occupational therapist would do it. To have a proper standard, the occupational therapists should be the assessors. I trust the Minister of State will make the right decision in this regard.

There is a point in section 3 about the financial considerations to be taken into account. I understand that 95% of the estimated market value of the house will be excluded. Then there is reference to excluding a prescribed percentage of the market value, or whichever is greater. Perhaps it is because I have no training in economics, but I have not a clue what that means. I read the section when the Minister of State made his speech, when he was talking of 5% of the house being taken into account, though the legislation refers to a bigger figure, and I have not the foggiest notion what it means, or where it comes into play. Does it refer to 95% of the value of a house valued at more than €500,000 in Dublin and more than €300,000 in the rural areas, being more or less discarded? What does this 5% mean and what is the need for this prescribed percentage of the market value? I would appreciate if the Minister of State would at some stage give me a briefing in economics for simpletons when reading health legislation.

This legislation is meant to be a tidying-up process on subventions and entitlement to them, so it should be clear. The Minister might look at section 3(b), with regard to the excluding factors, and explain it to me. Deputies may say this legislation amounts to taking houses from people. The Government has been very slow to publish a policy on future care of the elderly. In the past, the Minister for Health and Children, Deputy Harney indicated she has no great difficulty in taking houses from patients to pay for their nursing home care. Even though the paragraph in question is short, its meaning is quite unclear and we deserve clarity with regard to what will be taken from people.

The same section states that one fifth of the weekly rate of the old-age non-contributory pension will also be given back. That is good, because though I may be misinterpreting this, it looks as if a basic standard is being set so that all people who go into public nursing homes will be entitled to keep, going by today's figures, approximately €40 of their old-age pension. In the past we had a problem whereby patients who went into public nursing homes were left with practically nothing for their own expenses when their old-age pensions were taken from them, because subvention rates were so low. I hope I am reading this correctly and that patients will be left with €40 weekly from their old-age pensions when they go into public nursing homes.

The Minister of State also said that patients can have only a minimum of €11,000 and a maximum of €36,000 if they are entitled to subventions. I would like to see more clarity in what happens in the area between those figures. A person with only €11,000 will get the full subvention but a person with €36,000 will get no subvention. What is the pro rata set-up in between? Will a person who has €20,000 get only half the subvention, or what are the percentages in this regard? This is not stated in the legislation and I would like the Minister of State to clear up the matter. I would have expected greater clarity on Second Stage.

Am I to understand that the legislation regarding a house valued at €500,000 in Dublin and a house valued at €300,000 in rural areas is already activated, that when the HSE is assessing somebody for subvention it is already discounting the first €500,000 of the value of a house in Dublin and the first €300,000 of the value of a house in rural areas? I want to be certain that this is being applied for everyone assessed for subvention since the beginning of 2006. The last budget allotted some €15 million or €20 million so that more people would be able to take up subvention. The Government suggested such a figure was available for subvention, which was a little disingenuous. The Government was trying to fool people in some regard because looking at subvention payments, whether category 1, 2, or 3, the payments patients actually receive after being deemed entitled to them have not changed since 2001. Nor is there any indication that change is now to be made. It is fundamental that subvention payments should be index-linked to something. What people could buy for €130 in 2001 would require more money now, in 2006. The Minister of State needs to look seriously at those figures and not somehow try to mislead people into believing there is more money available if they need to go into nursing homes.

The criteria have broadened a little but the maximum amounts of subvention available, some €130 to €150 weekly for people who need to go into nursing homes, are totally out of step with nursing home costs. The cheapest nursing home cost in this country is probably about €700 per week, while the average cost would be about €900 to €1,000 weekly, and the cost in Dublin could be up to €1,500 per week. There are not enough public nursing home beds, especially in the Dublin region, which has been made glaringly obvious during the accident and emergency service crisis. Even where such beds are available in Dublin, the cost is quite significant. While the Government has talked a great deal about solving the crisis, the number of contracted beds it has taken up in the private sector is pretty low, given the size of the problem.

When Second Stage concludes, the Minister of State should return to the House with better news for people who are seeking or are in receipt of subvention, and are not just getting the same amounts of money they got in 2001 — too far back.

The next section refers to the applicant's annual income or "prescribed amount" being not less than €9,000. The term "prescribed amount" litters this legislation. The non-contributory old age pension exceeds €9,000. This figure should be changed because this legislation has probably been lying around since 2001.

Section 7C(6) of the Bill states: "The Executive shall only determine the amounts of alternative subventions after taking into account the resources available to pay the alternative subventions". This is enhanced subvention and is paid in an inequitable fashion across the country. Enhanced subvention in two neighbouring areas can be very different. The former South Eastern Health Board was reluctant to pay enhanced subvention whereas the southern health board was more willing. The HSE was supposed to provide a more equitable service throughout the country but the only change from the old health board system is the name. Every parliamentary question is answered by the HSE regional area, similar to the old health board structure, rather than by the HSE headquarters on the Naas road. Will alternative subvention be equal throughout the country or will it be implemented in different ways at local level? It is important this is clarified on Second Stage.

Will patients over 70 be entitled to free nursing home care? If a public nursing home bed is not available, is the patient entitled to a bed in the private sector, paid for by the HSE? Legislation in 2001 provided a medical card to every person over 70. Prior to that, the CEO of the health board could use discretion to decide if enhanced subvention was payable. The 2001 legislation stated that inpatient care was a statutory entitlement. I have sought clarification on this question several times.

The Tánaiste should be able to answer this question. When the legislation was being passed by the Oireachtas the current Minister for Justice, Equality and Law Reform was the Attorney General. When legislation with such fundamental changes is proposed, with subvention no longer at the discretion of the health board CEO but a statutory entitlement, someone must have asked the opinion of the Attorney General.

The illegal nature of some nursing home charges came to the fore in 2003. The Travers report and the review of the Travers report were published in 2004 and 2005. No member of the Government has stated if every person over 70 is entitled to nursing home care, paid for by the taxpayer. The Minister of State has prevaricated over this on a number of occasions and must now make it clear.

Legislation dealing with the illegal nursing home charges is also being passed by the Oireachtas. The Government is stating that any person still alive will not have to pay income tax on the nursing home repayments. Does that refer to any person alive when this legislation was published in December 2005 or any person alive after this legislation has been passed by the Oireachtas and signed by the Minister? We have awaited this legislation throughout 2005 and, with the progress we are making this year, the Bill will not be passed until December 2006, two years later. The average stay in a nursing home is not ten or 15 years but between two and three years. At the current rate of progress, the vast majority of patients alive when this issue was first raised will have passed away by the time the legislation is passed. Very few people will benefit from the provision absolving them from paying income tax on the repayment. Faster progress should be made if the Government is genuine in seeking to repay this money.

Section 7F(3) of the legislation states: "The proprietor of a nursing home who, without reasonable excuse, contravenes subsection (1) or (2) is guilty of an offence and liable on summary conviction to a fine not exceeding €1,000". Do nursing home proprietors who receive nursing home subvention by direct debit fail to inform the HSE when patients pass away? Do they continue to claim money from the HSE? Are there checks and balances to ensure proprietors inform the HSE so payments can be stopped?

This is important legislation, serving to clarify matters, but we need a number of answers. The Minister of State referred to other Bills he hopes to pass before the next general election. If legislation has not been enacted before the next general election, all Bills on Second Stage or Committee Stage collapse. It will be similar to a cattle crush, where a number of large farm animals try to squeeze through a small space as quickly as possible. It is like the publication of health legislation, where the situation is out of control and nobody knows what is going on. As the House approaches the end of its five-year term, the Department of Health and Children has published only one or two primary legislation Bills per year, the remaining legislation being amendments. The programme for the next 12 months includes the health repayments Bill, the Health Information and Quality Authority legislation, the pharmacy Bill, the nursing Bill, the medical practitioners Bill and standards in residential care, which may not require legislation. The matter of eligibility has been discussed since the 2001 health strategy was published. At least six Bills of major significance are expected to be passed in the next 12 months yet only one Bill has been passed in the past two years. It will not be possible to complete the legislative programme and my great fear is that the Tánaiste realises this. She has done very little but perhaps her predecessor, Deputy Micheál Martin, is more to blame for the problems in the health service than anyone else. I fear this may result in bad legislation being passed and the Tánaiste making a dolly mix of legislation from different Bills to create the impression she is making progress. I hope this does not happen.

More important is that the Tánaiste and Minister for Health and Children, Deputy Harney, be honest and state clearly what legislation she thinks might realistically get through the Oireachtas in the next 12 months. The legislation to establish the health information and quality authority looks like it will be ready to be put before the House by the end of the summer, which is reasonable. However, we should be realistic about what else might get through the House before the next general election. The eligibility legislation, which has been promised since November 2001, is highly unlikely to make it despite having been discussed by every Minister in recent years. We must decide what legislation has a realistic chance.

Regarding the HIQA legislation, the Tánaiste made it quite clear that whistleblowers' legislation will be incorporated in it when it comes before the House. Perhaps the Minister of State might inform the House whether that is true because I see nothing that stands out as being whistleblowers' legislation in the document put out for public consultation. It is typical of the Government in some respects.

There is a major problem with Our Lady of Lourdes Hospital, and Judge Harding Clark drew up a report on it pointing out a large number of difficulties regarding competence assurance, clinical audit and continuing medical education. The Tánaiste came to the Chamber bullish about how she would take on the consultants and change things. The Labour Party withdrew its whistleblowers' legislation when she stated that it would be easier to enact sectorally rather than taking all Departments together. She said that whistleblowers' provisions would be in the next major related legislation to come before the House, which is the HIQA legislation.

The Tánaiste should make it quite clear whether she has now dropped that proposal. She also threatened consultants that unless they had renegotiated their new contract by the end of the spring, she would unilaterally introduce her own public-only consultant's contract. When the time came, she went to the US to lecture the Americans on how to run their health service, which is as rich as anything ever was.

People expect the Government to act and to be honest with them, and those are the sorts of answers we want. The Minister of State should tell us what is going on. It makes me laugh when I think how the Cabinet must operate. Five years ago, as part of the health strategy, the Government stated that there would be a policy on care of the elderly. At least three reports were written thereafter, including the Mercer and O'Shea reports. Nothing happened. Afterwards we heard that it had gone to a Cabinet sub-committee, on which I believe the Taoiseach and the Tánaiste sat, together with the Minister for Social and Family Affairs, Deputy Brennan. It is to make proposals on how we take care of the elderly in future. That Cabinet sub-committee was established last October. The Government has all the information and has been aware of the problem since at least 2001. How we pay for care of the elderly is an important issue, but there is no movement and no policy.

The Progressive Democrats Members — the rancid meat between two slices of bread — were jumping up and down during and after my party's Ard-Fheis at the weekend claiming that we had no policies. The Minister of State, Deputy Seán Power, seems not to understand his own legislation. This is a very important matter regarding how we legislators run the country, but it has been treated in a cavalier fashion. When the Minister of State returns to the House, perhaps he might indicate when he expects a policy on care of the elderly to be put to the people. Will it simply become another promise like the health strategy, which was used by his party in its 2002 election manifesto? They claimed to stand by it, and it also went into the programme for Government. He should not think that, simply because it was published in 2001, he can now forget about it and start referring to the other 180 reports published since. I have left more than enough questions for the Minister of State to answer.

It is difficult to know where to start in the context of the Minister's contribution and the various Bills he has promised. This legislation is the latest element in a long and sorry saga regarding older people who are in the State's care and have a right to its protection. The Government's record on introducing promised legislation is abysmal and especially bad on health.

I did not know whether to welcome this Bill which is a cop-out. The current background of subvention stretches back to the Nursing Homes (Subvention) Regulations 1993. The Tánaiste has informed the House that an eligibility Bill is being introduced. There have been more consultations and interdepartmental meetings on it, and the social partners have been involved. According to the Tánaiste, there will be further consultation later this year. We had a promise that the eligibility Bill would be introduced towards the end of this year.

I agree with Deputy Twomey. The Minister of State may surprise me but I do not believe that the eligibility Bill will ever see the light of day because there are too many hard decisions to take on it. The easy option on the Government's part has been to give it to the Attorney General. Some six or seven months before the primary legislation on eligibility is brought before the House, he has decided for some reason that this Bill is required. I will wait and see, but I have my doubts.

It is another example of the Government, in the run-up to the next general election, not being prepared to take the hard decisions required to ensure the future long-term care of ever-growing numbers of older people who in many ways were responsible for the Celtic tiger. With very few means, they ensured their children were educated so that they could take part in our successful economy today. Alas, the experience hitherto has been all talk and no action on the Government's part.

Regarding another Bill to which the Minister of State made reference, the Health (Repayment Scheme) Bill 2006, no other group would be left waiting for nearly two years to have money returned.

It has not been two years.

We have been waiting for the Bill for nearly a year and six months and it is still on Second Stage in this House. We have not seen the promised legislation on the health information and quality authority, despite its being considered an essential element of the reorganisation of health services. We have heard reference to it today but the heads have not yet been agreed. The delay in introducing the legislation on the independent inspectorate for nursing homes is even greater. The Health Strategy 2001, which was launched with such aplomb, now lies in shreds with virtually none of its promises fulfilled. This failure is greatest in the case of older people. We do not have any new public nursing home places despite a commitment made by the Government that it would provide 2,000 new places. We heard the public private partnership arrangements would resolve all the issues and yet not one place has been provided.

We have no new strategy for the care of older people and we have no independent inspectorate. This is a clear indication, if one was necessary, of the Government's lack of concern for one of the most vulnerable groups in society, those who are no longer able to continue to live in their own homes because of age and infirmity. The bottom line in respect of this issue is that the State broke the law over a period during which Ministers and Ministers of State were aware of the problem but kept quiet or forgot about the issue. Arising from this error, the Tánaiste and Minister for Health and Children, Deputy Harney, introduced legislation with the purpose of denying the most frail people in society the money due to them in retrospective payments. During the debate on that Bill, Opposition Deputies and even some Government backbenchers warned the Tánaiste that she was running a risk introducing such legislation and that in all probability it would be found unconstitutional, as was the case. The rights of the elderly have been vindicated in the Supreme Court because the Government has failed to vindicate them.

On a number of occasions I had reason to raise in this Chamber the scandalous problem experienced by elderly people in need of long-term care in a public nursing home particularly in Dublin and including the rural areas in my constituency of Dublin North. These people are now waiting for up to 12 years, provided they live that long, to get into a public nursing home. Given the issues in accident and emergency units, priority is given to older people who need long-term care and are in acute hospitals. Where does this leave people living in the community who want to live in the community? Most older people want to continue to live in their own homes, but for particular reasons they are unable to do so. While some home care packages are coming on stream, many more are not available and the only option for people is to try to get long-term care in public nursing homes.

This Bill is a cop-out in many ways. How are people on social welfare to pay for a private nursing home when no public nursing homes are available to which they are entitled under legislation? The Minister of State referred to subventions I, II and III. In my area the average weekly rate in nursing homes within the Fingal area is €800 to €900 per week. Where more acute care is required, nursing homes could cost as much as €1,200 per week. The Minister of State agrees these people are entitled to a public nursing home, but all he will do is give them subvention of €114.30 for a person of medium dependency, €150.40 per week for a person classified as high dependency and he will even go a little further to give €190.50 per week for a person with maximum dependency. How can a person with maximum dependency on social welfare payment afford to get into a private nursing home with a subvention of €190.50?

The Minister of State goes further by providing enhanced subventions, which he claims will resolve the problems. In each health area only a limited number of enhanced subventions is available. There is a huge waiting list. Last week I spoke to a very helpful person in the Health Service Executive who told me that a constituent of mine was being given priority for enhanced subvention, but that she would need to wait until somebody dies in one of the nursing homes in my area who happens to be on an enhanced subvention so she could get one. That is the way we treat our elderly people who made such a contribution to the country. The promised substantial legislation ends up merely giving legal effect to what exists at present and is totally inadequate. Nothing in this legislation will make it easier or more accessible for older people who are entitled to public nursing homes to get into private nursing homes at the going rates in the greater Dublin area or elsewhere in the country.

With all the resources available to the Government and all the wastage that has taken place including in the Department of Health and Children, it has reneged on its commitment to provide 2,000 long-term public nursing beds. Other fundamental issues need to be addressed in legislation, which could have been included even in this Bill. What happens to older people who need care and cannot get the appropriate care in their home setting and for whom a Health Service Executive place is not available? This links in with what I said earlier. They are entitled to a service, which they cannot get from the HSE. Nothing in this legislation will improve their situation especially when they cannot afford a private nursing home.

I have received representations and have spoken in the homes of many older people who could not get into a public nursing home and cared for 24 hours per day for their loving spouse feeling they could not do anything else. When it became necessary they had no alternative but to borrow money from the credit union to pay for a private nursing home. Imagine having to do that in one's 70s. The Government does not support or respond to such people. There is nothing in this legislation to help them, or the thousands of others in the same situation throughout the country. They look to us as legislators to help them in a time of plenty.

In theory our law provides universal entitlement to long-stay care. The Minister of State and the Tánaiste know this but are not prepared to deal with it by bringing in substantive legislation. The reality is that long-stay places are not available to those who need them. People are pushed out of acute hospitals and into private nursing homes, which we and the Government know are not adequately monitored.

In 2004 I raised in this House the lack of an independent inspectorate for our public nursing homes. We all knew about this and many say nothing was done about it because an inspectorate might identify the problems that exist, not in the nursing but in the physical accommodation. We have seen the Leas Cross scandal and other problems arising in respect of nursing homes.

The Tánaiste replied to my question in January 2005, saying that inspectors of private nursing homes identified a range of problems, including staffing levels; nursing policy issues; maintenance of accommodation standards; hygiene problems; lack of activity for residents — elderly people are taken out of bed at 8 a.m. and left sitting in a chair beside the bed with no occupation for the rest of the day; lack of record-keeping; insufficient, or no, active involvement by the local authority in fire safety; lack of equipment appropriate to clinical practices, for example, pressure mattresses, surely a basic requirement; and discrepancies in the contract of care.

We know about this, and the Department of Health and Children and the Minister of State's two predecessors knew about it but did nothing until the Leas Cross scandal emerged. If we are to believe Deputy Twomey's contribution about the number of Bills outstanding at the Department of Health and Children I doubt the legislation we await will be enacted before the end of this Dáil session.

Long-term care arrangements for older people are unplanned, inadequate, inequitable and under-funded. It gives me no joy to say that. Older people want only to continue to live in their own homes. Fortunately, the majority succeed in doing so, maintaining active healthy lives, with some support from GPs, community care services, their families and communities. They are able to make and implement decisions about their lives and do not need constant or sustained care. People in need of care who must go into long-stay institutions are among the most vulnerable members of society.

A civilised society that respects human rights and promotes human dignity should be judged on how it provides care, and the quality of that care. A recent report reiterated this point in detail. Any objective judgment on our care system would be harsh because we have a stated policy which favours community or home care but in practice makes it extraordinarily difficult, and effectively gives more support to institutional care.

That has been the reality until recently. I acknowledge that the Minister of State and the Tánaiste have tried to divert more money into community care but the ratio of funding for this has been negligible. We do not have a fair and equitable system for financing care or a transparent set of rights and entitlements. Does the Minister of State not think that establishing such rights is paramount? It is time older people received the same rights and entitlements in law as any other group in society. Our system does not ensure the delivery of quality care. Care facilities have developed in response to the tax laws, rather than in response to the real needs of older people. The tax laws enable people to make millions of euro through offsets from providing facilities. The Government has reneged on its commitment to provide public nursing homes. There are not enough specialists working within the system. Many of the people who work within the system are not properly trained or paid. We do not facilitate the involvement of older people in decisions about their care. We do not have a suitable system of substitute decision-making for people who are no longer able to make decisions. This is a very important point in the context of the Health (Repayment Scheme) Bill 2006. We do not have a clear policy and appropriate services for combating elder abuse which is happening throughout the country. Thousands of elderly people are affected by elder abuse and they are afraid to come forward and bring it to official attention.

Perhaps the harshest judgment on our system arises from the fact that the problems are officially recognised, plans have been made to put things right, but virtually nothing has been done. The Government has stated that the care of older people will be given the priority it requires but it is a case of waiting and seeing if this happens. At present there is no clear entitlement to community care services other than to general practitioner services. There are severe shortages of home helps, occupational therapists and chiropodists. The Government acknowledged the shortage in the health strategy in 2001 but it has done nothing about it and the situation is now worse.

The Health Service Executive south western area saw a 16% reduction in home help hours between 2002 and 2003 and a further 3% reduction in 2004. I agree with the views expressed by organisations such as the National Council on Ageing and Older People that the absence of a right to a service is a factor in the failure of the Government to provide adequate facilities. In areas of County Dublin, including rural areas, older people living at home who are in need of long-term care in a public nursing home now wait for a period of 12 years.

Notwithstanding the Government commitment to provide 2,000 extra beds, I remind the Minister of State that the health strategy included a commitment to build 850 community nursing units. It seems this commitment has been effectively abandoned because of difficulties with the public private partnership. This is another example where it was envisaged the so-called public private partnership arrangement would solve all our problems. The Tánaiste stated that the public private partnership arrangement would sort out everything but it has failed. These beds should be provided directly by the public sector.

The House will have an opportunity to deal with this Bill in greater detail on Committee Stage. The issues of basic payments and enhanced subventions will need to be dealt with in greater detail. There is a perception that under the existing legislation and regulations the State can take away an elderly person's home to fund their long-term care in a private nursing home, care to which they may be entitled to in a public nursing home. The Bill is not clear on this point.

I wish to share time with Deputies Gormley, Catherine Murphy and Cowley.

I will put the Minister of State at ease by saying that I welcome the Bill which is designed to place the existing subvention scheme for private nursing home care on the basis of primary legislation. The Government has stated that this legislation will also assist the Health Service Executive to implement the scheme on a standardised basis throughout the State.

The Bill comes at a time when there is more debate and public concern than ever on the issue of pensions, long-term care for older people and all the social, cultural and economic implications of our ageing population. It comes in the wake of the Health (Repayment Scheme) Bill which seeks to rectify the unlawful charging of older people by the State for long-term residential care and which has yet to progress to finality. The shadow looming over all these matters is the experience of the Leas Cross scandal which exposed the neglect and abandonment of older people for which this State has been responsible. At the time of that scandal, the Taoiseach and the Tánaiste made commitments to establish an independent nursing home inspectorate. They soon rowed back on that promise and made another promise to extend the remit of the social services inspectorate.

While welcoming the purpose of this Bill which is to set an existing scheme on a sounder basis, it is also important to place it in the context of the many problems surrounding nursing home care. The regulatory regime has been found wanting with serious and sometimes tragic consequences for many older people. As I have stated before in this House and I emphasise the point once more, most of those providing private nursing home care do so efficiently and responsibly. It is important this statement is heard loud and clear. However, there are also many — in fact too many — such institutions where standards are poor, and I maintain that one would be too many. The State has still not invested the resources to regulate this sector properly. This essential action must be taken.

The 2006 budget allocated €160 million to the nursing home subvention scheme covered by this Bill. The Department of Finance review of property-based tax schemes estimated that nearly €55 million has been spent thus far on tax breaks for developers of private nursing homes. The question of how much of this really benefits older people needs to be answered. It is clear there are significant benefits and incentives for developers and proprietors of private nursing homes. They can bank on guaranteed income, a significant section of which is guaranteed by this legislation. I question whether older people receive the care they need and deserve in return for what they pay from their resources, supplemented by the subvention for which we are legislating and for which we taxpayers pay.

In many ways this is comparable to the situation of rent allowance. Sinn Féin has argued repeatedly over many years that rent allowance has subsidised substandard accommodation and rack-renting landlords. If resources were used instead to provide the local authority accommodation so desperately required, the outcome would be much better both for tenants and the economy.

The Department of Finance's review of tax reliefs stated that there is considerable variation across different regions in the number of nursing home beds per capita, the costs to the operator per bed, the rate charged per bed and the average occupancy rates. While the review claims that the tax breaks increased the number of nursing home places, it also states that it has been ineffective in reducing the cost of nursing home accommodation.

This Bill contains detailed provisions on how older people's means are to be assessed when they apply for subvention under the scheme. There is no such detail, however, in terms of accountability required from the proprietors of nursing homes. Are they providing the range and quality of care needed by the older people who will benefit from the Health Service Executive subvention? An ongoing assessment of that aspect also needs to be carried out.

I referred previously to the National Economic and Social Forum report, Care for Older People. I make no apology for referring again to this report which has not received the attention it deserves. At the outset it states:

There is strong evidence that older people want to remain living in their own homes and communities as independently as possible for as long as possible. This preference has been accepted by successive Governments as a key policy objective. Yet this objective is nowhere near achievement. This is reflected in our under-developed community care system, which is crisis driven, lacks sufficient co-ordination and resources and does not afford older people the choice, independence and autonomy they seek and deserve.

The report also states:

It is also clear that the funding of services for older people has not always been wholly consistent with the policy objective of encouraging community-based responses. Considerable resources have been invested in nursing home care responses, some of which was unnecessary, not wanted and inappropriate. For many older people, inappropriate or unnecessary admission to acute or long-stay residential care could have been avoided or delayed by greater development of community services and use of preventative and proactive approaches.

There are basic questions in what I cited about how public money is being utilised. The scheme for which we are legislating in this Bill must be subject to that test. We must reverse the excessive reliance on nursing homes and other institutions for the long-term care of older people.

That said, the NESF report also contains extensive findings and recommendations on care in nursing home settings. It points to the need for more systematic data to be collected to assess the range and quality of care. The report found that there are some very good care settings but others are in need of major and urgent improvement. While the report identifies initiatives at regional and local level being undertaken to improve standards of care, it points to the need identified in the Government's health strategy to prepare and implement national standards for community and long-term residential care. The NESF report states:

It is important, however, that the setting and measurement of standards are co-ordinated at a national level to ensure that there is consistency across different sites and to avoid duplication of effort and ‘re-inventing the wheel'. It is also important that advancement in the standards setting in residential sites is matched by quality initiatives in community services, for example: in relation to Day Care centres, the Home Help services and Meals on Wheels service, etc.

As I stated earlier, the Government does not propose to establish an independent nursing homes inspectorate, proposing instead to extend the remit of the social services inspectorate to include residential care for older people, as it committed to in its health strategy. What progress, if any, has been made on this matter? Will the Minister of State, Deputy Seán Power, address that point in his summation of this debate?

I again endorse the recommendations of the NESF report in this regard. It calls for the remit of the social services inspectorate to be extended on a statutory basis to include all care settings for older people, including residential settings with the necessary trained staff and financial resources; that inspection findings be published with sanctions for non-compliance with standards; and that the principles of autonomy and empowerment and person-centredness should inform the development and implementation of standards and standards should be developed in consultation with users. The latter point is crucial.

I support the Bill, but the Minister of State should take note of the various elements we highlighted that still remain to be addressed.

I welcome the opportunity to speak on this Bill. We are taking it on the advice of the Attorney General and previously we relied on, as the Minister of State mentioned, the 1993 Nursing Home (Subvention) Regulations under section 7 of the Health (Nursing Homes) Act 1990. It is time we revisited this area not only because of the revelation of conditions in Leas Cross, which opened our eyes and the eyes of many people to the terrible conditions in some of our nursing homes and to which I will refer later, but in the broader context of health care because it is clear that how we deal with our ageing population is crucial to the overall maintenance of our health service.

The analysis of consultants who attended a recent meeting of the Oireachtas Joint Committee on Health and Children was that while we need extra beds — step-down beds — in the community, they also clearly stated that society has changed in that we now have less time for our children and therefore put them into child care. By the same token, because we are busy and have less time for our ageing population, we put elderly people into nursing homes. Staying at home to care for one's children is a thing of the past. People want to care for their elderly at home and that is an aspiration and an ideal, but it is not possible given the changes in our society. An increasing number of people will enter nursing homes. Statistics reveal that people are living much longer and will spend much longer in nursing homes. That is simply a fact. We have the capability of keeping people alive for much longer.

Will the Greens live longer than the rest of us?

I certainly hope so. If we followed Green policies, we would have a much healthier society in general. Perhaps the Minister of State would agree. The consequence of that is people would live longer. Seán Barrett attended a meeting of the Joint Committee on Health and Children and spoke about this aspect in the context of Ireland. It is an interesting subject in that as many people emigrated from Ireland in the 1950s, we have fewer elderly people to care for at this stage. We have, in effect, what is known as a demographic bounce. The position could be much worse than it is.

I do not believe that Leas Cross was an isolated case. There are many instances I highlighted in the House previously, one being a nursing home in Cabra, which has since closed, where the conditions were appalling. Elderly people there were hungry, people who wanted extra food were given slices of bread which were already buttered and it was as if these people were simply commodities. There has been a commodification of the health service. Based on the cases I have heard of, some of the elderly are treated with less dignity than that shown to the animals in Dublin Zoo. That is unacceptable and is the reason we urgently require an inspectorate.

I agree with a point made by Deputy Twomey who said that certain sections of the Bill were quite difficult to understand in terms of how the Health Service Executive determines subvention applications. We need to examine this in greater detail on Committee Stage. There is a threshold of principal residence value above which subvention may be refused. The figure given is €500,000 for the Dublin area and €300,000 elsewhere. I live on a street in Ringsend, which is in Dublin 4 but is sometimes referred to as Dublin 4B because it is not part of the leafy suburbs. Even though it is not regarded as the wealthiest area in Dublin, cottages near where I live are being sold for approximately €450,000. It is a matter of time before small cottages in the Ringsend area are sold for €500,000. We need to examine this matter in the context of the property boom in Dublin because we will quickly find that people on very modest incomes are above the threshold for Dublin.

The pattern of society could be changed by developments of this nature. If one is forced to sell one's house, the idea of inheritance — passing on one's property to one's children — will disappear. The changes in society will place additional pressure on people. Those who want to buy houses are under enormous pressure. This aspect of the Bill will need to be examined in greater detail on Committee Stage.

I will not say much else about the subject of this Bill because I have spoken in previous debates about the conditions in nursing homes and I do not want to repeat myself. When the Minister of State, Deputy Seán Power, establishes the various task forces and review groups to which he referred in his speech, I hope he will take a long-term view of this issue, the consequences of which for society are profound.

I would like to share half of the time available to me with Deputy Connolly.

Is that agreed? Agreed.

This legislation will rationalise some matters for the Health Service Executive, but it will not change many matters locally. The aim of the Bill is to standardise the system under which subventions are organised by the HSE throughout the country, but it will serve to standardise an inadequate system. As we are all aware, the subvention that is made available meets just a fraction of the cost of nursing home care. The rates in my part of the country, with which the Minister of State, Deputy Séan Power, is familiar, range from approximately €850 in cases of low dependency to well over €1,000 in cases of higher degrees of dependency. They also vary between nursing homes. If people qualify for subventions, they must make up the bulk of the money themselves. What occurs in reality is that their families end up making up the difference by contributing to the cost of their nursing home care. In some cases, the family home is sold or rented. That is the reality as I see it.

When I meet families who are trying to work these things out, I find myself sitting down and doing the maths with them. If one half of a couple is ill and needs 24-hour care, the other person often must make heroic efforts to care for them. Carers can often make themselves ill in such circumstances. I find it quite difficult to give such people any comfort in terms of the maths. If one has an income of just over €12,000, one is entitled to the full subvention, which falls far short of the cost of nursing home care. A person who invested in a pension and now has an annual income of approximately €25,000 might have to spend €52,000 per annum on nursing home care without being entitled to a subvention. It is almost impossible to do the maths on that one. People often must sell or rent the family home in such circumstances, which is an awfully big step. If one has spent one's life paying off a mortgage, one's memories can be associated with a particular home and one's family might still come to that home to visit one. If one half of a couple is still well, it is hard for him or her to decide to walk away from the family home by selling or renting it as part of an effort to cover the costs of his or her partner's nursing home care. That is the unpalatable reality of the circumstances in which many people find themselves.

Elderly people do not want to be a burden on their families. They want to be as independent as possible. The impossible financial situation I have described causes many of them to feel they are nothing but a burden. They worry about the length of time their money will last for. People in their early 70s think about how long they will live for and whether their money will be enough to cover the cost of their care It is a major concern for older people and the members of their families, most of whom are in gainful employment and therefore unable to act as full-time carers now that the proportion of women in the workforce has increased. The levels of community care which existed in the past are no longer available.

In 1999, which was the international year of older people, the UN asked countries to sign up to a charter for older people. When Ireland signed the charter in 2000, it agreed to meet 18 obligations or principles, three of which I will mention. Principle 11 was: "Older persons should have access to health care to help them to maintain or regain the optimum level of physical, mental and emotional well-being and to prevent or delay the onset of illness". Principle 13 was: "Older persons should be able to utilise appropriate levels of institutional care providing protection, rehabilitation and social and mental stimulation in a humane and secure environment". Principle 14 was: "Older persons should be able to enjoy human rights and fundamental freedoms when residing in any shelter, care or treatment facility, including full respect for their dignity, beliefs, needs and privacy and for the right to make decisions about their care and the quality of their lives". As Deputy Gormley said, decisions are often taken out of the hands of elderly people.

I welcome the opportunity to speak on this Bill, which will standardise subvention rates throughout the country. The inconsistencies in the various health board areas have been a source of major concern over the years. No uniform system has been in place. The introduction of such a system will be helpful. Too many beds are occupied by elderly people who have been medically discharged but have nowhere to go. It is a real tragedy that this phenomenon is increasingly common in our hospitals. We cannot make progress in this regard because not enough resources are being invested in step-down resources. We heard a great deal of discussion of this aspect of the matter some years ago, but it has disappeared from the radar to some extent.

I contacted Monaghan General Hospital this morning to make representations on behalf of a patient who had spent three nights on a trolley in that hospital. When a consultant did his rounds last night, he dealt with some people who were medically fit to be discharged but had nowhere to go. That is not acceptable. The same happened again today. Another consultant visited the ward but found there was nowhere to send the patients because the special care unit was full. There are many difficulties in this regard. We used to associate this problem with winter, but similar problems are developing at present even though we are approaching summer.

A number of issues arise on foot of this legislation. If one compares the cost of care in a general hospital with the cost of care in a nursing home, one will find in most cases that the cost of a week's nursing home care equates to the cost of a day charge in a general hospital. I sometimes wonder whether economists think savings can be made by locking beds in large general hospitals because that means treatment does not have to be provided. Perhaps there is a hidden agenda in that regard. The availability of step-down facilities depends on the hospital one is in. People in hospitals in Dublin seem to be able to get step-down beds much more quickly than people coming from local general hospitals because the pressure is not the same. They are inclined to block up the system. It appears to me that approximately 2,000 people are in beds inappropriately — I will not call them bed blockers — and that approximately 2,000 beds should be available. We should look at this. We are talking about building private hospitals to take pressure off general hospitals, but we should also examine this issue because it is more critical and needs to be considered further.

I would like to speak about the distress that is sometimes caused when people are being evaluated for subvention. I am familiar with cases in which things were done which were wrong, in effect. Take the example of four elderly people, two of whom are in their late 70s and two in their 80s. Of the two in their seventies, attempts are being made to keep one of them in a nursing home. The family farm was initially ten acres, then an adjoining ten acres were bought in name of one of the family. The health board took the view that he should pay his own way, despite the fact that one could not rear snipe on that farm. Effectively, he was asked to pay his own way through a nursing home scheme. Alternatively, the health board wanted the family to split the farm and have costs incurred against it. That type of situation is not helpful.

I also encountered a situation where a 90 year old woman was being looked after by her pensioner daughters. Again, the health board wanted to put a charge on that home because the daughters had worked for a period of years. They were back, caring for their mother, but they did not want to put their mother through the trauma of signing the place over to one of them. Therefore, the health board was going to take first crack at having a charge against the home. I doubt whether that is what we should do at this time. We should not put people through the trauma of having to have a home signed over for a five year period. A major issue is involved as regards people wanting to hold on to their property and families respecting that right until the day they die. It is little more than opportunism on the part of the HSE to levy a charge against them.

On the notion of inspectors and their reports, the only area on which there used to be inspectors' reports was the psychiatric services. Regrettably, people were always told when the inspector was coming, and naturally they put the best foot forward on the day. That was wrong, because the inspectors in some cases got an entirely false impression. In other cases they did not, since they could see through a good deal of camouflage. However, as regards nursing homes, inspectors should be appointed and make visits on a regular basis, not just annually. If there is concern about a particular facility, there should be unannounced visits by the inspector. That is the key. We all can recall the Leas Cross scandal and what happened there. It made frightening television viewing.

I am pleased to have the opportunity to speak on the Bill before the House as it deals with the very important issue of subvention for nursing home care. The Bill is designed to address two areas, namely, to ground the existing regulations in primary legislation and to standardise a scheme across the country. These are two worthy initiatives.

I am delighted to see my successor, the Minister of State, Deputy Seán Power, my good friend and colleague, and some familiar faces from the Department of Health and Children here as well. I take the opportunity to pay tribute to all the committed people involved in the provision of service, whether in administration or delivery. As regards the subvention scheme being implemented by the Health Service Executive, I understand it is designed to provide financial assistance towards the cost of private nursing home care for older people who require it. This Bill will ensure that the existing arrangements are grounded in primary legislation and implemented across the country through a standardised scheme.

I do not suppose anybody has asked why it is the Health (Nursing Homes) (Amendment) Bill 2006. I asked this question before and initiated some queries in the Department while I was there in that regard. Equally, I put down a marker as regards the HSE. As someone who has been involved in the delivery and provision of health services over many years, all I can say about the HSE is that the jury is out. I am hearing this at many different levels. I am monitoring its progress. Everyone wishes that whatever mechanism is in place improves delivery, but the jury is out in that regard.

The question on the Bill is: why does it have to be a nursing home and why does it have to be private? We are talking about the cost of nursing home care at whatever figure one wants to pick, €700 for a person who requires a certain level of support or it could be €1,700 for someone requiring another level — particularly if specialised support is involved for Alzheimer's disease, dementia and so on. We are telling people that we will give them money towards the cost of care if they go through a process and asking them to fill out the appropriate forms, sell their family homes etc. This is done only on the provision that the person is taken out of the family home, away from their loved ones, and put in the care of others. I argued this point while I was in the Department. We initiated private home care subvention. For the life of me I do not see why we cannot be somewhat more innovative when introducing primary legislation.

This Government has repeatedly stated its commitment to older people. This commitment is evident in the consistent measures being introduced by the current Minister of State, Deputy Sean Power and — I shall exclude myself — many other people who are involved. A genuine commitment exists. As regards the general body of older people, this Government has increased State pensions and other secondary benefits in budget after budget. It has gone even further in recognising the contribution of older people to the economy and their community. It has given an extra €100 per week earnings disregard, following retirement.

I applaud those older people who remain active. Previously I mooted the idea of a register of volunteers to harness the good work of the great number of older people who wish to participate in community activity. We really should tap in to the commitment of such people and have some co-ordinated structure by way of a register of volunteers. I applaud and commend all the older people at different levels, who are actively involved in supporting others. One name occurs to me, which I have mentioned in the House before, Mr. Tommy Condren, a man in his 70s, who has driven the community development, Carleton Hall. Where one might expect others to drive the project, this man is doing it for the benefit of all the people in the community, young and old. There are many good people such as Mr. Condren in the community. We should recognise them, have that register and harness what is there.

I recognise that the time can come when older people need assistance and support in their daily lives. Some older people stay in their homes with the aid of the support services and or their families and friends. I am somewhat concerned, however, about the personal care packages, PCPs, we designed. There were a number of secondary benefits to PCPs, assistive technology and so forth. I would love to have a briefing on the development of PCPs. They can prove to be beneficial. However, for some patients whose needs are greater, further decisions may be required if PCPs are not able to provide the level of support required. It may be necessary to decide to send a person for assessment for nursing home care. I support what has been said about that being a difficult decision.

Stroke victims may be seriously debilitated for a period after the stroke but following rehabilitation may be well enough to return home. Unfortunately, what has happened in some cases is that following pressure to make the difficult decision to go into a nursing home, even though people wished to return home when their situation had improved, they were then faced with a decision to sell the family home to cover the cost of that care. That was wrong. People are in nursing homes or acute hospital settings who are recommended for long-stay care on the basis that they can return home when they get better but at the same time the screw is being turned and they are told they have to sell their family home. This just does not add up.

We must be aware of the limit on public nursing home beds. People need to avail of alternative care. Why must nursing home care be private? What is to prevent me from taking my mother or father home if I am prepared to do it — God rest my father, he is dead — or any other relative? What is to prevent any individual who wishes to bring a relative or other old person into his or her home to provide nursing home care at a time when it has been recognised that there are insufficient nursing home beds? When we are putting legislation in place, why can we not be a little more innovative and allow the subvention to be paid to people who will undertake the job? A process is in place so nobody will con the system. Only a small percentage of people would try to do this anyway and surely we can put a safety net in place to prevent this occurring?

It has been recognised that the cost of private nursing home care can be considerable and outside the financial capability of some people. In those cases, subventions are paid to contribute to the cost of the care. This is a vital part of how we take care of older people and we should ensure that people know their entitlements and how to claim them. We should take the stress out of the system and remember that older people and their families who are claiming the subvention are only doing so because of a need for extra care and because they do not have the means to pay for it themselves.

Subventions are provided by the HSE areas to assist persons in meeting the cost of nursing home care. I understand that it was never the intention that subventions would meet the full costs involved. Three rates of subvention are payable; €114.30 for medium dependency, €152.40 for high dependency and €190.50 for maximum dependency. I understand that enhanced subventions are also considered. It is difficult to explain this to individuals. There is a better way.

These rates were unchanged on budget day. The threshold for qualification for subventions was revised last year to reflect the changing economic climate and, in particular, rising house prices. The asset threshold above which a subvention may be refused has increased from €20,000 to €36,000 and the threshold for principal residence value above which subvention may be refused has increased from €75,000 to €500,000 or more, if the house is located in the Dublin area, and €300,000 or more where the residence is outside the Dublin area, where the applicant's income is greater than €9,000, previously €6,300.

The questions I have relate to sections 2 and 7. I have made my point on section 2. We should make the system a little easier in terms of removing any anomalies that exist. It should be recognised that property values in the Dublin area differ significantly. For example, on the road behind where I live and the road in front of where I live the house of one elderly person in a home could be worth €1 million while the house of another resident of the home may only be worth €500,000. An imputed income of 5% of the market value of the principal residence shall be taken into account. Does it matter whether a person's home is worth €1 million or €500,000 if he or she is on social welfare? The value of their home is of no benefit to people in this situation. I do not know how we will make this apply. A later reference in the Minister's speech stated that something had been added "for the purposes of consistency". If we are seeking consistency in terms of income I suggest more work remains to be done in terms of the 5% in regard to the market value of the principal residence.

The Bill defines a number of aspects of subvention and details how an application for subvention must be made. It is vital that this process is simple and accessible to those who require subvention and that it should take into account the vulnerability of older people who may require nursing home care. We should eliminate any unnecessary stress or difficulty in the application process. The level of subvention available is dependent on the level of medical need and the basis on which different levels of subvention are provided should be clearly defined so that the applicant is not in any doubt as to why and how a level of subvention is awarded.

The financial situation of the applicant is also a factor in awarding the subvention and the Minister of State has clarified how much income an applicant for subvention may have. This is useful for applicants and their families. In cases where an applicant is not awarded subvention, or not at the rate at which they hoped to qualify, it is important that the appeal system to the HSE is transparent and speedy. Being refused a subvention or not getting the amount for which one had hoped can be distressing for an applicant and his or her family and carers. It is in everyone's best interest to have any queries or questions resolved quickly. It is vital that older people who are in need of assistance are given all the supports and care they require, and that they are kept informed at every stage of the process and feel they have ownership and control over their lives.

From what we are told by the medical professions, more beds are required urgently for long-stay care. I detest the over used phrase of "bed-blockers", as it makes it appear as if these older, vulnerable people who are in need of care are somehow conspiring to prevent other patients from accessing services at the hospital in which they are deemed to be bed-blocking. It is not the fault of older people who are vulnerable and in need of additional care that there is nowhere for them to go. That responsibility lies with us in this House.

More nursing home beds are needed but also long-stay facilities right across the board, whether they be personal care packages, home care packages, assistive technology supports or the use of the thousands of people out there and their beds who would make themselves available should some level of subvention be available to them.

It is frustrating for people like me who recognise the needs that exist, such as on the north side of the city of Dublin. I was involved for a period in the proposed development at the orthopaedic hospital in Clontarf. That hospital has a tremendous caring record, as it deals with a high proportion of older people who have had orthopaedic operations. It allows patients to access additional short-term care while not having to rely on nursing homes, which may not be available. The hospital has been waiting for confirmation on a 120-bed extension. It has been a long time coming and I will push for a decision to be made within weeks. The application is with the Department for approval and I ask that the hospital team and I should be advised of the decision as quickly as possible. The extension will be a vital resource for older people in north Dublin and it will have a positive knock-on effect for northside hospitals. I refer to the purpose built day hospital required at Beaumont hospital. There has been much toing and froing about this but funding has been allocated. Will the Minister of State confirm the delivery of this project because I fear the money may have been used for other purposes? What is the position on the allocation, utilisation and implementation of the funding allocated for this purpose?

It is essential that those who need to access subvention should have confidence in the system and that the application process should be clear and uncomplicated. The vulnerability of older people must not be exploited through substandard nursing home care. Older people and their families must feel confident that the care provided is of the highest standard. Older people with medical cards who are forced into such care because other forms of care are not available must not be penalised. The cost of private nursing home care is an issue of grave concern. According to Age Concern Ireland, nursing home care in the greater Dublin area is the most expensive in the State but I cannot understand the reason for this. My constituents deserve the same level and standard of care as older people elsewhere but, for some reason, charges have increased recently. Subvention levels should reflect the costs of care.

Regardless of cost, the high standard of nursing home care is vital, not only for older persons accessing it but also their families. Public confidence in nursing home provision is vital. I congratulate Paul Costello of the Irish Nursing Homes Organisation who has repeatedly called for improvements and who has ensured standards are applied and maintained within his organisation. The focus should be on what is best for older people. They have contributed a great deal to society, their families and communities and caring for them in old age should be a priority. The Government has done much for older people through various increases and the implementation of other measures.

I welcome the Tánaiste and Minister for Health and Children's view that the Government should give every assistance to older people who wish to remain in their own homes. The supports necessary to make this happen may be expensive and difficult to resource but it is vital that older people should be given the choice for the sake of their dignity and control over their own lives. This is not always the easiest option as it requires co-ordination between different agencies. It may also require support from family members and friends but it is the best option as long as the older person feels confident and comfortable in his or her own home. According to an ESRI survey, four out of five adults felt it was important to be cared for in one's own home. This view is shared by many groups, including the North Dublin advocacy group. This group has done significant good work and it has been waiting on confirmation of funding for more than 12 months. I cannot understand why this is the case and this should be addressed. I congratulate Bob Carroll, chairman, and all involved in the National Council on Ageing and Older People, which issued a report earlier this week entitled, Improving Quality of Life for Older People in Long-Stay Care Settings in Ireland.

I welcome the opportunity to contribute to the debate. The legislation puts the existing subvention scheme on a statutory footing and aims to assist the Health Service Executive in standardising the scheme. There was no consistency between health boards in applying the scheme and this was unacceptable because people were being treated differently and there was discrimination in how it was applied in different areas. The problems with the nursing home subvention were outlined in the review of the scheme. The manner in which the means test was applied varied and different practices were used in applying enhanced subvention and the use of contracted beds.

The subvention levels set out in the legislation are not the maximum that applies and I expected the Bill to outline the criteria that would apply for the provision of enhanced subvention. The Bill correctly ensures standardisation of practice and rules but where is the standardisation of the enhanced subvention? Enhanced subvention is provided up to a maximum of €680 a week but that amount has never been paid in the HSE mid-western area with €200 a week being the highest amount paid. Will the Minister of State comment on this? The payment should be related to the cost of the nursing home care, given the different charges imposed by nursing homes. There is a wide variation in charges in homes in my area with them costing between €600 and €1,000 per week. At one stage, enhanced subvention was not paid at all but that practice has ceased. Contracted beds are not provided in the mid-west, except under the winter initiative, which provides that people are cared for in a nursing home for two weeks following hospitalisation. Should the use of contracted beds also not be standardised? The number of such beds varies between HSE areas and it reduces the opportunity for patients to avail of public beds in private nursing homes.

The primary legislation covering nursing homes is the Health (Nursing Homes) Act 1990, which provides for the registration of most private nursing homes and for standards to be set and monitored. The issue of monitoring has been debated at length in recent times. It is important and the Minister of State has recognised the need to invest in ensuring proper monitoring of nursing homes. As previous speakers said, 95% of nursing homes provide excellent care and service and they are of great benefit to communities. However, a small number require attention. A proper monitoring system would ensure standards are at an acceptable level.

The rules of the subvention are currently contained in the Nursing Homes (Subvention) Regulations 1993, as amended. Changes in the means test for nursing home subvention came into effect on 14 December 2005. This was the first time the threshold set in the 1993 rules were changed. The Bill does not propose major changes in the rules, but it does provide for some changes. One may get a nursing home subvention from the HSE if one wants to go into a private nursing home. In order to qualify for a subvention, one must be sufficiently dependent to require maintenance in a nursing home and be unable to pay any or part of the cost of maintenance in the home. In other words, a person must pass a means test. The amount of subvention depends on the means and the degree of dependence. The subvention is meant to help meet nursing home costs. It generally does not meet full costs, but there are circumstances in which the HSE may pay an enhanced subvention.

I know of a pensioner who has been refused a public nursing home bed and who lives with his wife, also a pensioner. He is currently in the step-down facility under the winter initiative. He is incontinent and he falls quite often. He will be forced to go back to live at home with his wife, who has serious ulcers in her legs. As they only have the pension, the only option is to bring him home. In a short time he may fall again and be back in hospital. We see these decisions being made all the time. I recently put down a question on the criteria applied to decisions made in granting access to public beds. There does not seem to be consistency in granting access to public beds in places like St. Ita's Hospital or St. Camillus's Hospital in Newcastle West in County Limerick.

Under the current rules, one must apply for a subvention before going into a nursing home, unless there is an emergency. If one goes into a nursing home before one applies, he or she may not be allowed to apply for two years unless the HSE decides otherwise. I do not understand why that is the case. However, I note that this provision will no longer be in the Bill. At any rate, it was rarely applied and it was more honoured in the breach than in the application. People often went into nursing homes shortly after being released from hospital and the subvention was applied a day or two later. It makes no sense that if one failed to apply immediately, one would have to wait for two years. My interpretation is that this provision will no longer apply once the Bill is in operation.

One must be told the result of one's application within eight weeks. If one is refused a subvention or granted less than the maximum applicable to the level of dependency, the right of appeal is available and the person applying must be informed of his or her right to appeal.

An assessment of the level of dependency is carried out on behalf of the HSE, usually by a doctor, nurse, occupational therapist or physiotherapist. The assessment involves interviewing the person and their nearest relatives. The medical condition of the person is taken into account and the assessment also includes an evaluation of the person's ability to carry out the tasks of daily living and the level of social support available. The assessment of one's ability to carry out the tasks of daily living takes into account one's degree of mobility, ability to dress unaided, ability to feed unaided, ability to communicate, extent of orientation, the level of co-operation, the ability to bathe unaided and the quality of memory. This latter task will be replaced in the Bill by cognitive ability. There is a subtle difference between quality of memory and cognitive ability. One could have very difficult short-term memory but very good cognitive ability, and vice versa.

Social support is assessed by one's housing conditions, such as the number of people in the household and the ability of household members to care for the person. The extent of support from one's community and the services received are also taken into account. The Bill does not specifically mention the elements of social support, but states the family and community support available, as well as any other issue which affects one's ability to care for oneself, will be taken into account. There should be room here for more guidance and standardisation. There will be more variation from different inspectors and assessors on this issue.

An assessment team, appointed by the Health Service Executive and which includes people with professional experience in the care of dependent people, decides whether or not a person meets the dependency requirements for a nursing home subvention. There are three levels of dependency. Medium dependency exists when one's independence is impaired to the extent that one needs nursing home care because the appropriate support and nursing care required cannot be provided in the community, and the mobility of the person is impaired to the extent that he or she requires supervision or a walking aid. This is known as category III in the Bill. High dependency exists when the person's independence is impaired to the extent that he or she needs to be in a nursing home.

The following assets may be taken into account: household property, excluding household furniture and goods; stock, shares and securities; money on hand, in trusts, lodged, deposited or invested; interest in a company or business of any kind, including a farm; interest in land, life assurance and endowments; and current value of business equipment or machinery, excluding a car. A farm is a livelihood and I would like to see the reference to farms in the Bill developed. How is the ownership of a farm calculated? Many difficulties may arise in families if a person in a nursing home was forced to sell the farm. The person who makes such a decision may be the person in the nursing home. Such a decision could cause much stress to the person.

If one disposed of assets in the previous five years, the value of those assets may also be taken into account. The first €11,000 in value of any asset is disregarded. The Bill does not clarify whether disposal of one's assets to help a son or daughter build a house, or to help the child of a married son or daughter, will be taken into account.

How can a parent seek repayment of the money he or she spent on buying a site for a newly married child? That, however, is implied by the provision that the disposal of assets will be taken into account when assessing nursing home subventions. Such assets may comprise stocks or shares, cash or mature life assurance or endowment policies. Parents may divide their assets with their children only to be asked to recover the money the money four years later.

The principal private residence is not taken into account if it is occupied immediately prior to the application and continues to be occupied by the spouse, a child under the age of 21 or in full-time education or a relative in receipt of disability allowance or a blind, disability, invalidity or old age non-contributory pension. A person may leave work to care for an elderly person but, if he or she leaves the carer's allowance scheme to receive unemployment assistance, the house will have to be sold because its value is taken into account in calculating the nursing home subvention. According to my understanding of the Bill, it does not take account of carer's allowance or unemployment benefit or assistance.

A neighbour of mine left work at the age of 35 and spent the following 20 years caring for her parents. When she turns 65, she will not be entitled to a contributory pension but, as a matter of principle, she refuses to accept the non-contributory pension. Having cared for her parents for more than 20 years, she feels entitled to the same rights as somebody who remained in full-time employment. A committed and intelligent person, she made the choice of caring for her parents. People leave work and, for example, move back to Limerick from Dublin to care for somebody for two or three years. An in-law of mine could no longer continue to provide care in the home because of serious health problems and will now be forced to sell the house because it will be taken into consideration when the nursing home subvention is calculated.

Under the current rules, if the house is not occupied by any of the aforementioned categories of people, its value may be taken into account. If the value of the house is taken into account, it is assessed at 5% of the estimated market value, net of mortgage, loan, rental or purchase repayments. Variations existed among health boards in terms of how houses were treated for the purpose of means tests. The Health Service Executive cannot require a person to let or sell a house but a subvention can be refused on the basis of the value of a house. If the house is sold, the proceeds are taken into account in the assessment of means. Houses now cost at least €200,000, so somebody on social welfare will have no choice but to sell it and join the local authority housing list. The Bill provides that the house must be taken into account unless it is occupied by the aforementioned categories of people.

The HSE may refuse to pay any subvention if the assets, including the house, are greater than €36,000, the principal residence is valued at greater than €500,000 in the Dublin area or €300,000 in the rest of the country and income is greater than €9,000. People earning €200 per week will therefore be obliged to sell their houses, even though it is barely possible to survive on €10,000 per year. They must pay for nursing home care because they inherited their residences. Houses in my area which cost €5,000 when first built are now worth up to €200,000.

I welcome the opportunity to contribute to the debate on the Health (Nursing Homes) (Amendment) Bill 2006. Care of the elderly is a vital issue. I believe that we should seek to maintain older people in dignity and independence at home in accordance with their wishes. Insofar as practicable we should aim to restore to independence at home those older people who become ill or dependent. We must encourage and support the care of older people in their communities by families, friends, neighbours and voluntary bodies. However, cases will always arise in which there will be a need to provide high quality hospital and residential care for older people when they can no longer be maintained in dignity and independence at home.

This nursing homes legislation will ensure that the existing subvention scheme for private nursing home care is grounded in primary legislation and will help the HSE to implement the scheme on a standardised basis throughout the country. I am sure most people would welcome that because we sometimes hear stories of differing subventions between HSE regions. Funding of €6.35 million was allocated for the first full year of the nursing home subvention scheme in 1994. In 2006, total funding is €160 million, including an additional €20 million allocated in the 2006 budget for the scheme.

The Bill contains provisions for applications for prescribed subventions, assessments of degrees of dependency and means of applicants, determinations of subvention applications, reviews of degrees of dependency and means of dependent persons who are paid subventions, and appeals against decisions of the HSE. The provision of an appeals mechanism is welcome because people sometimes believe they have been mistreated and I am sure the HSE will look sympathetically on appeals. People will not go to the bother of appealing unless they believe they have a right to do so. The Bill also provides for obligations on proprietors of nursing homes to notify the HSE of the death or discharge of dependent patients in receipt of subvention, recovery of payments of relevant subventions procured through fraud or misrepresentation, and the making of regulations, transitional provisions and guidelines to be issued by the HSE. There is no doubt that affordable residential care for older people is a key issue. We all regard supporting older people to stay in their homes and communities as a key policy priority, thereby moving away from the practice of placing people in residential care as a first option. Research has shown this is the expressed wish of the majority of our older people. I welcome the significant package announced by the Tánaiste after the budget. The budget allocated additional funding for services for older people and palliative care amounting to €150 million, comprising €110 million for 2006 and €40 million more for 2007. There is no doubt that this will mean a major improvement in home and community-based support for older people. Thousands of older people needing care will receive new services and support next year.

I welcome the Government's determination to put in place comprehensive health and social care for older people in a way that is reliable, that respects and values older people and that is financially fair to older people, their families and taxpayers alike. For those who say older people have been neglected by this Government, I say that the budget gave the largest ever increase in funding for services for older people, and rightly so. The initiatives that were set out today make a commitment to older people and put them at the centre of future health policy. The investment package is focused on caring for people at home, where they want to be. The investment package is a major step in focusing new resources on home care first and foremost, while still supporting appropriate residential care. This is in line with international trends and also reflects the growing independence of older people who want to stay living in their communities. It is wholly appropriate that substantial additional resources be devoted to services for older people. They have made a great contribution to our society and to our economic and social success. In this way, we are saying that the next generations value their contribution and will respect their needs and their continuing role in our society.

This Bill concerns people in institutional care but I believe, as recommended in the Mercer report on long-term care, that there should be a built-in bias towards home care solutions while retaining a capacity for financing care in institutional settings. The funding of long-term care will make many demands of us, our economy and our society. The Mercer report also made the point that there is no blueprint available for the funding of long-stay care from a comparison of developments and trends in other countries. It said that there are general pointers from developments in other countries that may be helpful in planning change here. The state is usually involved in the funding of long-stay care, mostly within a cost-sharing framework that encourages people to choose home care over residential care. The report found that the need to promote and encourage family responsibility for their dependent elderly kin through increased spending on community care and more flexible support mechanisms for carers is recognised in most countries. It also found that the importance of controlling access to expensive, long-stay facilities is accepted in all countries.

Another report by the National Economic and Social Forum made a number of recommendations last year. Among them was to bring public spending on care services for older people up to at least the OECD average of 1% of GDP over the next five years, at an additional cost of €500 million. Estimated public expenditure here on care services for older people in 2004 was just under €1 billion, which equates to 0.67% of GDP. This recommendation is worth exploring though it must be pointed out that sometimes GDP comparisons between Ireland and other OECD countries are not entirely valid. In other countries, GNP and GDP is about the same whereas in Ireland GDP is about 20% greater. GNP is a more relevant benchmark. Perhaps in the context of maintaining sound fiscal policies, the Minister for Finance and other interested Ministers could examine increasing spending on care services for older people to 1% of GNP.

Sometimes we look at older people only in terms of care. We need a new, positive agenda for older people. The NESF report also called for the development of a national action plan on ageing and for moves to root out ageism and promote positive ageing. Ireland still has a young population by comparison to our European partners but ultimately it is likely that we will have a similar age balance. There is no doubt that older people have a major contribution to make and it is vital that we facilitate them in making it. I gather that in the UK a few years ago B&Q opened an experimental store staffed entirely by over-50s. Fears that they would not be able to cope with shifting pots of paint were soon dealt with, and there were no problems in training the staff to use computers. The over-50s store did better than other B&Q stores in almost every way. Profits were higher by a fifth, staff turnover was six times lower, there was more than a third less short-term absenteeism and, most remarkably of all, theft reduced by more than half. The NESF report also rightly points out that the development of policy and practice regarding care for older people should be considered in an international context. Current trends in this regard emphasise the importance of including older people in the policy-making process, mainstreaming ageing issues into national development frameworks and optimising older people's opportunities for social participation. Rather than sectionalise old people we need to integrate them. There has also been a general shift towards person centred community or home-based care and making services more consumer-friendly and standards-driven.

The report by the National Economic and Social Forum also highlighted the key role played by the United Nations in the development of international policy understanding of ageing. The UN's second world assembly on ageing agreed the Madrid international plan on action on ageing in 2002. This plan promotes an intergenerational policy approach that pays attention to all age groups with the objective of creating a society for all ages and a shift from developing policy for older people towards the inclusion of older people in the policy-making process. The UN identified three priority directions, 18 issues, 35 objectives and 239 recommendations.

The NESF also points to the need to develop a national strategy on caring. This means supporting informal carers in their work, as well as providing funds for the social infrastructure so necessary to allow older people to continue living at home. Respite care, day care, day hospitals and rehabilitation facilities are important elements of the social infrastructure, as are visiting services such as public health nurses and home helps.

I acknowledge at this stage the work done by the Minister for Social and Family Affairs, Deputy Brennan, in advancing the cause of carers. Since 1997, weekly payment rates to carers have been greatly increased, qualifying conditions for carer's allowance have been significantly eased, coverage of the scheme has been extended and new schemes such as carer's benefit and the respite care grant have been introduced. The numbers in receipt of the carer's allowance increased from 16,000 in 2000 to 25,318 at the end of February 2006. Funding has risen from €99 million to more than €223 million in that time. Expenditure on carer payments — carer's allowance and carer's benefit — increased more than five-fold, from €46 million in 1997 to €232 million at the end of 2005. The carer's allowance has been increased by €90.16, or 101% for those under 66 years, and by €110.16 or 123.3% for those under 66 since 1997.

I know many people feel there is more that can be done, but the Minister has made significant progress over the past 18 months. I know many people wish to see the means test for carers abolished. As with other social assistance schemes, a means test is applied to the carer's allowance to ensure that limited resources are directed to those in greatest need. This means test has eased significantly over the years, notably with the introduction of the disregard of spouses' earnings From April this year, a couple with two children can earn up to €32,925 per annum and still receive the maximum rate of carer's allowance. The same couple will be able to earn up to €54,400 and receive the minimum rate of carer's allowance as well as free travel, the household benefits package and respite care grant.

Apparently, complete abolition of the means test would cost an estimated €140 million in a full year. It is important to have an open mind on this issue but it is debatable whether such a proposal could be considered to be the best use of resources. I know the Minster believes the view of some support organisations is that if this kind of money were available, it would be more beneficial to carers if it were invested in the type of community care services that would support them in their caring role, such as additional respite care facilities, more home helps, public health nurses and other such services.

The policy options for a financially sustainable system of long-term care are currently being examined. No doubt there will be significant cost implications. Numbers in care are projected to rise from 84,000 three years ago to 144,000 in 2031, and 203,300 by 2051. We will have to make some financial decisions. It is important we get the balance right.

Older people are an example to us all. They are friendly, courteous, honest, decent and religious, and they deserve all they get. They do not bother or annoy anyone. They are not greedy. I compliment nursing staff and management for their caring and understanding. I welcome the Nursing Home (Amendment) Bill.

However well written and delivered Deputy Kelly's speech was, and I respect him very much as a person, the speech completely misses the point with regard to care of the elderly. The Government has failed miserably and shamefully in its policy on care of the elderly in our nursing homes. There is a great deal of information to back up this statement which has not yet been released to the public, and I have not got it yet. I am speaking of the investigation into 95 deaths of senior citizens in Leas Cross nursing home in recent years. That report currently sits somewhere in the HSE. I understand it has been completed and has gone for "legal advice".

I am concerned that this report may be buried, that other documents are being prepared, allegedly by the HSE, to give its side of the story, and that this report will not be released independently, as it ought to be. I call for the report to be released immediately once it has gone through the legal hoops. It will inform this debate, and if we see the report, the speeches given by Deputy Kelly and others on the Government side of the House may be entirely different in two weeks' time. Leas Cross is the scandal of which we are most publicly aware in this area, but it is not even on the list of bad nursing homes the HSE gave me in 2001. Seven nursing homes, the subject of the most appalling and disgraceful reports, remain open. Nothing has changed under this Government except that more people are being treated badly by it because it will not insist on, and has not yet brought to the House, legislation to change the nursing home regime and appoint a fully independent nursing home inspectorate which will vindicate the right of the elderly and sick to decent and proper care. They get that in a majority of nursing homes, but in a significant minority they do not and will not get that until the law is changed.

The High Court decided that the law was not strong enough, that there is not sufficient power in the existing nursing home legislation to force the urgent and immediate closure of a nursing home. Currently, we can only close nursing homes through a long process that can take years to put through the District Court — so much for this Government and so much for transparency. After the Leas Cross scandal last year the Government and the HSE stated that changes would take place and that all nursing home reports would be placed in the public domain as they became available. However, the first decision made by the HSE with regard to nursing homes was that any information sought about nursing homes must be made through a freedom of information request. Nothing can be brought into the public domain without being subject to the Freedom of Information Act.

I refer to the Information Commissioner's annual report for 2005. On page 22 she states:

In last year's Annual Report I suggested that the Health Service Executive (HSE) should, as a matter of course, publish its reports on inspections of private nursing homes. I recognised that information of this type was of very significant interest to the public. In making the suggestion I was mindful of the provision at section 38 of the FOI Act that the Information Commissioner "shall foster and encourage the publication by public bodies . . . of information of relevance or interest to the general public in relation to their activities and functions generally". I pointed out that such an approach would be in line with the practice in the case of inspections of children's services by the Social Services Inspectorate. [...] In an immediate response to my suggestion, the HSE announced its intention (i) to make all completed inspection reports of nursing homes available on request, subject to FOI legislation and (ii) for the future, "[f]ollowing review and standardisation of inspection report formats and consultation with key stakeholders", to publish all future inspection reports on the HSE website. [...] At the time of writing this Report (February 2006), it remains the case that nursing home inspection reports are not being published as a matter of course. Access to the reports is still dependent on making a successful FOI request.

The Information Commissioner then outlines how long this can take and continues:

The situation may be further complicated by the stated intention of the Minister for Health and Children that the regulation and inspection of residential services for children, older people and people with disabilities should become the responsibility of a new statutory office (Office of the Chief Inspector of Social Services). [...] I am concerned that, pending the enactment of the legislation and the establishment of the Office of the Chief Inspector of Social Services, a decision to publish nursing home inspection reports may be further delayed. I would urge the HSE, in recognition of the very significant interest of the public in these reports, to proceed as speedily as possible with the implementation of the commitment, given in June 2005, to publish all nursing home inspection reports as a matter of course.

Since then, one year ago, the HSE has provided no openness, transparency or accountability. Nothing has changed.

Let us examine the case of the report on the Woburn nursing home in Cork, the only HSE inquiry I could find. I received this as a result of a freedom of information request. It dates to February 1996 and deals with complaints made about the home and submissions made in favour of it. The inquiry team received 15 complaints but proceeded with only five. Some 14 favourable submissions were received and all were processed. Why were these submissions treated differently? The reason is that there is no whistleblowers charter and no protection for people who wish to make a complaint. On page 11 of the report there is an account of a meeting with Councillor O'Leary and Deputy Batt O'Keeffe, now a Minister of State and one of the people who brought this case to the attention of the relevant bodies. One person was represented by a solicitor who:

raised the issue of confidentiality from the perspective of people making submissions from the Inquiry Team and the consequences of such submissions for those persons. The Chairman indicated that anyone who wished to make a statement to the Team could do so, but that in the interests of natural justice, the person against whom any allegations or complaints were made would have to be furnished with a copy of such allegations or complaints and the identity of their authorship indicated to that person. The Chairman also stated that the Team was legally inhibited from offering any indemnity against the consequences of any submission made to it. Furthermore, if any person, in the course of making a submission to the Inquiry Team, implicated themselves in wrong-doing then it would be a matter for the Chief Executive Officer and/or the appropriate Professional Body to take whatever action was deemed necessary.

If one wishes to put a complaint against a nursing home on the record one is not protected by the Government. No legislation exists to protect whistleblowers. Where 15 complaints were made, only five were subsequently substantiated because of the fear of legal action. It is unacceptable that no protection is offered to those who wish to tell the truth about the appalling level of care in our institutions. Despite the fine words and money spent on care of the elderly, there is emptiness and hollowness at the heart of Government policy. People are still dying because they are not properly cared for but nobody in Government is committed to changing this. Government Members stand utterly condemned for the continuing lack of action, one year after these matters were brought to their attention.

Some 25,000 people reside in nursing homes and there are ten cases of nursing homes comparable to Leas Cross. I do not know the results of Professor O'Neill's inquiry but I am concerned about what it will reveal. I have evidence of appalling practices in nursing homes and we need an inquiry into these. The HSE is aware of these and I will be happy to provide further details. I refer to doctors and nurses working in nursing homes that are the subject of bad reports and serious concern at the HSE. It is time for these doctors and nurses to speak up, expose the practices and clarify their role in the examination of these patients even though whistleblowers legislation that would protect them has not been passed.

I have been informed that information on a nursing home in Cork, which I am pursuing through the Freedom of Information Act, has been refused to me. I must wait three or four months while the case is referred to the Information Commissioner. Will the Minister for Health and Children and the CEO of the HSE agree to publish reports and information as promised? The Information Commissioner stated that this must happen and was assured it would.

I commend the HSE for the investigation of one particular nursing home. This reveals that there was no nurse on duty for 21 nights in March 1995, no nurse on duty for 20 nights in April, 16 nights in May, 16 nights in June, 21 nights in July, 22 nights in August, 15 nights in October, and 16 nights in November. The Health Service Executive has had that information for ten years, and yet there has been no change. I understand that the home in question has since closed. However, throughout the country, in a minority of nursing homes, that situation is being replicated. The Government has done nothing to protect these people. I recently mentioned a nursing home in north County Dublin. I was informed by staff that patients did not have their own clothes, or if they did, they rarely got them back. They might be left wearing a garment for a week and they were not being properly fed. There are nursing homes in this country where inspectors found no food. That appalling and disgraceful situation must change.

There is not too much time left for the Government before it faces the people. I will ensure that all the information I have is put into the public domain so that the Tánaiste will have to answer clearly, openly and honestly. The fact is that they have done nothing, and that is unacceptable. The voice of the elderly is mute. We have excellent advocates for care of the elderly, but at the heart of Government policy is an appalling neglect of such people. I hope that this publication from Professor O'Neill, which may start a debate, will be released immediately so that it might inform us of the truth. The other homes, which I can indicate to the Tánaiste with no difficulty, should also be examined and investigated. That is the only way for us to achieve change.

The Government stands utterly condemned. Its words regarding the great things it is doing and all the money it is spending are hollow, since ultimately it is not looking after the elderly. They are dying before their time in appalling conditions in some nursing homes, and the Tánaiste has done nothing to change that. The Government and the HSE have known about it but have not acted to protect people.

I welcome the opportunity to speak on this Bill. No issue could cause more anxiety in my office and the homes of Cavan-Monaghan than that of nursing homes and subventions. It is obviously linked with the delays in accident and emergency departments. I welcome this debate.

I will give one example. Only yesterday I received a telephone call from St. Davnet's Hospital where one of my constituents was waiting to see a doctor. She simply could not believe the situation. There was a marvellous building with many beds that were simply not being utilised. They are owned by the HSE, although they may be in the St. Davnet's complex. There must be more forward thinking to ensure that beds do not lie idle while people lie on trolleys or even worse in Cavan, Beaumont or elsewhere. There must be a degree of planning regarding use of the resources that we have but are not using, even as we allow people to suffer such discomfort.

The history behind this lady being in hospital is even more frightening. My constituent had been receiving one and a half hours' home help per day in her home. Suddenly that was cut from seven and a half hours per week to five because some inspector identified an anomaly. The woman could not feed herself, being dependent on the home help seven days a week. She is now in her fifth week in Monaghan General Hospital. Her daughter, who now lives in Northern Ireland, had been in to speak to the consultant and find out what the future held. Trying to save pennies on the one hand costs the HSE thousands on the other. There is no planning.

Regarding subventions, we in Cavan-Monaghan have one of the more serious problems. In the early 1990s, as many patients as possible were sent to the United Kingdom under the free scheme. We obviously had a low level of involvement in subvention as a result. The numbers receiving subvention before the previous general election and for a few days after went up to approximately 270. However, immediately after, an effort was made to bring it back down to 150. At the time, we had people almost 100 years of age on a waiting list to receive a subvention. That was and is unacceptable and must be changed.

The staff in the subvention office in Cavan are excellent. They are more than pleasant and helpful, but they must tell us the facts, which are that they must ensure they stick to the letter of the law so that as few people as possible receive subvention because funds are limited. Is that the treatment the elderly should receive after having given a lifetime's service to the nation? Is it right that someone should lie in Cavan General Hospital, Drogheda Hospital or elsewhere waiting on a subvention bed while others wait on trolleys? Those are facts rather than stories. People contact me every day on this subject.

This is another example of the misuse of property. There are 25 beds in a psychiatric ward in Cavan. The unit is reasonably new with approximately seven to ten patients at any given time. It is locked up but surely it could be divided so that some of those beds might be made available for the elderly who so badly need proper care. It is not happening, however. That has been suggested to me by personnel in Cavan who know the scene very well. At the other end of that hospital building is a step-down unit which is forced to provide long-term care. Surely some of those people should be in private nursing homes with the help of subventions to allow more step-down beds for the hospital. If those two units were utilised, we would not have 25 to 30 people on trolleys. I have passed on letters from some clients who spent time on trolleys there detailing how they felt.

This is an example of where the Government must wake up. There is no point in my tabling questions to the Tánaiste and Minister for Health and Children as I did this week, last week and on previous occasions. My colleagues and all the others do the same. All that we receive is a letter stating that the Tánaiste has no interest, since she is not involved, and the HSE answers such queries.

The Tánaiste was appointed by the Taoiseach after a general election that produced a coalition Government between Fianna Fáil and the Progressive Democrats. The only way we can get answers is for the Tánaiste to accept responsibility for her position rather than running away from it. It is very difficult for us to tell constituents that we have tabled a written question to the Tánaiste but cannot receive a simple written reply. Surely, with all the extra staff in her office and elsewhere, that should not be difficult. Will the Minister of State relay that message because it is so seldom we get a chance to see the Tánaiste and Minister for Health and Children herself? There is a need to recognise this House and its relevance to policy at least. Who decides the policy on whether beds lie empty, while people lie on trolleys? It is totally wrong that that should happen. We all want to see our people getting proper services. I will not indefinitely abide by a situation whereby facilities that could be used are available, but are being ignored or red tape is being allowed to get in the way.

The regulations for getting subvention are very difficult. A pensioner might live with an elderly parent but the house is still in his parent's name. While the person on pension is not dependent on his or her parent, the house is the only home he or she will have in the future, but because the house is in his or her parent's name the house must be taken into account. Is this fair? If that issue is not addressed in the Bill, I ask that it be rectified. Someone who is dependent, perhaps through disability, may be included. I had such a case in my home town, Clones, where an elderly person in her 90s lives in the family home with two daughters who have pensions earned in their own right through their taxes. The family home needed to be used for subvention purposes.

In another case a solicitor stopped an elderly man handing over the last 20 acres of his farm to his son. Those 20 acres were reckoned against him for subvention purposes and he needed to use nearly all the cash that was left behind for his widow. In such cases the Government is seen to be uncaring and unthinking. People over 70 now qualify for free medical cards and should qualify for free health service also.

We in the north east and particularly in Cavan and Monaghan are victims of circumstances. Sizeable numbers were sent across the Border in the 1990s and our subvention figures seem to be based on those earlier numbers. More seriously, the four counties of Cavan, Monaghan, Louth and Meath have the highest increase in population in the country. Admittedly Louth and Meath are the two counties that caused the increase. Two years ago the submission by the then North Eastern Health Board to the Government stated it would take an additional €40 million to cover the needs resulting from that population increase. However, the budget gave us the same 9.5% increase. Unless this changes dramatically we will have very serious problems.

The process for applying for subvention must be greatly simplified. Many of the people involved are elderly and some are not very well educated, which is placing enormous pressure on families. Help should be given directly by the HSE to help these people complete the forms. Some individuals are good at doing this and some district nurses and others are very helpful. However, the crisis arises when they need to meet the social welfare officials and they do not know what they should and should not do. The last budget gave figures purporting to show how the situation had improved and I genuinely believed it showed a major change. However, when the increase in house valuations and the increase in the amount a person was allowed to own are included, the changes were not that great. A person with €27,000 in the bank can now get an old age pension. However, the maximum allowable bank balance for subvention purposes is €11,000. In many cases the value of the house is immaterial because of how the means test operates.

Another issue arises with how the degree of dependency of an applicant is assessed. Surely the best person to make that assessment is the district nurse and the applicant's doctor. However, sometimes others are brought in to make the assessment. As the Minister of State knows, if his mother or mine were examined, the inspector would not know what was happening and for five or ten minutes would try to ascertain how well she is able to cope. In some cases an elderly person will go to the trouble — which is the norm if he or she is in any way fit — to provide a cup of tea for the inspector. Someone supplying a cup of tea to an inspector can surely expect the worst as this would indicate he or she is well able to look after himself or herself and there is no need to be in a nursing home. An inspector calling half an hour later or in the middle of the night might realise that things were totally different.

This all comes down to how the HSE determines an application for subvention. I hope the Bill will ensure that HSE officers in different areas deal with the issue consistently. Previously in the House I mentioned a particular case and it is worth repeating. A family whose mother was in a nursing home in Sligo needed to come back to the north eastern area in order to get subvention. The manager of the home spoke to me several times on the phone. He could not believe the difference between what I had to deal with and what he had to deal with. There were differences in the means test and the mechanisms for paying back until the person went into the home. We eventually reached a compromise and the family only needed to borrow for one month. It is vital that this situation be rectified.

I welcome the discussion on the issue of subvention. It is vital that it is sufficiently funded and that nobody needs to be on a waiting list, regardless of where they live. Private nursing homes are not getting any cheaper. I recently spoke to a person who is waiting to get into St. Mary's nursing home in Castleblaney. I make no apologies for saying it is one of the best in the country. It has a high-care unit for people with various problems. The unit was funded and opened by the then Minister, Deputy Noonan, prior to which it was a locked-up ward. It gives tremendous service. The person waiting to get into St. Mary's is paying €825 to stay in a nearby nursing home. Because he had some money and five acres of land he does not qualify for subvention. When he burns out the few pounds he has, I hope he will be allowed into St. Mary's. However, this is not acceptable. This person deserves to deal with his difficulties in some dignity. I hope that by the time this Bill is passed the Government will provide the necessary funding to give a subvention to all who need one. If the Health Service Executive was allowed to give proper home care much of the subvention would not be necessary, in cases such as that I mentioned of the woman who spent four weeks in hospital. There are many other cases of people who could be let go home from hospital if care was available. Home care funding in the north east was halved a few years ago. There have been small increases but it is unacceptable and unfair that a woman, an amputee, when living in Donegal received 12 hours home help a week but receives two hours since moving to Carrickmacross following her husband's change of job.

We are supposed to treat all children of our island equally but that is not happening. I urge the Minister of State to rectify the home help service. There are people prepared to deliver the service but they need flexibility. Their income is somewhat better than in the past but if home help can allow somebody remain at home the allowance should be improved. The Joint Committee on Social and Family Affairs, of which I am a member, agreed unanimously that a person receiving social welfare, such as an old age pension or widow's pension, should be entitled as a minimum to half the carer's allowance. That would dramatically change the situation.

I welcome the discussion on the Health (Nursing Homes) (Amendment) Bill. It is important to reflect on and pay tribute to the elderly in our society and to remind ourselves of who they are and what they did for us. The people we are discussing are former workers and taxpayers who were around in the tough times, the 1950s and the dark 1980s, when we did not have the massive resources available today.

I also pay tribute to the carers and those who work in nursing homes. I commend them on their dedication and the excellent services they provide to many elderly people. Many who talk about and care for the elderly do not realise the valuable work they do in respect of these services. They deserve a special thanks. In a few cases the elderly have not been properly treated but most of those who work with the elderly do a tough job in a caring manner.

Modern society does not seem to respect and care for the elderly. On beautiful summer evenings elderly people in my constituency are locked into their homes at 7 p.m. They are afraid to answer the door because they fear attacks or anti-social behaviour. It is a scandal that elderly people are barricaded into their homes every night. The Minister for Justice, Equality and Law Reform needs to wake up and deal with this neglect of the elderly. I blame successive Governments for failing to do enough for the elderly.

Old age is not a sickness. The elderly are the survivors of their generation and deserve more care and respect. Many people in their 70s and 80s are still physically able to contribute to society. I commend any efforts made to ensure they are always included. Many services such as meals on wheels would not run without elderly people. Those in my constituency, Marino, Fairview, Killester and Clontarf, involved in this work are themselves elderly people yet they are often forgotten. We must in turn look after these people. I welcome the progressive increases in the budget over recent years which marks a serious start in helping elderly people and pensioners. The people who provide meals on wheels asked me to ask the Minister of State who will continue the service when they move on or die. The entire Cabinet must face up to this reality and plan for the next ten or 15 years.

The decision of the Supreme Court to reject the Government's Health (Amendment) (No. 2) Bill confirmed the biggest theft of our time. I have spoken before about the €3 billion stolen from more than 300,000 older people over 30 years. The implications of the Travers report were devastating and showed State-sanctioned elder abuse over three decades. It also showed a lack of political leadership by successive Governments and Ministers. Many elderly people and their families feel let down by this.

Approximately 444,000 people, or 11% of the population, are over 65 years of age. Of these, approximately 266,000 are over 70, one third of whom live alone, and 25,000 elderly people are in long-stay beds or nursing homes. A further 13,000 elderly people need high to maximum dependency care and they continue to live at home. It is important to give them the necessary support and back-up.

Most elderly people want to receive care in their homes or in the local community. We must plan for that and I welcome measures aimed in that direction. Many families of the elderly make sacrifices to provide the best possible care for them but the inadequacy of our nursing home subvention scheme causes hardship for them. They are conscious of cuts in home care services which is not acceptable. The failure to abolish the means test for the carer's allowance is a further attack on the most vulnerable in our society. Services for the elderly in disadvantaged areas are grossly under-resourced. These should be resourced and serviced in coming years.

I demand that the Government put in place adequate resources and a comprehensive infrastructure for care of the elderly. I welcome the small steps forward but more home care packages are required. This is an issue which is raised regularly in my constituency clinics and when I meet people on the doorsteps in Dublin North-Central. The elderly need home care packages. In Beaumont Hospital in my constituency a number of elderly patients are waiting for the home care package to be implemented so that they can leave the hospital. They cannot leave until an adequate home care package is provided. I urge the Minister of State and the Government to examine the situation. Hospital beds must be freed up to provide more services in accident and emergency departments. Home care packages should be regarded as a right for elderly people. They were workers and taxpayers who contributed to society in the tough times and they have a right to these services, and home care packages must be part of these services. I commend all the carers who work with the elderly, the disabled and children at risk.

I pay a special tribute to Máire Buckley, that beautiful, caring teacher who was killed last Sunday in the tragic bus incident. Máire was an extremely competent, professional and caring teacher who worked in the inner city all her life. This evening her body is being removed to the church in Seán McDermott Street. I pay tribute to Máire for her work, to the parents in her school and to all the families that Máire has helped over the past 25 years as a caring, professional teacher. She was dedicated and was an honourable member of the INTO, the Irish National Teachers Organisation. On behalf of all Members, I express my deepest sympathy to her family. It was a very tragic event which has been a nightmare for her family and her death has been a sad loss to society.

The north inner city and the whole north side of Dublin is in mourning today for Máire Buckley because she was the person who cared for children with special needs and for the poorest children in society. She worked very closely with the parents and children who were at high risk and she gave 100%. This is a sad day and this country has lost a great person, a patriot, a citizen who cared about people, about the elderly and about children.

The nursing home subvention scheme was introduced in 1993 on foot of the Health (Nursing Homes) Act 1990 and the Nursing Homes (Subvention) Regulations 1993. The purpose of the scheme, which is implemented by the Health Service Executive, is to provide financial assistance to persons towards the cost of maintenance in a private nursing home. The purpose of this Bill is to ensure that the existing subvention scheme for private nursing home care is grounded in primary legislation and to help the HSE to implement the scheme on a standardised basis across the country.

Section 2 of the legislation amends section 2 of the Health (Nursing Homes) Act 1990 to specify that subvention shall only be paid to a person maintained in a premises in which a majority of its residents are members of a religious order or priests of any religion, if the premises are a registered nursing home. Section 3 of the Bill replaces section 7 of the Health (Nursing Homes) Act 1990 with a new section which outlines the principles and policies underpinning the subvention scheme. A number of subsections provide for the method for making an application for a subvention; assessment of the degree of medical dependency of an applicant; assessment of the financial means of an applicant; review by the HSE of the medical dependency and means of a person receiving subvention; a system of appeal against decisions made by the HSE on a number of different aspects of the application process; an obligation on a nursing home owner to notify the HSE of the death or discharge of a person in receipt of subvention; and the recovery of a subvention payment procured through fraud or misrepresentation.

Section 6 of the Bill replaces section 14 of the Health (Nursing Homes) Act 1990 with a new section which provides that regulations shall only be made after having been approved by both Houses of the Oireachtas. Under the current section 14, regulations are made before being laid before the Houses of the Oireachtas which may subsequently annul them.

The purpose of the Bill is to provide for the existing subvention scheme in primary legislation. Therefore, there will be no change to the current system of subvention payments as a result of this Bill. It is not expected there will be any significant financial implications either to persons availing of the scheme or to the Exchequer. It is important to highlight these sections in this debate.

I wish to deal with the issue of the rights of the elderly as citizens. I refer to the Irish Senior Citizens Parliament which is the voice of the elderly. I compliment a person from my constituency, Mr. Michael O'Halloran, and pay tribute to the people directly involved in the Irish Senior Citizens Parliament. I commend MichaelO'Halloran and his officials for the work they have done in the parliament.

The Irish Senior Citizens Parliament held its annual conference in Dublin on 21 and 22 April 2006. The parliament celebrated its tenth anniversary and 300 delegates attended, representing 95,000 members. The parliament is now the largest representative organisation of older people in Ireland. A total of 46 motions were debated, covering a wide range of topics dealing with issues affecting the quality of life of older people. The motions which were adopted will contribute to the policy development of the parliament. Motions covered issues dealing with chiropody, living alone allowance, cancer screening, resourcing of long-term care, discrimination in insurance, improvements in the State pension for older people, consultation and planning issues and others, which if implemented would greatly improve the living standards of older people.

The parliament was also addressed by the Minister for Social and Family Affairs, who spoke about the development of pension policy and the need to provide adequate pensions in the future for retired people. He also dealt with his wish to see a better pension scheme for existing pensioners. All Members will support these proposals.

I commend the parliament as a very worthy body. It held three workshops, one of which dealt with the subject of pension policy in Ireland. This workshop was addressed by Professor Gerry Hughes from the Economic and Social Research Institute. He covered a wide range of issues and outlined the way in which pensions could be greatly improved for the existing pensioners as well as securing pensioners' incomes in the future. Another workshop dealt with the organisation of older people at local level and the relationship with the local partnerships. This workshop was addressed by Fiona English, equal opportunities programme manager of the Wexford area partnership. She outlined the benefits of having older people well organised at local level and having a good relationship with their local area partnership. The third workshop dealt with the subject of older people's health. It was addressed by Dermot Smith, assistant secretary of the Department of Health and Children. He outlined the present proposals by Government, in particular the home care packages, which are designed to assist older people to remain in their own homes as long as possible. He also dealt with other issues relating to the health of older people.

The workshops provided a lively opportunity for the delegates to question and discuss issues of importance to older people in the area of pensions, local organisation and health policy. In his presidential address the president of the Irish Senior Citizens Parliament dealt with the issues connected with over-crowding in accident and emergency departments. He contended that part of the reason for the problems in accident and emergency departments was they had to deal with people who have accidents due to drink or drugs overdose. He called for some initiatives to try to reduce these numbers and to free up the facilities available in accident and emergency departments. I welcome the comments made in the parliament. This is a group of elderly Irish citizens who have put forward sensible proposals about care for the elderly and give their views on dealing with the problems in accident and emergency departments.

I welcome the debate on the Health (Nursing Homes) (Amendment) Bill. It is important to face the reality that our elderly people are not being given the maximum support. I pay tribute to many groups in my constituency. For example, there are the care services on Sybil Hill Road, which provide excellent services, and the Clontarf and Marino active retirement associations. These are people who go out regularly and keep their eye on their neighbour. It is old-fashioned community spirit, but it is something that is lacking in the wider society. I understand the problems in the wider society, because everybody is so busy and people have problems at work and issues with time, but we should all learn from the elderly, from their experience in life and from their vision for life which is one of caring for and looking after older people. Let us remember that many of our elderly have the experience of life and can still make a massive contribution to the State. They have done excellent work, and we should look on them as a valuable resource in society. Earlier, I mentioned the people who work for meals on wheels in their late 60s and 70s and the valuable service they provide. These older people are a valuable resource.

Another important issue is that of people with disabilities and the valuable work older people do in providing care and other services for adults with disabilities. Older people, with their caring nature and their experience, can have a fantastic relationship with people with disabilities. On some of the projects on which older people are involved, they have done magnificent work, and we see the reaction of the people, especially those with an intellectual disability such as those with Down's syndrome. They have a very good, open relationship with older people and a respect for older people that we in the wider society often forget, which is sad — we are losing focus on that in the broader debate.

I commend older people on their magnificent work with people with disabilities. The Special Olympics was another example of that, as a large number of the 30,000 volunteers were retired people. More important, however, is the amount of work they got involved in afterwards, when all the cameras and the media went away, and the amount of work that goes on in every part of the country where older people are involved in providing excellent services for people with disabilities.

This is a very important debate. We need services and home care packages and we need an inspector for nursing homes but, above all, we need respect and compassion for our elderly.

It gives me great pleasure to speak on this motion. We are supposed to be discussing the Health (Nursing Homes) (Amendment) Bill, but it appears everybody is talking about everything else, and I am sure I will be no different.

The Deputy would never do that.

The Deputy is a past master at it.

It all has to be said. The Bill is innocuous, although it is important in the sense we hope it will iron out some of the anomalies in the nursing home subvention, which meant families in one area were, seemingly, not getting the same level of subvention as families in other areas. Other such issues were also arising. If that is all it is about, it should get a fairly speedy run through this House. However, there is the more fundamental matter of the subvention itself, and I beg the indulgence of the chair in speaking on it.

In the process of life, people grow old, and there are only three or four ways in which the elderly can be looked after. There is no harm in stating them in a debate such as this. We all hope that when we arrive at the golden years we will be able to look after ourselves, live in our own homes and eventually go to Heaven. That would be lovely if it was possible and, thankfully, I know people to whom that has happened.

Were they people from this job?

Maybe. The next best way is when people are able to stay in their own home and be looked after by their own families. That happens all over the country every day but, for people for whom that is not possible, nursing homes, which we are discussing, become relevant. There are two different types of nursing homes: the State-run geriatric homes and private nursing homes, a relatively new industry. If we had a debate like this 20 years ago, most people would hardly have known what a private nursing home was, as there were so few of them at the time. If people were given the choice when they got old, they would prefer to remain at home, a view echoed in the debate.

Like every other Member, I have had occasion of speaking to people in nursing homes. This is not in any way a slight on nursing homes, as most of them are extremely well run, but I have often heard people in nursing homes saying they are grand, have everything they want, but would rather be at home. That is the most natural thing for people to want, which is why the objective of this Government is wrong. As many of my colleagues said, there are many older people who are almost self-sufficient. When people get old there are little things we take for granted, such as when a person is crippled with arthritis and cannot put on his or her shoes or make a cup of tea, but that does not mean the person has to be in a nursing home. Everything else about their health could still be all right, which is why the home help system has been such an extraordinarily good thing.

Most families get only two, three, four, five or six hours free a week. There are 24 hours in every day and, when that is broken down to two hours every day at most, what the home help can do is important but very limited and not enough. We always have to worry about value for money in this House but, even if the revenue for that system was doubled, it would be great value for money, because keeping people in their own homes basically means the subvention does not have to be paid. If people go to State-run homes, it costs about €1,000 or €1,500 a week. One might imagine that the right thing to do was to increase the funding on that level, but the next category for which funding should be increased is at the subvention level. I have not heard that raised here and it may have been overlooked, but it is a big issue in County Galway, my part of the world.

As is well known among the elderly, what is available at the top end of the subvention, if a person qualifies under all headings, is €190 a week. There is an enhanced subvention, which I shall talk about. Of the older people I know, although admittedly as the years go by there will be smaller numbers of them, there is a significant number of them without a thing in this world except for their old age non-contributory pension. That is the way it is if they were in non-insurable employment or self-employment. There has been much talk about how gracious the Government was towards those people in the last budget, with an extra €188, but if that is added to €190 it comes to a sum well under €400. I do not know of any nursing home, even in the west where the fees charged are generally lower than in other regions, where the minimum charge is below €600 per week. Several of them charge €700 to €900 per week. Where does that leave a person who when his or her pension and subvention are taken into account must still make up a shortfall of €200 or €300 to meet the cost of the nursing home care per week? I receive several telephone calls on this issue every week. It is not so bad for people who have families who can pay the shortfall but many families find it extraordinarily difficult to make ends meet. Everybody understands this and I will not waste the time of the House talking about it. By the time people pay their child minder, mortgage and car repayments and all the other bills, they have nothing over to pay for the care of another person. They might want to, but they are not able to afford to do so. How will this legislation assist poorer people who want to use the private nursing home service?

A great deal of good work has been done by the private nursing home industry, although as in every other industry there are blips. Unless the people who wish to use this service in the future are funded by something far greater in value than the State old age non-contributory or contributory pension, the future for this industry is not as rosy as it might appear. In some parts of the country the occupancy level in nursing homes is high and elderly people have to wait to get a place in them. However, I know of a number of nursing homes where places are available and one could walk in off the street and get a place.

The private nursing home concept will form an integral part of how we treat the elderly in the future. A great feature of private nursing homes, which has not been lost on the elderly, is that they are located in local towns and villages. In my town of Mountbellew and in many other towns in east Galway people who are in good health are able to meet their neighbours in the town and return to the nursing home in the evening. It is a lovely concept that elderly people can meet and talk to the people they were born and reared with. That is an excellent idea. I hope the Government will ensure that concept will not be pulled asunder on the basis that people will not be able to afford to use this service.

Even with the level of the subvention, people have to pay a large amount per week to make up the shortfall to meet the cost of their care. I pay a sincere and strong tribute, as other Members have, to the people who run this service for HSE western area. They are humane and do the best they can. I might have time later to refer to the manner in which, under the Bill, eligibility is decided for the granting of a subvention on financial or medical grounds. As in the case of all schemes, provision must be made, and included in legislation if possible, for hardship cases, of which there are many. There is not a family in Ireland, the members of which do not at some stage experience something unforeseen.

I know of a 58 year old married woman who has had two or three serious illnesses and she now cannot be cared for anywhere else other than in a private nursing home. This woman does not have a pension, given her age she does not quality for an old age pension, and she was not entitled to an occupational pension because she has been sick for many years. Her husband has a part-time job and is well paid but only on the basis of working part-time. On the basis on which means are calculated, the subvention awarded in this woman's case is only €100 per week. The cost of her care in a private nursing home is €600 per week. Where will a family such as that get €500 every week of the 52 weeks in the year, perhaps for the next ten years for all we know, to meet the cost of this woman's care? If the woman cannot be kept where she is, she will have to take up a bed in one of the geriatric State run homes and that will be even more costly. The family members have said to me time out of number in recent months that even if they could get €200 or €300 together they could manage to meet the cost of the care. They would walk the earth for their mother, but in terms of the cost they have to meet for her care, they are not able to walk that far. That is the problem they face. I do not see anything in this Bill that will give them any great hope. Provision for hardship cases might make bad law but we have to deal with them as we encounter them.

Account is taken of the assets a person has at his or her disposal at a given time. I assume that provision in regard to 5% of the value of the house the person owned will be foregone in this legislation. I have a difficulty with that requirement. The type of house in which most elderly people live is certainly not a manor or a castle. When an elderly person has to move to a nursing home or any other home, it is almost impossible to rent the person's home, even if he or she wanted to do so in that it is not fit for renting. Because the person is the registered owner of the house, a 5% value was applied to it under the old scheme. That requirement should be seriously reviewed as there is no need for it.

In regard to how we treat the elderly in terms of taking account of the totality of the problems they face, a society is judged, and correctly so, on the manner by which it treats its elderly. We live in a world where the pace of life is fast moving. Thankfully, many of us are in jobs that are reasonably well paid and, more important, we have been extraordinarily lucky in enjoying good health all our lives. However, for the many people who were not so lucky, they fear the thought of growing old. This country always had great credibility in terms of looking after the interests of the elderly, but our system is breaking down big time. I have been long enough in this world to remember the wonderful chain of affection that existed between parents, grandparents and grandchildren but sadly in this nuclear age that chain is badly broken.

I fully support the idea that, irrespective of which party or parties are in Government, it is not possible to supply all the various services without the help, guidance, love and care of the family members of the elderly person concerned. One's sons or daughters may not be able to help one financially but there are many other ways they can help. A point that is not made often enough is the great debt of gratitude children owe to their parents for what their parents did for them down through the years. Most families accept that without any trouble, but there is a certain cohort of people who glibly say they want to do their best for their aging parents, while they shrug their shoulders and say that unfortunately there is nothing they can do. That is just not good enough.

There are certain principles and objectives that any Government worth its salt must bear in mind. The provision of services for elderly people should not relate to how well or how badly the economy is doing. This is an important aspect of the debate on the care of the elderly. When people are a certain age they have an actual right to a certain level of care, consistent with their various abilities or disabilities, below which they should never be asked to accept. This country has not yet arrived at that stage, although some of its services are excellent.

I would like to highlight an important aspect of any debate on nursing homes. Many people have referred to the problems in this sector. As I said in this House some months ago, the nursing homes with which I am familiar are well run and I do not receive complaints about them. In that context, however, it is hugely important for the Department of Health and Children and the Government to ensure that what I call "flying squad" inspections take place at the drop of a hat. Inspectors should be able to call to nursing homes in any part of the country, on any day of the week and at any hour to ascertain who is responsible for what and to determine whether everything is above board. That is the only way for us to ensure that the system that serves the elderly people of this country, for whom we are striving today to do the best we can, remains straight, honest and proper. I know some people will think that is a heavy-handed way of doing business, but I do not accept that. If the system is working as well as I think it is, nobody other than the cowboys who are operating in this sector should have any problems with "flying squad" inspections. An episode of "Prime Time Investigates" that was broadcast some months ago showed that not all nursing homes are being run as well as they should be. I would like to refer to two other matters, but my time is up.

I am glad to have an opportunity to speak on this important Bill. It is difficult to know where to start when speaking about an issue of such fundamental importance to everyone concerned. As we are all getting older, it is inevitable, unless something happens to us in the meantime, that we will all need some support in our old age. I use the term "support" because nursing care is a subset of support. The basic difficulty in this regard is that the Government has lacked vision in its efforts to give older people the support they deserve. Its handling of the elderly support system has succeeded in medicalising and institutionalising the care and, more appropriately, the support of older people.

When the Minister of State, Deputy Seán Power, introduced the Bill before the House, he said there was a legal imperative to sort out the private nursing homes subvention payment system, which no more than 5% of the population will require. The debate on older people should not start without a recognition that 95% of older people will not end up in nursing homes and, therefore, will not require the services of such a home. If one were to arrive from Mars to examine the debate in this country, one would swear that there was very little in this country other than nursing homes. That is the reality of the situation. I accept that massive resources are being invested in nursing homes to remedy the mismanagement that has taken place. I accuse the Government of medicalising the care and support of older people. Perhaps I will have a chance to speak about another way of approaching this issue later in my contribution.

We need to bring some order to the total chaos in the elderly support system. Older people who require the services of a nursing home, as 5% of the population will do at some time, are caught between the devil and the deep blue sea when they try to work out where exactly they stand. The Department of Health and Children and successive Governments stand indicted in this matter. There is no clarity in the system. Anyone who knows older people as I do is aware that they like to be well organised, to have everything clearly set out, to cause as little trouble as possible and to have everything in order. I refer to a wonderful generation of people who have done so much for this country. The system that is in place to support them is totally chaotic, unfortunately. No matter where one goes in this country, one will not have a clue about one's entitlements in this regard.

I pay tribute to the many excellent and professional people employed by the Health Service Executive, particularly in my locality, who do a really excellent job, for example in assessing older people for subvention payments etc. The same praise cannot be given to the system as a whole, unfortunately, because it suffers from a lack of direction and vision, through no fault of the staff I have mentioned. I sincerely believe that one gets a different subvention rate in one part of the country than in another. I accept there are three basic categories, but we should bear in mind a further category, the enhanced subvention that may or may not be paid. This Bill refers to the enhanced subvention, but I would be happier if it brought some order to the chaos that exists in this regard. I know the Minister of State plans to introduce an amendment, which will outline the exact subvention rates, later in the legislative process. Older people need to know for certain exactly how much they will pay.

I am not criticising private nursing homes in any way. Many of them have been developed in recent years as a result of Government policy. Such nursing homes are profit-driven, however. Communities have a large part to play in supporting older people. The desire of people to turn a bob has been prioritised in this sector, as it has in many other facets of life in modern Ireland. It has taken precedence over the wonderful potential of communities to look after their own people. As someone who is involved in supporting older people in their own communities, I have to say the supports which are available to communities do not incentivise them to get involved in such activity. The needs of the vast majority of people — the 95% of people who do not end up in nursing homes — are being totally and utterly ignored. We need to take an overall view of the support of older people in modern Ireland, rather than concentrating on the 5% of people who end up in nursing homes, who represent just one aspect of the issue.

We should think about investing from the start, for example, by supporting the 85% of people who wish to remain in their own homes. No more than lip service has been paid to the well recognised group of people who need to be supported at home, although that has started to change in recent times. Just half a dozen home care packages were available in County Mayo last year, which was not enough to satisfy any home care arrangement.

As I said, the system has developed in the way it has as a consequence of the Government's policy of making the rich even richer. I am not in any way criticising nursing homes. I believe there are some really excellent nursing homes and the vast majority of people running them are very professional and do a good job. There are a few, however, as mentioned in this Chamber today, which are not as good. As in any calling there will be rogues and people who do what they should not do. The system encourages people to make profits. Private nursing homes are profit-driven enterprises. There is an alternative, namely, not-for profit community-based facilities. I look forward to continuing this debate.

Debate adjourned.
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