Social Services and Support: Motion (Resumed) [Private Members]

The following motion was moved by Deputy Tom Fleming on Tuesday, 14 July 2015:

“That Dáil Éireann:

calls on the Government to:

— implement a range of policies that are favourable to senior citizens to maintain independent living;

— provide the supports and services to assist people to continue to live in their own homes;

— in light of the upturn in the economy, prioritise the household benefits package including the electricity/gas allowance and the free television licence among other measures;

— continue to maintain the free travel scheme and the Christmas bonus;

— ensure that home help hours be maintained in line with demand so as older people can age in the community;

— invest in the Health Service Executive community care and community mental health services;

— ensure that:

— the living alone increase continues to reflect the cost of living; and

— the carer’s allowance and the half-rate carer’s allowance be maintained and recognise the value of the respite supports; and

— acknowledge the importance of:

— the household adaptation grant for people with a disability, housing aid for older persons scheme and home insulation and energy saving for older people living at home; and

— maintaining and enhancing rural community bus services.”

Deputy Aengus Ó Snodaigh

It is important we take this opportunity to speak on this very important matter. The Government has stated from its initiation and reiterated in the national positive ageing strategy in 2013 that its policy was to enable people to age with confidence, security and dignity in their home and communities as long as possible. I do not believe anybody in this Chamber or elsewhere would speak against that laudable aim. However, as has been shown, the Government has acted contrary to that stated policy.

The Irish Human Rights and Equality Commission has emphasised in its publications the need to ensure older people's human rights and dignity. That is similar to the Government's aim. It has also stated that this can be done by enabling older people to stay at home for as long as possible through the provision of home care that is both available and adequate. It is not just half an hour every day or four hours when 20 hours are required. It needs to be available and adequate. Despite this and the Government's 2013 national positive ageing strategy, of the total budget for older people's services, only 14%, €190 million, was spent on home help service and only 9% spent on home care packages.

These are the two services that support independent living "with confidence, security and dignity" as the Government promised.

It is clear that Government resources are not aligned to its stated policy and have not been since it took office. Since 2009 the number of people aged 65 and over has increased by over 20%. The Central Statistics Office predicts in its demographic trends that this increase will continue over the next ten years and by 2016, 16% of the population will be 65. That shows how Ireland has developed but it also poses a challenge to us as legislators and to Government to budget. We know that 91% of older people rely on the State pension and related supports to protect them against poverty. That will put a huge pressure on State funding and our already stretched health service, on hospital beds and acute hospital services. We need to consider whether we are spending the money properly. The State is concentrating on subsidising private nursing home beds. ALONE has stated that one in three of those in nursing home beds could be supported to live in the community thus relieving pressure on State finances because it has been shown that living in one’s home and community is more cost-effective in the long run. There needs to be a shift in emphasis in respect of the home help packages and home care.

Enabling older people to live at home could reduce the amount of grant aid required for a nursing home. Ireland has 35% more older people in nursing homes than other EU countries. That figure was published by ALONE. Moving the one in three from nursing homes to their own homes would be a job well done. That does not seem, however, to be the trend under this or the previous Government.

I condemn the litany of cuts which have cumulatively inflicted hardship on older people, in particular those who are dependent on social welfare during the lifetime of this Government. They have shouldered an unfair and scandalous burden. I heard the Tánaiste and Minister for Social Protection say in this debate last night that everything is rosy and that the Government is living up to the commitment made in 2013 that it would "enable people to age with confidence, security and dignity in their home and communities for as long as possible". We must not forget what has happened, that this Government has slashed the housing benefits package, the fuel allowance, the Christmas bonus, the living alone allowance, medical cards, the carer's allowance, home help hours, home adaptation grant and dental and optical benefits, as well as rural transport services. There are extra charges, which include the introduction of prescription charges, property tax, water charges, universal social charge for anyone with an additional income, the pension levy and the loss of the free passport. All this came at a time when the cost of living increased, as well as the cost of electricity, gas and fuel, forcing older people to choose between heating their homes, paying prescription charges or putting food on their tables.

If we are moving out of the period of austerity we have an opportunity to be fairer and to concentrate on the weakest in society, especially those who depend on social welfare, who have no opportunity to increase their income, particularly pensioners. We should consider, for example, increasing the respite care grant, the home help hours and home care packages. We should also increase the living alone allowance and reverse some of the cuts heaped on senior citizens and others who depend on social welfare, for example, by reinstating the fuel allowance.

Our party wants to ensure that older people can live independently in dignity and comfort in their homes and communities for as long as possible. I will live up to that commitment if I am ever in government. I ask the Minister of State at the Department of Education and Skills, Deputy English, to live up to that commitment now. The Government has not done so to date. It has a few short months left and there needs to be a change in the way funding is allocated to older people’s services so that a greater portion of money goes towards keeping people in their homes, if appropriate. If it is more cost-effective to have home help and home care packages, that is the way to go rather than to subsidise a growing industry of nursing homes when in many ways it would be much more appropriate for people to be in their homes for the last years or months of their lives and enjoy their retirement and later years rather than feel them as a burden.

Deputy Mary Mitchell O'Connor

I am pleased to contribute to tonight's motion as it gives us all the opportunity rightly to acknowledge the immense contribution our elderly citizens have made to this country. Their contribution to the State cannot be overlooked or underestimated. They have helped drag us through not one but two terribly difficult recessions. They have watched the face of Ireland change from a small rural-based island to a leading international hub. Nothing would have been possible without their hard work and support.

I am proud that this Government is committed to our older citizens. However, more can always be done and I ask the Minister of State to ensure we continue to prioritise and do our best for our elderly parents, grandparents and pensioners. The State pension is a lifeline for the elderly. Safeguarding this has been a key priority for the Government. However, as the number of pensioners is gradually rising, I urge the Minister of State to continue to safeguard its role and ensure the continued expenditure allocation for it. Increasing the living alone allowance last year was a very welcome move.

The last time it was increased was in 1996.

Isolation and the lack of supports can make daily living for an elderly person extremely lonely and difficult. I cannot over-emphasise the key role the household benefits package and the Christmas bonus play. As we steer the country out of recession and into recovery, I ask the Minister to look at restoring the Christmas bonus fully. It goes a long way in many elderly households and such a move would be greatly welcomed by all.

Mobility ensures social inclusion for many elderly people who otherwise would have no daily contact other than with their local postman or postwoman. Hailing from Galway, I have seen first-hand the many benefits the free travel scheme has brought in both rural and urban areas. I see pensioners using their free travel pass on a daily basis to get from Milltown to Galway and even to take day-trips to Dublin and further afield. Only last week I welcomed the Dún Laoghaire senior citizens group to Leinster House. They are a wonderful example of how the elderly should be living. They are active, involved in the community and enjoying life as they should be after their many years of contributing to the State. The free travel pass, the living alone allowance and the State pension help to provide for and ensure their continued involvement in the community.

I have been to social inclusion week events throughout the constituency of Dún Laoghaire and it is heart-warming to see the events and activities organised, the creative initiatives and the groups in place, all with an age-friendly focus. They are a credit to the constituency. Last month Dún Laoghaire-Rathdown County Council held an age-friendly consultation process so as to help to draft a comprehensive age-friendly strategy. The aim is to ensure the constituency of Dún Laoghaire is a great place in which to grow old. I wholeheartedly welcome this initiative and will do my very best to work with all elderly groups and communities to ensure their voices are met and their needs are met at both local and national level.

I welcome this debate. I am confident that the Minister and the Government will continue to support and give back to the bedrock of our society - the elderly.

Deputy John O'Mahony

I commend Deputies Tom Fleming, Maureen O'Sullivan, Michael Fitzmaurice and Thomas Pringle on bringing forward this motion. With so many new parties and groupings in recent times, it is good to see a group of Deputies putting forward sensible suggestions on how we treat the elderly.

The motion comes up with many common-sense proposals into which parties on all sides of the House could buy. I am glad that the Government is not opposing the motion and that it has acted on some of the proposals made already. As was pointed out by Deputy Mary Mitchell O'Connor, the Christmas bonus was partially restored. I very much support the idea that it be fully restored in the upcoming budget. Funding has been put in place to address waiting times under the fair deal scheme, which has shortened waiting times from 16 weeks to four. Obviously, as well as easing the stress and trauma for families who want their elderly cared for in a nursing home setting, this was badly needed because, as well as allowing elderly persons to move out of acute beds, it freed up beds in hospitals.

It is, of course, the wish of the elderly and their families that they be cared for in a home setting, if at all possible. I understand €185 million worth of home help services, or 10.3 million hours, has been allocated in 2015 and that €114 million has been allocated for home care packages. I very much support the idea of increased funding in all of these areas, as resources allow. As well as giving the elderly security and the comfort of being cared for in their own homes, it allows faster throughput in carrying out elective surgery and means fewer patients on trolleys in accident and emergency units throughout the country.

Two of the other proposals referred to in the motion are very sensible. One concerns the need to prioritise and maintain the household benefits package, including gas and electricity allowance units and the free television licence. The number of units should be increased and restored to at least what it was previously. Reducing energy prices continues to be important and although there were some recent decreases, energy prices remain volatile. At some of our committee meetings with the various providers their advice was to switch energy provider at least once a year to gain the most benefit. The issue is that many elderly people, in particular, do not have the knowledge or capability to know how to switch. As it is mostly elderly persons who do not switch, they do not save money. Some method should be put in place to make it easy for them to switch, which would mean that they could carry forward their free allowance units. People have come to my office who have switched and then lost the benefits of the free units. There are also other complications. Something needs to be done to gives a sense of security to the elderly and an easy way to switch their energy provider.

The State pension was maintained during the economic crash, which is to be welcomed. That was in contrast to the actions of the previous Government which abolished the Christmas bonus, cut carer's allowance and the disability allowance twice. It also cut the blind pension, the widow's pension and invalidity pension. Any restoration of these payments should be prioritised.

Free travel is an important topic. I know that the scheme has been reviewed recently and that Opposition parties can sometimes scaremonger in a way that concerns older people who come up to Deputies in the street and say things like, "Do not touch our free travel." It is very important that the scheme is not touched, but it is also important that people realise it is a central policy of the Government. I understand there are 771,000 people with free travel passes and, when companions are taken into account, there are over 1.1 million who can avail of the scheme.

Deputy Catherine Byrne

I am grateful for the opportunity to speak to the Technical Group's motion. Like many others, I have been following the very sad news from Greece, in particular, the state of turmoil, the riots and the state of the parliament. Unfortunately, over the weekend, we saw the sad pictures of older people not being able to withdraw money from ATMs and queueing for food parcels. Dioceses in Greece have given millions of bags of food to people who turn up on a daily basis. We are all deeply affected by the suffering of the people concerned.

I point out to my constituency colleague, Deputy Aengus Ó Snodaigh, that Sinn Féin supported taking the path that has led to Greece being destroyed in supporting the outrageous party that has caused the lives of people there to be practically extinguished.

Deputy Aengus Ó Snodaigh

Go back to sleep.

Deputy Catherine Byrne

The Deputy then stands up to say we are in a better condition in this country than we ever were and that we should be giving people more money. That is what happened in Greece. People did not realise things did not come for nothing and that they have to be paid for.

Deputy Aengus Ó Snodaigh

It is right-wing government. People know what happened.

Deputy Catherine Byrne

Older citizens are the backbone of our community and deserve to be supported with the very best care we can provide. As other speakers said, the country has an ageing population. There will be approximately 850,000 people over the age of 65 years by 2026.

This will place huge burdens and pressures on our services. Only by laying the foundation now as a stable Government can we in any way expect that these people will be able to receive their benefits in the future.

At present, citizens have a number of State supports from the Department of Social Protection and the HSE, as a number of speakers have said. The State pension has been maintained by the Government despite the very challenging economic circumstances we have gone through over the last years. The living alone allowance was increased to €9 per week. There are also the household benefit packages worth €35 per month and the free TV licence, which many senior citizens tell me are the lifeline of their week. The Christmas bonus was abolished by the previous Government in 2009. The Tánaiste, Deputy Joan Burton, partly restored it this year and will hopefully continue to do so.

There are currently approximately 820,000 customers in receipt of free travel allowance, at a cost of €77 million per annum. No one can tell me that is not caring for the elderly. I hear regularly that in other countries, such as our neighbour across the water, people with free travel can only travel within the region in which they live and cannot go all over the country like elderly people here. It is a real benefit. I believe in the carer's allowance, the domiciliary allowance and the respite care grant. They are all very important in having a civilised society which helps older people.

The Government's policy of supporting older people is for them to live in dignity and independence in their own homes and communities for as long as possible. I am fully behind this policy as I know many elderly people who are capable of caring for themselves at home but might need a little help now and again. The home help service is of great value in the community. People in the community see the same friendly faces each morning and work side by side with each other. They are the backbone of home help provision in every community across our cities, particularly when it comes to dressing older people, washing them, giving them their meals and just being there to sit with them and talk to them.

We all want dignity when we get older. We want our loved ones to be able to be cared for whether they are our parents, aunts or uncles, but especially our senior citizens. It is not always possible for families to be around 24/7, which is why we need to keep providing the home help service to care for senior citizens and allow people to stay at home. The increase in home help services into the future will allow people to remain at home and live out their days with dignity in the community where they want to be.

Deputy Dan Neville

I welcome the opportunity to speak on this debate. I am pleased that the Government has decided not to oppose it.

There have been many improvements in the nursing home situation under the fair deal scheme. The waiting time has halved in the past year from eight weeks to four. At one stage it was up to 15 and 16 weeks. The number on the waiting list has fallen from 1,265 in May 2014 to 557 in May of this year. The fact that €44 million was invested to reduce the number of those on the waiting lists for 15 weeks means it is now four weeks, down from 11 weeks earlier this year. I welcome this.

I wish to raise one problem in respect of the fair deal scheme. It concerns people who are at home, are emergency cases and need direct access to the nursing home from home rather than from hospital. Given that there is not the same detailed medical evidence on their conditions, only a recommendation by a GP, the assessment can be delayed. Nursing homes are obviously very reluctant if a person cannot pay. However, some people have some money with which they can pay for the nursing home. If someone has €5,000 and the cost of a nursing home is €800 to €1,000 per week, that is enough for five weeks. If, because of a delay, the assessment is not made within five weeks, the situation becomes very difficult for the nursing home, the family and the patient. Now they are unable to pay for the nursing home.

Going back some time, there was backdating once the application came through. That was suspended by the previous Government. It should be looked at in respect of how we handle patients' nursing home requirements and recommendations from GPs to access a nursing home. There should be some short circuit to ensure they get the same opportunity as those in a hospital situation. In a hospital situation, in most cases patients are kept in the hospital until the fair deal comes into operation. The same difficulty does not arise for the family and the patient also gets faster assessment because there are consultant reports, X-rays and other forms of medical evidence.

Fine Gael believes it is very important that older people should be supported to live at home as long as possible. The Government will continue to implement policies to support this objective. We know there are people in nursing homes who could be facilitated in the community in their own homes with more assistance. I welcome the fact that the Government has already restored certain payments for older people with increases in living allowances for the first time since 1996 and partial restoration of the Christmas bonus. This contrasts with the previous Government's record in office. It abolished the Christmas bonus, which was effectively cutting the State pension. It cut the carer's allowance, disability allowance, blind pension, widows pension and invalidity pension twice.

I congratulate the Technical Group on bringing this motion forward.

Deputy Michelle Mulherin

I welcome the opportunity to speak on this very important motion. I thank the proposers.

How we respect and support our elderly people is the measure of our society and where we are going. They should always be to the fore. We go from childhood to adulthood, obviously, and then become elderly and become in some ways dependent again. These are the people whose shoulders we stand on and who saw hard times that we have no idea about. They kept families together and kept things going when the social welfare State was just a fledgling idea. We owe them a lot of care and support so that they can live with dignity and independence in their own homes. They should be looked after from a health point of view.

One of the biggest challenges as people get older is that they are more liable to suffer from chronic illnesses that will not go away and will require treatment indefinitely. It is important that we have community supports in place whereby they can be cared for in their homes. Both their personal needs and also medical care should be provided for through home help, home care packages, intensive home care packages and community intervention teams.

If people could be provided for in such a way, they would not end up in emergency departments on trolleys, and they would not reach a point where their condition would become acute, such that they would need care in an acute hospital.

We must plan ahead because we are all ageing. In many ways it is a selfish pursuit as we lay the foundations for standards of care that could ultimately benefit us if we stay the course. We must have honest conversations about care of the elderly and how we measure that. Through my constituency office and clinics as families and individuals come to see me, I get a sense of the care people are given. While there are many challenges, many supports are available. I take issue with people peddling the politics of fear to gain political support and momentum. They prey on the fears of the elderly by suggesting they are being forgotten about or that they are not at the heart of what we want to achieve in terms of allowing them to be independent within existing financial constraints. I have had some experiences in that regard in County Mayo, for example, relating to the Sacred Heart Hospital in Castlebar. Many column inches were devoted to its supposed demise and closure due to lack of funding. The speculation continued for months. That did not come to pass but such cases are part of the Opposition’s political arsenal.

My first exposure to such carry-on was shortly after I was elected to this House. A big public rally was staged in my home town of Ballina due to the closure of beds in the district hospital. It was extrapolated that the community nursing home and all other health services would close. It was natural that there were fears because there was a moratorium on recruitment and people were retiring. People were rightly concerned that all the priorities were kept in order as much as possible and that older people would be looked after. It was a shocking display on that occasion. I was new to the job but my sense of it was that there were plans and that the best was being done that could be done. Lo and behold, far from the beds being closed, additional beds have been opened and the hospital is now operating to its full complement. The hospital is a step-down facility for Mayo General Hospital. Ten additional beds were opened recently, which have cleared the trolleys in Mayo General Hospital, for the moment at least, and ten additional new staff are employed full time in the hospital.

Deputy Brendan Ryan

I welcome the opportunity to speak on the motion. It deals with fundamental and vital issues at the centre of maintaining a core level of decency and support for vulnerable groups in society, particularly older people. The population is ageing rapidly, with advances in health care leading to a dramatic rise in the older population. Each year, the total number of persons over the age of 65 is growing by approximately 20,000.

In government, we have worked to protect older people through the most difficult of the budgetary adjustments in recent years. The free travel pass has been protected and recognised by us as both an integral benefit for older people and also as an important contributor to local economic stimulus. Every year, some in opposition would stoke up a fear or worry that the travel pass would be revoked or cut, but we ensured it has remained a core benefit for older people. The travel pass allows elderly people to engage with and contribute to their local communities. That is increasingly important for older people who live alone and need to be supported in independent living. Support for older people to remain living in their community, in line with a balance for appropriate residential care places, is an important plank of the programme for Government. It is also in line with the positive ageing strategy national goal to: "Enable people to age with confidence, security and dignity in their own homes and communities for as long as possible."

Resources have been scarce and it has been difficult to get to the levels of support to which we aspire. However, as the recovery takes hold, we will have the ability to do more and to deliver more. According to Alone, up to one third of residents in residential care are capable of living independently in their own homes and communities. Independent living with supports would provide a massive saving to the State over nursing home care. At the same time, it would free up much needed residential care beds for people who cannot live independently. I raised the matter in the Dáil this year in the context of the fair deal scheme, and the need to ensure it is demand-led rather than resource-led. Following the debate, the Minister with responsibility for disability and older people has changed the policy direction of the fair deal scheme in this regard, which is very welcome. However, it is very important to get the balance right between services to keep people at home and nursing home supports. Currently, resources are wrongly skewed towards nursing homes.

I support the call in the motion for home help hours to be maintained in line with demand. That must be assisted by adequately funded housing adaptation grant schemes within local authorities. In addition to funding, we need adequate personnel in the relevant departments to process and act on applications in a quicker manner. I know from experience with my local authority in Fingal that the hard-working staff in the architect's department simply do not have the personnel to process the workload of applications. In addition, there is an annual funding ceiling which can delay much-needed adaptations. I support setting a target for waiting lists for the housing adaptation scheme and housing aid for older people scheme to perhaps a maximum of six months. If targets are matched with the appropriate resources, we can make further efforts to show how the recovery will benefit those most in need.

We must apply a mix of strategy and funding to the need for independent living and we must bring an end to the bunker approach. A mix of supports needs co-ordination, for example, carer's allowance and the half-rate carer's allowance, which we have protected in government, housing adaptation grants, home help hours and new primary care centres. All these are support structures which aid independent living for older people. I welcome the progress on the new primary care centres throughout the country, especially in my area in Balbriggan, in Fingal and in Swords. The provision of primary care centres has the capacity to further assist older people to live independently as comprehensive medical care will be provided within their communities.

We must end the bunker approach Departments can have and examine an integrated approach which will best serve individuals in need of support. The increase in the living alone allowance which was provided in last year's budget must be, and I am sure is, in a state of ongoing examination to ensure it reflects the extra cost of living for those people who live alone. The Christmas bonus payment was partially returned in last year's budget, and I will make the case for a further restoration of the payment in the upcoming budget. The Christmas bonus is an important measure to allow pensioners and families on low income a little support in providing for a better Christmas. I thank Age Action and Alone for the material they contributed in advance of the debate this week.

An Ceann Comhairle

Deputy Seamus Healy is sharing time with Deputies Pringle, Fitzmaurice and Mattie McGrath.

Deputy Seamus Healy

I welcome the opportunity to speak on the motion. I thank Deputy Tom Fleming for tabling a very detailed, important and significant motion. The core of the motion relates to independent living for the elderly to ensure they can remain in their homes and communities for as long as possible. That is something to which we all aspire and which we wish to be supported. We all want supports and services to be put in place to ensure that happens.

I take the opportunity to highlight a very successful pilot project on dementia which has been in operation in south Tipperary for approximately three years. The project has been funded through Atlantic Philanthropies and the HSE through the Genio Trust. I compliment and congratulate all those involved in the project.

The project is led by a consortium of people with various interests in dementia. Importantly, the consortium includes people with dementia, carers, the Alzheimer Association, the Carers Association, Muintir na Tíre, South Tipperary Community and Voluntary Forum, GP representatives and HSE staff.

The project aims to create one point of contact for all dementia inquiries; to provide information, supports and services for every stage of the dementia journey; and to facilitate people with dementia to live full, enriched and happy lives at home and within their own communities for as long as possible. This is the key element that is replicated in tonight's motion and it is important to highlight it. The project also aims to provide individualised support on a needs-led basis, including home-based respite, crisis intervention and home from home respite; to acknowledge that the project is an additional service and is not to replace existing services; and to improve the quality of life for people with dementia and their families by providing high quality, flexible, person-centred care.

The project has been ongoing in south Tipperary for the past three years. The funding is coming to an end in October and we hope funding will be made available to ensure the project will be continued, mainstreamed and rolled out on a national basis. The project has dovetailed with and been part of the process of the development of the national dementia strategy, which was published in December 2014. It is important to remember that, due to our demographics, dementia is a widespread problem and will become more prevalent in the future. It is estimated that approximately 48,000 people suffer from dementia in Ireland, and this figure is projected to reach 96,000 by 2031 and 140,000 by 2041. This is a very significant demographic and is a time bomb at the heart of communities across the country.

The supports and services put in place in south Tipperary by the project can be replicated nationally. The scope of the project is to transform the life experience of people with dementia and their families by increasing public awareness of the illness among the public, dispel myths that surround it, reduce stigma and encourage people to come forward for early diagnosis and treatment. The project is entitled Five Steps to Living Well with Dementia. The first step is pre-diagnosis, building awareness in the community and providing timely information for as many people as possible. The third step is to deal with progressive dementia by way of home-based support from dementia support workers. The fourth step is advanced dementia, which involves the provision of a memory library and assistive technology equipment. The final stage is living well and dying well. The five steps were built on during the project. The first step is delivered through a clinical nurse specialist. There is great value in this service, which enables people to connect at an individual level with the health service and get support on the basis of their individual needs. Creating and raising awareness in the community was done through talks in community organisations, libraries, day care centres, pharmacies, men's sheds, sports partnerships, the Irish Countrywomen's Association, ICA, and meals on wheels. Awareness is a major part of it. There was a significant and effective localised media campaign which was significantly helped by the local radio station, Tipp FM, which was a key element of it.

Deputy Thomas Pringle

I thank Deputy Tom Fleming for introducing this Private Members' motion and dedicating the time to issues around elder care in Ireland. It is a timely issue, coinciding with yesterday's Dáil motion expanding the Ombudsman's remit to include private nursing homes. As I stated yesterday, our over reliance on private residential care and our approach to elder care has led to under investment in our home care sectors. The sector is reaching a critical stage as demand for home care increases with an aging population taking hold while people begin to prefer a more holistic approach to elder care needs. Predictions suggest that 75,000 people could seek to avail of home help services in 2021, compared with 48,000 in 2012.

There is a growing trend of people with low to medium support needs being admitted to residential homes such as nursing homes. ALONE's Home First campaign has tracked this trend, observing that 35.4% of people in the long-stay beds have low to medium support needs with an increase of 44.6% in the number of low dependency beds since 2004. The number of medium dependency beds has increased by 17.6% since 2004, while the number of high to maximum dependency beds are decreasing. High dependency beds are more likely to be kept in community hospitals, where there are nursing staff available to deal with patients. We can only imagine how many of these people are also located in hospital accident and emergency wards throughout country. This has become our policy for dealing with chronically ill elderly patients, leaving them physically on the margins of the health care service.

It is clear that nursing homes have a policy aimed at a lower level of needs for easier and more manageable environments, to reduce staff costs and in an effort to increase profits. Simultaneously, the Government has cut funding to vital home care supports for both carers and elderly patients, including supports to improve their housing environments. To further add to the disintegration of the home care model, the number of people aged over 65 is increasing and will reach nearly 1 million by 2031, an increase of more than 86% or an extra 20,000 people every year. Some 7% of people aged over 65 live in nursing homes in Ireland, compared with just 4% in the Six Counties. People want to age with dignity and respect and as thriving members within their communities, and home care should and can reflect this. These principles are even reflected in Government policy documents, such as the programme for Government, the national service plan and the national positive aging strategy. Unfortunately, home care continues to be underfunded, under-regulated and undervalued by the Government.

Home care can take place in a number of arrangements, informally through family members, friends and neighbours or professionally through the HSE home care packages either directly or outsourced to private care companies, which is a growing trend. This country does not appreciate or respect the role of carer and many family members care for an elderly relative and others provide informal care. The carer's allowance and respite care grant have been under constant attack and scrutiny in successive budgets. It is imperative, if we are to have an ounce of respect for the role of carer, that we invest in and protect our carers in the community by maintaining these supports and improving on them to fit within the home health model. The carer's allowance must be maintained alongside the half rate carer's allowance.

People could also be encouraged into employment by becoming carers if the Government had the imagination when it comes to labour activation measures.

Direct supports to elderly people are also under threat. The living alone allowance does not reflect the current standard of living while the over-70s GP card is too restrictive, allowing only free GP care without access to the services which come with the medical card. EUROSTAT data released this year showed the Government spent just 10% of social protection outlay on the elderly in 2013, almost 12% less than the eurozone standard. Countries like Bulgaria, Luxembourg, Austria and Romania all dedicate over 25% of their spend on the elderly. The State pension has not seen an increase since 2009. For many elderly people, their weekly incomes have been cut by over €14.

It is important the household benefits package, the free travel scheme, the Christmas bonus, the housing adaptation grant, the disability grant and other supports for the elderly are maintained in the forthcoming budget. A lack of financial investment in home help hours and home care packages, cuts to mobility aid and a lack of housing supports have meant elderly people have been forced away from the home care setting and into residential care. Up to 1.6 million hours of home help were removed from the sector over the past four years. Funding for home help services declined by almost by almost 12% since 2009. Overall, 72% of the older people’s services budget is spent on the nursing home support scheme, fair deal, while only 9% of the budget is allocated to home care packages. Housing supports, such as the housing adaptation grant, have seen a reduction from €79 million in 2011 to €50 million in 2015. As a result, home care provision is incredibly underfunded and is unevenly distributed across the country.

Thankfully, Donegal has one of the lowest proportions of elderly people living in nursing homes and has a culture of supporting the elderly in their homes. However, this too has been put under threat with cuts to home help hours, or rather home help minutes.

We also have a highly unregulated home care system. Many informal carers are not recognised and there are no set standards or legal obligations on home care provider companies to vet staff. HIQA is left with no remit to monitor or enforce the sector, even though we have heard time and time again of dreadful standards witnessed in some private home care settings. The HSE is paying millions of euro to home care providers but due to an unregulated market, thousands of elderly people are at risk of poor quality care, abuse and medication failures. This is against a backdrop of a majority of over 50 private providers in Ireland not having relevant external quality assurance certification. Certification is only reflective of their business practices and management systems, not the level and quality of care they provide for an elderly person.

The HSE claims the approved providers are selected through a tendering process, covering areas such as client focus service, appropriate complaints processes and training and supervision of staff. A new tendering process was meant to be completed in 2013 but here we are in 2015 and we still have not seen the roll-out of this. It is over four years since it was first promised and we do not have another four years to wait. It is needed to ensure a high quality of care for elderly people.

I acknowledge the incredible work done by voluntary organisations such as ALONE and Age Action in the area of home care provision, independent advocacy and campaigning for the rights of elderly people and their needs. I only wish the Government could have such a strong record as many of these organisations have shown. We might otherwise be witnessing a more dignified approach to our most vulnerable in society.

Deputy Michael Fitzmaurice

I commend Deputy Tom Fleming for tabling this motion and the Government on accepting it. However, implementing the proposals set out in the motion will be a separate matter. I hope all of Deputy Fleming’s proposals are implemented by the Government.

We all know of the increasing ageing population in the country, particularly in the west, be it parents, aunts, uncles or neighbours. These are the people who laid the foundations for the rest of us through hard work and have passed on the baton to us. These are the people who, in their latter years, deserve to age with grace and dignity. We do not need to take away their free bus travel, telephone allowance or television licences.

Carers, be they relations, neighbours or professionals, do much work in helping the elderly. However, it is sad to see their hours being cut down to only 45 minutes. This needs to be re-examined. Putting a person into a nursing home instead would cost more, however. The maths of home care packages are simple, with employment being provided to many while the elderly people enjoy staying in their home.

This evening we learned the HSE has cut funding to men’s sheds. Rural isolation is becoming a major problem. Many people in rural areas do not go to the pub, for example, or do not meet people during the day. The men’s shed brought people together and saved the country money in mental health services provision. I accept efforts have been made to continue rural bus services, like in Roscommon and Leitrim, but their funding needs to be secured into the future, not decided on every year.

I thank the Minister of State, Deputy Kathleen Lynch, for committing to keeping the Rosalie unit in Castlerea, County Roscommon. We need full teams of nurses and carers to assist elderly people across the country. I know there is a pilot project in Galway which is working well. These projects can actually save money in the long term. Every old person wants to spend their last days at home with their families and neighbours. We need to ensure the recommendations of the national positive ageing strategy are carried out. We will all be elderly some day and will want a system in which we will be cared for with dignity.

Leitrim has the highest rate for dementia per head of population, followed by Roscommon. I hope during the summer we can devise a new system of helping those with dementia to be able to stay in their homes. I recently visited a company in Athlone which is producing new devices that will make it safer for people with dementia to live at home. These products will ensure, for example, that a cooker will turn off or the front door will lock if they leave the house. In England, there is no VAT on these items. I will be making a similar submission in the forthcoming budget. While a VAT exemption cannot be provided, a VAT refund could be given to family members who wish to buy these products for an elderly relative suffering from dementia. These are ideas we must examine to make it more flexible for elderly people to live at home.

In addition, the few hours of caring that a neighbour could provide could make it viable for another family in an area where there might not be much employment or industry.

We need to examine this matter in terms of the whole of its benefit to communities.

I commend Deputy Tom Fleming and hope the Government implements some of our suggestions.

Dáil Éireann debate - Wednesday, 15 Jul 2015

Social Services and Support: Motion (Resumed) [Private Members]

Dáil Éireann debate -
Wednesday, 15 Jul 2015