That leave be granted to introduce a Bill entitled an Act to allow for the provision of home care services to a person who qualifies for and is being offered long-term residential care in circumstances where suitable home care services can be devised for that person and such services are less costly on the State than the long-term residential care being offered and to provide for related matters.
I thank the Ceann Comhairle's office for facilitating this matter. State policy or at least State philosophy in this country is that elderly and infirm people should be catered for in so far as possible in the comfort and security of their homes. However, as in many other cases, philosophy and practice diverge.
If somebody reaches the position that they are too old and infirm to look after themselves or for their family to look after them without support, two routes are open to them. The first option is the fair deal scheme where somebody goes into a nursing home, pays the appropriate contribution and is supported by the State. The second option is home-care services. As the fair deal scheme is on a statutory basis, people have an absolute right to it if they fulfil the relevant criteria. Home-care services, on the contrary, are given on a discretionary basis. Therefore, State policy has directed more people to the fair deal scheme than should otherwise be the case.
Another issue with the home-care scheme is that it is geographically based. Therefore it depends on whether the various ingredients that make up an appropriate home-care package in any case are available in the locality where the patient resides. Local health officials may determine that if the necessary ingredients are not available in a locality, the patient will have no option but to opt for the fair deal scheme. Ironically it costs the State approximately three times as much to provide a fair deal package as it does to provide a home-care package. If the home-care package were put on a statutory basis whereby people who meet certain criteria have an absolute right to it, more people would opt for the home-care package with a considerable saving to the Exchequer.
Existing home-care services are sporadic and inconsistent. They are not patient driven and there are significant geographical disparities in the availability of services. Often it depends on where the person happens to live. There is no transparency in eligibility criteria and decision-making; it is entirely at the discretion of the health service. In view of this, many elderly infirm people have little choice but to opt for nursing-home care at far greater cost to the Exchequer. The ultimate solution to this is to amend the legislation providing for the fair deal to have a similar set of criteria for home-care packages. The health criteria should be the same but the financial criteria would be different to reflect the different cost structures of looking after somebody in a nursing home as opposed to at home.
I am currently drafting legislation to encompass this but in the meantime this Bill would provide a temporary solution whereby if somebody is assessed for the fair deal, he or she would have a right to request that a home-care package be put together. The health service would be compelled to put that home-care package together and the patient would be entitled to receive it as opposed to the fair deal scheme if it is less costly for the Exchequer and also if it can be safely done.
I emphasise that when I say "less costly for the Exchequer", I am talking about the difference between the net cost to the Exchequer of home care packages under the fair deal scheme after the person's contribution has been deleted and the full cost of a home care package. I am not suggesting that as part of this Bill we should propose to impose a charge for home care packages. I think this legislation is a reasonable first step towards putting home care services on a statutory basis for the benefit of the population at large and, not least, for the benefit of the taxpayers of this country. I commend the Bill to the House.