Older People: Motion [Private Members]

I move:

That Dáil Éireann:

acknowledges that:

— it is long-standing State policy to support older people to live with dignity and independence in their own homes and communities for as long as possible;

— as of 2018, home care services are being delivered through a single funding model, combining the home help and home care budgets;

— funding allocated to enable older people to remain at home provides not only the best value for money but also the most humane result for older people;

— the Home Care Package (HCP) was introduced in 2006, and there has been a significant increase in numbers of HCPs provided since then;

— the Economic and Social Research Institute has forecast an increased demand for home care of up to 66 per cent by 2030;

— the Health Service Capacity Review anticipates an increase in demand of some 120 per cent;

— the share of population aged 65 and over is projected to increase from one in eight to one in six by 2030;

— the number of people aged 85 and over is projected to almost double by 2030;

— there will also be a major increase in the numbers of people with dementia in the coming decades;

— the availability of home care also has significant consequences for capacity in other areas of the health service;

— the number of delayed discharges in hospitals has increased from 481 to 613 in 2018;


— 136,239 hospital bed days were lost through delayed discharges in the first eight months of 2018;

agrees that:

— the demand for home support continues to grow and waiting lists for services have become a feature;

— there has been a significant increase in the numbers waiting for home support, from 4,481 people waiting for public home help and a HCP in 2016, to 6,287 in 2018;

— it is a matter of concern that waiting times for home support are not currently collated nationally;

— there is a lack of information around services, and geography, not need, is determining access to care;

— the roll-out of the Single Assessment Tool (SAT) for the assessment of care needs has been too slow;

— the processing of applications for the carer’s allowance is too slow;

— at around 6.5 per cent, the proportion of the population aged over 65 years receiving home support in Ireland is significantly lower than the Organisation for Economic Cooperation and Development estimate of approximately 10 per cent of this age group needing such services; and

— supported housing options must also be provided as an alternative to residential care; and

calls for:

— a sustained and significant increase in investment in home support to meet existing unmet need and future requirements;

— measures to expand the availability of supported housing for older people;

— home support to be adaptable and responsive, especially for conditions such as dementia;

— individual need to be the decisive determinant of care, not geography or funding;

— the accelerated implementation nationwide of the SAT;

— a statutory system of home care which gives priority to those who need it and is regulated fairly for both care recipients and carers;

— home support to be provided on a seven-days-a-week basis; and

— timely and efficient processing of applications for the carer’s allowance.

I welcome this much-needed debate on older persons' care. I hope it will be very constructive. The continuing challenges in meeting the care needs of Ireland's older people must be addressed by Government. We need a sustained and significant increase in investment in home supports to meet existing unmet needs and future requirements. Our motion is in direct response to what I and my Fianna Fáil colleagues across the country and, I am sure, many other Oireachtas Members see on a weekly basis. Every week, people in all of our constituencies are worried about their family members who cannot access home care packages. It is a long-standing policy to support older people to live in dignity and independence in their own homes and communities for as long as possible. As we are all aware, Ireland has an ageing populating. It is estimated that we will have 1 million people aged over 65 by 2030. As we know, we are all going in only one direction. I often liken this to a tsunami coming at us. By 2030, a large proportion of our population will be made up of older people.

Every day, 11 people in Ireland are diagnosed with dementia. This is extremely challenging for families because 63% of all our older people who have dementia live in the community. I hope the provision of dementia advisers will be addressed in the HSE service plan. I have discussed the issue at length with the Minister of State and I appreciate that. These advisers would also help the situation by providing much-needed guidance and signposting for hard-pressed families reeling from the news of a recent diagnosis. People with dementia have specific home care needs that differ from those of other cohorts. It is important that this is highlighted.

While I acknowledge that the Government has spent €411 million on home care supports, we are still a long way off of where we need to be. There is a shortfall in respect of 6,287 people. These are our mothers, fathers, aunts and uncles. They are all family members and they need our support. People want to be able to live at home in the bosom of their families with the correct wraparound supports for as long as possible.

We are facing a winter of discontent in the healthcare services. The figure of 6,287 people to which I referred is an increase of 700 on last year and an increase of 1,800 on 2016. The figures are going in only one direction, which is a seriously worry. The availability of home care can also have significant consequences for capacity in other areas of the health service. There are approximately 600 people in an acute hospital setting who cannot be released into the care of their community because the necessary supports cannot be found. If these people could be released into the care of their families in the community, it would go a long way towards solving the issues we have daily with people lying on trollies. It would free up capacity if we could put home care supports in place. Some 136,000 bed days have already been lost this year due to late discharges. In many cases, the reason for these late discharges is that the home care supports are not put in place in a timely manner when needed.

This motion calls for home support to be provided on a seven days per week rotation. I have discussed this with the Minister of State before. Currently, the majority of home care supports are provided by the HSE from Monday to Friday and by private providers such as Home Instead or Caremark at weekends. They all do a fantastic job but when a person living in a rural area needs two people to hoist him or her out of bed three times a day and help with toileting and so on, it can sometimes be very difficult to find people for these tasks on a Saturday or a Sunday. I know of people who have been put to bed at 7 p.m. on a Friday evening and have not been able to get up again until Monday morning. It is not that they do not get some form of support but that they do not get the two people required to hoist them in or out of bed. That can be very challenging for their families.

We also need to see a sustained and significant increase in investment in home support. I know the Minister of State made an announcement today and I am sure he will deal with it. We can discuss it later. It is also important that individual need, rather than geography or funding, is the primary determinant. We see demand vary between the various community healthcare organisation, CHO, areas. Some areas face significant challenges. I was struck by figures showing that Galway has 674 people waiting for home care supports, while 578 people are waiting in Wexford. My constituency of Waterford fares better with 97 people waiting for home care supports. However, one person waiting is one family too many.

Administration and medical staff are being put under extreme pressure to juggle hours. I am lucky to have a very good relationship with a service provider in Waterford. She is a fantastic lady who I can ring her on a Friday evening when somebody is in trouble in a given area and she will juggle her hours as best she can to deal with it. I am lucky to have that excellent relationship with her, but not everybody has such a relationship. It is wrong that families have to pick up a phone on a Friday afternoon to tell their local Oireachtas Member they have just been informed that only one person will be available the following day to provide supports when two people are required. This creates an awful predicament for the administration and medical staff who are trying to juggle this.

It has come to my attention that in some areas there is no budget left to provide any more home care packages between now and Christmas. The only way to provide this support is if, unfortunately, a member of some other family passes away. That might free up eight, 12 or 14 hours, which can then be allocated to someone else. That is hard on the staff dealing with the matter.

It must be acknowledged that it costs the State three times more to look after older people in a nursing home than it does to look after them in the community. It makes sense to keep older people in their own homes for as long as possible. I fervently believe that if we get the home care supports right - I will speak about community care later - the knock-on effect throughout the acute hospital sector would have to be acknowledged. If we could have people released into their communities from acute hospital settings in a timely manner, it would be a good day's work.

I compliment my colleague, Deputy Butler, on this very timely motion, particularly when we know there is a trolley crisis. As the Deputy outlined, people often find themselves on a trolley because home care packages and supports are not in place to allow their families to take them home. She also outlined the facts showing that it is three times cheaper to keep a person at home than for the State to take care of him or her in a nursing home. That makes the case in black and white.

In Cavan-Monaghan, there are 240 people on the waiting list for home care packages. As we know, this is one of the greatest crises for families whose older members depend on the support, assistance and care that enables them to stay in their own homes. I will cite two particular cases. All of us deal with a large number of these cases in our offices but these two cases are particularly heart-wrenching. One involves a gentleman in his 90s who was allocated a home care package last May. His wife, who is in her late 80s, spent 25 years of her working career as a carer for the HSE. While I am not saying she should have been shown a positive bias, one would assume that someone who has given her life to minding others would have been taken care of. However, the home care package was not provided until October, almost six months later. When I contacted the HSE about this particular case, it replied as follows: "Unfortunately as the home support service must work within an allocated budget, a prioritisation system is used to determine each client's clinical needs." This case involves someone in his 90s whose wife is in her 80s. The person who contacted me about it is their daughter who is young widow. She has one son to raise and depends on her job as a special needs assistant in a school. It was not an option for her to take time away from the school.

I support the motion. Anything the Minister of State can do to ensure there are more home care packages would be very welcome.

I thank my colleague, Deputy Butler, for bringing forward this timely motion. She acknowledged an announcement the Minister of State, Deputy Jim Daly, had made during the day. My concern is that we are not short on announcements but that we are very short on the delivery of home care packages. The Minister of State is aware of how much time I have spent engaging with him and other Ministers in trying to deliver much needed home care packages. This is not about staff but about the lack of funding. For example, since 2016 the number of home care packages has increased by 2,000. That is causing bed blocking in hospitals and nursing homes. We know that people are more comfortable living in their own homes where they are happier. However, additional funding is not being provided to meet the additional demand. The maths are very simple - the funding is not available.

In community health organisation, CHO, 7 which covers my constituency of Kildare, part of Dublin and Wicklow a total of 992 people are awaiting approval of home care packages. In Kildare alone there are 260 people waiting. The home care packages cannot be approved because there is no money available. When those responsible met the Minister for Health, Deputy Harris, six weeks ago, they pleaded with him for money because of the crisis. That has been the position since April and the number waiting has been increasing month on month. Where is the money going? Why are services not being delivered and why are home care packages not being provided for people who have been identified, assessed and approved to receive them? The reason they cannot be put in place is there is no money available.

I will quickly outline two cases for the Minister of State. One concerns a constituent who was in Peamount Hospital. It was decided that he would be moved to Naas because of bed blocking. He is going back to Naas Hospital or another hospital as they have been trying to have him moved. This has been ongoing for five months because the home care package has not been approved.

Another case concerns an old lady in her 80s who has a heart condition. Her husband is very ill, but she cannot have a home care package put in place. This week she borrowed money from a moneylender to keep her husband in a nursing home until a home care package is put in place. That is the reality. We need home care packages to be approved and funding to be put in place.

I compliment Deputy Butler on tabling the motion and the seriousness of the discussion. The Minister of State knows as well as anybody else that since July the provision of home care packages and the allocation of additional home help supports for families throughout the country, especially in County Cork, have completely dried up. It is impossible to assist constituents who come to us for help to keep their loved ones at home and provide every support they can for families. Families look at ways by which they can work around their work schedules and other family commitments to try to ensure they will have supports in place. Nurses and other health professionals recognise the chronic need for additional support, but it is not available. What we are being told by the HSE is that no additional home help hours are available. In some cases, the numbers of hours have even been reduced.

A figure was trotted out again this morning for the number of extra home care packages being allocated in order to alleviate a potential trolley crisis in December and January. Given the number in chronic need of help, I would dearly love to see the 550 home care packages allocated. In some cases an elderly husband or wife is caring for his or her partner or loved one and he or she is looking for extra support. The situation is simply not acceptable. I put it to the Minister of State that we will come back here in the first or second week of January to see whether any of the extra home care packages has been allocated. I believe they will not have been. We must be serious about this issue because there is a chronic need for help across services.

I thank Deputy Butler for introducing the motion. As the Minister of State can hear, we all have stories of problems from our constituencies. I have raised the issue with him on the Order of Business and the problem has persisted throughout the year.

I acknowledge the work of the public health nurse in my area and, in particular, the staff in Cherry Orchard who deal with this issue. They are in an impossible position. They are trying to cherry-pick who should receive help and when they should receive it from very limited and diminished resources available. The pressure they are put under is not fair. They are trying to decide how the resource should be divided between two families.

The HSE's national service plan indicated clearly that it would provide 50,500 home support service packages in the year. In response to parliamentary questions I have been told that 52,500 people are in receipt of home support service packages and that another 6,000 are on the list. It appears that at the beginning of the year the HSE grossly underestimated the level of need, yet no attempt has been made during the year to correct the position. That is the underlying and persisting problem.

Another problem is that the HSE is unable or unwilling to state for how long people are on waiting lists. In response to parliamentary questions I have been told that slightly in excess of 6,000 are on waiting lists. My area is serviced by CHO 7. At the start of the year while 6,000 were waiting nationally, 650 of them were in CHO 7. By April the figure of 650 had risen to 857. The latest figures I received from the HSE this week are to the end of August. In total there are 6,200 waiting, but the number in CHO 7 has increased to 1,111. There is a very specific and particular problem in CHO 7 where the numbers are spiralling out of control. Will the Minister of State, please, examine the issue?

I thank Deputy Butler for introducing this important and timely motion which concerns older people not receiving the home care supports they need. Many families are often misled into believing the battle has been won once they receive approval, yet it only begins at that point to receive the service for the number of hours approved. Elderly, vulnerable and ill people who have been assessed as being in need of support are not receiving it. A total of 578 people in Wexford are waiting to receive home support services. The waiting list is one of the worst in the country. Conversely, in many counties there are no waiting lists. Next door in the Carlow-Kilkenny area nobody is waiting for support. Why are vulnerable people in Wexford being discriminated against in comparison to people living in other counties?

I will briefly provide three examples for the Minister of State. An 84 year old woman who is living alone and crippled with arthritis has been approved for a home care package for almost one year, yet she does not receive support for even half an hour. An 85 year old who is bed ridden and living alone can receive no support at the weekend. A 74 year old who has an oxygen tank, cancer, chronic obstructive pulmonary disease, COPD, and asthma and been approved for home support for almost a year cannot receive any support. What does the Minister of State say to these people? It is totally unacceptable that so many older people cannot receive the vital supports they need, but it is outrageous that some counties such as my own - Wexford - are bearing the brunt of the waiting lists. Why are older people in Wexford being discriminated against and when will it end?

I add my voice to the others in debating this extremely important motion. The current method of allocation of home support hours is far from satisfactory. Access to healthcare should never be based on a postcode; it should be open and transparent and the system applied consistently throughout the country. Thankfully, home supports provided in my region are good. I acknowledge the administrative support staff who run the scheme and also those on the front line who provide care for individuals on a daily basis to allow them to stay in their homes where they want to be. However, as my colleagues have done, I wish to raise some hardship cases.

In one case an adult child is being cared for by two parents who are almost 80 years of age. They have provided care for their adult son for more than four decades. He has Down's syndrome and now Alzheimer's disease. They urgently want him to move into long-term care because they can no longer physically provide care. However, there is no place available for him. As a compromise, they have been told that they have been approved to receive 14 hours of home help. However, there is a waiting list. The business case has been made and the HSE is waiting for recycled hours to come back on-stream. That is not good enough in this day and age and must stop. That is the reason my colleague Deputy O'Dea produced a Bill to place the provision of home care services on a statutory basis, just like the fair deal scheme. It would ensure people would have access to home care services. It would make good economic sense and, far more important, good social sense. If anything is to come from this motion, I encourage the Minister of State to accelerate the passage of the Bill to give people confidence that they will be looked after in their homes in their old age.

Táim buíoch as ucht an deis labhairt faoin ábhar tábhachtach seo. Sa chéad áit, ba mhaith liom mo bhuíochas a ghabháil chuig na Teachtaí as ucht an méid atá ráite go dtí seo.

I thank the Deputies opposite for raising this important issue. In particular, I thank Deputy Mary Butler, who always has been, if anything, highly consistent and commendable in her approach to issues affecting the elderly, especially in the areas of dementia and home care. I wish to acknowledge at the outset her consistency and collaborative approach in working on this issue at all times. Although she is a very nice person socially, I dread meeting her on the corridors. I find myself ducking the corridors more often than not because of her utter consistency and care in this matter. I wish to acknowledge her collaborative approach. She is always constructive and collaborative and wants to work with others as opposed to scoring cheap political points. She has always found that to be beneath her. I commend and acknowledge her approach in this regard.

We all share the common objective in what is being said today in the debate on the motion. As Minister of State with responsibility for this area, not only do I agree with the motion but I welcome it. Moreover, I welcome the opportunity for us to debate the issues and to share views from all sides of the House. This allows us to increase the focus on the issue. Collectively, we all want to ensure our people are cared for as they get older. Our elderly people represent our most treasured possession and we want to ensure they get to live and age well in society. We want to ensure the very best of facilities for them.

We are all committed to Government policy, which is to allow people to age in their own home and to continue to live as well as they can there. The policy is to provide as many supports as we can to people to live in their own homes.

We have several challenges facing us in the demographics as Ireland catches up with the rest of the EU demographically. Our population is growing older, with the number of people over the age of 65 years set to double and the number of people over 85 years set to treble in the next 20 years. While this will prove something of a challenge, it will also prove an extraordinary opportunity for us as a society to radically change how we approach the care of our elderly. It will allow the inter-generational aspect come to the fore more at a time when our younger people are more and more obsessed with screens and lack of social interaction and so on. This represents an extraordinary challenge for us but also an opportunity to tap into the wisdom, wit, company and friendship of our elderly and young people. We can realise the challenge by working together. We must embrace other challenges that are coming down the tracks and we must look at other opportunities when it comes to care. One such challenge is what is at the heart of this motion, namely, providing home care for the elderly population.

People will know the statistics. Last year, the HSE provided 17 million home help hours. Deputy Curran and others are tenacious in seeking this information. They will know all of these figures by heart. Anyway, it is no harm to put them on the record and to put them into focus. Sometimes we say there is no service there. As politicians we do not have people coming into our offices telling us when they get the service and what they are getting. Rather, we come across people who do not get the service. A total of 17 million hours were provided by the HSE last year. The budget in 2015 was €306 million and it is now at €420 million. That indicates a significant increase in the budget over that period. Of course, that is not enough. I have accepted that every time I have spoken on the matter in the Dáil, including during Questions on Promised Legislation. I acknowledge that it is not enough and that we need more. Yet 52,000 families have benefitted from home care delivery. It is important to acknowledge the good work of the HSE and to acknowledge where the HSE is delivering and providing an exceptional service as well as acknowledging the individuals who are providing the service.

Certainly, I am not shy in wanting to share in the ambition of the party opposite to increase and improve on this delivery and to ensure that we can allocate the maximum possible amount of resources available to us to ensure we continue in this regard.

We are keenly aware and acknowledge that in some cases access to the service may take longer than we would like. However, the HSE monitors the delivery of home care on an ongoing basis to ensure that activity is maximised relative to individual clients' assessed care needs within the overall available resources.

Following the recent budget announcement, the HSE and officials from the Department of Health are in the process of developing and agreeing the HSE national service plan 2019. The plan will set out in detail the type and quantum of services to be delivered in 2019, including services for older people.

In the context of winter planning there has been a sustained focus in recent years on reducing delayed discharges and enabling patients to be discharged from acute hospitals sooner. The HSE is currently finalising its winter plan in conjunction with the Department of Health to provide the most effective response to the challenges to unscheduled care provision in the coming months. The plan will contain a range of measures across hospitals, primary care and community care settings to manage critical demand pressures during winter to ensure the system is working at full capacity throughout busy periods.

As part of budget 2019 an additional €10 million has been made available to the HSE for the winter period for home supports and other supports to minimise delays in people getting home from hospital, with a focus on those in the over 75 age group. My Department immediately sanctioned the release of €5 million of this additional funding to support the deployment of social and primary care measures to enable patients to return from hospital to their home or community with the supports they need. The funding will support an additional 300 home support packages, additional aids and appliances and additional transitional care in the run up to Christmas. The expected impact of these measures will be considered in the context of the broader winter plan.

The HSE has committed to prioritising the full-year cost of these measures in the national service plan for 2019 and to including additional measures in early 2019. These will include an additional 250 home supports packages. This means that in the months ahead an additional 550 home support packages will be made available. Importantly, these measures are being actively operationalised.

Deputy Troy referred to Deputy O'Dea's Private Members' Bill. As Members will be aware, we launched a consultation last year to find out what people would like to see in a home care scheme to be set out in statute and underpinned by statute. The idea is that it would be demand-led like the fair deal scheme. Anyone who wants to go into nursing home care is guaranteed that the funding would be available. Thankfully, it has been available for several years now and people have to wait no more than three weeks for an application to be processed. We have the same ambition for home care. We have begun the journey. The Sláintecare implementation strategy sets a target of 2021 for introduction of the new statutory scheme. We hope that in 2020 we will have an outline of how the scheme will look. However, it will take a further 12 to 18 months before we can get to where we need to be to design the policy in full. Much work has to be undertaken behind the scenes to ensure the availability of staff to respond to the needs of such a scheme. The scheme will introduce clear rules on the services for which individuals are eligible and on how decisions are made on allocating services. For that reason, developing a new statutory scheme will be an important step in ensuring the system operates in a consistent and fair manner for all those who need home support services.

It is important to note that a significant amount of detailed work remains to be carried out before final decisions are taken on the form of home support scheme and the system of regulation of these services.

It is important that people are supported and encouraged to live independently in a supportive environment for as long as possible and to plan for this. The Department of Health and the Department of Housing, Planning and Local Government are working together on developing a policy framework by which Government can facilitate and promote a variety of housing options, including housing with care for older people. The Minister of State at the Department of Housing, Planning and Local Government, Deputy English, and I held an expert conference yesterday on housing for older people. The conference provided the opportunity to hear from experts in housing, health and social care services. It was an opportunity to inform those present on the development of an appropriate policy framework to respond to the challenges and opportunities ahead. The Department of Health and the HSE are participating in a demonstrator project in partnership with Department of Housing, Planning and Local Government, Dublin City Council and the Irish Council for Social Housing. A site in Inchicore has been identified for development of a housing with support model under the Rebuilding Ireland plan, which will deliver 52 homes and is due for completion in 2020.

One important aspect of the home care debate is that we provide real and meaningful alternatives for people who want to move, to downsize or to live in supported environments. These people want a real alternative rather than simply the choice between their own home and a nursing home. There is a mid-way place where people can go to supported housing developments with on-site supports. There are some wonderful examples throughout the country. Many of the Deputies opposite and on this side of the House will be familiar with them. Often I quote the example of Kilmaley in west Clare, where there are 24 units for elderly people. One person is on duty 24 hours per day, seven days per week to provide whatever assistance is necessary to the people there. More important, in 20 years of these 24 units being in place only one person has ever gone from the supported housing unit to a nursing home. Only one person there has ever graduated to a nursing home. Anyone who has had end of life experiences or who has died has either died on-site or in an acute setting. We can be far more ambitious. That is a part of the solution. It is not the whole solution but it is another part of the debate.

We are developing a new statutory care scheme. It will be 2021 before it will be brought in. This comes under the implementation of the Sláintecare strategy. As resources become available we will continue to enhance and improve on the available resources to maximise the amount of home help we can provide to people. We understand the benefits for the acute setting. We understand the advantages of taking people out of hospital, which is the least safe place for elderly people to be when they do not need to be there. We certainly support the motion from the party opposite.

The great Nelson Mandela, or Madiba as he was known, once said that a nation should not be judged by how it treats its highest citizens. He went on to indicate that it is how we treat all within our number. It is timely that we are debating this Private Member's motion this evening, and I commend Fianna Fáil for bringing it forward. I pledge the full support of Sinn Féin for its proposals.

Our older people are the bedrock of our society, those who have contributed so much in building our communities, raising families, working and paying their duty of tax to build a better country. Indeed, they pass on the knowledge they have accrued and experience they have gained to their younger family members, and indeed to younger citizens in general. They deserve our warmest appreciation. Do we treat our elder citizens with the dignity and respect they deserve? The answer, unfortunately, is no. We have been through horrific economic times, which I acknowledge. We are still bearing the scars from those times. Indeed, the cuts that caused those scars over the last number of years are still bleeding inside. However, we can stop this. Revenue returns have improved significantly, and we have more money in our public coffers today, which allows the Government to make choices. The choices it makes will inform the judgment of how we as a nation treat our citizens, especially our older citizens.

The Tánaiste, speaking in this very Chamber last Thursday stated that: "6,269 people approved for new or additional home supports were waiting for funding to be made available". This morning I noted that the Minister for Health, Deputy Harris, and the Minister of State, Deputy Jim Daly, announced an additional 550 home care packages for the winter period, including additional transitional care beds and €4 million towards required aids and appliances. This investment is to be welcomed, but it is nowhere near enough. It comes down to choice. It is estimated that the current waiting time for a home care package averages at three and a half months. Some of our citizens, including some I know personally, have waited years. Three and a half months, however, is still too long to wait. What does this tell us? As is the case in so many other areas of our health service, it exposes a complete lack of capacity caused by under-investment. Based on the figures I have cited, and despite today's announcement, the agony experienced by many people continues.

Perhaps it is a coincidence that this morning's announcement happened on the same day as this private member's business; I would never call it a gimmick or a stunt. Some might suggest that the announcement was made to nullify the embarrassment this Government feels given that its policy choices determine where public moneys go. Whatever the reason, we welcome it for what it is. There will still, however, be 5,700 older people awaiting home care packages to allow them to live in their own home with the necessary additional supports. It seems to me that this morning's announcement was borne of panic.

On a not unrelated matter, today there are 425 Irish citizens lying on trolleys in the corridors of hospitals. Many of them are older people. On this day in 2017 the figure was 448; in 2016 it was 397; in 2015 it was 292; and in 2014 the figure was 321. This Government does not have a handle on the health service, evidenced by the figures I have just cited. The problems are growing. It has been slow to move on the all-party Sláintecare initiative. It has picked and chosen the items it wants to implement, not wanting to upset certain vested interests. The Minister of State, Deputy Daly, only two days ago, referred to "bed-blockers". I am glad that he did not repeat that in his address a few moments ago. That phrase is insensitive. It was repeated by another Member of this House this afternoon. It should be rejected. These so-called "bed-blockers" are people. They are our parents and grandparents, and deserve dignity and respect, and the maintenance of their integrity as they face health challenges in their later years. These challenges are going to present at some point in all of our lives, so I appeal to everyone to show compassion and respect, and to cease using that objectionable phrase.

Sinn Féin absolutely supports the proposition put forward by Fianna Fáil this evening. I would make further points if I had more time, but I ask the Minister of State, in making the choice to put more euro in the pockets of those who already have enough, to remember that not everyone wants that. Many Irish people are carers, and many more care.

Home supports, home help packages and home help hours are some of the most vital services provided by the State. This was evident to me as someone who represented home help workers a number of years ago when the Fianna Fáil-led Government brought in the moratorium on recruitment. As bad as things were, home help workers were exempted because it was a good value for money service. There were other issues in terms of the hourly pay, but it provides great value for money. In truth we should be making sure that the provision keeps step with the age and demographic profile of the population, and the fact is that neither the Minister for Health nor the Fine Gael-led Government have provided the financial and human resources necessary to do that.

The percentage of our population over 65 years of age and over 85 years of age is increasing every single day. This is really good news, and is also entirely predictable from Central Statistics Office, CSO, data. Every single time we raise this issue, either here on the floor of the House or via parliamentary question, we are told that the population is aging and that there is an increase in demand for services. This is completely predictable, yet the Government acts surprised. People aging and requiring home support is not the reason for waiting lists. Waiting lists are caused by poor planning. To date, the planning for this has been absolutely atrocious. In 2016 there were 4,481 people waiting for home help. Today, that number has increased to 6,287. What kind of planning does that represent? We knew there was going to be an increase in demand. Some counties have been totally abandoned. Some 674 people are waiting in Galway, 623 in north Dublin and 578 in Wexford. The situation is a serious cause for concern, because these waits for care contribute to an increase in instances of illness.

Getting older or having a disability should not leave a person invisible in this State. The supports should be in place. I represented home helps, but we also spoke to the people who were availing of home help services. Those people do not want services on the cheap. They want to know that the person coming into their home has a decent job, decent pay and decent terms and conditions. As I said at the outset, home helps provide a fantastic value for money service. I commend the Fianna Fáil Deputies for bringing forward this Private Member's motion and I am delighted that Sinn Féin is supporting it.

I commend Deputy Butler for bringing forward this motion. The issue of home help is one that we all deal with on a regular basis across the whole country. The Minister of State in his speech mentioned that the provision has grown and that more money is being put into home help, and that he has a continual need to better resource the service.

The reality on the ground which everyone needs to acknowledge is that demand is moving beyond provision. As the elderly population continues to grow, there will obviously be greater demand. We are not even keeping up with the current demand, never mind future growth.

It is an issue of geography. Some areas are worse off. In rural Ireland it is particularly difficult to obtain home help services. One of the things that stands out for me is that many of the new packages are part home care packages; they are not full packages. A problem is diagnosed and a solution determined. It is deemed necessary to prescribe a certain number of home help hours for someone coming home from hospital. The district nurse determines what is needed. When the service is required, a package may be put in place, but it might include only half of the number of hours required. There may be no service provided at weekends. I am dealing with an elderly person whose family have been told to hire someone to provide home help for an additional number of hours.

That is the position for the vast majority. First, they find it difficult to obtain a service in a lot of rural areas. If it is available, a huge cost is put on them. Many of them paid taxes all of their lives. They worked long and weary years with the expectation that at the end of their days the State would care for them, having paid and contributed so much to it. They feel extremely let down.

The waiting list issue was mentioned. It was said that in some counties waiting lists were much shorter than in others. Deputy Louise O'Reilly obtained some lists a couple of months ago and I could not understand them. They showed that nobody was waiting in community healthcare organisation, CHO, 1 in Sligo, Leitrim and Donegal, yet when I contact the service, I am told that hundreds are waiting. Sometimes the figures are massaged by someone to look good, but looking good is not good enough for the people who need the services. The waiting lists are very often misinformed, which needs to be acknowledged.

I commend Deputy Butler on bringing forward the motion. The issues raised clearly need to be dealt with as quickly as possible. As a merry little dance goes on as the confidence and supply agreement is worked out, I expect the motion to be a signal that the issue will be front and centre and that if a deal is finally done, we can expect to see increased provision of home help services and services for older people before Christmas.

I welcome the motion tabled by Fianna Fáil on the need to deliver a sustained and significant increase in investment in home supports and the provision of seven-day cover for older people. It is an issue that affects every county in the State, none more than my county of Louth. Fine Gael, with the Labour Party, the party's former partner in government, removed the 23 public long-term care beds from the Cottage Hospital in Drogheda. They also removed the 15 respite care beds and replaced them with temporary step-down beds to facilitate the transfer of patients to private nursing homes. At the time, Fine Gael and the Labour Party promised a new 100-bed facility at St. Mary's Hospital on the Dublin Road, but it never materialised. It was clear that the Government never had any intention of delivering a new 100-bed facility. The plan was to force people into private nursing homes. That has to be the most sickening aspect of it all. When Fine Gael looks at old people, it does not see mothers, fathers, grandparents, aunts, uncles or families. It sees profit. It looks at an elderly person in a bed and all it sees is a cash machine, a euro sign over the bed for the benefit of its private nursing home buddies. The idea of elderly care as a cash cow for private interests runs through the entire system. For example, under the fair deal scheme, many patients have to pay for toiletries, newspapers, hairdressing costs, transport to hospital appointments, prescription charges and many other items and services. Perhaps most seriously, patients must also pay out of their own pocket for therapies such as physiotherapy, speech therapy and chiropody. They even have to pay for social programmes, despite having already paid for their care through the fair deal scheme contribution. This is blatantly forcing elderly people, many of whom are vulnerable, to pay for their care twice.

Earlier this month Care Alliance Ireland published a report that outlined the shocking deficiencies in service provision. It made for stark reading. Up to 6,000 people are waiting for a home care service and the average waiting time is more than three months. Those who are deemed to be "low priority" can be left waiting for more than two years. Another shocking statistic is that people are receiving up to 18% less home care than their assessed needs. There are such cases all over the State, particularly in County Louth. There are cases where care for half an hour is provided, despite assessments showing that a higher level of support is required.

The Government needs to face up to this reality and no piecemeal approach will solve it. If the Government is going to boast about the importance of independent living, it needs to back it up with services. It is clear that Fine Gael is incapable of working in the interests of elderly people. It has failed them miserably on every count, but, above all else, it fails them when they need help the most.

I welcome the debate and commend Deputy Butler on her consistency in dealing with the issue of dementia. I have vast experience of dealing with the issue. Working with elderly people with dementia for three years as a care assistant in Cherry Orchard Hospital gave me probably the best life experience I have had in my life. I refer not only to the elderly people there but also the staff and relatives who had to deal with this issue. It is testimony to the staff who work in health services. They show such dedication in these extremely difficult circumstances. The debate we are having is welcome.

Elderly people have suffered immensely because of austerity cuts and increasing poverty levels in the last decade. A report in the Irish Examiner in March this year estimated that 65,000 older people were at risk of poverty and that 85,000 people experienced deprivation. Another report in October stated about 6,000 elderly people were on waiting lists to receive home care support. This issue urgently needs to be dealt with.

To deal with the present we must deal with the past. In 2008, in response to Fianna Fail's attempt be bring forward changes to the medical card scheme for the over-70s, more than 15,000 older people mobilised to force an embarrassing climbdown by the then Fianna Fáil Government. In another blow to elderly people Fianna Fáil intended to reduce the State pension in 2011, but huge pressure from elderly groups made it back down. However, it managed to make significant cuts to carer's benefit, carer's allowance, disability allowance, widow's, widower's and surviving civil partner's contributory pension and death benefit, all of which hugely affected the elderly. These are not abstract actions but decisions that greatly affected older people's lives and well-being.

Let us not forget the former Minister for Health and Children, Mary Harney, who in coalition with Fianna Fáil introduced the fair deal nursing home support scheme in 2009. Instead of providing public care for the elderly, the scheme introduced a co-payments system under which the cost of care was shared between the State and patients, making people pay for services to which previously they had been entitled under the guise of so-called "fairness". By 2011 the funding allocation for the scheme had run out, leaving elderly people waiting in hospitals instead of nursing homes. It was an abject failure caused by the very bad decision to privatise elderly care services. I also note that the Minister of State, Deputy English, made a statement in the Irish Examiner yesterday that public lands could be used to support private ventures such as retirement homes. It was a bizarre statement. Both the Minister of State, Deputy English, and Deputy Daly were quoted in The Irish Times warning that a housing crisis was looming for older people. Of course, they are right; the ongoing housing crisis affects everybody.

I am curious as to how the obsession with privatisation and the market is going to solve the housing crisis or provide care for the elderly. We can see the damage this agenda has caused and is causing and what it will do in the future. I hope this is only the beginning of improvements to care services for the elderly, as weak mitigations will not be enough to provide care on an equal basis for all.

The Minister has confirmed that the HSE will make 550 additional home care packages available over the winter. Obviously, this is welcome, but it is not nearly enough.

There are more than 6,200 older people waiting for home care packages nationally. The 550 additional packages would not even clear the 578 waiting in Wexford alone.

The Fine Gael-Labour Party Government - it is interesting that the Labour Party did not turn up today - destroyed home care hours. The reported additional 550 care packages need to be seen in this context. Using the original 2011 HSE service goals for home care as a baseline, Care Alliance Ireland found a deficit in provision in 2016 of 1.64 million hours. In its most recent report, published last month, Care Alliance Ireland shows that while provision has increased since, the rate of increase has simply kept pace with demand. Therefore, it estimates a deficit in provision in both 2018 and 2019 of a similar amount, in both cases well in excess of 1.5 million hours. That is a scandalous figure.

There is a considerable discrepancy between the figures on the waiting lists in various counties. The figures reported last week from a freedom of information request received by Sinn Féin show that in Wexford there are 578 people on the waiting list for home care support. In Louth, there were only two on the list. There is nobody waiting for supports in Kerry, north Cork, north Lee in Cork city, Carlow-Kilkenny and south Tipperary. I have many questions about these discrepancies between the numbers of people on the waiting lists. The Minister of State, Deputy Jim Daly, will not be surprised to hear that I find it a bit baffling. Does each community healthcare organisation, CHO, area or local health office get the same budget per head of population? If so, how do we account for the wild discrepancies between the different counties? Are we to believe that Wexford and Galway, for example, have a grossly disproportionate elderly population compared with Kerry, Carlow-Kilkenny or south Tipperary? If that is the case, which I do not believe is so, surely Wexford and Galway should be getting suitably larger budgets. Is it the case instead that the administration of home care packages in Wexford is completely inefficient and not fit for purpose? Is it the case that Kerry and Carlow-Kilkenny are faster and more efficient at assessing claims? The Minister for Agriculture, Food and the Marine, Deputy Creed, during Leaders' Questions two weeks ago, stated:

It is not simply a case of throwing money at the issue. We need to make sure that the additional resources that we provide are used appropriately.

The Government is essentially saying that this is a failure by the respective CHO areas to manage their budgets properly.

One Wexford family who are desperately in need of a home care package have been in contact with my office. Ms Finula Byrne is just 39 years old. It is important to remember that home care packages are also sometimes required for younger people. Finula normally lives at home with her mother and father. She used to have up to ten epileptic seizures per night, but a few months ago she was admitted to hospital because the number of seizures has increased so much. Finula's parents have been her main carers for their whole lives. They are elderly pensioners and they cannot cope any more without help. Finula's father has recently had a hip replacement. The Byrne family has always maintained responsibility for Finula's care with minimal support from the HSE or any other organisation. They have not requested help from the HSE for 25 years. They have sacrificed so much, and when they are, for once, desperate for help, they are told there is no support available. In early November this year, the office of the general manager for disability services in the south east told the Byrne family that there are no funds available for 2018 as they have been exhausted. This is not just a postcode lottery, as it was called last week. Access to a home care package is also determined by the time of year. We need to find a solution for the Byrne family and many like them.

I am delighted to have the opportunity to contribute on this important motion. I commend Fianna Fáil on bringing it forward because we hear every year of the increasing numbers of people who are without home help hours or have insufficient home help. Indeed, in my constituency of Dublin Bay North, I often meet distressed family members and those who urgently require more home help. There are many reported instances of constituents being approved for home help but not having access to the service because of a perceived lack of resources from the service providers. Often these cases are even categorised as urgent but are still left waiting with little or no help. Week in, week out, I deal with a number of such cases.

Census 2016 showed that there were 637,000 people over 65 years of age, an increase of more than 100,000 or 19.1% on the previous census. Of those, 577,000 were living in private households and there were almost 23,000 in nursing homes. The ESRI has forecast that the demand for home care will increase by 66% up to 2030. We are aware of the figures and the needs. It is the job of the Minister of State, Deputy Jim Daly, to resource that. As stated in the motion before us, however, the health service capacity review puts that increase at 120% because, at that stage, one in six of us will be over 65 years and the number over 85 years will have doubled.

As the motion before us also references, by September 2018, the number of hospital delayed discharges had increased from 481 to 613, and a reported 136,239 hospital bed days were lost because of delayed discharges. I particularly agree with the motion's call that home support should be provided over seven days a week, outside of normal office hours, and to 100% of long-term recipients of social protection payments. A Programme for Partnership Government 2016 committed to "Working to Make our Older Years Better Years". The actions in the motion, if the Government were to follow them assiduously, would significantly move along that path, but we have not seen that so far.

As Deputy Wallace and others have said, the lack of information on this service and that reference to geography are the most frustrating aspects for all of us. It is difficult to ascertain the level of need and the impact. That is why Members from all sides of the House are constantly asking questions about this. For example, in a reply I received to a parliamentary question at the end of last month, the HSE would not provide information on the cost of delivering an additional 5,000 home care packages which I had asked for and instead informed me of the new single funded home support service for older people which has amalgamated the previous home care packages and home help service. The reply also informed me that, nationally, the average cost per client per week for home support services funded by the HSE is estimated to be in the region of €160 per week and that it would cost approximately €41.5 million to deliver home support services to an additional 5,000 people per year. Earlier this year, there were reports that private nursing home places are costing approximately €1,200 per week, an astonishing difference when one thinks about it which, in the spirit of the motion before us, puts the emphasis rightly on home care.

Even today, I received another answer to a parliamentary question, which related to the HSE National Service Plan 2018 targets which provided for 18.25 million home support hours to be delivered to more than 50,000 people. It is difficult for us Deputies to figure out what these hours mean for citizens who, perhaps, have a half an hour a day and who are looking for an additional half an hour. As the leader of Sinn Féin stated recently, what on earth can one do in half an hour?

I warmly support the motion before us and urge the Minister to move towards a funding model which will support the senior citizens throughout the country. Of course, what has happened in home care, as in so much else, relates to the ferocious cuts by the Fianna Fáil and Fine Gael led Governments in the austerity years and we must regain all that territory for senior citizens.

Deputy Michael Collins is sharing with Deputies Harty and Mattie McGrath.

Last month, my Rural Independent colleagues and I spoke on the Vulnerable Persons Bill 2015, where we highlighted the vulnerability of elderly people. We are here again speaking about elderly people and the difficulties that they face. Is it not clear to the Minister of State, Deputy Jim Daly, that issues of the elderly are coming up every day, sometimes several times a day, in the Dáil? This surely highlights the seriousness of the issues that elderly people face.

Elderly people are being victimised in this country. I have recently been told of the closure of the west Cork carers support group's office in Bantry. This is a terrible loss to carers in Bantry.

Not only will Bantry lose this facility, but I have been told today that the blood pressure clinic there is also closing. This is another attack on our elderly people.

We can see the splashing around that has happened but nothing is happening on the ground. We have seen the release of shocking statistics. It has been reported that in the past year, almost 10,000 elderly people were left waiting on hospital trolleys for over 24 hours. These shocking statistics have led to this being branded a national scandal. My fear is that with the onset of winter, these numbers will increase again. A HIQA report from 2012 suggests that best practice should involve a patient spending six hours or less in an emergency department. In its service plan, this Government recently set a target of 24 hours or less. This is 18 hours more than the suggestion by HIQA. There are elderly people waiting years for procedures, some of which only take 15 minutes. How does the Minister of State think it acceptable to ask an individual aged 90 to wait for up to four years for a cataract procedure? Many of our carers are elderly. Time and again, I have raised in this Chamber the unacceptable situation whereby carers wait months for their carer's allowance. How does the Minister of State expect anyone to survive without money for months? I have been crying out for extra home help hours. When will this happen? The bottom line is that elderly people are bearing the brunt of the Government's leadership from the lack of home help hours to the lack of respite facilities to the long waiting times for procedures to delays in emergency departments.

It goes without saying that keeping people in their homes and communities provides the best value for money. It also gives them a superior quality of life. Regardless of what nursing homes do, with the best intentions in the world, it is very hard to prevent people from becoming institutionalised in them. They have a significant amount of activities and other supports that allow residents to live a life as close as possible to life in their own home but living in a nursing home is a second-class option. Of course, some people have to go into nursing homes because of their needs but many people are still going into nursing homes when they could be supported at home. It is very important that we realise that the best quality of life is provided by allowing somebody to live in their own home.

I note that the Fianna Fáil motion argues that supported housing options must also be provided as an alternative to residential care. This is very important because there are low-support housing units around the country for people who cannot live in their own homes because of the quality of the house, because they are living in social isolation or because they are living in fear in isolated areas. When they come down into these supported communities, they are still living independently but they have a much better quality of life, greater security and care either from other able-bodied residents looking after them or the local community. These options should be looked at, particularly supported housing. Each community, parish and village should have a supported housing unit where the elderly can live in security with minimal or low support.

The other issue that arises is that many people are allocated home care packages but the carers to provide that package are not available. With the increase in employment, it is becoming increasingly difficult to find people who will act as carers. I have come across people who have been allocated home care packages but cannot find the personnel to deliver them. I spoke to the previous Minister for Employment Affairs and Social Protection about altering social welfare rules so that if somebody on social welfare delivers one or two hours of home care per day, they would not lose their entire day of social welfare. It should be calculated on the number of hours per week rather than the number of days per week. If somebody on social welfare provides home care for ten hours per week, ten hours should be taken from their social welfare payment instead of removing social welfare in its entirety. Trying to find personnel to deliver home care is a significant problem.

When statutory home care comes in, and I hope it comes in very quickly, it will come at a price and we will have to explain to people that if the State is to deliver statutory home care, it cannot be entirely free. A cost must be attached to it otherwise it will become completely unaffordable, particularly with our growing population.

I am also happy to speak on this important issue. I compliment Deputy Butler on bringing forward this motion. The protection of older persons and the prioritisation of service delivery for them are things that concerns us all. As Deputy Michael Collins said earlier, we talked about it only last week. I made these points recently in the context of my Private Members' Bill, the Vulnerable Persons Bill, which dealt specifically with the issue of elder abuse, in particular the financial abuse of older persons. Deputy Harty made some very good suggestions on that occasion. Being a practising GP in rural Ireland, he sees the issues at first hand. In terms of the more obvious policy challenges, we are aware that approximately 50,000 people are in receipt of publicly funded home care. However, there is no statutory entitlement to it. It is the luck of the draw or, as someone said, a post code lottery. As a result, there is a lack of clarity and consistency about who is eligible for services and how they are allocated. There have been clear policy statements dating back a number of years - a decade - making a commitment to move resources out of the acute healthcare sector and into community care services. The Taoiseach stands up here every day every week to talk about the €17 billion in health. A couple of years ago, it was €14 billion. The billions are going in but we are not getting the outcomes. It is all being gobbled up in administration. In 2008, the then Taoiseach, Brian Cowen, stated that the whole purpose of health service reform was to take resources from the acute hospital sector and spend more resources in the community sector. That was ten years ago and as far as I can see, the situation has got worse. Where are we now? I suggest we have actually moved backwards in this regard and at quite a pace as well.

We know that 10.7% of pensioners live on an income below the poverty line. We can come in here and talk all we like and Deputy Butler and ourselves can bring Bills forward but nothing seems to change in the HSE. Nothing seems to change with the delay regarding carer's allowance. There is a listening service in south Tipperary called Good Morning South Tipperary that also covers part of Deputy Butler's constituency in west Waterford. The service cannot get a cent in funding from the HSE. This is a very valuable service. The people who engage with it love it. They spend one day per week with specially trained volunteers who do not receive a shilling.

It is the same with the lack of home help. As Deputy Harty said, it will be harder to get home help staff so we must be flexible with people on social welfare so that they can provide the hours because the personnel simply are not there. Regarding waiting times and delays relating to home care, there are a number of people in my constituency who have had strokes and are awaiting a DPG. One gentleman is at home and cannot shower. He was told this week that funding has run out. This is in mid-November. He might not be able to do anything until next March or April. This is disgraceful. Surely there should be an emergency fund kept back for people who have had an acute stroke and are in acute need of a special downstairs shower or something like that.

I very much welcome the opportunity to speak in this debate and welcome the tabling of this motion by Deputy Butler. It is very important that we take time in this House to talk about what is a very pressing issue, namely, the services or, in many cases, the lack of services for older people, particularly with regard to health and social care. Healthcare for older people is sometimes regarded as a minority aspect of the health service or an add-on when the provision of services for older people is integral to how we organise our health service and ensure that people are provided with an opportunity to live as long as possible, to live a life free from disability or chronic illness and to live with dignity. This should be everybody's entitlement but, unfortunately, it is not. If we are to uphold those rights, it is incumbent on Government to ensure that adequate services are available. Unfortunately, this has not been the case to date. Not only should older people be entitled to appropriate services provided at the appropriate time in the appropriate location, it makes significant sense for the health service generally to provide those services in an appropriate way.

This is how we ensure we have the most efficient health services available and at the same time get much better value for money. Delayed discharges are an issue across the country. Many people in acute hospital beds whose acute phase of treatment is complete and who are ready to go home with supports or move to a step-down facility or nursing home are awaiting physiotherapy. At any one time over recent years there have been between 500 and 600 people in acute hospital beds who are ready to leave hospital but cannot be discharged because funding is not being provided for home care supports or step-down facilities. In terms of health service management, this is a no-brainer yet the issue has not been addressed head on. This is, in part, due to the manner in which the HSE operates and the way in which it has been structured by Government. On the one hand, we have hospitals and on the other hand we have community social care services and never the twain shall meet. They do not speak to each other and they operate under separate budgets, which is one of the reasons our health services are dysfunctional and we get poor value for money.

Today, it was announced that funding is to be provided for an additional 550 home care packages, which is good news but it should have happened long before now. We should not have spent the last few years with hospital beds being occupied by people who are ready to go home and all of the knock-on implications of that for older people and the operation of the hospitals. This is not a once-off need. The funding is welcome but this is a constant issue. For as long as we have a dearth of supported places in the home for older people and a shortage of step-down facilities and nursing home places, we will continue to have large numbers of acute hospital beds occupied by people who are ready to be discharged. This makes no sense. In terms of the operation of the hospitals, when this is the case, we do not achieve the level of value of money one would expect from the use of those hospital beds to accommodate patients who come through the emergency departments or from the waiting list for elective surgery because those beds are effectively closed from the point of view of other patients. They are inappropriately occupied, which means there are major inefficiencies within the hospitals. It means that the normal throughput of patients, for example, admitting people for hip operations and moving them to hospital wards three or four days later to enable recovery, cannot happen and this is leading to further increases in the waiting lists. It also leads to a shortage of beds for admissions through emergency departments, which causes blockages in emergency departments and extra beds being placed in wards and so on. As a result of there being between 500 and 600 delayed discharges at any one time, these beds are lost to the system, with the resultant loss of value for money and inefficiencies on the part of staff and hospital management. As I said, the announcement is welcome but we should ensure that delayed discharges are kept to a minimum on an ongoing basis.

We do not have an entitlement to home care on a statutory basis. This is long overdue and I welcome that work is being done in this area, albeit painfully slowly. It makes no sense from the point of view of the patient or from a health management point of view to have a system which provides for a statutory entitlement to a nursing home place at a cost of €1,300 or more per week and no similar statutory entitlement to a home care package which costs a fraction of the cost of a nursing home place. The cost of an acute hospital bed is €1,200 per night. The cost of a nursing home place is €1,200 per week and a decent home care package costs less than €200 per week. It is a no-brainer. I do not know why we are being so inefficient and disrespectful of the wishes and best interests of older people who find themselves in this position.

It is welcome that funding is being provided for delayed discharges and additional home care packages. However, there are many older people in their 70s, 80s or 90s who are living at home and are infirm and becoming less mobile, very often with nobody to look after them, who have never been in the hospital system and are not in the hospital delayed discharges category but are waiting on home care packages. Currently, there are 6,287 people on waiting lists for home care packages. This is an indictment of Government policy. As public representatives, we deal daily with people whose sight or mobility is severely impaired and who are at high risk of falling. Despite having been assessed and deemed to be in urgent need of a home care package, they are place on a waiting list. As I said, there are currently over 6,000 people in this category. The longer they remain without support in their homes, the more likely they are to fall or burn themselves and end up in emergency departments. This is one of the drivers of the high number of presentations at emergency departments, particularly in winter. Again, this issue could be addressed by joined up thinking in this area. We must ensure that there are services available to support people to remain in their homes, where they have the best health outcomes and we achieve the best value for money.

What is happening in regard to home help services and home care organisations is a disgrace. There is now a race to the bottom, with community organisations that have been providing these services for years on end being sidelined in the name of privatisation. Services are being contracted out in many cases to companies whose main interest is the profit to be made. Meanwhile, many people who have provided excellent services to the State are being swept aside. We will pay a huge price for this because standards and terms of employment are dropping and, most important, the quality of service being provided to older people is disimproving as a result of this trend. This has happened in my constituency in regard to the Drumcondra Home Help and Care Services Company, with which I have engaged recently on this issue. The HSE is being forced to consider only the bottom line rather than quality of service. This is a disgraceful move in regard to home help services and home care services. As I said, we will pay a huge price for this but, most important, older paying are currently paying the price for it.

The funding for delayed discharges will result not only in value for money but the provision of humane care to older people. I acknowledge the thousands of people who are caring for people in their homes. They are doing phenomenal work for families. When the system is not delivering for them, they are too busy caring to be able to fight it. This needs to change, in particular, as the number of people with dementia and other conditions is ever increasing.

Day centres are of great benefit to carers and the people for whom they care and they should be available in every community. There are a number of day centres in the areas surrounding Macroom but there is gap in this regard in the town, one which I have highlighted to the authorities a number of times. For example, on the hospital grounds there is a vacant HSE building that would make an ideal day care centre.

When a person leaves a job or moves to part-time employment to care for a family member that person is eligible for carer's benefit.

However, it can take anything up to 16 to 18 weeks to have the benefit approved and it is a benefit based on one's stamps. It is not means-tested. It should be very straightforward and approved to support carers in supporting their families at home.

The home help service is fantastic. When approved, people think it is great that they have it, but there is still a challenge to have it delivered on the ground. It needs to be smoothed out and speeded up.

Last night I attended the AGM of the Kildare branch of the Alzheimer Society of Ireland. I met wonderful men and women who were supporting their wives, husbands and parents in a home setting. It suits them to be in a familiar setting. Some of the families receive support, while some do not. Speaking to the outgoing chairperson, Margaret Nolan, who has been a very effective chairperson of the organisation for 14 years, reminded me of the many challenges families faced in providing care for people with dementia and how many thousands of families there were throughout the country who were selflessly caring for older relatives with very little help from the Government. Without doubt, staying at home with the appropriate assistance and support from the State was and is the preferred option of the older people whose relatives I met last night and those to whom I speak in my constituency day after day, week after week. They deserve dignity, respect and a choice as to where they want to live out the last years of their lives.

Not only is the most humane solution to offer decent, relevant home care packages, but it also offers the best value for money for the State coffers. The home care package introduced by Fianna Fáil in 2006 provided for the provision of the necessary financial support and help for the families who availed of it. However, with the ageing population, the demand for packages is increasing steadily. There is no doubt that when we look at the ESRI's figures which show the increased demand for home care packages, we must be ready to meet that demand. It appears that geography is dictating whether families receive home care packages. There are six CHO areas in which there is absolutely no one on the waiting list, yet in CHO 7 which covers Kildare and west Wicklow there are 992 people awaiting the provision of home support, the third highest number in the regions, with Laois not being far behind.

At a public meeting I held last year the most common query from the very large crowd was about home care packages. Some attendees were very distressed and older people who spoke about how difficult life was as a carer with no Government support. They also queried the length of time it took to process applications for carer's allowance. That is one of the most common queries I receive. People's lives and health, physical, mental and emotional, are being impacted on by the backlog and delays in the processing system. We believe funding allocated to older people to enable them to remain at home provides the best value and the fairest, most dignified result for older people. We need to make real progress in dealing with this issue.

I thank my colleague, Deputy Butler, for bringing forward the motion.

By 2031, 21% of the population are expected to be over the age of 65 years. In my constituency there are now more than 16,000 people over that age, accounting for one in eight of the population of Louth and the coastal area of Meath. I acknowledge the good work that has been done and the great initiatives undertaken, be it by HSE staff or voluntary organisations such as Good Morning Louth, meals on wheels and the community alert scheme. There are also great examples of sheltered housing, including Moorehall Lodge and Great Northern Haven, a local institute which uses virtual care accommodation and technology to provide a service for older people.

All that said, the reality is that if someone is sick or old at the weekend, he or she must wait. A person cannot be sick between Friday and Monday. There is a crisis looming. There is an over-reliance on nursing home care. We all know that it is the preference of those who are ageing to remain in their own home, with adequate support available to allow it to happen. However, the complete dearth of options between independent living and nursing care must be addressed. Funding for home care packages needs to be increased. My office is constantly frustrated at the number of calls received about people blocking beds needlessly because a package has not been put in place. I am aware that the Government is introducing an additional 550 home care packages, but the reality is that there are 680 waiting for such a package in my area alone.

I support Fianna Fáil's motion. A famous lady by the name of Eartha Kitt said ageing had a wonderful beauty, for which we should have respect. I urge the House to show respect for the motion.

I thank my colleague, Deputy Butler, for bringing forward this timely, appropriate and important motion. Since the home care package was introduced by my party, Fianna Fáil, in 2006, there has been a significant rise in its uptake, and for good reason. Everyone, regardless of age, prefers to be at home, particularly when he or she is at his or her most vulnerable. It behoves us, as legislators, to ensure this is possible, yet there are 107 people waiting in Cork South-West for home care support. Some 610 patients are eligible for a hospital discharge, but there is nowhere for them to go. It has reached the stage where constituents of mine are advising the discharge teams in Cork University Hospital, CUH, that they cannot take their loved ones home without a plan being in place. They are aware of the fact that the moment they go through the revolving door of the hospital with their loved one, the supports required will not be in place to facilitate a smooth transition, be it short-term respite care or returning to the family home to provide long-term care.

I note the intention to provide an additional 550 home care packages to cope with the winter trolley crisis. That number falls short of the 610 awaiting discharge from hospitals. With respect, I ask the Minister of State to simply get on with it, put this system in place and ensure the announcement will not be like many others but rather ensure this will one come to fruition. As an aside, my office is constantly fielding calls from concerned relatives who are experiencing great difficulties in accessing information on home care services. With this in mind, the Minister of State can imagine my surprise when I received a call this morning advising that the HSE-funded West Cork Carers Support Group located in Bantry would close at the end of 2018. It has been a huge crutch for so many carers in recent decades. How can any Minister who is serious about improving supports for home care service users and others, specifically the people who are saving the State thousands by caring for their loves ones, turn it around and dispense with such a vital service?

I have an awful lot more to say about this issue, but, as unfortunately, some of my colleagues ran a little over time, I will sit down to allow in the last Deputy.

Perhaps since Deputy Aindrias Moynihan was brought forward to the first group, there is a vacancy in the final slot and we might put Deputy Aylward in that group, if the Deputies so wish.

Unfortunately, there was a swap.

As we debate this issue, it is important to acknowledge the very dedicated staff who work so hard to deliver home care packages on the ground to some of the most vulnerable older people. They can often be put under extreme pressure to meet the extensive care needs of the older people for whom they are caring owing to unreasonable expectations and unrealistic time constraints. Will the Minister of State take note of this and liaise with those in the relevant management positions within the HSE to ensure their staff on the ground will be managed as efficiently as possible to avoid incidents where a home care worker can only spend five minutes with the person he or she visits at the end of the day due owing the fact that he or she may have run over time in visiting other service users earlier in the day. The people working on the ground are passionate about their jobs and have a strong vocation which the Government must support and facilitate. I have always believed the funding allocated to enable older people to remain at home provides not only the best value but also the most humane result for older people. Many thousands of families help their loved ones to stay at home when they are ill or very frail and receive very little assistance from the State. This needs to change, especially to deal with the growing challenge presented in delivering dementia care services.

Real progress must be made in meeting the challenge presented in providing home care which is the preferred option of older people. It is well acknowledged that care provided in the home is vital in keeping people active in their communities which has enormous health benefits. The importance of the provision of home care cannot be emphasised enough.

It keeps older people in their homes and in the home environment. It is a proven fact that this saves the State and taxpayers large sums of money compared with either private or public nursing homes. More important, it prevents the holding up of beds in hospitals that are badly needed in accident and emergency departments. It also reduces the use of trolleys, which is an epidemic at present. I call on the Minister of State to continue to finance home care to the greatest possible extent with whatever funding can be made available.

I am replying on behalf of my colleague, the Minister of State, Deputy Jim Daly, who had to leave. In his opening statement the Minister of State agreed with many of the sentiments expressed in the motion. It reflects work that is, hopefully, well under way. It is one of the great success stories of our age that so many more people are living for much longer. The success achieved in recent decades in improving health and extending life expectancy should be acknowledged and celebrated. However, without doubt, our ageing population poses significant challenges, and those challenges need to be recognised and addressed across a wide range of areas. This includes ensuring that the best possible health and social services are in place to meet the changing needs of people as they age.

To the Opposition Deputies and those that have already spoken, I speak as someone who had an elderly mother who was cared for at home by my two brothers. I know only too well how important family is in times of need in respect of elderly people. Not every family, unfortunately, can have that service at home so they rely on services from the community as well. Home supports are crucial to helping older people, and people of all ages with particular care needs, to remain where they want to be, namely, at home in the surroundings with which they are most familiar and comfortable. Regarding resources, the HSE will spend approximately €420 million on home care packages in 2018.

I recognise some of the issues raised and also that most Deputies spoke in support of the 550 home care support packages that will be available for winter time. That is a step in the right direction. I acknowledge, however, that the process of approving carer's allowance application is taking a long time and we need to speed it up. I receive many calls on this issue. I agree with Deputy Shortall on the support provided by community care services and other organisations on the ground that do so much with so little acknowledgement. One of those in my area, the Mother McAuley centre in Drimnagh, deals with elderly people every day. I acknowledge the work done at the centre, not only by the people from the community who run the service but also the many volunteers.

Many more of our older people with complex care needs are now being maintained at home, leading to increased demand for additional levels of service and for services outside of core hours from Monday to Friday. We want to develop home care services and we are working to provide a more viable alternative to nursing home care for a greater number of people. Demand for community services is rising as more people are supported in their homes rather than in hospitals or nursing homes. The HSE funds a range of community supports aimed at supporting older people at a cost of approximately €300 million annually. These include short-stay beds, day care centres, meals on wheels and other services.

As I indicated, the Government agrees with many aspects of the motion. Our health care system must acknowledge that older people by and large prefer to stay at home for as long as they can. We are already looking at how that preference can be facilitated and supported. It is critical that the appropriate supports are in place to match each person's needs at whatever point he or she is at in his or her interaction with the healthcare system. This means providing a range of flexible supports focused on prevention and early intervention and providing the greater portion of care in the community.

I acknowledge again the contributions of many Deputies on this matter. I give my full support to finding solutions for the many issues raised by all of the speakers. The Minister of State, Deputy Jim Daly, told me before he left that he will also support the motion.

I call Deputy Butler.

Deputy Eugene Murphy would like to contribute.

I call Deputy Eugene Murphy for the view from Roscommon.

Like Deputy O'Loughlin, I speak on as many issues as I can. I thank Deputy Butler for giving me some time. We have a major difficulty in Roscommon. The community healthcare organisation, CHO 2, area, covers a population of 475,000 in counties Mayo, Roscommon and Galway. There are 1,246 people in the area waiting on a home care package, which is shocking considering it is one of the smaller areas.

Per head of population, my county of Roscommon has the highest rate of Alzheimer's disease in the country. It also has a large elderly population. We need to get home care packages in place without delay. As Deputy Breathnach pointed out, the number of people aged 65 and over is projected to increase from one in eight to one in six of the population by 2030. The number of people aged 85 and over is projected to almost double by 2030. There will also be a major increase in the number of people with dementia in the coming decades. The Economic and Social Research Institute, ESRI, has forecast increased demand for home care of up to 66% by 2030 relative to 2015.

Why is the Government not taking this matter seriously? We must address it. I will cite one example that involves a constituent of mine whom we will call "Kay". I have lodged appeals on Kay's behalf numerous times and she has been unsuccessful in securing a home support package. She has undergone many reviews and has been on the waiting list for a service since September 2017. Her family are anxious that she secure a long-term home care package as she would like to continue to live at home. I understand Kay received approval for three hours of home support but resources were not available at the time. Unfortunately, she is still waiting for home care to this day. She has mobility issues, is diabetic, suffers blackouts and is in the early stages of dementia. She is a 73 year old lady who, in the words of her general practitioner, GP, is in dire need of a carer. She lives in a remote area with her son but he works some distance away and is not with her during the day. She suffered numerous falls over the past year and is on many different medications, as is made clear in the GP's letter to which I referred. That is the best way to describe the crisis we have in our system. We have to deal with the issue. While I welcome the more than 500 home care packages announced by the Minister today, more than 220 of them are needed in County Roscommon at this very moment. These packages are appreciated but they will do little to bring down the waiting lists.

I thank everyone who contributed to this constructive debate. In my opening comments, I expressed hope that it would be constructive because that is what is needed. All our constituency offices are inundated with constituents who are trying to secure home supports for elderly relatives. I warmly welcome the Government's decision to support the motion. There was not one dissenting voice among all the Deputies who spoke. There was cross-party support and it is not often we see that. Some history might have been thrown in but I am only concerned about the present, the here and now, and the 6,287 people who are unable to avail of home supports.

I have some concerns. I listened with interest to the Minister of State, Deputy Jim Daly. Deputy Ó Caoláin stated that the cynic in him was a little surprised when he saw the reports this morning indicating that 550 extra home care packages were to be provided. I am not a cynical person, so when I saw the news this morning I welcomed it. It is very important. As part of budget 2019, €10 million has been made available to the HSE for home supports during the winter period, with a special focus on those aged over 75. We warmly welcome that.

The Department of Health immediately sanctioned €5 million to support an additional 300 home support packages. The other 250 packages will come in the months ahead. Unfortunately, we do not have time because the health service is overloaded. Every day, 300, 400 or 500 people are on trolleys. There are 610 people in the acute hospital system who cannot be released into community care or the care of their loved ones because they do not have home care supports. This year alone, 135,000 bed days will be lost in the system because of late discharges.

I welcome that there will be 550 additional packages in the months ahead but the measure is too bland. We really need definition in this and, as people always say, the devil is in the detail. There is not enough detail there. We really must deal with the issues.

Deputy Harty made some very good points on supporting housing options, and we must consider different housing options. There is a model of support in the south east that has low intensity community care homes. For example, in St. Carthage's in Lismore there is a home where 42 people live. They have meals provided, laundry sorted and companionship. They get their medication every day. Nevertheless, they still live independently in a home care setting. That is something we will have to consider as this model could be rolled out throughout the country. It works extremely well for bachelors or older people who may not have family any more but who do not want to live in rural isolation.

I know the following does not come under the remit of the Minister of State, Deputy Daly, but rather the Department of Employment Affairs and Social Protection. He mentioned it. The timely processing of carer's allowance applications is a major issue and it now takes up to 20 weeks to have an application processed. It is really causing a blockage. If there is an appeal, a person could be waiting for another 20 weeks. It is another reason for the system being blocked.

We must really see movement on the rolling out of the single assessment tool for the assessment of care needs. It has been too slow, and although it has been piloted in some constituencies, it has not been rolled out everywhere. The figures have 6,287 people waiting for home care supports, with 674 waiting in Galway but nobody waiting in Kilkenny. The same statistics must apply to each community as this would make a major difference.

Keeping people in their homes for as long as possible delivers better results, as everybody here acknowledged. Everybody supported the motion. Older people who get to live in their homes, surrounded by friends, families and neighbours, do better than those who live in nursing homes. I will hold the Minister to account on the 550 home care packages promised today. If those packages could be made available immediately, it would make some difference to the 610 people in the acute hospital setting who cannot be released into their communities and to their families. If they were released from the acute setting, we might not have as many people on trolleys tomorrow, next week or next month. I thank everybody for their constructive support today and I commend the motion to the House.

Question put and agreed to.