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Dáil Éireann debate -
Thursday, 20 May 2021

Vol. 1007 No. 4

Nursing Homes Support Scheme (Amendment) Bill 2021: Second Stage (Resumed)

Question again proposed: "That the Bill be now read a Second Time."

Deputy Marian Harkin was in possession with ten minutes remaining. I must call the adjournment of this debate at 2.30 p.m.

I am sharing the last three minutes with Deputy Fitzmaurice. Yesterday, at the start of my intervention, I welcomed this Bill and I thanked the Minister of State for bringing it forward. It is good legislation which protects the productive income from the farm or business and that is what is most important.

My understanding is that if someone has been in care for over three years, once he or she appoints a successor, he or she will no longer have to pay the 7.5% contribution based on his or her asset. If someone is in care for two years and ten months and appoints a successor, does he or she have to pay just the two months or the entire three years to bring it up to the three-year cap? I do not know the answer to that question and I hope the Minister of State will clarify this for me in her reply. I hope it is the latter case.

I want to return to an issue I have spoken about before, which is the increasing challenges being faced by private nursing homes, especially some smaller ones in rural areas. We are talking about a fair deal, so it has to be a fair deal for everybody. The average weekly fee in 2018 for public nursing homes was €1,564, whereas it was €968 for private nursing homes. I recognise in some specific cases, those with more complex needs may be more likely to be cared for in a public nursing home. Nonetheless, the vast majority of people are being cared for in their locality.

In my constituency, public nursing homes cost the State 60% more in County Sligo, 68% more in County Leitrim, 70% more in County Roscommon and 81% more in County Donegal. All nursing homes, public or private, must operate to the same standards and I am not, for one instance, suggesting we pay public nursing homes less, but we have to look at paying private nursing homes more.

Back in 2015, a review of systems for setting prices under the nursing homes support scheme was set up by the then Minister for Health, Deputy Varadkar. It was supposed to report back in 2017. Before Christmas, I asked the Tánaiste why that report had not been published. I still do not know why, and it still has not been published today. Why is that? It seems fundamentally unjust to commission a review of pricing policy in the sector in 2015 and to leave nursing home owners waiting on its recommendations six years later. It was needed then; it would not have been commissioned if it was not.

The truth is that many of those private nursing home owners are barely hanging on. I have spoken to many of them in my constituency and they are under serious pressure financially. They cannot compete with the HSE when it comes to terms and conditions for their staff, even though they want to do so because they have top-class staff. They have difficulty in retaining staff. If some of those nursing homes close, the State will have to step in, which will mean greater cost to the taxpayer. Foreign investment is already coming into the sector. I am not saying it is like the housing sector but there are parallels. That is not negative in itself but it changes the dynamic. We need to take a more holistic view of our procurement model and we must never equate value for money with a race to the bottom. I am not saying that is happening; I am just sounding warning bells.

I ask the Minister of State to publish the review of the systems for setting prices under the nursing homes support scheme. I have given plenty of anecdotal evidence about the need for that review to be published and acted upon, and I am sure other Deputies will do the same, but I am not just relying on anecdotal evidence. I have read HIQA's yearly overview reports and what they say is very clear. The 2017 report notes:

In 2017, five registered providers advised HIQA that they had made a decision to close their nursing home. The five nursing homes [were] all small centres with less than 40 residents...

In 2018, HIQA stated that "smaller nursing homes — which often provide a more homely environment — are closing voluntarily due to concerns over their financial viability." The 2019 report read:

The nursing home sector in Ireland has changed considerably in terms of the size of new centres ... [and many of] these new centres are largely concentrated in the east of the country, particularly in Dublin. At the same time, smaller centres are closing across the country, presenting a challenge to rural communities.

It is happening. We need a vision for the sector and that vision must be underpinned by the resources necessary to deliver it.

The traffic in Dublin nearly had me beaten. I welcome the Bill. There is one issue I would like the Minister of State to clarify. My office has been onto her's about it already. Will people who have been in nursing homes for three to five years so far be covered under the three-year rule straight away when the legislation comes in? Going by what she has said, they will have to be there three years starting now. That is a pity because many people in farming and business are financially stretched at the moment and their next of kin are paying large amounts for nursing homes.

This is a progressive step forward. Rural Deputies from all sides have been lobbying for this change for the past four or five years. It is welcome because it will take pressure off families down the road. We have to remember that a business or a farm is like a torch for people to hand on. The situation that had evolved was that someone could have a house worth €1 million somewhere and once the three years were up it would be gone out the window. However, if that person had a farm or a business, the rate was 7% a year and that kept going for whatever length of time. It is great that those people were living a good while but the longer they lived another 7% was defrayed and the State would end up owning the farm or the business. I ask the Minister of State to look again at people who have been in homes for the past three years. People are paying for their loved ones for eight or ten years and that has put a fair amount of financial pressure on them. Farming or running a business is not the simplest thing in the world at the best of times and it puts big financial pressure on people but it also keeps them in their community and keeps them in employment.

The other issue I would like the Minister of State to look at, and she probably will because we were on a group regarding to it previously, is helping local communities to keep a nucleus of people from the area in one-bedroom or two-bedroom chalets. That way, one carer or nurse could call to them and they would stay in their communities for as long as possible. We are well aware that it would not work for everybody but it might help people with Alzheimer's and so on, and new technologies could be used to keep them safe and in the community.

We also need to look at the issue of carers and the hours and hours that sons, daughters, brothers, sisters, aunts and uncles spend looking after their loved ones in houses around this country. I have seen people working in Dublin give up their jobs to go down the country to look after their mother or father, and because they had a house here in Dublin, they had to get it assessed and all that craic. They get damn all, to be quite frank about it. It would be helpful if we could look at that situation. I welcome the Bill and I know the Minister of State had a personal interest in it. I ask her to look at the issues I talked about.

I pay tribute and thanks to all the staff and support workers in our nursing homes and community hospitals who have taken care of many of our elderly family members over these difficult and sometimes lonely times during the past year and throughout the pandemic. These were very difficult times for residents, who were isolated from their loved ones and family members. The staff provided security, comfort and care to many of our family members. I am glad that visits have now been restored on a phased basis to those family members we have missed so much.

I welcome this Bill, which has taken some time to come to fruition. It was included in both this and the previous programme for Government. Since the commencement of the nursing home support scheme, or fair deal scheme as it is more widely known, farmers and small businesses have raised concerns about the charges on their farms or family business assets under this scheme. Some compared it to the death duties that were abolished decades ago. Those charges were abolished because families often had to sell the family farm or small business to pay taxes, which left the younger members of the family without an income or a home.

The family farm or small family business is not used as a capital asset to transfer wealth from one generation to the next, but rather as a means to provide an income for hard work, often undertaken 365 days of the year. We must remember that according to the IFA only 34% of family farms provide a viable income. This Bill recognises that fact. Inheriting a farm is not a road to riches and wealth, but an invitation to work hard for many years to earn enough to provide for one's family and the next generation.

The need for a scheme such as this has come about mainly due to improvements in our health services, which has increased life expectancy for all our people. It was not long ago that average life expectancy in Ireland was in the mid-to-late 60s, but it is now in the mid 80s. Those born in Ireland today are forecast to have a life expectancy closer to 100 years of age. The nursing home support scheme, sometimes referred to as the fair deal scheme, is a scheme of financial support for people who need long-term nursing home care. Under the scheme, a person contributes towards the cost of care and the State pays the balance. The fair deal scheme represents an annual investment of €1.4 billion by the State and it benefits more than 22,000 people.

I am proud to say that the changes included in this Bill were adopted by the Government led by Fine Gael in July 2018, on foot of the proposal from my former colleague, the then Minister of State with responsibility for mental health and older people, former Deputy Jim Daly. He stated at the time that these changes would take away a great deal of stress and worry from affected families and allow them to plan for the future, while allowing them to continue to run family business without the fear of losing it.

I mentioned earlier that this Bill has taken some time to come before the House. I understand that a review of the scheme was published in 2015 by the coalition Government of Fine Gael and the Labour Party. The review recommended reconsidering how productive assets were dealt with in the scheme. The process of reforming this scheme has taken more than seven years, and during that time many families have endured extreme hardship in meeting these charges. Often, they have had to sell parts or all of their family farms, or businesses, which may have been worked on by those families for generations.

Will the Minister of State consider setting up a hardship fund that would repay or not levy some of these charges? I refer to the possibility of it being necessary to sell some farm or business assets to meet these charges and, in that context, the need to ensure these family farms are viable for the next generation. This Bill addresses possible funding and how charges can be levied for nursing home care in respect of farmers and their spouses. However, another group at the heart of the scheme should also be considered for special treatment. Recently, I raised with the Minister of State some concerns from nurses regarding their pay and working conditions, including the Haddington Road agreement and registration charges. No one doubts that nurses were on the front line and carried out sterling work in the last year when providing treatment during the pandemic. They are also at the very heart of the nursing home care system. There is consensus among people that nurses are undervalued and underpaid in our health system. There is also a similar consensus that they played a vital role in the treatment of many of our elderly people during the worst days of the pandemic.

There is a belief that the Trojan efforts and contributions of nurses must be recognised and rewarded. While I understand the complications and knock-on effects associated with giving a special pay award, I suggest that we might be able to examine other factors in respect of their pay and conditions of employment. One possibility might be for us to examine the possibility of offering a special deal to nurses. I would love to think that we could introduce amendments to this Bill on Committee Stage to provide for a special treatment package under the nursing home support scheme for nurses who have worked so hard during this pandemic. One potential proposal would be to look at the three-year rule for charging. It might be possible to change that criterion to a two-year charge for the first year. However, that is only one potential method that could be applied. The Minister of State and her advisers may be able to come up with some other package to demonstrate our nation's gratitude to all nurses who have worked on the front line during this horrific pandemic. I support this Bill and I hope the Minister of State and her advisers might take on board some of my suggestions, as well as amendments, on Committee Stage.

We have all seen how challenging Covid-19 has been for older people, those living on their own and people living in nursing homes. Nursing homes are at the heart of their respective communities, meeting the vital healthcare requirements of a cohort of our society during a difficult time in their and their families' lives. Nursing homes are very much a home away from home and a safe place in which loved ones can be cared for. The major increase in our older population will present big challenges for our healthcare services within our regions. It is crucial that public investment in long-term care services is maintained for those who need it.

Care must remain accessible and affordable, including for those families with a farm or business. I have been saying for a long time that the fair deal scheme needed to be fairer, and now it is. I met many farming families who told me of their concerns regarding how they were assessed. I welcome the fact that after three years the value of family-owned farms will no longer be considered when calculating the cost of care for people in nursing homes, where a family successor commits to working on the farm or in the business and allowing them to be passed down to the next generation. That is an important point. Farming is part of our history and culture, and in that context we must ensure that we get this legislation right. I am delighted with this Bill because it will protect our family farms and businesses. By inserting additional safeguards to the scheme, the Bill will promote and protect the sustainability of family farms and businesses. It will ensure they are not consigned to the history books.

Updating the nursing home support scheme legislation to enhance protection for farmers and business owners was an absolute priority for the Minister of State and I applaud her for her work. This legislation has been her priority since she became a Minister of State, and especially in recent months. I have spoken with her several times and I know she has faced many obstacles, but this is a really good Bill and it is good for our farmers and businesses. This is what we must do to protect the most vulnerable in our society. The Minister of State shares my desire to find ways to support and enable older people to live in their own homes with dignity and independence for as long as possible. In that context, this again is a great Bill and I support it. However, we all know we must do more when it comes to achieving the goal of finding better ways of enabling our population to stay at home while ageing.

I have been speaking to families and many of them would like to have their elderly parents in their homes. This aspect is a priority for the Minister of State, and we must look at more supports in that regard, including more funding and full-time care. It is a matter for another day, but I ask the Minister of State to examine that area as well. We are lucky that people are living longer. It is great to see that happening. My mother at home is 86 and my sister is her carer. We are so lucky. They have had all their vaccines now as well, which is great. I got my vaccine yesterday, and I am delighted. Things are changing.

I compliment everybody involved in nursing homes. It has been such a difficult time. The impact of the Covid-19 pandemic has been very hard on nursing homes, but they have been absolutely brilliant. We must express our thanks to all those involved for what they have done for elderly people. It is important that we do that. We appreciate all that has been done and we must show that. Life is precious, and if we have learned anything from Covid-19 it is that we must make the best of what we have and try to work with, be kind to and look after people.

It is the Minister of State's role, as she has responsibility for older people, to put their needs first. I thank her for that.

We have discussed the issue of rental income in respect of the fair deal scheme. That is an issue for another day.

This Bill is to be welcomed. I have spoken to many family farmers in my own area of Carlow and they are delighted with this Bill. They feel that they have been waiting a long time for it. Indeed, it has been in the pipeline for some time. Now it is here. This Bill shows that we, in Fianna Fáil and in government, are committed to looking after our older people.

I have only question left for the Minister of State. What is the timescale with the Bill? I am delighted that many of the parties are supporting the Bill. As it is such an important Bill, I am wondering about the timescale. It is important that we try to get it through the House as soon as possible. Perhaps the Minister of State can write to me, providing me with details of a timescale and how long the process will take. I urge the Government and all Members to get this legislation through the House as soon as possible.

I wish to thank everyone involved, including the Department and the Minister of State, for putting such hard work into it.

I welcome the Bill. It aims to limit the period for including the value of family farms or businesses to three years for financial assessment under the fair deal scheme, where the family successor continues to operate the farm or business for six years and takes over the running of the farm or business within three years. It is, indeed, a welcome reform.

However, it is a real shame that the Bill does not address some of the other issues with the scheme that I and others have been highlighting for several years. For a number of years, I have sought to find a way to stop the double charging of residents of private nursing homes for items and services to which they are entitled as medical card holders. This practice goes on in many nursing homes where elderly residents or their families have to pay for items as basic as wound dressings, certain medications, sanitary products and services such as physiotherapy and occupational therapy. If these residents were living in the community, these would be provided free of charge under the medical card scheme. The legislation states that this should not happen, but in practice, residents have to sign contracts that include clauses allowing nursing homes to charge them for these items and services. These residents need the nursing home care; they have no choice but to sign the contract. I have highlighted this matter repeatedly to the Government, but it has failed to address it or even to acknowledge that it is a serious problem for some people who have to pay enormous bills for items that should be provided free of charge.

That is only one issue that needs to be addressed. As a member of the Committee of Public Accounts, I know only too well that there are significant shortcomings in how the fair deal scheme is run. Last October. we raised the fact that the National Treatment Purchase Fund, which decides what price nursing homes will charge patients in private and voluntary nursing homes, had ad hoc and inconsistent record keeping, which meant that the process was not transparent in some cases. We know that the maximum price decided upon for a patient's care is always the actual price. That is not acceptable.

We also know that when some assessments are done, the process of checking when properties and other assets were signed over to family members is not thorough, meaning that people who hastily sign over assets a year or two before they join the scheme often do not pay the correct amount as the scheme is unaware of the actual value of assets they owned.

We also know that some private nursing homes will not accept certain high-dependency residents, particularly those who are very unwell, or have significant impairments. The public nursing homes often look after these residents, which places an unfair burden on them.

We have been told that some of these are being addressed and the committee will continue to work on these issues. However, I have seen no evidence that any of these issues have been addressed.

I hope that this Bill is only a first step in addressing some of the problems with the fair deal scheme, as a huge number of people rely on it. It has to be fair and work for as many people as possible.

I take issue, in particular, with the charging of residents who are in possession of a medical card for items and services. If they were living in the community, they would be entitled to those products, medicines and therapies free of charge. However, because they are in private nursing homes and have signed contracts, they are being charged. If the residents cannot afford to pay, their families must pay. I came across a family facing a bill of almost €1,500 for a one-year period. That is unfair. The resident in question was entitled to all of the items for which the family was being charged under the medical card scheme. If there is one issue that I ask the Minister of State to tackle from today onwards, it is that. It is wrong.

I also wish to welcome this Bill. It is a resolution of sorts to what has been fundamental unfairness in the so-called fair deal scheme. It has affected farming families, in particular. In capping the contributions at three years as they relate to family farms, the scheme now essentially reflects the reality that in many cases, family farms are extensions of the family homes rather than a speculative asset that is hoarded or treated as a business or other type of asset. That is most important.

My regret, which I believe is shared by many in this House, is that we are so late in bringing the legislation to this point. My fundamental regret is that the people who have highlighted this anomaly and campaigned for changes in the legislation will not get the benefit of it. Those people who have been in nursing home care for more than three years will not receive a rebate. I appeal to all parties to work as hard as possible and explore every avenue with a view to finding a legal basis by which the issue can be resolved so that those people can get their payments back. Undoubtedly, if that is not the case, farm holdings will be lost to families who simply do have the resources to pay the nursing home care bill.

While the resolution makes the fair deal scheme fairer, it still does not make it an entirely fair deal. In bringing this Bill to Committee Stage, I urge all parties to reflect on the stories that we have heard from our constituencies and ensure that we do not repeat the mistakes of the past.

It is a good opportunity for us to reflect on how we deal with legislation that comes before the House, particularly from Departments that may not have an explicit responsibility for rural communities. The difficulty with the original legislation is that it was adopted without any consideration as to what it might mean for farm families. We are only now getting to the point where that is being addressed. The Deputies will be aware that Sinn Féin has been trying to pass what is referred to as "rural equality legislation" in this House since 2015. Most recently, the Sinn Féin Deputy for the Roscommon-Galway constituency, Deputy Kerrane, brought legislation before the House that is designed to essentially ensure that every Bill passed is "rural-proofed", for want of a better term. It involves assessing what the legislation might mean, and what its implications might be, for the rural communities that we know are struggling in many ways. In the past, this legislation has been opposed by both Fianna Fáil and Fine Gael. I encourage Members to work with us to ensure that that Bill can be brought through this House and passed to make sure that we do not repeat the mistakes of the past.

I also support Deputy Munster's call for focus to be placed on addressing anomalies in nursing home care. We need to move to a point where we actually have publicly-provided nursing home care. Just like all other forms of healthcare, nursing home care should not be driven by motivations of profit; rather it should be considered to be a fundamental part of our healthcare system.

Debate adjourned.