Deputy Carthy was in possession.
Nursing Homes Support Scheme (Amendment) Bill 2021: Second Stage (Resumed)
Question again proposed: "That the Bill be now read a Second Time."
I was in possession.
The Deputy is correct. There were a number of speakers before him but they are not here. We are making sure we have not overlooked anybody.
I am sharing time with Deputies Ó Murchú, Cronin and Donnelly. I welcome the opportunity to speak on this Bill. It has been some time coming. Many people are interested in the issue and would have liked to see the Bill being brought forward sooner. Its provisions will be important for those affected, particularly small family farmers and small business owners. It will provide them with some solace and protection and will also ensure, in some part, that their businesses and farms are sustainable and viable. That is a really important point for our rural communities, in particular, and is to be welcomed.
It also speaks to the greater point about models of care and the nursing homes support scheme. There are very significant challenges. Those of us interested in the demographics and the nature of our health services know that we have a very particular challenge in Ireland in sustaining nursing home support and care of the elderly. We all want to see a model that provides for people living at home for as long as possible. That is an important element. Nursing homes have an important role to play, but much needs to be done to ensure that older people can live at home for as long as possible.
Regarding the role of carers and the need to support them to care for people in their homes, my colleague, Deputy Claire Kerrane, brought forward a charter for carers. A number of important measures would be of significant benefit in terms of practical supports for carers, such as talk therapy and expanding GP visit cards, in addition to increasing and expanding carer's allowance, carer's benefit and support grants. The introduction of a discretionary grant for carers would be another important measure that would be a significant positive. I know many who are struggling to pay their heating and electricity bills, such is the nature of their work and, unfortunately, the way in which they are valued by this State. It is well recognised that carers play a major role in providing care, which is not valued in the way it should be. That issue needs to be addressed.
The greater point about the role of the nursing homes scheme is that it has developed in a largely uncontrolled way. I see it in my county of Meath, where there was much speculation, general tax breaks and incentives for people to build nursing homes. People have ended up in that sector for reasons other than having a traditional background in healthcare provision and delivery. That, in and of itself, raises the real need for a strong role for HIQA, but also for ensuring maintenance of high standards, which includes the terms and conditions of employment.
The Covid-19 pandemic highlighted, certainly in its first wave, many of the weaknesses within the system.
We will have an opportunity to address that. Many people working in the sector are dedicated and tremendously hard-working. It would be to everybody's benefit to put in place robust standards and protections for staff, workers and the residents themselves. That will be important going forward as the growing ageing population puts pressure on those services. I welcome the opportunity to speak on the Bill and there will be further opportunities to develop it as well.
I concur with Deputy O'Rourke. We are glad to see this legislation. The nursing home support scheme, or fair deal scheme, needs significant tweaking. More widely, we need not only to support people in nursing homes but ensure we are not impacting on the sustainability of small businesses and small family farms. That is something that has to be dealt with.
The pandemic period has made us look at how we deal with elder care. There have been a number of reports in the last while, including those from the expert panel and HIQA, which stated that nursing homes should not be the only option for older people in need of enhanced care. We are going to need an entire package. We all know that home care packages can be lacking and that has been mentioned in this House from time to time. Multidisciplinary supports are required to facilitate people in later life. Our demographics are going to change and we will have a greater number of older people. They should be able to stay living within their own homes, which is possibly better for them and their families.
Both HIQA and the expert panel agreed that we need reform of nursing home care. We need to look at the way we do it, how we audit systems and the way we situate, organise and construct buildings. We have to look at public versus private provision. As Deputy O'Rourke said, some of our system was not necessarily designed but was the result of unintended consequences from tax breaks. Money went in a particular direction and we ended up in the situation we are now in. A number of nursing homes operated as separate businesses and outside the wider controls of the State or did not have the relationship with the HSE and the healthcare system that we would have wanted. That led to difficulties, particularly at the beginning of the pandemic. That is why a major part of the report of the Covid committee was on the requirement for an inquiry into how we dealt with that period. There needs to be significant emphasis within this House on ensuring draft terms of reference are provided because they are required and we are behind time. That was meant to have been done already. There have been discussions and Government sources have said in the papers that we are moving towards an overall inquiry into elder care, and particularly into how it was dealt with at the beginning of this pandemic. That is absolutely required. We also need a committee to look at the guidance that has been given to us by these reports on how to deal holistically with elder care and produce a system that will deliver for all of us, especially our older people.
We all remember the significant tragedies that occurred in nursing homes a year ago and we had a repeat of that in January. A number of families who have gone through deep trauma and hurt are looking for answers. They will require these inquiries. I have spoken previously to both the Minister for Health and the Minister of State about the terrible tragedy that occurred in Dealgan House, with the loss of 22 residents. That had a significant impact on their families and I commend them for the considerable work they have done in looking for answers. The Minister and Minister of State have met with them and there have been discussions about creating a mechanism to provide them with answers. As much as there needs to be a wider inquiry into the nursing home sector, how we dealt with the pandemic and how we deal with elder care in to the future, we also need a specific public inquiry into what went wrong in Dealgan House and what the lessons are for the future. Everyone needs that. The families are also experiencing difficulties in accessing information from the HSE. I understand that we are in a difficult period due to the recent ransomware attack but this is something I will continue to bring up. I will have conversations with the Minister and the Minister of State about this matter because we have to provide for these families. Beyond that, we need to deliver a fit-for-purpose system and scheme for our elderly across the board. I commend this legislation.
This Bill has merit as regards the fair deal scheme and family farms and businesses. I am sure there is great regret in homes across the State that funds that went out cannot be recouped. The care of their elderly is preoccupying many families at the moment and it never stops, because true as night follows day, we are all getting older. There is just no way out of that.
While the fair deal aspect of the Bill has merit, I regret that it takes no proper account of the ongoing privatisation and commodification of the nursing home sector, where personal and State money is increasingly going to global wealth funds. We should be asking questions about this in our Parliament, here in the Dáil, and in public, because it is degrading and diminishing for our older people that their needs as they age are the subject of international profit and speculation. We learned last week that French healthcare giant Orpea is to become the biggest provider in the nursing home market. Orpea was reported as having a half-year revenue to June 2019 of €1.9 billion. That is almost €2 billion revenue in six months alone. This is serious business news with equally serious social consequences. We are talking about wealth fund billions for the essential care of our own people, who worked hard, raised their families, bought their homes and paid their taxes all their lives. I do not see anything in this Bill at this stage addressing how the care of our older people is being increasingly profitised and commodified. That is everyone’s business because if we are lucky, we will all live to be old and the care being speculated on as a market commodity will be our own.
I know I speak for vast numbers of my constituents when I say we would like to age under our own steam and in our own communities wherever possible. That is why in government, Sinn Féin will establish a statutory home care scheme, in order that our care is based around our needs, as opposed to our experience of ageing being made to fit the preferred care model. A model that favours private profit over public service is just not acceptable. I am not referring to the small, family-run private nursing homes. I am referring to the huge investors and wealth funds. We have been talking about these funds coming into our housing market but they are taking over our nursing homes as well. We have to see elder care as a necessity and a right. We would rather have supports for community living than the elevation of the nursing home model, and the private nursing home model at that. However, it is inevitable that some of us will require nursing home care and we favour the public model in that necessary instance. It can come as quite a shock to people to find out that only 20% of our nursing homes are in public ownership. Just as with housing and childcare, elder care should never be commodified, because these are not options or luxuries. These are essentials of living in which we, as citizens of this State, should not be placed at the mercy of profit and the market.
It should be the same as in housing and childcare and in the care of older persons. I believe it is fair to say that in the social contract, there is no deal, fair or otherwise, about that.
With the agreement of the House, I am going back to Deputy Flaherty, who is now in the Chamber. Deputies Ó Cuív and Michael Moynihan are also here, and they will be next after him. I call Deputy Flaherty.
I apologise for not being here earlier. I pay special tribute to the Minister of State for her work on this Bill. It is an area she has been extremely passionate about for several years. She identified the many inequalities in this sector early in her political life and resolved to put them right. It is fair to say we have a great champion for our older, and often most marginalised, people. I digress somewhat, but I also take this chance to commend her on her hands-on role in the administration and management of the home vaccine programme. It was, arguably, one of the most difficult strands of the vaccine programme, but the Minister of State realised that it was one we had to get right. Working with the National Ambulance Service, she made it her personal mission.
I take this opportunity to thank the staff who have worked in our nursing homes and care facilities throughout what has arguably been the most difficult 14 months of their lives. I think especially of St. Joseph’s care centre and Laurel Lodge nursing home in Longford town, Thomond Lodge nursing home in Ballymahon, Our Lady's Manor nursing home in Edgeworthstown, and Costello's care home and Innis Ree Lodge nursing home in Ballyleague, which, although they might be over the bridge in Connacht, we still regard as part of Longford.
In all these locations, staff have gone above and beyond the call of duty over the past 14 months, and often in the most trying of circumstances. It has been a terribly difficult time for the residents of these facilities, while for their family members who have been unable to see and visit them, it has been truly agonising. Again, however, it was the Minister of State who campaigned week after week for greater access and visitation rights for family members. As our vaccination programme rolls out with momentum, we are finally nearing a return to normal visiting access for these and many other care facilities.
Rural Ireland has waited a long time for this Bill, as many speakers said. Every constituency office has tales of despair and disappointment concerning the existing fair deal scheme. Finally, we have the long-sought scheme to provide greater protections for farm families and family-owned businesses. I am very proud Fianna Fail’s fingerprints are evident on this Bill. It was a firm commitment from our party, north, south, east and west, that we address these inequalities, and thanks to the Minister of State and her team in the Department we are able to stand over that commitment today. After three years, the value of family-owned farms or businesses will no longer be factored in when calculating the cost of a person’s nursing home care. This will be the case where a family successor intends to continue working the farm or running the business. It is a necessary change if we want to sustain and protect the family farm and the many related small businesses, all of which, when combined, are the bedrock of rural Ireland.
We are incredibly proud in this House of rural Ireland and the stellar international appeal and reputation which it enjoys. Rural Ireland looks green, spectacular and incredibly inviting, and that is thanks to the many farm families and small family businesses. The farm family is not a business, an institution or some legal entity. It is a family treasure, burnished over generations, and protecting it and its dependents is sacrosanct for any Government. I am extremely pleased to see that this Bill has almost universal support. There is a message here and it is a simple one. When ideological differences and agendas are parked, solutions can and will always be found. Too often in this House, debates and problems are battled out on ideological grounds. Rather than arriving at solutions, we are allowing and, in many cases, forcing issues to fester and deteriorate further as the House loses itself in acrimony and the recycling of past failings and future fears.
The Minister of State and all the parties listened to the public, to the families affected, to the farm organisations and to the many owners of small family-run businesses and realised that change was needed. The nursing home support scheme has operated for more than a decade and in a political world that is a lifetime. We all readily agree that it has been a success and a mechanism through which families have been able to access the care and supports for loved ones which would otherwise have eluded them. Up to the end of 2020, 22,755 people were participating in the scheme at an annual cost of more than €1 billion.
Participants in the scheme contribute up to 80% of their assessable income and a maximum of 7.5% per annum of the value of assets held. In the case of a couple, the applicant’s means are assessed as 50% of the couple’s combined income and assets. The overall aim of the scheme is that participants contribute to the cost of their care according to their means, while the State pays the balance of the cost. The capital value of people's principal private residences is only included in the financial assessment for the scheme for the first three years of their time in care. This is known as the three-year cap. Currently, this unqualified three-year cap does not apply to productive assets, such as farms and businesses, except in the case where a farmer or business owner suffers a sudden illness or disability and as a result requires nursing home care.
This Bill seeks to address this issue by introducing additional safeguards to the scheme to further protect the viability and sustainability of family farms and businesses that will be passed on to the next generation of many families. The proposed change is to cap the financial contributions based on farm and business assets at three years, where a nominated family successor commits to working with the productive asset within the first three years of the resident’s time in care. Sadly, this Government struggles to find favour as we are caught in a maelstrom of public discontent and frustration in the face of Covid-19 and crises in health and housing. Today is a good day for the Government, however. It is a great day for the Minister of State and also a great day for our colleagues in Fianna Fail, Fine Gael and the Green Party who were involved in talks on the formation of a Government. We can all say that this is one they did get right.
I am conscious that I have a few minutes left, so I have two key questions for the Minister of State to respond to, if she is able to do so. First, regarding the case of a family member who has been in a nursing home for two and a half years, will that time count towards the three years? Will only six months remain in that case? Finally, it is important that the Minister of State and her Department can today give the House commitment regarding the implementation of these changes, because this Bill has been in gestation for a long time, as many speakers have said. We are beholden to the Irish people, and particularly the many families who have struggled with the fair deal scheme, to give a clear and distinct timeline concerning when this legislation will come into effect.
I welcome this Bill. I did not get a chance today to count all the parliamentary questions I submitted over the years concerning when this Bill would be introduced. It was promised and promised, and yet, like many things, it never happened. The Minister of State is less than a year in government and she has already brought this Bill before the House. I congratulate her on doing that. Promises never fed anybody or solved a problem. Action is what was needed here, and action is what we are getting.
In this State, we need to look holistically at our care of the elderly. We have not done that for many years. Many policies impact on care provision. Covid-19 made one thing very clear in that regard. It was interesting that a statement made at the height of the pandemic crisis by then Taoiseach, and now the Tánaiste and Minister for Enterprise, Trade and Employment, Deputy Varadkar, remarked that it was not a great policy to put people into nursing homes who, if better arrangements were put in place by the State, communities and society, could have lived independently or with intensive support within the community.
In looking at this, the issue of physical planning has to be taken into account. Looking at our rural areas, all of the plans and designs of the great experts in planning seem to be designed to stop people living in the area from which they come and near their parents, particularly in rural Ireland. I have argued repeatedly that the free choice of people to live in the community from which they come and to live near their parents should be facilitated. There are two very obvious human consequences from that, which professional planners and academics, in particular, seem to overlook. The first is that in the earlier years, parents often become grandparents and become a very big support within the family network in terms of babysitting, nurturing, supporting and educating, doing all the things that grandparents can do and can do in a special way. As the years go by, the grandparents are often looked after and cared for by the next generation. In those situations it is often possible to continue living in one's own home, which I believe is the wish of most older people.
Therefore, we should think this out again post Covid. It does not matter what mistakes we have made in the past. Just because we may have got it wrong, there is no need to avoid putting our hands up and admitting that is the case. We can admit that we did not think about a particular element and revise our thoughts on the matter.
The second option is the provision of dedicated housing for the elderly in small clusters. There is a perfect example of the provision of such housing in my parish. It is a community-operated social housing scheme. It is built around an old convent which is now a day care centre and a health centre. It is located beside the church, the shops and the post office. There are eight houses in the development. In my parish, the vast majority of older people choose to stay in their own homes, but there is a minority for whom that is not a viable option. They move into these houses where the services are all near-by. There should be one such scheme in every parish, so that support and meals can be provided easily. However, meals-on-wheels should be available pervasively throughout the community.
There are also models which provide even higher levels of support that are not nursing home care. Therefore, in many cases nursing home care should be the last option. However, it is one that is absolutely vital and for which there will always be a demand. Some people choose to go into a nursing home for reasons that are good to themselves. For others, there is no choice because of the level of disability and the support that they need. All of these must be facilitated.
When we look at our model for nursing home care, the one good thing is that I can always reassure people that those of very little means will go into the same nursing home as those of significant means. They will get the same care and they will only pay according to their ability to pay. According to the scheme, 80% of the person's income is assessed, and he or she gets to keep 20%. However, assets are taken into account. That is the issue that we are addressing.
Normally, a couple's assets are divided into two in the means test. In the case of a single person, all the assets are taken into account. There is a disregard of €36,000 for a single person and €72,000 in the case of a couple. The house or principal residency is taken into account and 7.5% of that value is included in the assessment each year for three years. Therefore, the maximum amount that is taken out of the estate by means of a charge is €22,500, because the collection of this money can be deferred. However, there was a problem with the scheme. The value of family farms and small businesses could be assessed continuously, with no cap, at a rate of 7.5% per annum.
The average stay in a nursing home is less than three years, but there are many people in respect of whom it is longer. I recall the case of a neighbour of mine, who went into a nursing home. I visited that neighbour two years later. I did not think that person would survive as long. It was a great thing that the person did survive for years as a single person who had been living alone in the nursing home. If that person had a farm or a business, the amount included in the assessment would have increased until virtually the whole farm or business would be taken away. For many families, a family business or farm is something that they have effectively inherited on trust, which they pass on to the next generation. They hope to pass it on intact.
The other rule that catches people out is illustrated by the following example. If an elderly parent had a son or daughter working on the farm with him or her, unless he or she transferred the farm to the son or daughter five years or more before going into the nursing home, except in exceptional circumstances, the assessment would include the total value of the farm. So, if he or she transferred it three years before going into the nursing home and did not own the farm on going into the nursing home, he or she would still be assessed as owning the farm. Of course, that rule has placed a huge burden on people. I have often pointed to what I refer to as the double lock system in rural Ireland, whereby parents are reluctant to hand over the ownership of their property at times and they will it to their children. For one reason or another, they keep their name on the deeds of the property as they get older.
There are many reasons, which I do not need to go into, why this might happen. By introducing the rule whereby if the successor has worked on the farm in three of the previous five years and undertakes to continue to devote a reasonable amount of time to the farm in the following years - I believe it is six years - the value of the property will only be included in the assessment for three and a half years, this means it will be treated on the same basis as the family home. What that means is that if the person lives in the nursing home for three years, 22.5% of the asset will have a burden on it that will have to be repaid to the State. That is a far cry from what can happen if somebody lives, for one reason or another, in a nursing home for ten years. The inclusion of 7.5% of value of the property in the assessment would amount to 75% of its value. That does happen in some cases involving various conditions that we can fully understand and that we have all come across.
There are many other issues, but I will run out of time before I can cover all the issues I would like to cover. I would like to raise an issue that I think needs addressing. I refer to the example in which a couple or a single person goes into a nursing home and they have a private principal residence which is empty.
They are in the nursing home for one, two, three, four years and so forth. After three years the clock stops, but the house is empty. However, if at any time one liquidates the asset and ensures that somebody can occupy the house, in other words, one sells the house, one then becomes liable for the cash one received on a continuous basis in the fourth, fifth, sixth and seventh years. There is no doubt that at a time of huge housing shortage there are houses in this country that are owned by people in nursing homes. They are either afraid that if they cash out now that after the third year, if the people in the nursing home survive, they will keep having to pay, or where they have already spent the three years in the nursing home, they would certainly be levied indefinitely on the capital they would realise. Therefore they do not sell and make the house available. This is a pity because, as I said, housing is in short supply. We should consider a provision whereby if a vacant house belonging to somebody in a nursing home is sold after the person goes into the nursing home, the proceeds of that sale, whether it happened within the three-year period or afterwards, would be treated as if they were the house. If we made that change, we could do away with the scandal of vacant houses around the country at a time so many people are screaming out for housing.
Reference was made to the model of private versus public nursing home care. First, HIQA does a very thorough job. One of the good decisions was to bring HIQA into the equation. The authority was set up during the Taoiseach's time as Minister for Health. It certainly was proposed at that time. It is very important that such a service exists to monitor, on our behalf, the human and physical standards adhered to in the many health facilities, particularly in the nursing home sector, because ultimately we do not know which service, be it private or public, might leave a little or a lot to be desired in how it operates.
The argument regarding the private and public sectors is old, and one I do not find easy to resolve. Public care is very good and there is a number of the facilities in my constituency. They earn universal praise. Most of the private nursing homes in my constituency appear to be owner-run. They, too, provide top-class services. If we had relied on the public service to provide all the nursing homes we needed with a burgeoning older population, I am not sure that we would have met the demand in time in the way the private sector did. There were flaws and difficulties with that, but in the greater scheme of things, the private sector delivered in great measure to meet a rapidly increasing demand, brought capital into the process and delivered projects. As I said, there is a very strict regime in terms of scrutiny by HIQA. The other issue is that because people have a choice in nursing homes, it is fair to say that there is fairly fast migration away from the nursing homes that are not providing a high standard of care.
That said, as in so many facets of life, I do not like the corporatisation of businesses by big players. I would much prefer the small operator dedicated to the task. I do not know if there is any way to try to incentivise that approach, particularly in line with EU rules that can often be a barrier by favouring one thing rather than another. I would prefer that because personal attention is very good. I recall reading a document about the 1940s when the question was asked of Fianna Fáil as to what its policy was on private property. A very interesting answer was given. It was that Fianna Fáil was in favour of private property, but, and this was vital, in as diffuse an ownership of private property as possible. The party was making it quite clear that many people owning a little was a great deal better than the few owning a lot. Unfortunately, modern trends are going the other way and it appears that small operators of every type in social and commercial services and in so many facets of life are being swallowed up by the might of the euro, and those who have a large number of them. Whether it is private housing, social care, nursing home care or ordinary private business, I am not sure that this is a good model. It is not just confined to this sector, and it is something on which we need a wider debate on another day.
I welcome the opportunity to contribute to this much promised debate. I congratulate the Minister of State, Deputy Butler, on steering this through the Department and the Government. I know the tenacious way she applied herself to the job, to ensure the Bill was brought to the Dáil and, hopefully, through the Seanad and onto the Statute Book as soon as possible. I wish to ensure that it be done as soon as possible. It is a very important legislative measure. No constituency office, rural or urban, is unaffected by this or is not having discussions with family members about small businesses and farms, trying to do the right thing for them and trying to ensure the future viability of small businesses and family farms into the next generation. It has been a discussion for many years between farming organisations, business organisations and the Department. However, it took the Minister of State to ensure that this came through, and I congratulate her on the way she did it. She should keep up the good work she is doing in the Department.
Before I discuss the substance of the Bill, I should point out that nursing home care is a massively important part of the care of the elderly in our society. For decades, community hospitals provided nursing home care.
It was, by and large, done in the public sector and in community hospitals up to 20 or 25 years ago. Going back decades, the acute services in those hospitals, of which there may have been some, were withdrawn and they became hospitals providing care for the elderly. The debate on refurbishment enters at that point. I am glad to say that the Department of Health and the HSE are moving to advance the refurbishment of Macroom, Kanturk and Millstreet community hospitals. Those hospitals have provided vital services over the years. The staff and management of those hospitals must be commended for the excellent way in which they have cared for the people, particularly in the Kanturk and Millstreet hospitals. They have cared for the people of Duhallow in their most vulnerable time of need. There is not a family within our communities that has not had a loved one in those hospitals for some time. Many have spent their final days in either Millstreet or Kanturk hospital. The workmanship and standard of care provided by the nurses, care assistants and all who are inside those hospitals need to be applauded and they should be thanked for their dedication and work. Any time that one goes into those hospitals, one can see the commitment of the staff and the compassion they have for those whose care they are charged with. It is important that we acknowledge and accept that, and applaud it in every way we can.
Over the past number of years, HIQA has come on board. HIQA was initiated approximately 20 years ago and it has done various reports into the community hospitals and residential settings and has been critical of the antiquated buildings. The Department and the HSE have worked at a slow pace to bring those community hospitals up to standard. It was clearly evident many years ago that these hospitals would not meet the correct standard required today. The bed numbers were reduced because of HIQA reports. The capacity was reduced. While nursing homes would take up the long-term care, many people would require acute hospital and medical care. Such people were predominantly being cared for in the community hospitals. It is important that the HSE and the Department of Health come up with the money to ensure that any community hospitals which receive a critical report, stating they are not up to standard, are brought up to standard and their capacity is maintained. I am glad that the hospitals are working at pace to get the foundations laid and work started. Tenders, documents and so forth are in place. It is important that we keep an eye on it and ensure that the work on those hospitals starts. It is long-awaited and long-promised but it will happen at last.
An amount of work is being done by the private nursing homes. In some past instances, families have started nursing homes. There is regulation in respect of nursing homes nowadays, guidance for care and instruction as to what is needed and expected of someone who starts up a nursing home. In some of the instances where nursing homes were started, the dedicated people involved understood people's care needs and built nursing homes with little or no help or guidance. We must applaud them. They have continued to maintain those nursing homes. The people who work in those institutions have committed their lives to caring and are dedicated.
It would be remiss of me while speaking on this topic not to refer to the recent report of the Ombudsman about young people who require long-term care, whether they have a capacity issue, in terms of disability, or have been the victims of a road traffic accident or any other issue. Such people are sometimes committed to long-term nursing homes because no other residential setting is available for them. We as a country need to take that head-on. It is vital that we ensure it is no longer acceptable that nursing homes or community hospitals are settings for young people with long-term care needs. Some people in their 30s or 40s, or younger in some instances, with care needs have been left without alternatives. We as a State need to be mindful of that. We need to take head-on the report that was published a couple of weeks ago. We need to try to challenge what is in that report and ensure it is corrected in the shortest possible period of time.
This Bill is predominantly to ensure a fairer deal for people with small businesses and farms, and to ensure a nursing home set-up is there for them. I know that the Minister of State has been a champion of keeping people at home and in their own communities as long as possible. That must be an extremely strong arm of the State. It must be strong in the context of public health nurses, home help co-ordinators, the people who provide help at home and home care assistants, who were once called "home help". They have been doing invaluable work. Our family has benefited enormously from the professionalism of the public health nurses and the home care team and we are deeply indebted to what they did for our family when we needed them. We will be indebted to them for the rest of our lives for the work they did in our setting. Many other families are in the same position and understand this too.
We must further empower the sector and ensure that it is stronger, better and more robust. Some people are looking for extra hours of home help and, depending on a family's circumstance, they may need help in the evening to get an elderly person to bed and so forth. We need to accommodate the needs of people, including the families and the people who require care. People will try to manage for as long as they possibly can but when they go looking for help, we need to be more robust in ensuring help is out there. Much of the time, the challenges relate to getting home help professionals and people to do the work in different parts of the country. We need to take a fundamental look at the whole home care package to ensure that people are kept in their homes as long as possible. It is far more beneficial for society, whatever way you look at it, to have people in their homes for as long as is humanly possible. It benefits everybody, including the patient, the family and the State. We should be looking at it in a critical way and examining how we can improve the position as we go forward. Those services have been invaluable to many families but there are gaps that need to be addressed and we need to be mindful of that. We must be at the forefront in ensuring the continuation of those services.
I pay the utmost tribute to those who are on the front line and providing those services in people's homes on a daily basis. They have showed professionalism, particularly over the past 12 months. They dealt with the situation and stepped up to the plate, showing courage and commitment in everything they did. I am referring to public health nurses and care assistants, and I say "well done" to everybody for what they have done over the past while.
Some nursing homes have added different services and extra charges. That is unfair. A family with somebody in a nursing home are depending on their means and circumstances. They are paying so much towards nursing home care that we need to be mindful there is not much more that family can give.
Some people have paid extraordinary fees over the years, in particular, as I said, the family farm units. They do not have very big farms but because it is on paper, it is valued for a huge amount of money, which causes an awful lot of difficulty.
As we are debating it, the discussion must acknowledge that our population will grow older over the next number of years. We have to be mindful that the policies being discussed by the HSE, the Department of Health and the Government, which we should discuss on a regular basis, will impact on society for the next 25 years.
We must recognise the direction in which the demographics are going and what is coming down the tracks in terms of what we need regarding care. We also need to make sure we are not just doing it the cost-effective way. The State is always looking at the cost-effective way and how much it will cost but what is best for the greater good of society?
The previous speaker, Deputy Ó Cuív, spoke about the role of planning. It might be very far away from this Bill but it is fundamentally right. If one can ensure the support is intergenerational, then a couple of generations of people who live in close communities will support themselves. The older families would support the younger families in the first instance and, as time goes by, the younger families would support the older families. That has always been the case going back over the decades.
There was this notion that we should urbanise the entire country and have nothing in rural communities. Covid-19 has shown without any shadow of a doubt that this was a wrong policy. We need to reverse that and recognise the greater good in terms of providing the intergenerational support that was there in decades past. It can be recreated if we have the mind to challenge some of the rhetoric or policies.
There is much we could talk about. I welcome the Bill and congratulate the Minister of State on the way she has brought it forward. It is important this Bill becomes law as soon as possible. Will the Minister of State in her closing remarks give us an idea of when she envisages that it will be on the Statute Book? Will it accommodate people who are going into nursing homes today and tomorrow? Will it ensure the family farms or small businesses will not be affected if people are going into nursing homes on the last week of May 2021. The Minister of State might refer to that issue.
I also pay an enormous tribute to all those who worked on the front line during the last 14 months in community hospitals and nursing homes given the challenges they faced and the suffering and heartache they saw among the elderly people who died as a result of Covid-19. As a result of that pain and suffering, it will be two or three generations before the heartache those workers saw in the families who lost loved ones to Covid will be erased from memory. The way they had to part with their loved ones, particularly in the earlier part of the pandemic, will resonate for a long time.
I thank all those who have put their lives on hold for their professionalism in how they deal with people who are at the end of their days. It is important we treat the elderly with respect.
I also want to ensure the Minister of State takes on board the Ombudsman's report on people with intellectual and physical disabilities who are in long-term nursing homes or community hospitals. It is not a setting for them, certainly not in 21st century Ireland, and it needs to be looked at.
We must bear planning in mind in every discussion we have with regard to the next generation and the ageing of our population. We have to bear in mind that a huge swathe of the countryside needs to be repopulated, where people have family support. That feeds into a whole raft of other issues in terms of housing and everything else. That is a scéal eile.
The other issue is sheltered houses and the sheltered housing model in terms of people who are moving into towns or villages. The sheltered housing model that was in place comprised the small community groups, which were set up as section 39 housing organisations, did such great work right throughout the country. We should be encouraging this more, and encouraging those who have done it in the past to perhaps add another number of units onto their facility, because they are doing excellent work.
As the Minister of State will be aware, there is a huge appetite for day care centres, which provided massive services to elderly people in their own homes, and to reopen them as soon as possible. Sage Advocacy has issued statements over the last few days in that regard and I support what it is doing. I thank the Ceann Comhairle very much for the opportunity to contribute to the debate this evening.
The Solidarity slot is next but I do not believe anyone from that group is present. The following slot is a Government one. Deputy Calleary is sharing time with Deputy Devlin in whichever order they choose.
I thank the Ceann Comhairle. I will go first because I am probably closer to benefiting from the legislation than Deputy Devlin. I commend the Minister of State, Deputy Butler, on this legislation, although not just this legislation but on her work over the last number of years as Opposition spokesperson on older people in pioneering this legislation and delivering it within ten months of the lifetime of the Government. I commend her persistence and commitment in a very challenging time to ensuring we will get there.
I have some concerns about the legislation, particularly where a direct successor may not be available to a person or may not be in a position to carry on the business. The Minister of State is taking those concerns on board, otherwise there would not be the same benefit for the legislation. I acknowledge her interaction around that issue.
I also commend her on the vaccine roll-out in nursing homes. It is very difficult to think back even a year ago, let alone last January and February, on the pressure and horrendous experiences that were seen daily in nursing homes. They are now in a much better place because of the vaccine programme, even though many people have lost their lives. Our thoughts are with their families. The vaccine programme and the roll-out in nursing homes, in particular, is a tribute to the Minister of State and her work. I commend her on that.
There is no doubt that despite its challenges, the fair deal scheme has given people many options and opportunities. I acknowledge the various offices around the country which run the scheme and their professionalism and fairness in dealing with it. It has given opportunities and options to families which may not otherwise have been there. It depends a lot on the private nursing home sector to make it functional and to give those options. I join with previous speakers in acknowledging the role of the private nursing home sector.
All nursing homes, public and private, play a very important role. They are all staffed by people who care deeply for those who live with them. In the last number of months, however, the private nursing homes sector has faced particular pressures. I hope that as we catch a breath at some stage in the coming months, we will reflect on the challenges facing the sector, particularly the owner-occupied and owner-managed parts of it, which have to deal with unequal funding from the National Treatment Purchase Fund, NTPF. They have to deal with the challenge of trying to keep staff in competition with the HSE, which can offer higher rates, or with other care companies. They are an important component and they need support. I know the Minister of State will try to level the playing pitch for them in view of that.
I want to come back to a point made by Deputy Moynihan, and Deputy Ó Cuív before him, about community generally. Nursing home care is an important part of community.
Care in the home is even more important and it should be facilitated and made easier where it can be done. We are lucky to have extraordinary people providing home help throughout the country. The role played by home help providers, carers and palliative care nurses, co-ordinated by an amazing team of public health nurses and district nurses, is vital. However, many families are left trying to put together the jigsaw of publicly funded supports while also trying to source private help. That puts a huge strain and burden on families and often on one family member in particular. It would be worthwhile to consider setting up a home care hub in each area that would assist families to identify people who provide home help and home care services. Families are told to do that online but it is hard to do so when people are working and trying to juggle many responsibilities. A home care hub in each locality would help to promote and encourage the concept of keeping people in the home.
To pick up on a point made by Deputy Michael Moynihan, it is important that sheltered housing schemes are not forgotten. As a huge investment goes into responding to the housing challenge, which needs to be done, we must keep in mind that older people may decide to stay in their community if there is sheltered housing available, along with the appropriate healthcare supports. For many older people, faith-based supports are important and they can be provided in a sheltered home care setting. That type of provision keeps communities alive. All over the country, local community organisations have developed sheltered housing that has enabled older people, in particular, to stay in their communities. Sheltered housing is often built near, or adjacent to, a community centre, where people can get meals, have interactions with neighbours and attend religious services. It is a model that keeps rural communities alive and allows individuals to stay among their own people rather than going into a nursing home as the first option. I hope the Minister of State will consider providing an increased investment in sheltered housing for older people in communities.
I join colleagues in paying tribute to everybody who has served on the front line over the past 14 months, particularly in the nursing home sector. It is extraordinary that just as the success of the vaccine programme had allowed us to begin to take a little breath, we got hit last Friday by the cyberattack on the health service. The service has, once again, shown an amazing capacity to respond quickly and flexibly and the sacrifices being asked of the staff this week are phenomenal. It is absolutely despicable that somebody would think that a health service is ripe to be attacked in this manner, that it could be subject to a ransom note and that the concerns, illnesses and lives of people are worth the ransom note. It is an absolutely sad indictment of our world that there are people who see an industry in that. It is an even sadder indictment that people see opportunities in it for legal challenges and promoting legal services when the focus should be on protecting the information that was compromised and the individuals affected. We saw during the week a rush to judgment in that regard. I wish the HSE and the Department of Health well in dealing with the issue.
The Ombudsman's report on the nursing home sector declared very clearly that younger people in nursing homes are being forgotten. That needs to be addressed. The nursing homes commission report last year laid out the future options for the sector. The lessons of the past 14 months in terms of the experience of nursing homes during the pandemic must be learned and changes enacted without delay. We cannot wait any longer. There must be supports and backup for owner-run nursing homes to enable them to rebuild their staff complement and give them a chance to take a break after a very intensive 14 months. Similarly, staff across our public home care sector will need breaks and time to take stock of what they have had to deal with for more than a year.
I ask the Minister of State, with her mental health hat on, to put in place a specific programme of mental health supports for nursing home staff and service providers throughout the country, as well as for nursing home residents, to help them come to terms with what they have witnessed and lived on a daily basis for the past 14 months. After the Covid pandemic, many nursing homes will find that the heart of their community has been taken away. Many of the residents who made up that heart and were part of their nursing home community for many years were taken by Covid. Staff and owners will need support to rebuild their communities and allow staff and residents to grieve, in the same way that communities all over the country, separate from nursing home settings, will need the same support. As the Minister of State begins the process in the next few weeks of planning for budget 2022, I ask that she focus in the mental health side of her brief on rebuilding communities and giving supports to communities to deal with the legacy of Covid.
Is Bille an-tábhachtach é seo mar déanann sé cúrsaí féaráilte le haghaidh feirmeoirí agus daoine le gnóthaí beaga. Déanaim comhghairdeas leis an Aire Stáit as ucht na hoibre atá déanta aici. Maith thú. Mar a dúirt sí, is tús maith leath na hoibre ach níl ann ach tús maith. It is a good start and I have absolutely no doubt she will finish the job of providing a much fairer deal, not just for those in nursing homes but for older people throughout the country.
I begin by clarifying for Deputy Calleary that just because I am from Dublin does not mean there is no benefit for me from this legislation. There are farms in Dublin too.
I understood Deputy Calleary was making a reference to age when he said the legislation might be more relevant to him than to Deputy Devlin.
Perhaps he was. I welcome the Nursing Home Support Scheme (Amendment) Bill 2021, which updates the fair deal scheme to give greater protections for farm families and small business owners. I commend the Minister of State, Deputy Butler, on her work in bringing the legislation forward in such a short period. Since her election to the House in 2016, the fair deal scheme has been in her focus. Now, after only ten months of being in office, she has brought it to fruition. I thank her for that. It has always been a priority for her and the update to the policy is very welcome. I also take this opportunity to thank her for her efforts on the vaccine roll-out programme. She has always been very available to Deputies on all sides of the House in dealing with individual queries, which is greatly appreciated by all of us.
The nursing home support scheme has been in operation since 2009. As of 31 December 2020, there were 22,755 people participating in the scheme, at an annual cost of just more than €1 billion. Participants contribute up to 80% of their assessable income and a maximum of 7.5% per annum of the value of assets held. In the case of a couple, the applicant's means are assessed as 50% of the couple's combined income and assets. The first €36,000 of an individual's assets, or €72,000 in the case of a couple, is not counted at all in the financial assessment.
The overall aim of the scheme is that participants contribute to the cost of their care according to their means, while the State pays the balance of the cost. Where an individual's assessed weekly contribution is greater than the cost of care, he or she does not qualify for financial support. Therefore, applicants with substantial assets or incomes are unlikely to qualify for financial support. The capital value of individuals' principal private residence is only included in the financial assessment for the scheme for the first three years of their time in care. This is known as the three-year cap. Currently, this unqualified cap does not apply to productive assets such as farms and businesses, except where a farmer or business owner suffers a sudden illness or disability and requires nursing home care as a result. The Bill seeks to address this issue by introducing additional safeguards into the scheme to protect further the viability and sustainability of family farms and businesses that will be passed down to the next generation.
Reforming the fair deal scheme to support farm families and entrepreneurs was a firm commitment in the Fianna Fáil manifesto in the last general election. I am delighted to see progress being made in this regard. The change to the scheme, which Fianna Fáil has long sought, will mean that after a period of three years, the value of family-owned farms and businesses will no longer be taken into account when calculating the cost of a person's nursing home care.
This will happen when a family successor commits to working the farm or taking on the business. This change is essential to the viability and sustainability of family farms and businesses, allowing them to be passed down to the next generation. This will ensure that the fair deal scheme is fair, more accessible and more affordable for farm and business-owning families. This has been a hugely emotive issue for farm families and business owners in communities right across Ireland and one the Minister of State has acted on as promised.
The Covid-19 pandemic has brought into sharp focus the vulnerabilities of many older people, especially those living in long-term residential care. It is absolutely critical that public investment in long-term care services is maintained for those who need it and it should be increased as our population ages. We must see more capital investment in facilities for older people to allow them stay in their homes as long as possible - particularly the construction of more dedicated sheltered accommodation. I am thinking of the ones in my constituency such as Rochestown House in Sallynoggin, Beaufort day centre in Glasthule, Glasthule Buildings, Kilbegnet Close in Dalkey, Ailt and Óir in Glenageary and the list goes on. We are very fortunate in our urban area to have a number of different types of residential accommodation for our elderly which have been built up over time. However, that is not to say there is enough such accommodation. Not everybody wants to go into long-term residential care. The vast majority of older people want to live independently, as the Minister of State knows from her own engagement with the organisations and services for older people. However, it is essential that not only the private sector but the State looks to plan over the long term for residential care and residential settings. If we look at the financial contribution, Dublin City Council, for example, has used that quite successfully, although it must be said it was limited. I would like to see it used in other local authority areas, where people in private accommodation can, if they choose, sell that accommodation and look to step down into accommodation that is council-owned, provided through an associated housing body or through other agencies. It is very important that we look at this and plan now. Arguably, not enough planning has gone into it over the last number of years but it is essential we look not only at reforming fair deal, as we are doing today, but also at reform of accommodation and sheltered accommodation for those who may need it over the next number of years. I hope the Bill will receive cross-party support to ensure these welcome and necessary changes are introduced without delay.
In the time I have left, I have a query for the Minister of State which she might come back to me on. I know she may not have the information to hand but I am wondering whether there is an inbuilt review of the fair deal system with this particular change. If the Minister of State has time she might come back to me on that. I am thinking of an automatic review in, perhaps, three years because while these changes are welcome, other changes may come to light over the next little while. I do not expect the Minister of State to have any answer to my final question today but her office might reply to me in writing. It concerns the promotion and better understanding in the public domain of the power of attorney. It is really important that knowledge and understanding of that system is out there. It is not only about, as I said, planning for people's accommodation needs into the future but so people can actually plan for their future if anything happens with their mental or physical needs into the future.
I congratulate the Minister of State for progressing this legislation which was a commitment in the programme for Government. It is very welcome, particularly for rural communities, farm families and people with businesses. The fair deal scheme has been successful, very important and vital in providing community care settings for people. As the Minister of State knows, the scheme has been criticised in the past for the difficulties with qualifying and the numbers that are on it.
It is a sad demographic fact that our country's population is ageing and the care burden is going to increase. What is also salutary for all of us to consider is that family sizes are getting smaller. It would traditionally have been recognised that the care for elderly parents would have fallen to sons and daughters. They might have shared that burden and indeed do every day but there are fewer of those coming through and the burden of care is getting greater. Also we are living longer, thankfully, but that means we have different needs at different stages and later in life. Therefore, we must look to try to enhance community care, elderly care and residential care. That also extends right across the other spectrums of population that are implicated in that, particularly the disability sector.
As I said, I welcome this legislation and hope it will go on to improve things but it cannot go far enough in trying to expand it. It is also the case that every sector of the economy, particularly every sector providing a public service, is looking for more money, and there is not endless money. We therefore need to prioritise where money should be spent. We must also create efficiencies in public service spending. That is an area where we have probably taken our eye off the ball in this last year of crisis. Certainly, at the end of this crisis we will face very significant challenges to the Exchequer and public payroll. We are going to have to really get down to the minutiae of how we are spending our money and what we are getting for that spend.
It is also the case that people would like to stay living at home for longer, where possible. I hope the Minister of State will look at this again and particularly at new technologies. There are a lot of new technologies that are allowing people to carry on living at home for as long as possible. I know of very few people who would be rushing into nursing homes if their quality of life was such that they could remain in their own place. Most of us would like to remain in our own place as long as we possibly can. We can see now where technological advancement is going, particularly with home monitoring systems, which have revolutionised the care of people at home. I am aware of this in rural areas of County Waterford. Relatives of mine have been facilitated to spend longer in their homes because of home monitoring systems and these should be looked at. I know there are grants available for those who are challenged but again, we should look at spending more money in this area rather than trying to divert people into community settings, where their care costs much more.
In the context of Covid, I raise the reaction of both the public and private sectors with respect to community care of the elderly and people with disabilities. When it came into the country, the main danger of Covid was that it was targeting the elderly. I will not rehash the problems we had with elderly people perhaps finding themselves in settings where they were at risk. I want to give a special shout-out to the health service in general, and those in residential care settings in particular, for the Trojan work they have done over the past 12 months and that they continue to do. With that in mind, last year the Government announced it would give a temporary assistance scheme to nursing homes, particularly private ones - nearly 80% of the burden falls on them - to support them with costs. That was done at the outset to provide, in the main, for PPE. It also went into creating isolation space and also with recruitment. Those challenges have probably abated somewhat but the money is very much required. At present we are operating visiting guidelines within the nursing homes and they are being facilitated by the temporary payments because people have been brought on to act as visiting co-ordinators. This is because we are trying to check whether visitors are vaccinated and to determine what setting the residents are going to see them in, be it in the resident's room as per the protocol, or perhaps outdoors. We need people to manage all that. I understand this scheme is due to finish. Has the Government thought about that or how it is going to support nursing homes to continue these protocols without that money?
The other thing that has been going on for quite some time is the HSE and Health and Safety Authority, HSA, were doing screening testing where outbreaks occurred. Again, I understand that is to be stood down soon. Essentially, the HSE has taken a position that where 80% of staff are vaccinated, this testing will finish. We must be mindful that we have vulnerable people there. Happily, we have done very well on the vaccination front, especially with the elderly. Everybody in those settings should now be vaccinated but one imagines there may still be a risk, perhaps with temporary staff cycling through those settings, where someone may carry an infection from one facility to another.
I ask the Minister of State to look again at that money.
Beyond that I will mention the existing supports. I was a member of the Special Committee on Covid-19 Response and the question of nursing homes and congregated settings came up quite a bit. There was a massive bias on the committee at times in favour of public nursing homes as opposed to private operations. Private nursing homes were often presented as being purely for profit, which is not a fair representation. I know many people in the private nursing home business and they are excellent carers of elderly people.
In the private care setting there are people who get €1,000 per week in support but in public settings those supports can go up to €1,500, €1,700 or €2,000 per week. In providing exactly the same care, there is a difference in the country as we support public costs more than private. As I stated, nearly 80% of the care in the sector is provided by private operations. That does not make sense to me and tells me there is inequity that should be looked at. It is very hard to stomach talking about the lack of adequate care in the private sector if we are going to pay them 50% less for doing the same job. That is something that must be considered.
The Minister of State is aware of the expert review panel convened to look at concerns in nursing care. There were 84 recommendations made in that report and perhaps the Minister of State will return to the House at some point to provide an update on where those recommendations are now and on the number that have been implemented?
Another matter topical in the media for some time is rapid testing. I am on record as saying I brought the idea of rapid antigen testing to the National Public Health Emergency Team, NPHET, in May 2020 but to date we still have not implemented antigen testing. A recent debacle saw a senior person in NPHET describing rapid antigen testing, which is approved by the US Centers for Disease Control and Prevention, as "snake oil". That is more than regrettable and it also demonstrates a medical bias.
In the past 14 months of the Covid-19 pandemic, I have engaged with senior specialists, some of whom were using antigen testing informally in hospitals to try to guide Covid-19 pathways in their hospitals because there were not sufficient beds. Those doctors were more than happy to use the test and reported 100% success in identifying people in danger of transmitting the disease. Nonetheless, the HSE still appears, under NPHET guidance, to have taken advice that it will not use antigen testing, or it is at least very slow in adopting it.
I know the Minister, Deputy Donnelly, when he participated in the proceedings of the Covid-19 committee, supported rapid testing. He has probably moved base slightly in the past few weeks. I heard Dr. Holohan describing the Cochrane report as saying antigen tests are effective only 50% of the time but that is absolutely not the case and it depends on what is being measured. They are effective 100% of the time when detecting transmission levels or when a person is in danger of transmitting Covid-19.
In this country we are now trying to figure out how to open the economy and get aviation operating in some way in the country. We have a proven test, and in America testing has been done on more than 300,000 antigen processes, with the rate of false positives at one in 10,000. The rate of not detecting virus at a high load was zero. Nonetheless, we are still trying to figure out how we are going to do this.
Professor Mark Ferguson from Science Foundation Ireland undertook a report on antigen testing at the behest of the Tánaiste and the request for such a process to be introduced. He was asked how many Departments engaged with him but only one did so, which was the Department of Further and Higher Education, Research, Innovation and Science. The Minister, Deputy Simon Harris, was looking at the possibility of using antigen testing for the back end of the year and the reconvening of universities. On top of this legislation I ask the Minister of State to go back to the Department and consider the matter again.
Another question raised recently at the health committee was vitamin D supplementation. There is a large body of international evidence suggesting the major benefits that can be found by supplementing vitamin D, but this does not happen overnight. Most of us in this country are low in vitamin D levels because we live in northern latitudes and none of us is outside enough. Perhaps from now on we might get adequate sunshine to generate vitamin D but we have not had that up to now so we should have this supplement. It is a very cheap fix for many problems and it is well regarded and known to benefit immune supports over years.
I have spoken with a number of doctors who have used vitamin D deficiency as a marker in determining patients who could have adverse outcomes from Covid-19. Some of those doctors gave a presentation to the health committee and, to be fair, that committee produced a very substantial report on the benefits of vitamin D. Despite that, we cannot get NPHET to make any public pronouncements that people in general in the country should have these supplements. It is a cheap process and it is a small number of people in different patient cohorts who need to watch their vitamin D levels. They can do that in conjunction with GPs. The levels being spoken about for the majority of the population are in no way dangerous and could be beneficial.
Not alone has the message not got out but it has been obstructed, like the message on antigen testing. That has been obstructed by NPHET and I do not know why. I have said many times before on record in this House and in committee rooms that the test is used widely everywhere. We must seriously consider how to revive the economy. I am thankful we are making good progress on the vaccination front but we will still need rapid testing and ways to test in case of future outbreaks, potentially of variants. Antigen tests will play a part in that. Will the Minister of State take back that message to the senior health officials, including those in NPHET? They are not listening to me and do not seem to be listening to the wide body of science or other medical opinion outside of what is in their own think tank. That has been a problem for some time.
I congratulate and say "well done" to the Minister of State on the legislation. I welcome it.
It gives me great pleasure to speak to this Bill, which amends the nursing home support scheme. Like others, I compliment the Minister of State on her doggedness and determination to get this Bill before the House. It has been a difficult year for the Department of Health and great recognition and praise is due to the Minister of State that in the space of 12 months, she has managed to get this Bill to the floor of the Oireachtas.
I was president of a farm organisation when the fair deal scheme was introduced in 2009. At that time we saw the unfairness in the fair deal scheme, and unfortunately it has taken from 2009 to now to get amending legislation to take that unfairness out of the process. As Deputy Calleary has said, there are still some matters we would like to discuss to ensure there are no anomalies in this new legislation. I am nonetheless thankful this will take away the major financial hardship that farm families and small business owners have had to endure over a long period since the fair deal scheme was introduced.
I have seen farm families being brought to their knees financially in trying to meet the contribution to fund the fair deal scheme. It brought hardship on them when a farm is just an ability to make a living for farming families. The main wish of the majority of farmers is to pass that farm, intact or improved, to the next generation. Unfortunately, when ill health strikes and a person must go into a nursing homes, for example, the initial contribution is 7.5% per annum with no cap and this puts huge pressure on the family farm structure. This Bill, as a result, is most welcome and many people will breathe much easier with the introduction of this cap.
A significant contribution must still be made but that is only right. Where an asset exists, a contribution should be made, and this will be done over three years. The continuous drain with no end is being taken out by this legislation being brought forward by the Minister of State. I cannot give her enough credit for the haste with which she has brought the legislation before the Dáil. We were both elected in February 2016 and we pressed a former Minister of State, former Deputy Jim Daly, when he held the relevant position in the previous Government. There were many false dawns but it is a great day for the Government that it is now on the floor of the Dáil. I praise it highly.
I will make another few points to the Minister of State when I have the opportunity to speak about care for the elderly.
As other speakers have said, people's main aspiration is to be able to stay in their own home as long as possible. With regard to home care and extending home care, I am aware it is a solid ambition of the Minister of State, Deputy Butler, to improve the home care system currently in place.
On the package that is there and the home care workers and support teams that go around to individuals to help them stay in their family residence for as long as possible, a point was made to me about the shortness of the visit being imposed. This needs to be looked at. The duration of the home care visit by the home care worker in the home must be a reasonable level. This is not just to make sure the person can get all the work done. To attract home care support workers into the scheme we also must have consideration that the person has to be able to make a reasonable income from it. To expect the support worker to come in and have half an hour or three quarters of an hour at one location and then to rush to the next location does not make sense with regard to getting the work done from the perspective of job satisfaction and from an economic and practical point of view, such as allowing people to earn a reasonable income. These workers are going to be a key part of our healthcare going forward. I am aware that the Minister of State is fully committed to home care support and that she will take these observations on board. It can really benefit a family. Everyone has a lot of commitments, we live in a rat race of a world and we have financial commitments to meet. To be able to devote the time to look after the elderly in the family can be very taxing. This support from home support teams can make the complete difference between trying to keep an elderly relative in their home or having, regrettably, to put them into a nursing home.
During Covid we saw the excellent care delivered by nursing homes and the huge pressure they came under. Unfortunately there were cases of clusters in nursing homes but the precautions and care taken by nursing homes with their patients during Covid must be commended to the highest degree.
Members have all been lobbied by private nursing homes. The contribution they get from the State per patient needs to be looked at. The public bed costs roughly 170% to 180% what a private care bed gets from the HSE. This must be examined going forward to make sure there is a level playing field and to make sure the private nursing homes, which are a key part of our health system, are able to continue and do so viably. In the days when we had pre-budget submissions and pre-budget lobbying these nursing homes had lobbied us all intensively. In my view, they made a very solid case for themselves. I ask the Minister of State to look at this to see if the contribution paid by the HSE to private nursing homes could be increased to make sure their viability is not threatened.
The roll-out of the vaccine for the elderly has been excellent. I commend the Minister of State on it. I made representations to the Minister of State about some people who were housebound and she really put her shoulder to the wheel to make sure it happened. The National Ambulance Service got involved and there was a very speedy delivery of what was a very tedious process to visit people in their homes to make sure those people, who were probably the most vulnerable in our society, got the vaccine. It was done with great speed and great efficiency. We had a few outliers for a couple of weeks, but when representations were made they were taken care of very quickly. Again, it was a job extremely well done.
Thankfully, the vaccine roll-out is going exceptionally well. We have a lot of critics in this House but not a lot of them are standing up to praise the vaccine and the way the Department of Health has handled the roll-out. It has exceeded all expectations with the level of efficiency and the amount of people per week who are getting vaccinated. Hopefully, we are over the hump with the roll-out and we are coming down now into the younger age groups. This will greatly benefit the opening up of our economy, for which we all yearn.
This Bill has taken an awful lot of pressure off a lot of families around the country. It will stand as a testament to this Government. It was in our programme for Government and we have delivered on it within a year. It is most welcome legislation. I am delighted to be able to speak to it. When the Bill was introduced I was wearing a different hat, but I saw the unfairness of the system. It is great to be part of the Government that is taking that unfairness out of the system.
Like previous speakers I commend the Minister of State for bringing this legislation before the House. Sometimes one marvels at how resistant the system is to change and how long it takes to achieve change. When someone does bring a measure before the Dáil that changes the system, albeit long argued for and long promised, they are to be commended. I commend the Minister of State, Deputy Butler, on that. As Deputy Cahill has pointed out, it removes a potential unfairness from the fair deal scheme. The scheme is excellent and is availed of by many.
This Bill removes a potential unfairness in the scheme. Where there is an asset, and where people have to pay something towards the support of their family member, it is not unfair. It is unfair, however, if the entire asset is dissipated, especially in circumstances where it is a working asset and where a family member is willing to take it on to farm it or work in the business. Just because a person became unwell or aged more rapidly than he or she had anticipated and did not have time to transfer his or her assets, it should not be a reason the entire asset is dissipated or that the person should somehow be disadvantaged.
The five-year rule, by which anything that has transferred within the previous five years is looked at, does seem a little unfair. I can, however, appreciate why it is there. We do not want somebody on the eve of going into a nursing home dissipating all of his or her assets and somehow frustrating any attempt to have to pay. I understand why the five-year rule is there but it does seem a little bit unfair. I am aware that the Minister of State has officials in the Chamber who would say that the line has to be drawn somewhere. I accept that a line must be drawn somewhere and I will come back to this drawing of the line towards the end of my contribution.
Like many previous speakers I wish to talk about the need to resource home care packages adequately. In fairness, the Minister of State is well aware of this and I know it is something she intends to move towards. I do not want to seem churlish in any way by pointing to that or to diminish the achievements of the Bill. They are an achievement of this Government and of the Government I have at times been highly critical of. It is a particular achievement of the Minister of State, Deputy Butler. I would take the credit when it comes because, as she well knows, it does not come very often in politics.
The Minister of State was a member of the committee for Covid-19. Deputy Shanahan said there was a bias in the committee against private nursing homes. I am not entirely sure I agree with that. There was certainly a strong bias by some members of the committee against private nursing homes, but I am not entirely sure that this was a bias of the committee as a whole. I rather think it was not. Many committee members realised that private nursing homes exist to fill a lack of capacity by the State, which the State has not managed to fill. The State certainly should provide more nursing home care.
A new site, St. Joseph's, is one of the things that have been pledged and I look forward to it being delivered. I was delighted that Raheen District Hospital, which was effectively slated for closure when I was first elected to the Dáil in 2011, is certainly flourishing now. It is a huge asset to the community and one that is very close to my own heart. It means a lot to people to know that their family members are looked after. One cannot put a financial value on that.
This is equally true of private nursing homes as it is of State nursing homes. The one my family member was in is a public home. I have been critical of the visiting regime and I endorse what Deputy Shanahan said about antigen testing and anything that enables visiting to take place safely. I am not saying that we should abandon our duty of care to the residents because it is their home and it has to be protected but anything that can make it safe should be looked at.
I very much agree with what Deputy Shanahan had to say in respect of vitamin D. NPHET's attitude to antigen testing and vitamin D is inexplicable. I have spoken to doctors who are respected in their profession and communities and who hold very senior positions of responsibility in our hospitals. I am not a doctor, and I do not ever wish to pretend I have any medical expertise. However, these doctors convinced me that there is a correlation between vitamin D inadequacy and the ill-effects suffered when people contract Covid-19. This attitude to vitamin D and antigen testing is inexplicable and is almost dogmatic. Of course, dogma is the polar opposite to empirical science. We are told we are being led by science in this regard. I digress slightly and I will return to the issue.
The Oireachtas committee on Covid-19 made a number of recommendations. I see Deputy Durkan, who was also a member of the committee, in the Chamber. The report of the committee stated:
The State is over reliant on institutional care for our vulnerable population. This issue was starkly highlighted by the Expert Panel report and was also a central theme of the Committee's Interim Report on Covid-19 in Nursing Homes in July 2020. The Committee is grateful to Professor Kelleher and the Expert Panel for providing a blueprint for the further care of the elderly and will make recommendations accordingly. The Committee is of the strong view that future moves to support the older people at home must have, as a priority, a publicly funded and publicly provided model of care that is underpinned by community intervention teams from the HSE.
I know this is not something the Minister of State has forgotten about but I fear it has the potential to be forgotten. The committee recommended that an implementation plan be drawn up in respect of the recommendations contained in the report of the Covid-19 nursing home expert panel, which was the panel chaired by Professor Kelleher, with a requirement to provide six-monthly progress reports to the Houses of the Oireachtas. The committee also recommended that standards regarding staffing and staff ratios in nursing homes be developed by HIQA.
This goes back to the idea of home care. I am not unique in believing that the latter is essential. I was not here for all of the debate, and I appreciate the fact the Minister of State is here to listen to all of it. That shows a certain attitude to the Parliament and it is one I respect and I am grateful for it. I heard Deputies Cahill, Calleary, Moynihan and Ó Cuív referring to this idea. This view is broadly held across the House and it is something that I hope we will see some movement towards in due course.
While we are all grateful for the fact nursing homes exist, I do not know how I would react if and when I am put in one. I would say the same of the Minister of State. It may become an inevitability some day but if it is an inevitability, it is one we all want to put off for as long as possible in the context of ourselves and our loved ones. I have seen that our loved ones will put it off for as long as possible, and understandably so. We need to move towards care in the home and in the community even from a humane and societal perspective. If the past 12 months have taught us anything from a disease control and infection control perspective, it is that we have a further reason to move towards care in the community. I want to draw the attention of the Minister of State to this because it needs to be highlighted.
The alternative to care in the home is a risk of institutionalisation, and I appreciate that some nursing homes are far more institutionalised than others. Two very recent HIQA reports happen to pertain. One, in respect of an unannounced visit to Cahercalla Community Hospital and Hospice, was published on 9 April 2021. The visit took place on 20 January 2021. It has to be said it was in the midst of the Covid outbreak and in fairness to Cahercalla this has to be borne in mind. HIQA stated:
A system of communication was in place throughout the centre that included loud speakers on every unit. This was used to call members of staff to different areas of the centre. Inspectors found this system to be intrusive distracting and incongruent with an environment that is meant to be a residents home.
Inspectors observed some residents watching television or listening to the radio to pass the day. However, over the three days of inspection there was limited social engagement observed between residents and staff. One resident explained that she had not had access to a newspaper for a couple of weeks and that while she had a radio and access to television, a read of the newspaper everyday kept her going. Limited access to meaningful activities and little opportunity for social engagement are repeat findings from the inspection last September.
These are the two passages I wish to highlight from the report in respect of Cahercalla. A report on St. Joseph's Hospital was published on 11 May, the unannounced inspection having taken place on 10 March. Again, this was during a Covid outbreak, in fairness to the staff and management of St. Joseph's Hospital, and it should be borne in mind.
During conversations inspectors were told by residents that they were not allowed to have showers as a result of the COVID-19 outbreak. Residents spoken with were of the understanding that if assistance was required this meant that the option of a shower was not available for them. Inspectors reviewed the care records and spoke with care staff. Records evidenced that there were periods of months where residents did not have a shower. This was discussed with the nursing management who took immediate action and on day two of the inspection all residents that chose to have a shower were facilitated to have one.
I do not draw this to the attention of the Minister of State to beat her up over it or to beat up the HSE or the management teams at Cahercalla or St. Joseph's. All of us, the Minister of State included, would accept it is not acceptable as, I am sure, would the management of St. Joseph's and Cahercalla. We need to move away from this. It is not enough to accept that it is unacceptable. We need to move forward. We need to move towards care in the home and in the community. If anything, not being able to choose when to eat or what to watch on television, or whether to watch television, and not being able to choose what newspaper, if any to read, shows how important this is. There was a time in my house the Irish Press had to be read every day, and it had to be the Irish Press. To some younger Members of the House, this is of no consequence but Deputy Durkan has a certain understanding. I am making the point that autonomy is hugely important. It is part of what gives us dignity as human beings. It is better served by care in the community if and when possible. I urge the Minister of State to move, if possible, in this direction.
Another point I want to bring to the attention of the Minister of State is a slight unfairness that has emerged in the existing system. As the Minister of State is aware, the nursing home support scheme, which she is reforming - I congratulate her on doing so - essentially means that a person who is a resident of a nursing home is able to borrow money that pays for his or her care against an asset. He or she borrows this money from the HSE and it is repayable to the HSE. It is against an asset and is capped at 7% a year and now will be capped at three years. All of this is excellent. Rightly, this money has to be repaid and it is set out in the primary legislation that the interest shall start to accrue following the person's death.
That is all dealt with by way of statutory instrument and it could be changed at the stroke of a pen. The way it is set out is as follows. There is an interest rate set out. It is 0.02% per day payable on the overall amount until it is repaid. That is entirely fair. The rate is 8% a year. I suppose 8% a year seems high because interest rates are so low. When the statutory instrument was introduced in 2009, however, interest rates were probably a bit higher, and were certainly higher than they are now. When the nursing homes support scheme was introduced way back, interest rates were much higher. As a result, 8% a year seems low. Interest is not payable where the money is repaid within a year of the person's death. If they do not pay, however, it all becomes payable thereafter and payable from the moment of death.
The point I would make, and I think the Minister of State will agree, is that this has not been an ordinary year for regulating affairs in terms, for example, of selling part of a farm - if it is a farm that is involved - if that is what is required. Obviously, the vast majority of people will do a lot rather than sell a piece of a farm. To repay the money, they will try to refinance and get a loan, as Deputy Cahill said, in order to keep the farm together and pass it on to the next generation. It has not been an ordinary year in terms of going to solicitors, banks and, where necessary, auctioneers. The statutory instrument states: "Interest shall not be payable on a repayable amount which arises from a relevant event or a deferred relevant event where the repayable amount is paid within the period of time specified in Regulation 3(2)(a) or (b), as the case may be." It also refers to "the period of 12 months from the date of the relevant event or deferred relevant event, as the case may be ... ." What I would urge the Minister of State to do, by way of a further statutory instrument, is merely to say, "the period of 12 months from which can be deducted any time that we were in a level 5 lockdown." That is not unfair. I am not suggesting that people should not have to repay the money. Of course, they should have to repay it. I am not saying that there should not be an interest rate. Of course, there should. It is merely the period of 12 months about which I am concerned. Interest does not start to accrue after the 12-month period; it starts to accrue from the moment of death. It is quite punitive in that regard. I urge the Minister of State, in light of the year that we have had and given the unfairness to which this can give rise for some people, to look at whether that period could be extended by, for example, including the wording, "In the context of Covid-19, periods of level 5 restrictions shall not be taken into account." It is a few of words but it would bring a great deal of fairness to bear.
I appreciate that this is not something the Minister of State can decide here and now, but it is something I would urge her to look at in the interests of fairness. Like Deputy Cahill, I was brought up in a farm family. Deputy Cahill, unlike me, was chairman of a national farming association. Fair is fair. If one has an asset, one has to repay the money. However, the timeline that is provided for in the relevant statutory instrument is something that I would urge the Minister of State to look at in the context of the year we have had. In terms of contacting professional people, I think the Minister of State will agree that it was all quite difficult. Even contacting the Department was quite difficult. People were working from home. That was, of course, true of any of the professionals that one would need to go to in order to regulate affairs after somebody's death.
I commend the Minister of State on bringing this Bill before the House. It introduces a degree of fairness. If a person has an asset and he or she is availing of a service, that asset should be used to pay for the service but there should be a cap on that where it is something like a family business or a farm that is being farmed by the next generation. I am aware that the idea of a designated successor is slightly controversial and has the potential to be unfair. The Minister of State has agreed to look into that to see what can be done. I again congratulate the Minister of State for having brought some small bit of change to an institution that sometimes looks completely impervious to change.
I cannot see anybody else offering so I call the Minister of State to reply.
I thank all the Deputies for their valuable contributions. I greatly appreciate the positive words and the cross-party support for the Bill. We have heard many contributions over the past three days. I understand that the Bill is technical and complex in nature and that there will be some further work required to refine it as it passes through the Houses. I look forward to working constructively with the House to achieve the best possible outcome for families with farms and businesses. We will work through the details of the Bill on Committee Stage and consider any amendments tabled by Deputies. As I already indicated, I will also have a small number of Government amendments. It is my sincere hope to progress this Bill through the Houses as quickly as possible in order that this long-awaited measure can begin to have a positive impact on the lives of families with farms and businesses across the country. Indeed, I am already in talks with the select committee to have Committee Stage taken next month.
This is a complex Bill, as I have said, involving many legal considerations, but its core aims are straightforward: to ensure fair treatment for farm and business-owning families without impacting negatively on the future sustainability of the scheme, thereby preserving access to care for those who need it. The Government recognises and acknowledges the real concerns that farm and business families have had for many years regarding the fair deal scheme. This legislative change will address the uncertainty faced by family successors to a farm or business as they will now be able to operate that business or farm in the knowledge that the maximum charge on the property for the person receiving care services will be 22.5% of its value, provided all of the conditions of the scheme are met. This will assist in protecting the future viability and sustainability of these productive assets for many families.
Farms are traditionally passed down by families through generations and it is important for rural communities that farms can continue to operate within the family unit and be maintained as sustainable productive assets. Small farms, in particular, play an important role in supporting rural employment and maintaining the social fabric of rural areas. This amendment will help sustain rural communities by encouraging the orderly succession of farms to family successors, encouraging young farmers to remain farming, and potentially encouraging family members who had changed occupation or emigrated to return to the family farm.
I acknowledge the important contribution of the business community, particularly small, family-run businesses, to Irish society. As someone who worked in a small family business for many years, and sold both the Irish Press and the Irish Independent, I know how important it is that we recognise and value the investment of time and effort that business-owning families have made, and their equally strong desire to pass down their livelihoods to the next generation. The preservation of smaller family-owned businesses is a priority for the Government and has been a key focus of the supports we have provided throughout the pandemic.
I again thank all the Deputies who spoke on the Bill and raised important questions. I will address some of their points now, although there will be more time to discuss them in detail on Committee Stage. I will first address the matters that were raised in respect of the provisions of Bill.
Several Deputies asked whether retrospective payments will be considered for contributions to the cost of care already paid by nursing home residents with farm or business assets. This matter was examined in detail and, unfortunately, retrospective payments will not be possible. Retrospective application of the proposed legislative changes would create a challenging precedent, involving high legal and administrative costs and risks, in attempting to apply retrospectively a complex set of conditions. Following the contributions by Deputies Harkin and Fitzmaurice, however, I wish to make clear that the absence of retrospective payments does not prevent a person who is already in the scheme from availing of the three-year cap. The time that a person has already spent in care counts when making up the three years to quality for the cap. If, therefore, a person has spent five years in care, he or she can qualify for the relief from further contributions straight away once he or she appoints a family successor and meets the other conditions of the relief. Similarly, if a person has spent two and a half years in care, he or she can avail of the cap after he or she has paid contributions for the final six months and has met all the other relevant conditions, including the appointment of the family successor. However, the family successor must still be committed to working the farm or business for six years from the date he or she is appointed.
Deputy Pringle raised a number of issues regarding the operation of the scheme, including when the three-year cap will apply. The three-year cap will always apply after three years have been completed within fair deal, provided that the family successor has been appointed at some point in those first three years. However, applicants would be advised to appoint their family successor as soon as possible after they enter care services, so that the six-year period which the family successor must commit to can begin.
Deputy Pringle also mentioned the situation where an identified family successor who may have been working abroad returns to run a farm or business when a parent needs care services. When applying to appoint a family successor, the applicant must declare, by way of statutory declaration, that the farm or business asset had been actively worked for at least three of the five years before he or she entered care services. The family successor does not have to have worked the farm in that period as long as it was being actively worked for at least three of the five years by the person in care or his or her partner. One point to note is that the family successor does not need to provide proof of income or having worked the farm at this point.
The review process was also mentioned by Deputy Pringle. Although it is expected that most applicants will only appoint one family successor, this amendment allows a person in care to appoint multiple family successors to multiple different assets, although only one family successor can be appointed to any given asset. Once the three-year cap applies, the HSE will review each appointed family successor to ensure compliance with the conditions of the scheme. There will be an appeals process for all decisions made by the HSE.
I continue to hold the view that the scheme should not be extended to change the method of assessing income from productive assets that are subject to a lease agreement. The policy intent of this amendment is to protect family farms and businesses that will remain within the family as a source of employment and income into the future. This policy would not be advanced if income from leasing arrangements was included in the cap.
I would also like to thank Deputies for their contributions on matters that extend well beyond the scope of this amending legislation. It is heartening to hear the commitment across all parties to the improvement of older people's care in Ireland. I am particularly encouraged by Deputies' support of existing Government policy, which is to support people to live in their own homes and communities for as long as possible with the correct wraparound supports.
As Deputies are aware, the programme for Government commits to the introduction of a statutory scheme to support people to live in their own homes which will provide equitable access to high quality, regulated home care. To advance this, I am committed to establishing a statutory scheme for the financing and regulation of home support services. Work is ongoing in my Department to determine the optimal approach to the development of the new scheme within the broader context of the ongoing reform of the health and social care system, as envisaged in the Sláintecare report.
This work encompasses the development of the regulatory framework for the new scheme, the examination of the options for the financing model for the scheme and the development of a reformed model of service-delivery. Regarding the development of a regulatory framework for home support services, I am pleased to say that the Government gave approval on 27 April to draft a general scheme and heads of a Bill to establish a licensing framework for publicly funded for-profit and not-for-profit home support providers. I intend to progress this general scheme and heads of Bill as a priority with a view to bringing it through the Houses at the earliest opportunity.
In the meantime, real progress is being made that will enable us to put the scheme in place. I expect the national home support office in the HSE to be established this year and sanction has been provided for the appointment of 128 assessors to roll out the use of the standardised tool for the assessment of care needs. I have championed the single assessment tool in opposition and in government as I know it will be a vital part of improving how care is delivered for older people. I look forward to bringing this legislation to Government and anticipate strong cross-party support for it.
In the interim, 2021 saw unprecedented levels of investment in home support, with an additional 5 million hours provided to support older people to remain in their own homes for as long as possible. This means that 23 million home support hours will be available this year to support people to live well and age well at home.
Deputies also emphasised the need for broader reform of services for older people, including the development of new models of housing to support older people to age in place. Experiences over the past year have provided us with clear indications of where and how services need to be improved. The work of the Covid-19 nursing homes expert panel is a very important element of this and I am fully committed to its ongoing implementation. I also fully support the collaborative working that is ongoing under the joint policy statement, Housing Options for Our Aging Population. We must ensure that these and other strategies and plans deliver real change for the older people of Ireland.
Several Deputies highlighted the impact in communities where homes are left vacant for a period of time as a result of residents being in long-term care. It has been proposed that rental of these homes might alleviate the housing crisis. However, this brings with it real challenges and high risks of unintended consequences. There is no other exemption of rental or other business income from assessment in the scheme and care needs to be taken to ensure that incentives do not incentivise premature entry to care or create financial abuse or other safeguarding risks. It is also important to note that there would be complex legal and other impacts and responsibilities arising for residents and their families, including eligibility for reliefs and benefits they may currently be entitled to.
Throughout their contributions, Deputies emphasised the critical importance of ensuring that the fair deal is fair. Therefore, we must ensure that any incentives do not undermine the principle of fairness at the heart of the scheme or create precedents that would undermine its financial sustainability into the future. These challenges are not, however, wholly without solution and I believe that working constructively with Government colleagues on this matter will bring results. My Department is actively working with the Department of Housing, Local Government and Heritage on this issue. I am certain that we can work together to devise and bring forward policies in this area that are targeted, equitable, safeguarded and based on robust evidence.
My priority at this time is to bring forward the legislation for farmers and small business owners without delay. In the meantime, I am committed to working towards bringing forward an amendment on Committee Stage on extending the three-year cap to the proceeds of the sale of a principal private residence. This proposed amendment relating to the three-year cap, which is the subject of this Bill, is grounded in the principle of fairness that is fundamental to the fair deal scheme and seeks to remove a disincentive to those who would otherwise choose to sell their home. It is also targeted at bringing into use those homes that would otherwise be vacant for many years.
I also thank Deputies for their contributions that relate to wider questions of the financial model of the scheme and the balance between public and private provision. These are important questions that the Department is actively considering and will be an integral component of the overall reform of services for older people.
Finally, I would like to emphasise the extensive range of supports provided to all nursing homes throughout the pandemic. These have included serial testing, the provision of free PPE, infection prevention and control supports, training, financial supports, the availability of 23 Covid-19 response teams and temporary accommodation for staff. Under the temporary assistance payment scheme, up to €92 million was made available in 2020 for nursing homes, with up to €42 million available for 2021.
The last 14 months have been an incredibly challenging and difficult time for people living in nursing homes, their families and nursing home staff. However, the advanced stage of the vaccination programme across nursing homes has had a considerable impact to date with the current positivity rate at 0.11% and the number of outbreaks reduced to five. To put this in context, there are currently 571 registered nursing homes operating across the country. I would like to join with each and every one of my colleagues who have over the past three days complimented and paid tribute to the incredible work that has been done in the nursing home sector, including private, public and voluntary services, over the past 14 or 15 months. It has been an extremely difficult and challenging time for all.
To conclude, as a Minister of State from a rural constituency, and based on my own experience in family business, I am fully aware that family farms and small businesses form the backbone of our economy. They perform a vital role in providing employment and enhancing the future development of rural Ireland. I am also aware that farmers and small business owners often do not see their farm or business as an asset, but rather as something they are taking care of for the next generation. It is, therefore, essential that these farms and businesses are protected so that they remain viable and sustainable assets for families long into the future. This legislation will deliver a fair deal for these families, enhancing protections and improving the accessibility and affordability of long-term care for farm families and small business owners.
I welcome the Deputies' support for the Bill as we move to Committee Stage.
Question put and agreed to.