Earlier this year, in the course of a debate in this House on the need to regulate the manner in which elderly, sick or infirm persons were maintained in premises commonly and loosely referred to as nursing homes, I announced that it was the intention to introduce legislation to confer on health authorities powers in respect of places of the kind, and to enable the Minister to regulate the standards of care provided in them. The present Bill proposes to give effect to that intention. Subject to certain specified exceptions, it provides broadly that where more than one incapacitated person is being maintained for private profit, the person in charge of the premises must notify the health authority in whose area it is situated of the fact; and the health authority, being thus notified, will be empowered to inspect such premises in order to ascertain that the conditions obtaining in them comply with regulations made by the Minister for Health.
We do not have full information about such premises, nor how many incapacitated people are maintained in them. There is no reason to doubt, however, that the number of the latter is not insignificant. Where such persons are properly tended and cared for, those who undertake the task provide a useful service. Therefore, where their obligations to those in their charge are fulfilled reasonably well — and in this context I would like to stress reasonableness cannot be assessed without reference to what patients or their relatives can afford — the State should not interfere. In the course of the debate to which I have referred some Senators evinced suspicion and anxiety that the care and attention generally given falls short of what it should be; and no doubt in this they reflected the views of others. The purpose of this Bill is to remove so far as may be, all reasonable occasion for such anxiety and to give health authorities powers which should enable them to eradicate abuses where they exist.
I would now like to mention a few things that the Bill does not purport to do.
First, I should make it clear that registration of nursing homes is not provided for. Under a system of registration the proprietor of a home would have to apply to the health authority, which would then be called upon to inspect and register the place before business could be carried on. But I suggest that the important things which should be considered when determining whether a home of this kind should be permitted to carry on are not so much the amenities attached to the premises, but rather the human qualities of the staff; the kindness, care and attention which they extend to their patients, and which is reflected by these in the degree of happiness and contentment which they manifest in their environment. Moreover, with a system of registration the description "registered" could be included in the title of a home. This might be taken as implying that because the undertaking had fulfilled certain rigid standards—and rigidity is the last thing we want in dealing with this problem —a special seal of approval had been conferred on it by the health authority.
Secondly, Senators will note that nowhere in the Bill is the term "nursing home" used. Some of the premises which it will cover could, perhaps, be legitimately described as nursing homes, that is premises in which professional nursing is provided, but not all of them are or, indeed, need be of such a standard; so that it would be inappropriate to designate such places as nursing homes and misleading to allow them to apply the style to themselves.
Accordingly in directing the preparation of the Bill, I laid it down that a fair degree of elasticity in administering it should be provided for and that the minimum standards prescribed under the Bill must not be such as to put out of business any home in which accommodation, feeding and care suffice for the frugal comfort of those staying in it. If an attempt were made to impose higher standards very many undertakings which meet in a reasonably satisfactory way the needs of an invalid whose family circumstances are modest would be faced with the option of closing down or making their charges prohibitively high. I am sure that those who have been anxious that something should be done in the matter of such homes would not desire this.
And now for the details.
Section 1 defines the premises to which the Bill will apply. It will be noted that there are exemptions in certain circumstances. There is, for instance, an exemption in respect of the maintenance of close relatives, as defined in the section. Then there is the case of the home where, say, the proprietor was a trained nurse and, having the necessary skill and perhaps free time, she agreed to take in an incapacitated friend on the understanding that the latter would pay for the care and attention she got there. To meet this case, a home where only one person is kept is exempted. Maternity homes obviously had to be excluded from the provisions of the Bill, since there is an effective system of registration and control in respect of them under the Registration of Maternity Homes Act, 1934: the same is the case also with institutions for the care of the mentally ill, which are already subject to surveillance under the Mental Treatment Acts.
It will be noted that Section 1 also provides that the measure will be construed with the Health Acts, 1947 to 1960 and, in particular, that a reference in the Health Act, 1947, to that Act will be construed as including a reference to the new Act. These are most important provisions. By reason of them it will be possible to apply to premises covered by the Bill the adequate powers of inspection of premises which health authorities and their officers already have for the purpose of enforcing the Food Hygiene Regulations and other enactments relating to-health.
Section 2 specifies the matters on which the Minister may make regulations. These may include the numbers and qualifications of staffs, the design, maintenance, repair, ventilation, heating and lighting of the home, the amount of space in bedrooms and wards, washing facilities and sanitary conveniences, the quality of the food served in the home and the standard of cleanliness. This list may appear intimidating, but I would repeat that it is not my intention that the standards prescribed should be excessively difficult to reach. Contravention of a provision of the regulations will, however, under sub-section (3) of this section, be an offence punishable by substantial penalties: in addition to provision for fines and imprisonment, there is to be a power for the court to disqualify a person convicted of an offence under the Act from carrying on, or taking part in the management of, a home for the incapacitated.
Section 3 provides for the notification to health authorities of the names and addresses of homes to which the Bill applies and of the names of the persons in charge of them. This will apply both to homes in operation when the Bill becomes law and to new homes opened thereafter. It is hoped, by the operation of this section, to ensure that the health authority will be fully informed of the existence of all homes in their area.
Some concern may be felt for the home where, upon inspection by the health authority's officer, it emerges that conditions are not all that they might be. The proprietor of such a home may be quite willing to rectify defects, if reasonable time were given for him to do so. Since the initiative in taking prosecutions for offences against the provisions of the regulations will, under Section 4 of the Bill, rest with the health authority, it may be assumed that the health authority in such a case would allow the proprietor of the home such an opportunity.
Many elderly, infirm or other incapacitated persons who cannot be cared for by their families, need no special nursing care apart from some little assistance in the ordinary physical functions. One thing, however, must be assured to them, their food must be kept fresh and uncontaminated and handled and served with no less consideration for standards of hygiene than is demanded in the case of hotels and boardinghouses. Under Section 5 of the Bill, the provisions of Section 64 of the Health Act, 1947 will accordingly be applied to those premises to which the Bill applies; so that those concerned with the preparation, keeping and serving of food in them will be required to comply with the appropriate provisions of the Food Hygiene Regulations.
Section 6 of the Bill is a saving clause in respect of the care and treatment of persons who are mentally ill. It is aimed at ensuring that, though a person who is—to use a homely word —"bothered" may be maintained and cared for in a home of the type with which this Bill deals, there will not be conferred on such homes any right to receive or care for a person suffering from a mental illness which should properly be treated in a statutorily approved mental institution.
Under Section 7 regulations made under the Act must be laid before each House of the Oireachtas. Since the livelihood and freedom of individuals conducting these homes might be affected by the conditions imposed upon them under the regulations made under Section 2, it is important that the Houses of the Oireachtas should have the opportunity of seeing and approving of these conditions before they become obligatory under the law.
I recommend the Bill to An Seanad for a Second Reading.