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Seanad Éireann debate -
Wednesday, 16 Feb 2005

Vol. 179 No. 8

Home Subvention Scheme.

I welcome the Minister of State, Deputy Seán Power, to the House. I would like to ask him and his colleague, the Tánaiste and Minister for Health and Children, when the home subvention package, which is at pilot project stage in the east coast section of the Health Service Executive, will be available nationwide. What level of assistance will be given to people who require it under the scheme? The Minister of State is aware that a successful pilot subvention scheme has been operational in the eastern regional area for 14 months. I would like the scheme, which involves the paying of an additional allowance to old age pensioners over the age of 65 up to a maximum of €190, to be extended throughout the country.

The home subvention payment is an important support because it helps elderly people to access additional services. It allows them to continue to live in their homes and communities. Most public representatives appreciate the importance of helping elderly people to stay in their own homes. The home subvention scheme, which is means tested, is economically viable — its cost is far less than the cost of maintaining people in private nursing homes or public institutions. The scheme allows people other than family members to provide additional care to an elderly person. It is offered in addition to existing schemes such as meals on wheels and the home help service, which are provided by the bodies which used to be called health boards.

The ongoing review of the scheme and the Government's drafting of its plans should be completed as soon as possible. It is a particularly urgent matter because of the current crisis in the nursing homes subvention system. It appears, following a Supreme Court judgment this morning, that health boards were making illegal deductions from elderly people.

I do not know if anybody can emphasise sufficiently the importance to elderly people of being able to recuperate in their own homes after a stay in an acute hospital. It is reassuring for them to be in the company of those they know best in the comfort of their home surroundings. If the Government is a caring Government, as it claims to be, the Tánaiste and the Minister of State should immediately extend the home subvention scheme throughout the country. The scheme is important in major urban areas such as Dublin, Cork and Galway. Its importance in rural areas and communities, where there is a shortage of home help workers and providers of other services which are readily available in major urban areas, cannot be over-emphasised.

I ask the Minister of State and his senior colleague, the Tánaiste and Minister for Health and Children, to extend the home subvention scheme. Can the Minister of State tell the House how much progress has been made with the drafting of legislation to give effect to the scheme, if such legislation is necessary? To what extent will resources be made available for this important scheme, which could make a substantial difference to the lives of many people throughout the country?

I thank Senator Ulick Burke for raising this matter on the Adjournment. I appreciate his interest in the area of subvention. It is nice that we agree the Government is a caring one.

It claims to be a caring Government.

The Government's policy on developing and delivering services for older people is to maintain them at home in dignity and independence for as long as possible in accordance with their wishes. That policy involves restoring to independence at home older people who become ill or dependent and encouraging and supporting the care of older people in their own communities by family, neighbours and voluntary bodies. All studies indicate that older people are much happier in their own homes and recover more quickly from illnesses when at home. The Government will continue to support people in that regard for as long as possible.

The aim of the home help service is to enable older people to remain living at home in their communities who would otherwise have to move into residential care. It is recognised that the home help service is an essential support to the individuals concerned and their carers. The home help service, by its nature, is a flexible service designed to respond to clients' needs. The service is targeted at high-dependency and medium-dependency clients in accordance with their assessed needs. As a result, the level of service required in individual cases will fluctuate from time to time. Nevertheless, the total increase in expenditure on the home help service across all the former health board areas since 2000 has been over 113%.

The Government is committed to developing the home help service as a community support for older people living in the community. In 2005, expenditure on the home help service will be over €131 million. This increased funding for home help services is a clear example of the Government's commitment to improving the lives of older people living in the community.

There are a number of reasons for the increasing demands on the home help service, one of which is the fact that, each year, an additional 6,000 people over 65 years of age enter the system. Furthermore, there is, proportionately, a greater increase in percentage terms pertaining to those over 80 years of age who are more heavily dependent.

An expenditure review of the nursing home subvention scheme was undertaken jointly by the Departments of Health and Children and Finance in response to a Government decision in 1999. The review, which was carried out by Professor Eamon O'Shea, National University of Ireland, Galway, was published in June 2003. The report recommended that a home-based subvention scheme be introduced to help support vulnerable older people living at home. The health strategy also recommended the introduction of a home-based subvention scheme in conjunction with other Departments, including the Department of Social and Family Affairs, as part of an integrated approach to caring for people in the home.

The introduction of a home-based subvention scheme is consistent with the policy of successive Governments of maintaining older people in their own homes in dignity and independence for as long as they wish. The HSE eastern region has been piloting the Slán Abhaile and Home First pilot schemes to help support vulnerable older people in the community. Those living in the community and those who no longer require inpatient care in the acute hospital sector have benefited under these pilots schemes. The schemes have recently been evaluated and have proven to be very effective in supporting older people in their communities.

My officials have been working closely with the national nursing home team to develop a national home care grant scheme. The proposed scheme is seen as an important initiative given that it directly supports the Department's long-standing policy of supporting older people. It is expected that the scheme will, when introduced, relieve the demand on private nursing homes beds and extended care beds in community hospitals and relieve pressure on the acute hospital sector. A draft of the scheme is being finalised by the HSE and will be submitted to my Department for consideration in the near future.

In November 2004, the Minister for Health and Children announced additional funding of €70 million to implement a ten-point action plan to improve the delivery of accident and emergency services. My officials are working closely with the HSE to ensure early implementation of these measures. The measures include the transfer of 100 high-dependency patients to suitable private nursing home care, negotiating with the private sector to meet the needs of 500 people annually for intermediate care of up to six weeks and an expansion of home care packages to support 500 additional older people at home.

Funding of €2 million is being provided in 2005 to establish the home care grant scheme throughout the country based on protocols approved by the Department. The effectiveness of this scheme will be monitored and it is hoped that it will help to redress the imbalance alluded to in the O'Shea report, in which it is stated that the current system allocates resources to residential care to the detriment of alternative care programs, such as community care.

It is the policy of the Government to try to maintain older people in their homes in independence for as long as possible, in accordance with their expressed wishes. The home care grant, while not representing the entire solution, is one step towards fulfilling this goal and also demonstrates the Government's commitment to older members of our population.

Does that mean it is coming?