Elder Abuse: Statements.

Minister of State at the Department of Health and Children (Deputy Máire Hoctor)

I thank the Cathaoirleach and the Senators for giving me the opportunity to make a statement on the subject of elder abuse. It is important to highlight this issue at every opportunity and that is the reason I appreciate this opportunity.

Elder abuse in any form is unacceptable and I reiterate the Government's full and continuing commitment to tackling this issue. Elder abuse is a societal as distinct from a health problem. Significant progress has been made in recent years and we want to ensure that continues and any gaps are addressed in full. We also want to ensure older people who feel they are the subject of abuse in any shape or form have the confidence to report their anxieties to a social worker, a public health nurse, a member of the Garda Síochána or any professional or care worker, whichever they are most comfortable with. These are key objectives.

Elder abuse is a complex issue and difficult to define precisely. It may involve financial abuse, physical abuse, psychological abuse, sexual abuse or it may arise owing to inadequacy of care. The current policy on elder abuse is outlined in the 2002 report of the working group on elder abuse, Protecting our Future. It defines elder abuse as: "A single or repeated act or lack of appropriate action occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person or violates their human and civil rights." That report recommended that a “clear policy on elder abuse is formulated and implemented at all levels of governance within the health, social and protection services in Ireland”, and I will show how we have made substantial progress, especially in so far as the health services are concerned.

We do not know the prevalence of elder abuse in Ireland. We can assume that the instance is not unlike that in other developed countries where studies have shown that approximately 3% to 5% of older people living in the community may suffer abuse at any one time. In Ireland this could mean that between 14,000 and 23,000 people living in the community may be suffering from abuse, neglect or maltreatment. No figures are available on the incidence of abuse in institutions but, unfortunately, we know that it happens.

The Health Service Executive report on Elder Abuse Service Development 2008 shows that there were 1,840 referrals to the service in 2008, an increase from the 2007 figure of 927. The 2008 statistics do not make for easy reading. The majority, 67%, of alleged abuse victims are women. The reported rate of alleged abuse increases in the over 80s age group. Psychological abuse is the most common form reported at 25%, followed by neglect — 20%, financial — 16%, and physical abuse — 14%. Self neglect referrals are at 18%. Public health nurses are the main source of referral, with hospital, HSE staff and family being the other major sources. The majority, 82%, of referrals relate to individuals who live at home.

Nationally, 83% of cases report just one person causing concern, with a further 14% allegedly perpetrated by two people. The predominant alleged persons causing concern are those that have the closest relationship to the person, that is, son or daughter — 43%, partner, husband or spouse — 17%, and other relative — 12%. Nationally, in 53% of cases the alleged person causing concern is living with the older person. These findings are in keeping with the experience elsewhere, as is the finding that in a significant number of cases the persons causing concern are likely to have mental health, substance abuse or behavioural problems. Mediation and counselling are the most common supports provided, followed by referrals to other services.

As I said, the data have just been released and will require further study. Self neglect was not included in the definition of elder abuse by the working group. Internationally, practice and policies vary. However, it is now included in the data and the HSE has developed guidance on how to respond to such instances.

Current policy on elder abuse evolved from the National Council on Ageing and Older People, NCAOP, report, Abuse, Neglect and Mistreatment of Older People, which was published in 1998. The Government acknowledged the importance of the issue and established a working group on elder abuse in 1999. Following a comprehensive work programme the group published its report, Protecting Our Future , in 2002. That report provided the foundation for the development of policy and procedures to respond to actual or alleged cases of elder abuse.

In 2003 the elder abuse national implementation group, the EANIG, was established to oversee the implementation of the recommendations of the report. The EANIG includes representatives of the HSE, the Health Information and Quality Authority, the Garda Síochána, the NCAOP, the Law Society of Ireland, the Irish Association of Older People and the Department of Health and Children, and is chaired by Professor Desmond O'Neill, consultant geriatrician.

In the period 2003 to 2005, the Government allocated additional funding of €2.45 million to implement the findings of Protecting Our Future. In 2006, an additional €2 million was provided over a two-year period to complete the funding requirements set out in the report. These included the development of a national research centre. Last year, an additional €300,000 was allocated for the development of a public awareness campaign to which I will refer later.

Significant progress has been made in developing a comprehensive response to deal with elder abuse. I commend in particular the Health Service Executive which has made significant progress in developing the appropriate structures and mechanisms necessary for tackling and preventing elder abuse in a consistent manner throughout the country, namely, a HSE steering committee to oversee and ensure a nationally consistent approach in the provision of elder abuse services by the HSE in relation to its detection, reporting and response; four regional steering committees, which are an essential link in good inter-agency working practices and the development of practice specific networks; four sub-groups to examine the areas of training and development, communication, media-public awareness and policy and procedure; a national policy for HSE staff responding to allegations of elder abuse and associated implementation plan; the establishment of a national research centre for the protection of older people at University College Dublin; 27 of 32 senior case workers and three of four dedicated elder abuse officers in place; the development of a training programme for staff in public and private care settings; a public awareness campaign aimed at informing key audiences about the risks and realities of elder abuse; and annual reporting, that is, the Elder Abuse Service Developments 2008 report.

On the national centre for the protection of older people, building up knowledge for policy and practice is essential for the development of a sound service. Based on a recommendation in Protecting our Future , the HSE ran a competition to establish a national centre for the protection of older people. The contract was awarded to University College Dublin for an initial period of three years.

The principal function of the centre is to create a knowledge base of Irish and international research on the occurrence, prevalence, detection and response to abuse of older people. The principal function of the centre is to create a knowledge base of Irish and international research on the occurrence, prevalence, detection and response to abuse of older people. The objective of the centre is to place elder abuse in the wider social context as opposed to within the context of the HSE only. Financial abuse, ageism and discrimination are key issues which cannot be resolved solely within the HSE and the opportunity to inform policy across a wide range of departments and agencies will be strengthened by a centre that has an inter-agency mandate. The centre will be developed to integrate elder abuse issues from the arenas of health, social welfare, justice, finance and legal authorities. Therefore, while the HSE acts as the lead agent on the development of the national centre for the protection of older people, it will have links with other relevant sectors to influence policy in these areas.

Many older people may be reluctant to report abuse, particularly because elder abuse, by definition, occurs within a relationship in which there is an expectation of trust. If an older person is being abused by a close family member, the older person may not wish to upset that relationship. Similarly, if the abuse is perpetrated by a carer, the older person may be reluctant to report it. Sometimes the abused or the abuser may not recognise the actions as abuse. This may be particularly true in cases of financial or psychological abuse which can be more insidious and less easily recognised than other forms of abuse.

To address these issues the HSE ran an awareness campaign which began at the end of 2008. The campaign was aimed at informing key audiences, such as people over 50 years, carers, health workers and other stakeholders, about the risks and realities of elder abuse, and to create awareness of the elder protection services provided by the HSE and other agencies. The campaign highlighted the need to protect older people from abuse in all its forms and particularly aimed to educate key audiences on how to recognise abuse, make everyone aware of their responsibility to act and report, publicise the support services available and highlight, in particular, the issue of financial abuse.

The potential abuse of our older people, including financial abuse, is of concern to us all and is an area that I intend to vigorously pursue until the best possible measures are in place to protect our vulnerable older people.

The main goal of any response to elder abuse is prevention. There are two types of prevention, primary prevention, stopping elder abuse from happening in the first place, and secondary prevention, when it does happen, taking steps to ensure that it does not happen again.

The initiatives described earlier outline measures taken by the HSE that have been found to be effective in tackling elder abuse. I have focused on the HSE because of the key importance of the service, but some types of abuse, for example financial abuse, require action from other agencies and will be a priority focus from now on. In addition, negative attitudes towards, and perceptions of, ageing and older people can lead to intolerance and acceptance of abuse. We have to be ever mindful to eliminate ageism and ageist attitudes. These are not the only factors contributing to elder abuse but can give rise to a culture or an environment in which elder abuse can develop, leading to age discrimination and devaluing and disempowering older people.

Cosc, the National Office for the Prevention of Domestic, Sexual and Gender-based Violence, is a dedicated Government office with the key responsibility to ensure the delivery of a well co-ordinated "whole of Government" response to domestic, sexual and gender-based violence against women and men, including older people. In 2009, Cosc launched a public awareness campaign, Your Silence Feeds the Violence, on billboards, national and local radio and on-line. The campaign was designed to encourage Irish society to realise that only by taking an active role can we stop domestic violence from destroying thousands of lives. As the solutions needed to tackle various types of abuse differ, my office and Cosc work closely together to create, where possible, synergy to achieve maximum impact and awareness.

Late last year I asked the NCAOP to undertake a formal independent review of the implementation of the recommendations outlined in Protecting our Future. I was particularly anxious that any gaps in the present policy would be identified and that research would be carried out on areas not covered in the original report, such as financial abuse, institutional abuse, self-neglect and gaps for vulnerable adults. The terms of reference frankly acknowledge that insufficient progress has been made in areas other than the health services and significant issues, such as financial abuse, are not being addressed in a coherent or comprehensive way.

A key element of the review is that gaps in the present framework are addressed. The review is being guided by a steering group which has representatives from the NCAOP, the Department of Health and Children, the Irish Association of Older People, the HSE and HIQA. It includes a consultation process with all the main stakeholders at national and regional levels. I hope to have the completed review in May and I expect it will include recommendations on the structures, arrangements and mechanisms needed to inform future policy and actions.

Our first choice is for older people to remain living at home for as long as possible with the support of their families and community support services where necessary. When this is no longer possible, it is important that older people have access to the best possible residential care available. It is Government policy to develop and improve health services in all regions of the country and to ensure quality and patient safety.

We all need to ensure the protection of residents, to safeguard and promote their health, welfare and quality of life and to ensure that there is a focus on the well-being, dignity and autonomy of older people. Older people deserve the highest quality of care that we can provide in both public and private settings and these standards apply to all designated centres for older people.

The new national quality standards for residential care settings for older people in Ireland provide for 32 standards under seven groupings. Standard No. 8 sets out the criteria necessary to protect residents from all forms of abuse. These include the development of a policy on the prevention, detection, and response to abuse within the residential care setting. Persons in charge must take steps to ensure residents are safe from all forms of abuse including neglect and acts of omission. Procedures on whistle-blowing and protected disclosure are required under the Health Act 2007. All staff should receive induction and ongoing training in recognising, prevention and responding to elder abuse.

The standards are an objective and transparent way for care providers to implement and for inspectors to enforce standards to the benefit of nursing home residents. I am confident that they will play a pivotal role in driving improvements in the quality and safety of residential care for older people in the years ahead.

There are 23,000 people in long-term nursing home care in Ireland. It is important that everyone gets the best service and opportunities regardless of where they reside, be it public or private. The Health Act 2007 extends the registration and inspection to all nursing homes. From 1 July 2009, future inspections will be carried out by the chief inspector of social services, part of the Health Information and Quality Authority.

The establishment of the office for older people underlines the Government's commitment to older people. For that reason, I am pleased that one of the key functions of my office is to develop a strategy for positive ageing. My goal is to develop a meaningful and innovative strategy that will result in real improvements in the lives of older people.

The programme for Government stipulated that the strategy will involve, for example, the development of operational plans by Departments, clearly setting out objectives relating to older people, and joined up thinking on initiatives serving this community. Other areas for consideration include ongoing mechanisms to monitor progress and identify challenges. The cross-departmental group to develop the new strategy is in place. I also have responsibilities in the Departments of Social and Family Affairs and the Environment, Heritage and Local Government. I am also a member of the Cabinet committee on social inclusion, which ensures that there is an integrated coherent approach to issues relating to older people across Government level. This approach is key to delivering the Government's vision of improved integration of services, and thereby further supporting older people into the future.

My office will also continue to develop health policy and will oversee and monitor the delivery of health and personal social services for older people and the running of the long-stay charges scheme. It is, in short, the focal point for the development of a more comprehensive policy on older people. The resources of my office, which is currently staffed by officials from the Department of Health and Children, will be strengthened by the addition of staff of the National Council on Ageing and Older People.

Last week I introduced the Health (Miscellaneous Provisions) Bill 2009 in the Dáil. The Bill gives effect to the Government's decision to rationalise a number of health agencies and integrate some into the Department of Health and Children. One of these, the National Council on Ageing and Older People, is directly within my area of responsibility. The council enjoyed great respect and has made a significant contribution to policy development in regard to older people. The formulation of policy, however, is usually best located in Departments, and bringing the council's body of work into the Department will assist that role. Council staff have built up a range of expertise and experience on older people's issues that they can bring to the work of the office for older people. I have full confidence that the council will bring refreshing and rejuvenating insights into the Department and I am delighted they can join the office and assist in the development of the national positive ageing strategy and the work of the office into the future.

I reiterate the Government's commitment to improving protection services for this vulnerable section of our society. We have made great strides recently in developing appropriate services and raising awareness of elder abuse. However, we cannot become complacent. We must continue to carry out further research and develop appropriate mechanisms, to work in collaboration with other agencies and to keep a critical eye on all developments. Senators will agree any form of elder abuse is unacceptable and I urge all to open their eyes to elder abuse. If a person is in contact with an older person and has concerns, he or she should seek advice and not assume someone else will take action.

Senator Frances Fitzgerald

I wish to share time with Senator Twomey.

An Cathaoirleach

That is agreed.

Senator Frances Fitzgerald

I thank the Minister for coming to the House to discuss this important topic. Of course, there must be ongoing debates not just about elder abuse but about the issues of how we treat our elderly in society, ageing and ageism in Ireland and how we can have a more inclusive approach to the elderly and the development of health and personal social services for the elderly.

The withdrawal of the medical card from the elderly was a retrograde step. It took away the peace of mind of many elderly people. The universality of the medical card was extremely important to the peace of mind of the elderly. The provision of the medical card was a good step and we saw the benefits of its universality in terms of the peace of mind it gave, the encouragement for people to remain in their homes and the confidence it gave them about their medical needs. These were incredibly important in the lives of elderly people in Ireland. Its removal was a retrograde step.

Today, I heard from community groups that an important grant of €3.5 million for security for the elderly has been withdrawn. The community groups have been notified of the withdrawal of this important grant for the provision of security equipment, such as pendants and so forth for use in an emergency, and are very concerned about the impact it will have on the elderly.

Recently we have had debates about standards in nursing homes and the Leas Cross report. As the Minister said, there is no room for complacency so I am glad we are having this debate today. People will find it hard to believe that 1,800 cases of alleged elder abuse were reported to the HSE in 2008. The vast majority of these incidents occurred within people's homes and were carried out by somebody known to the elderly person. There are parallels in this area with what we have learned about child abuse. We are still shocked by what we hear about child abuse but the issue of elder abuse is only now becoming more widely known. The same standards, guidelines and implementation will be required in the area of elder abuse as have been developed over the years to deal with child abuse. It took us a long time to learn good practice when dealing with child abuse in terms of intervening properly and implementing and monitoring the right approach. I hope it will not take as long with regard to elder abuse. If it does, people will die. I welcome some of the initiatives the Minister mentioned which are being taken by her Department and the HSE.

Age Action Ireland has described the figures for abuse of the elderly as just the tip of the iceberg. There is probably a great deal happening that has not yet come to public attention or been reported. The issue of elder abuse is complex. The abuse can take many forms — psychological, physical, sexual or financial. Today, however, in the short time available to me, I will focus on the findings of an inquiry commissioned by the Mental Health Commission into two psychiatric hospitals, which was published last Friday. This was a Mental Health Act 2001, section 55 inquiry. There have been only two such inquiries in Ireland.

This inquiry, its recommendations and what it discovered make shocking reading. The report not only outlines the dreadful conditions that many elderly patients were exposed to within HSE care but also raises serious questions about the care practices in the hospitals examined. This report has been published four years after the Leas Cross report, about which there was a huge public outcry. The inquiry was into standards at St. Michael's unit in South Tipperary General Hospital and St. Luke's Hospital, both of them in Clonmel. It was prompted following concerns expressed about the number of fractures suffered by a number of residents at the two hospitals.

The reports are very upsetting. This is not to suggest that all staff in those hospitals were involved in this or that attempts were not made to provide good care. However, the reports found that residents were inappropriately sedated or tranquillised to control their behaviour, wards were unnecessarily locked, seclusion was used too often, the poor design of the building posed difficulties, more than 19 patients suffered fractures between 2002 and 2004 and there were environmental and safety and welfare defects. The Irish Times and the Irish Independent commented on the conditions of the people who were living in those hospitals. They said the findings of the report paint a bleak picture of life at St. Luke’s, a picture of an environment in which human dignity has reached rock bottom.

There are many elderly people in institutional and residential settings throughout Ireland and serious questions must be asked about this report and its implications. Why was no action taken despite the fact that the Minister was informed of these issues regarding lack of care by the inspector of mental health in 2006? What action has been taken to date to remedy the major failings highlighted by the Mental Health Commission report? Has the Minister met the HSE to discuss its plans to deal with the issues raised in the report? How confident can we be that this is not happening elsewhere? We must be confident it is not. These are very serious questions. I do not have time to deal with the matter in more detail but it is critical that elderly people in institutions get proper care.

Senator Liam Twomey

My gut instinct from what the Minister said in her statement is that everybody in the Department is politically correct in terms of being seen to do the right thing, have the right policies, put the right structures in place and, yet again, review the recommendations of a previous report but they are not really concerned about what is happening on the ground. That is probably because the establishment of the HSE disconnected politicians and Ministers from what is really happening. I do not get the sense that the Minister fully understands what is taking place.

I raised the Leas Cross issue a number of times in the House and with the Minister. One of my first questions to the Minister was about Leas Cross. I asked her when the Garda would investigate it. Leas Cross exploded on to the airwaves in 2005 but we are still waiting for another report on what happened there from both the Garda Síochána and the HSE. What happened in Clonmel is recent. It is shocking because it involves a HSE facility. I am sure the Minister is also well aware of the significant complaints that have been made about abuse of patients in St. Mary's in the Phoenix Park. There is an ongoing dispute there involving the HSE, the Department of Health and Children and a former employee at that hospital. However, the Minister's statement is the type of drivel one would get from a masters degree student who has never stepped inside an institution. It is all about policy; there is nothing about the human beings inside these institutions.

The Government has shown no leadership in dealing with elder abuse and the instances of neglect I have mentioned in St. Mary's, Phoenix Park, Clonmel and Leas Cross. The institutions where this is happening are the Minister's responsibility. The majority of abuse is happening in the home and is caused by relations, family members and people who know the person. The elderly patient is significantly isolated within the community and therefore has nobody to stand up for him or her. The Minister correctly pointed out that public health nurses are more likely to notice abuse of elderly patients but these nurses are not now in a position to visit elderly patients as often as they should, due to Government cutbacks.

The number of case officers mentioned by the Minister is roughly one per county. One case officer to investigate all the cases and potential cases of abuse in a county is insignificant. It will not work. Despite the number of organisations and strategy groups the Minister is establishing to examine the issue of elder abuse, my instinct is that the Minister is just going through the motions and being seen to do the right thing rather than actually doing the right thing. If she was really honest about this, she should pursue the Leas Cross issue. That would show the Government has the concern and the teeth to do something about patients being abused in institutions. That type of action would not take long to feed into the system and demonstrate that somebody genuinely cares about what is happening to elderly people.

We will not stamp out all abuse, be it physical, emotional, sexual or financial. This is because it is far more ingrained within society than the Minister of State cared to admit in her contribution. The least we can do is to care, not to seem to care, and to try to do something about the issue. That is where the Government has failed completely.

If the Minister of State has an opportunity to respond now or in the future, I would like her to outline the final outcome of the investigation into Leas Cross. I have asked about it in this House for the past two years and for the two years prior to that when I was a Member of the Dáil. Why does the Health Service Executive not make a more comprehensive effort to deal with obvious cases of abuse when they arise? It is not enough to have an inquiry or a whitewash report that gets a number of people off the hook. We need to change the way we see and do things within the health service when it comes to elderly abuse.

I accept there are difficulties for people working in the health service. It is not always easy and there are two sides to every story. Sometimes unfounded allegations of abuse are made. If an elderly person or a family member read the Minister of State's contribution, he or she would not get involved because he or she could read between the lines that he or she could get into a lot of bother with other family members or people in the community and could not rely on the full and committed support of either the HSE or the political establishment. That has shown through. Perhaps the Minister of State will respond now or later, assuming she is still in office after 21 April, to some of the questions we have asked, tell us what is going on and what she is doing about stopping this abuse in society.

Senator Mary M. White

I welcome the Minister of State and congratulate her on her excellent and wide-ranging speech. I compliment her on the seriousness with which she has taken her ministerial role with responsibility for older people. At the time of the 2006 census, approximately 500,000 people living in Ireland, or 11 % of the total population, were over the age of 65. The number of older people is expected to double in the next 20 years.

The growth in the older population is a cause for celebration as our life expectancy continues to increase. The majority of older people live full and active lives, enjoying good health and independence. However, it is a fact that a number of older people suffer abuse of one form or another. The likelihood of abuse appears to increase as people get older. International research indicates that anywhere between 3% and 5% of older people may be subject to abuse. This would suggest that between 14,000 and 23,000 older people suffer abuse in Ireland. The numbers referred to the HSE are significantly less than that, which indicates we have a hidden problem with elder abuse in this country. That is in keeping with international literature which documents reporting rates as low as 1% to 2%.

Under-reporting is likely to be due to a number factors. Many older people may be reluctant to report abuse, especially because elder abuse, by definition, occurs within a relationship in which there is an expectation of trust. People may be too ashamed or embarrassed to say they are being abused. They feel there is something wrong with them or that they must be inferior if somebody is abusing them. If an older person is being abused by a close family member, the older person may not wish to upset the family relationship. Similarly, if the abuse is perpetrated by a carer, the older person may be afraid to report the carer who is abusing him or her.

Sometimes, either the abused or the abuser may not recognise the actions as abuse. This may be especially true in cases of financial or psychological abuse which can be more insidious and less easily recognised than other forms of abuse. According to Ms Mary Nally who runs the senior helpline in Summerhill, County Meath, one of the commonest forms of abuse is financial. Older people are terrified and they are frequently financially abused by relations. There are several forms of abuse which have been outlined by the Minister of State. They include physical, sexual, psychological, financial, material and discriminatory abuse, including ageism, sexism and abuse based on a person's disability and other forms of harassment or slurs.

Some Members may be aware that I have embarked on a campaign with The Irish Times to address ageism in this country. Commencing in June, we will make inspirational living awards to older people, private and public organisations, those who have provided examples as role models, and to companies that promote older people and deal with their human rights. We will have quarterly awards in three different categories.

My mission is to address the human rights of older people. One is an asset to the State until one is 60 or 65 and then one becomes a liability. That is the way the legislation is framed. I made a valiant effort to ensure people aged 65 should not have to retire, that they should have a choice. I got that included in the programme for Government of June 2007. That has not been delivered yet but we will get to it.

Most Members are familiar with my policy document from June 2006, A New Approach to Ageing & Ageism. Recommendation 26 states: "The recommendations of the Working Group Report on Elder Abuse should be implemented immediately, and dedicated social workers should be provided to identify and prevent cases of elder abuse." I am very pleased that subsequent to the document's publication a national elder abuse steering committee was established in October 2007 to oversee and develop a national and consistent approach towards the provision of elder abuse services by the HSE. I am very impressed with what has been achieved. While I accept there is a significant job to be done, good progress has been made by the HSE in the development of its approach to elder abuse. There is no doubt about that and we must give recognition to the HSE where it is due. Mr. Frank Murphy, who is the dedicated officer in charge of dealing with elder abuse, is based in Roscommon. Since my document was produced dedicated officers and social workers are in place to deal with elder abuse. I addressed those areas passionately in my document.

I outlined in my document that elder abuse is a serious issue in Ireland that has not received the same priority as in other countries. There is no doubt that the events that came to light in Leas Cross opened up a Pandora's box. Like childhood abuse we did not believe that people were so callous and ruthless in how they treated children and older people.

When I wrote the document in 2006 the only freefone elder abuse helpline was run from the United Kingdom and that is still the case. The main freefone helpline, 1800 940010, is manned from the UK. There was such a demand for the UK-based helpline that a special line was developed for this country. That is run by volunteers from the UK. Many Members will be aware of the senior helpline in Summerhill, County Meath. This is a unique example of what local people coming together as a community can achieve. That senior helpline has now been rolled out throughout the country and will also be rolled out in Boston. It is driven by Ms Mary Nally. Those who man the senior helpline are older people themselves and they have great empathy. I spoke to one of them today to bring myself up to date with what they hear. I asked how one knows the person ringing is being abused. The lady said to me that one must let the caller talk and talk. Ms Mary Nally told me the people who run the helpline receive tremendous training on how to identify abuse.

There is no doubt that we have made progress but we have a lot more to do. The bottom line is that we must have greater awareness such that people will watch out for one another, ascertain whether they know someone who is being abused and report it where it occurs.

Senator Rónán Mullen

I welcome the Minister of State to the House. I am grateful that this very timely debate has been organised.

Nuair atáimid ag caint faoi luacha inár sochaí, is minic a deirimid gurb í an chaoi ina gcaithfimid leis na daoine is lú a bhfuil cumhacht acu an slat tomhais maidir le caighdeán ár sibhialtachta. Agus muid ag breathnú ar ár sochaí, measaim go gcaithfimid súil a choimeád i gcónaí ar ceist na luacha. Conas a chaithfimid le daoine nuair atá siad an-óg, nuair a bhíonn fadhbanna acu agus nuair atá siad ag dul in aois? Ba cheart dúinn bheith dearfach faoin aois. Ba chóir dúinn béim a chur ar an méid a thugann daoine níos sine don sochaí. Ag an am céanna, caithfimid bheith díograiseach nuair atáimid ag iarraidh dul i ngleic leis na fadhbanna a bhíonn ag daoine níos sine, mar shampla, ina dtithe cónaithe. Caithfimid déileáil, i gcomhthéacs na díospóireachta seo, leis na fadhbanna a bhíonn ag daoine níos sine atá ina gcónaí sa bhaile. Bíonn mí-ionsaí i gceist ó am go ham. Is slat tomhais dúinn uilig an chaoi ina oibrimid chun na fadhbanna áirithe a shárú. Is dócha go ndéanfar breithiúnas orainn amach anseo ar an chaoi ina láimhseáil muid na fadhbanna sin.

It is timely that we are having this debate, not least because of the very stark figure to which the Minister of State referred, namely, the troubling doubling of referrals to the Health Service Executive from approximately 900 in 2007 to more than 1,800 in 2008. In recent years, especially during the boom years of the Celtic tiger, we often asked whether we were forgetting about certain social values. People worried about a new coarseness and materialism.

We may look back with fondness on such debates but we were asking a very legitimate question. There was even a conference, entitled "Are we forgetting something?", organised by Fr. Harry Bohan and others. One of the indicators of the forgetfulness of the material society was undoubtedly the way in which older people were treated and often forgotten because of the new pressures on people in the workplace and also the greater propensity to neglect older people and exploit them as carers of children. Caring for a child can often be wonderful for the older person but sometimes the expectations generated can be oppressive.

These concerns continue to arise, even as we face economic problems. Perhaps it is more urgent than ever that they be addressed because there is a danger during a time of scarcer resources that we would not put the necessary supports in place to ensure we are doing everything possible to prevent the abuse of older people and to maximise the considerable resource they represent in society.

While I am conscious there is a danger in mythologising the past as idyllic, I must repeat a story told in our house many times over the years about an Ireland we no longer recognise. It was about a poor farm labourer boasting that he was raising a large family, paying off an old debt and putting money in the bank. The riddle concerned how he could do all this as a poor farm labourer. The answer was that he was looking after his parents in his own home, thereby paying off the old debt, and that by bringing up a large family he was putting money in the bank since his children would look after him in his old age. That was a story about a time when people were interdependent. As the Irish saying goes, "Ar scáth a chéile a mhaireann na daoine."

We should remember that was not an idyllic world. We know from Peig Sayers's now infamous autobiography that she was shown the door once the sister-in-law came into the house. Domestic life was not always idyllic. It seems that countless plays and novels depict the torrid relations between people of different generations living under the same room. One only has to think of the appalling scene in "The Beauty Queen of Leenane" involving the scalding of the older person to realise the idyllic scene was not always representative of the reality.

Life in recent times has been much better in many ways but for whom exactly? I learned not too long ago about a fairly well-off household in which the grandmother lived with her son, daughter-in-law and their family. The phrase "lived with" is something of a misnomer because granny resided in isolation and meals were sent up to her. She was to be seen occasionally but definitely not heard. Her presence was not welcome when the children were entertaining. While we like to celebrate community values in Irish life, this harshness can be in the middle of it all.

Being young has always been preferable to being old. Yeats talked about this not being "a country for old men". However, there was a certain mutual regard at times when age was honourable and youth was valuable. As family forms have changed, there often seems to be less appreciation of what older people have to offer outside their economic and safety related role as child carers for hard-pressed parents. In the years since the late Charles Haughey made the famous quip about Chinese leaders ruling into their old age, older people have become less prominent at the top in society. Youth or relative youth has become a requirement for the Presidency, the Cabinet, business leadership and perhaps even a prime time slot in RTE's programme schedule.

American academics have observed that all segments of society can hold negative attitudes towards ageing. Even stories about acute hospital beds being blocked by older people helped to fuel a perception that the elderly were a problem rather than people to whom society owed an obligation and who have needs we must address. In Britain in recent years, unhealthy elements crept into the debates on living wills, etc. Even Baroness Mary Warnock, who has been lauded in Britain and here as some kind of ethical expert and who was brought to speak at a conference here some years ago by a Government-established commission, was the very one who suggested that the frail and elderly should consider suicide rather than becoming a financial burden on their families and society. This lady was dubbed the "philosopher queen" by The Sunday Times and has been a key shaper of British laws on sensitive ethical issues. In 1993, Baroness Warnock agreed a ban on euthanasia but since changed her tune having been influenced by various famous cases.

Even those from whom we should expect more in society have bought into a certain harshness in terms of how they perceive more vulnerable members of society. Very often, those more vulnerable persons are the elderly. In this regard, consider the debate proposed to take place in the coming days in Cork University Hospital, organised by the Cork University Hospital Ethics Forum. At this debate, a leading academic, Professor Len Doyal, is to address the theme of why euthanasia should be legalised. This is very controversial. There is no doubt about Professor Doyal's academic credentials but certainly a lot of doubt about the values he espouses. He addresses the debate very much in material and financial terms, and in terms of preventing a burden to society.

One wonders about the lack of tact of a hospital in organising such a debate. It is all very well to have a debate in a university – we would all be for it and willing to hear the different sides – but to hold in a hospital a debate on why euthanasia should be legalised is questionable, given that older people or those who feel ill or vulnerable would see the poster. What type of message would it send to them at a time when people talk about scarce resources and worry about the response being adopted by the Government and those in power? I note that many good things are happening and I acknowledge the work being done by the HSE. It is fair to state that on the whole the HSE and the Department of Health and Children have risen well to the challenge of elder abuse. However, concerns exist and Age Action points out that yesterday's budget suspended the scheme of community support for older people which cost only €3.4 million last year but is vital for the support of community groups. We need to ensure that elder abuse officers are properly resourced so they can do their work.

According to international figures, between 3% and 5% of older people suffer abuse and, as was stated by Senator Fitzgerald, undoubtedly this is the tip of the iceberg when one considers all the abuse that is not reported and the pressure on people not to report abuse. Like the horrible evil of child abuse, very often the abuse can and does take place in situations of mutual dependency and trust where there is some good in the relationship but also bad. This is where abuse can be particularly insidious because people are not in as good a position to blow the whistle.

Age Action has pointed out that the financial and legal sectors need more training to recognise and deal effectively with elder abuse. I understand that a recent case occurred which involved a sales representative driving a pensioner to an ATM machine while the representative's colleague stayed behind in the pensioner's house. This is the type of matter that is of concern. While good work is being done by the HSE and the Department, we need to examine how the financial and legal sectors measure up. It is fair to state that banks and auctioneering firms are not sufficiently alert to the concept of elder abuse or the dangers of it. No structures are in place to deal with the detection and prevention of elder abuse, for example, where unusual spending patterns by elderly people arise. I gather that Australia and Massachusetts have such structures in place and we should examine them.

Certain financial products are abusive of older people. Even though the Law Society advises against dual representation where lawyers act for both parties, such as a child and the older abused person, there is no absolute ban on it. We need to be more vigilant in this area.

I would not like to conclude on exclusively negative terms. We must acknowledge very clearly what Professor Des O'Neill and the Irish Gerontological Society have called the demographic dividend. We need to acknowledge the good work being done by many older people who are very active, for example, as carers. Not only do they save the State a fortune but they bring great love and care into society in a way that the State could not possibly match. We need to be alert as we discuss the needs of more vulnerable older people in society to celebrate, champion and encourage the tremendous contribution they have to make, particularly in the context of the greater likelihood of people living to older age.

Senator Dan Boyle

The subject of elder abuse as a matter of debate in this country has not received sufficient airing for a number of reasons. As has been commented on in the Chamber, representative groups such as Age Action have noted the level of elder abuse is substantially under-reported. This is probably because the nature of the abuse means it often occurs in close familial relationship and there is a reluctance on the part of the older abused person to report such abuse.

We must consider the type of abuse that occurs. We tend to think of physical abuse but often it can be emotional, psychological, social and economic, as was pointed out by Senator Mullen. There is an onus on the State and State agencies to define the abuse and then find out the incidence of it in society. We are probably not prepared to admit that it exists to as great a degree as many of us fear. Those who work at the coalface give anecdotal and personal evidence of its existence. In part this comes down to the level of support we are able to offer as a society. We had, and still do to a certain extent but less so than before, a good neighbourly concept and a sense of community. However, this has drifted and become more distant. We have relied more on the activity of voluntary groups which find it hard to find volunteers and receive sufficient support from the public and the State. State authorities, which are meant to fill existing gaps, operate under unacceptable constraints in the present circumstances.

Mention was made of the programme for Government. One element which, as a negotiator, I was happy to have included was a commitment towards piloting on a wider scale the integrated approach to elder care which exists at the Westgate facility in Ballincollig in Cork. This facility has long-term residential care and day care and meets the social and medical needs of the people who avail of the centre. It covers a large geographical area. I appreciate the economic situation has changed substantially since the programme for Government was published which makes spreading out a pilot scheme much more difficult but I argue that this is still a far more cost-effective way of dealing with care of the elderly and, more particularly, as a means of identifying the existence of elder abuse. With this integrated approach which links family, home, community and individuals we have a system that does not exist in the more formal aspects of care of the elderly.

Yesterday's budget brought an end to many tax reliefs in the area of health. Many of these were unacceptable, particularly tax relief with regard to private hospitals. Tax relief is being maintained for nursing homes and for child care facilities. I am not sure whether this is the correct approach and the money foregone in tax is money we could acquire and spend more effectively in communities.

Mention was made of the decision of the Department of Community, Rural and Gaeltacht Affairs to prune its budget under a very small heading which covers €3.5 million for security assistance for the elderly. As someone who has experience of community work, I am not sure of the value of specified grants. I would much prefer a generic approach to be given to communities with varying demographic circumstances. Block grants should be given to various communities and depending on their economic circumstances they could choose to spend them accordingly. If an area of economic need has a large population of older people it should have the freedom to do this and not depend on a specified grant system to allow this work to happen. If anything comes out of the review by an bord snip of the work of particular Departments and how public money can be spent more effectively, it could be that we spend more money in these areas but give more freedom to local communities to choose how the money can be used.

My father was very involved in Neighbourhood Watch in our community in Cork. While it was considered a general community security measure, most of its work involved elderly people living on their own. It had a system of home visits and ensuring panic buttons and particular doorbell systems were installed which allowed people to feel safe in the communities in which they lived. They knew there was somebody living nearby whom they could contact. Ironically enough, often this is more difficult in an urban setting than a rural setting because elderly people living on their own close to a large number of people can feel quite isolated and more alone than in a rural setting where one lives at a distance from one's nearest neighbour. We should promote these supports and I wish the Minister of State well with this.

I must admit that I am very disappointed with the report of the task force on elder abuse. It was a missed opportunity. It did not report to the extent it should have and the narrow follow through which came out of a narrow-based document did not go as far as it could. If today's debate has a particular use in informing the Minister of State and helping the Government, it is that we must be more precise in knowing the nature of the problem we face, allocating the resources that can and should be made available to it and admitting as a society that we have a problem that must be faced up to. Overall, even though we are an ageing society, and this has been mentioned by several speakers, in European terms we are still quite young. If the economic resources are not available, in so far as possible we should be reknitting those community links that have become broken in recent years. We should use the resource of younger groups of people within communities to reconnect with older people and address many of the gaps in provision and help to prevent the type of circumstances referred to.

Senator Phil Prendergast

I extend a warm welcome to the Minister of State, Deputy Hoctor. Elder abuse is an issue that gets far too little public support and attention. The only time we hear about elder abuse is in horrific media reports about robberies, rape and murder. Such events hit the headlines for a few days and then become the chip wrapper tomorrow. These are primarily policing issues although health and social services have a role which at times they have failed to adequately deliver. One only needs to hear the words, "rape" and "murder" associated with the elderly for an emotional response to be elicited. We recognise the vulnerability of the elderly and regard the immorality of such attacks to be repugnant. The head in the sand attitude to the wider issues of elder abuse is understandable to some degree because the subject rarely even makes it to the chip-wrapper stage.

The HSE conference on elder abuse to be held in June is therefore welcome and I am looking forward to listening to a range of speakers. It is worth considering the definition the HSE uses to define elder abuse. It makes the point that abuse can be a "single or repeated act". This points out that the single acts I referred to earlier are not the only types of abuse. We must also remember acts such as fraud or deception. Repeated acts are more likely to occur in an institutional setting and that includes families. The HSE definition then refers to a "lack of appropriate action", in a word, neglect. This can be familial or professional and we must never forget it can also be governmental. The definition goes on to describe acts which occur "within any relationship where there is an expectation of trust". This applies to commerce as well as to the more obvious civil, social and familial relationships. It concludes by saying that abuse is an act causing "harm or distress or violates human and civil rights". Harm and distress translates into physical as well as emotional and psychological abuse. This is an excellent definition which points out the variety of ways the elderly can be abused or are being abused.

It is worth going through that definition in detail because one of the challenges for society is to recognise the scope and variety of abuse. The Minister of State in her contribution cited the range of elder abuse. In the area of commerce, for instance, while everyone can be targeted by bogus charity collectors and sales people, the elderly are particularly vulnerable. They are targets for both overt confidence tricks and all too frequently, more covert targeting by supposedly reputable institutions. By this I mean somebody purporting to be from Bord Gáis, the ESB or Eircom who asks to come into the house. They often have an authentic-looking uniform or bogus ID card and they gain access to people's homes and violate their trust and rob them. Particular care must be taken with regard to Internet scams. The concept of elderly people using a computer is no longer as unusual as in the past. Many older people are participating in computer courses in supported environments or in their own homes. They are using the Internet for shopping and to go on eBay. I note the current advertisement which is very amusing, showing a woman running home across the fields because she wants to bid on eBay for a foot spa. I recently received an e-mail purporting to be from a well known bank. I was alerted by a little flash in the corner of the screen which means that the e-mail had come from another source rather than from the bank. We all know that a bank would never ask for one's ID or password but it is very important to reinforce this message to older people. Such messages may look authentic and the wording is well done. Such messages may say , "It has come to our notice that people are being targeted and your system may have been violated. We now ask you to re-enter your password." People can be taken in by what seems to be an authentic message. We need to be very aware of such scams because many elderly people use computers.

We know public services can be inadequate especially in the medical setting resulting sometimes in overt abuse such as happened in Leas Cross and more recently in St. Luke's. I made a fairly comprehensive statement on St. Luke's on the Order of Business yesterday. I indicated that I had a particular interest and that my husband works in that hospital. However, their hands are up with regard to the deficiencies within the system and that the HSE should never have made the excuse of the changeover from the health board setting to the HSE setting to discontinue implementing what would be good and best practice. To sit on reports for four or five years is absolutely appalling and is not good practice. We should not be proud of such a model.

There should be an increase in home support with monitoring of the client in the community. There is much reliance on the meals on wheels service. I refer to a press release dated last November from the National Council on Ageing and Older People. It reveals that 89% of staff who work in organisations providing meals on wheels do so in a voluntary capacity. They provide a significant service for older people which allows them to stay at home when they might otherwise need institutional care. The study on the meals on wheels service notes that it is often the first service offered to older people who are becoming more dependent but who are still capable of continuing to live in their own homes. It underlines the importance of meals on wheels as a source of nutrition for older people and as a means of enabling the early detection of medical problems that will require further interventions.

Two years ago during the general election campaign in May and June I called to houses where people were cold. They told me the fuel allowance was not sufficient because it stops too early in the year. I acknowledge the amount was increased subsequently in a budget but I am still not happy with it. We do not have the kind of weather where one can say with certainty that by a certain date in the year it will be warm and there will be no need to light a fire every night.

The Minister of State launched the report on the role and future development of the meals on wheels service for older people. It concluded that the research found that 89% of those working within the service were volunteers and the Minister of State acknowledged their contribution. That is laudable and is to be commended.

Senator Fitzgerald raised the issue of the suspension of the scheme for community support for older people. This is a retrograde step. The scheme of community support for older people was initially introduced in 1996 to contribute to the social supports available for vulnerable older people. The emphasis of the scheme had been on providing funds for local community and voluntary organisations to install personal monitored alarms and items of home security, such as door and window locks, to enable the older person to live independently. Grants are not made to individuals under this scheme. Instead, eligible older people are identified through local community groups and an application is made on their behalf. The Carers Association in Clonmel was playing that role which was replicated throughout the country. There was a significant take-up and the number of older people who benefited in 2007 was 10,764, in 2008 it was 11,762 and so far this year it is 1,866. It offers substantial security of tenure for these people. Yesterday, the Minister stated that given the urgent action needed to restore stability to the public finances and the requirement to prioritise funding to restore economic activity and employment, he regretted that he had to make some tough decisions. The Minister of State, Deputy Curran, announced the suspension of the scheme with immediate effect but indicated that he hoped to be in a position to provide support for all applications on hand.

It was not costing much money to provide this scheme and the savings could have been found elsewhere within the system. When the Health Service Executive was established to replace the original eight health boards there was a substantial increase in the number of staff. However, it did not result in an increased or better service. Instead it created layers of bureaucracy and red tape and created a good many jobs for people. Nurses were promoted to jobs which involved carrying clipboards and ticking boxes. The person who receives a front-line service appreciates it. I am not saying people within the HSE do not have a role, because they do. However, if one were to prioritise who should go, whether the person providing the service on the front line or someone ticking boxes elsewhere because of a number of statutory obligations made by us, I question the way forward. I do not believe this is the way and although I may not be here for the Minister of State's concluding remarks I will listen to them.

Senator Larry Butler

I thank the Minister of State, Deputy Hoctor, for outlining the care dedicated to older persons. As a member of a health board for ten years I had the opportunity to visit many elderly care centres throughout the country, which was an education. I will not deal with the problems regarding health care for the elderly as it has been addressed by a number of other speakers. However, it is worrying that there has been an increase in the number of complaints about elderly abuse from 900 to 1,700.

On a more positive note, the elderly played a major role in the Celtic tiger and in terms of their contribution to the country for many years. I include those who emigrated and now live in London in circumstances not as favourable as those of some elderly people in this country. This is an area of the health services over which we do not have control. However, I believe we should ensure a service is provided to cater for the needs of our older people who emigrated many years ago. Such people sent significant sums of money back when we were not so wealthy.

Senator Mary White dealt with ageism, one of the worst aspects of the way we treat our elderly. Very intelligent people who held very high positions during the tenure of their working lives are treated on retirement as imbeciles and we do not use the skills they have. Such people have tremendous skills which are not being tapped. We could use some of their skills for upgrading and training some of those now unemployed. I wish to see our elderly more involved in the day-to-day life of the country. As Senator White said, one should be able to choose when one wishes to retire. That is a right which should be implemented and defended.

Very significant advances have been made by the Government and the HSE in the past ten years. It is great to see the facilities at the disposal of the elderly. There are wonderful day care centres in my constituency of Dún Laoghaire. There is bowling and various other entertainments set up for the elderly, and rightly so. These represent significant advances and we should accept and acknowledge that we have done well in certain aspects, although I am sure we can do better.

It is regrettable to have to put in place services to protect the elderly when abuses take place. However, it is necessary no matter how much one polices a given area. There are 15,000 police on the streets of the country, but abuse still takes place and there is a breakdown of law and order every day. The health services look after 23,000 elderly people throughout the country and it is very difficult to police and enforce the rules when abuse takes place, but it is incumbent on those working in the health services to do so.

The homes and care we provide are very expensive. The average cost of staying in a home is probably between €800 to €1,000 per week. The least we can expect is for those delivering services to the elderly to be professional. I believe the Minister of State, Deputy Hoctor, has done much during her time in this portfolio to ensure a professional service is delivered to our older people, which is vital.

In the debate on the delivery of services there has been mention of physical, mental and various other forms of abuse, but verbal abuse is probably the worst of all. Much abuse is verbal in nature and is not reported because the older person does not wish to draw attention or create a problem in the household or home in which he or she lives. This occurs every day but goes undetected.

The most vital service we can deliver to the elderly is that of carers looking after them at home. This enables older people to stay at home where they are familiar with the surroundings, where they wish to be, where their neighbours are near and where the community lives. The longer we can maintain that service the better. It is a cheaper service and when making decisions about costs and trying to get value for money and the best delivery of services, we must consider the work of such carers. Their money is earned by their hard work and diligence and we should support them.

Senator Paddy Burke

I welcome the Minister of State. I also welcome the opportunity to say a few words on a topic that has been well discussed this evening. While I have not read the report in great detail, the parts I have read shocked me. When the young people who appear on talent shows are interviewed, many say they do it for their grandmothers or grandfathers. It is difficult to reconcile this with the report which states that the majority of abuse occurs in the family home.

In many cases, perhaps people do not realise what abuse is. The report does not spell it out either, but what constitutes abuse and its forms should be defined. The Minister of State mentioned financial abuse, sexual abuse and so on. I assume isolation is a type of abuse. The elderly could be vulnerable to people in the family home who are abusing them without realising it, particularly where isolation and money are concerned.

Often, parents want to do their best for their children and to give them as much money as possible. Sometimes, the children believe they are entitled to all of that. Perhaps the fact that the elderly are as entitled to their independence as anyone else should be brought to the children's attention more forcefully.

I welcome the report, but I wish to mention an issue that has been raised by Senators Fitzgerald and Prendergast, namely, the support scheme for older people, which has been good. The grant aid for devices for people aged over 65 years of age has been withdrawn. This is a sad day. We are discussing the report and abuse of the elderly, but withdrawing those forms of security is an abuse. I have seen at first hand the good service provided by both. When the security system schemes were first launched in 1996, they only cost £5 million. They cost no more today.

Senator Frances Fitzgerald

Some €3.5 million.

Senator Paddy Burke

It is a small amount of money when one considers the security it has provided to 10,000 or 12,000 elderly people. Older devices were recycled three or four times, but I am led to believe that newer devices have ten-year warrantees. In this light, they can be recycled several times.

The amount of money at stake is small. I am shocked by the Government in this regard. Many people who live on their own, particularly in rural areas, were given a great sense of security by devices like the telephone and the device that could be worn around the neck. It also gave their family members security, as they would leave knowing they could receive a telephone call at short notice in the event of an emergency.

I do not know whether north County Tipperary has a hub town, but there are two in County Mayo, namely, Castlebar and Ballina. Since funding from the new Leader programme does not apply to hub towns, it cannot give money to meals on wheels programmes or other projects for the elderly. This is a bit petty. There is no point in a town having hub status if it is unable to qualify for grants or decentralisation. Hub towns are now dormitories, with houses, houses and more houses. The Minister of State is tied into this Government policy, but she should consider the matter.

I received a letter from Castlebar Voluntary Social Services, which is providing good services in terms of meals on wheels and buses. However, the majority of those to whom it is providing these services are located up to ten miles outside the town. It is the same for all hub towns, yet they do not qualify for Leader funding. This is another attack on services for the elderly and should be brought to the attention of the Minister for Community, Rural and Gaeltacht Affairs, Deputy Ó Cuív, or which ever Minister has responsibility for this aspect of Leader funding. The situation should revert to the status quo because the organisation in question is providing a rural service within a radius of ten miles of Castlebar.

I am disappointed by the news that the support and security device schemes have been withdrawn. Given the small amount of money involved and with the aim of retaining security for those who have had it in recent years, I hope the Government reintroduces the schemes. Since the Government is highlighting something on the one hand in this debate and withdrawing it on the other, it should consider the two issues I have outlined.

Senator Maria Corrigan

I welcome the opportunity to speak on this important issue. I also welcome the Minister of State. I am conscious that many colleagues have contributed and I will do my best not to repeat them. It is a pertinent subject to discuss.

In recent years, awareness of child protection has increased, but there is no corresponding awareness of the protection of vulnerable adults. Even where there is an awareness of and debate on the matter, we tend to speak in terms of adults with mental health issues or disabilities, particularly intellectual disabilities. It comes as a shock to many people that the protection of the elderly needs to be addressed. When the subject was raised in recent months, I found people were taken aback by the occurrence of elder abuse.

I will revert to this point later, but I want to take the opportunity to congratulate the HSE on its campaign to highlight the issue of elder abuse. The campaign commenced at the end of 2008, but its inclusion and the inclusion of a leaflet in the Sunday newspapers in February were helpful, as much chat was generated. It provided practical and sensible information pertaining to elder abuse and gave real information about the forms it could take in easily understandable language. Most importantly, it provided a telephone number with which people could make contact if they had concerns regarding older people within their communities of whom they knew or of whom they had become aware and who were the victims of elder abuse. This was a highly welcome initiative on the part of the HSE.

Other Members have mentioned that this does not take away from the fact that many older people will continue to play an important and worthwhile role in communities. They contribute, are highly active, provide invaluable supports to the community, often on a voluntary basis, and can themselves be carers. However, a number of older people can be adversely affected by the onset of various age-related disorders that can increase their vulnerability and decrease their capacity to protect themselves. These are the individuals of whom Members are cognisant in particular this afternoon.

I will not repeat the definition of such abuse because other Members have spoken about it extensively. However, I wish to comment on the alarming statistics that have emerged, which indicate that abuse appears to be much more prevalent in a person's own home than anywhere else. I welcome the introduction of standards for nursing homes, which obviously are extremely important in ensuring an appropriate standard of care. However, their introduction also has put in place an important layer of protection for older people. Older people who are resident in nursing homes have the augmented safety of having other people around. They seldom find themselves in the company of the same person all the time and if there are concerns or incidences of abuse, there is a higher likelihood of them being picked up on.

Some of the emerging statistics appear to suggest that those who live in their own homes are somewhat more vulnerable. This may be because they have less outside contact but also may be because of a lack of awareness as to what constitutes abuse. That is something about which it is particularly important to create awareness and provide information. Because of the vulnerability of people in their own homes, it is important to highlight the signs and symptoms of elder abuse among HSE staff in general, as well as those who may have reason to have contact with individuals who are living in their own houses, such as GPs, local priests, neighbours and family members. This was one reason the HSE's recent campaign was particularly important.

I commend the role of public health nurses in the community. In my constituency of Dublin South, I pay tribute to the brave members of the public who bring forward their concerns about elderly neighbours and to those working in GP practices or pharmacies who have reason to come into contact with vulnerable adults and who, on becoming aware of a concern or the possibility of abuse, find the courage to come forward and to pass it on. Public health nurses are an invaluable support in this regard. In my experience, whenever a concern is raised about an older person in my community, I have been able to make contact with the local health centre. Moreover, if a public nurse does not already have knowledge of the person concerned, he or she often will make a point of calling in to say hello and to check out the person. This again provides vulnerable older people with opportunities to make disclosures or to mention that something untoward is taking place. I commend public health nurses in this regard, as well as in respect of the support they provide thereafter. My personal experience has been extremely positive in this regard.

I wish to raise a number of issues that differ slightly from those which already have been mentioned in the House. If we are to tackle elder abuse, a number of legislative issues remain outstanding that must be addressed as a matter of urgency. They do not apply simply to elder abuse but pertain to the protection of all vulnerable adults. One such issue pertains to capacity and I welcome that new capacity legislation is due to come before the House. I also welcome that the indications are that a functional approach to capacity will be taken. Such an approach to capacity for older people is particularly important because it gives them the opportunity to maintain as much of their independence regarding decision-making as they can, while enabling it to alter in tandem with alterations in their circumstances. I welcome that a blanket approach to capacity will not be taken.

While the issue of capacity remains outstanding for older people in particular, it increases their vulnerability, especially in respect of financial measures. However, it also increases their vulnerability when it comes to following up on incidences of abuse. This also is evident with regard to other vulnerable adults. Greater difficulty is experienced when trying to take action through the courts subsequently, if that is deemed necessary. Greater difficulty is experienced in so doing because there is much ambiguity and blurring as to what can be accepted as evidence from a person over whose capacity a question mark exists. This is an issue both in respect of elder abuse and other vulnerable adults, such as those with disabilities. I welcome the forthcoming legislation and in addition to the comments made by other Members, the Minister of State might take away from this debate the importance for the aforementioned capacity legislation to come before the House because it will have implications.

I welcome the report that has been produced and the work that has taken place on foot of it. Awareness of this area will continue to increase. Some of the steps that have been taking following the report's production are proactive and I wish the Minister of State well.

Minister of State at the Department of Health and Children (Deputy Máire Hoctor)

I understand that ten minutes are available to me. Is that correct?

Acting Chairman (Senator Geraldine Feeney)

Yes.

Deputy Máire Hoctor

I thank Members for their comments. A wide range of issues was raised in the debate, which I welcome. As many Members noted, the issue of awareness must be increased and expanded and I believe that while we have made good progress, there still is much to be done. Until relatively recently, elder abuse and the abuse, neglect or mistreatment of older people was not recognised as a problem, in common with other forms of abuse and maltreatment. The report of the Council of Europe study group on violence against elderly people in 1992 advises that a widespread lack of awareness, together with a slowness to accept its existence, was further exacerbated by the "veil of silence which too often surrounds this phenomenon". In the past 15 years of so, this has begun to change, in part because of the recognition and acceptance of other forms of abuse, such as child abuse and domestic violence, as social problems. Other factors also played a part, including studies on and reports of elder abuse in professional journals and by the media, developments in the provision of care as the number of older people has risen and the involvement of professional and advocacy groups with older people.

Thankfully, people are living much longer and healthier lives. While in ancient Greece, the average age of survival was 30, thankfully it has increased dramatically in recent times. It now is suggested that on average, a little girl born this year can look forward to living to the age of 100. Medical science has improved and this is a great tribute to all those who are engaged in medical research and who work and strive towards such findings. We also must act on such findings and must help people to develop the requisite quality of life for longer living.

Many issues were raised and I ask Members to put themselves in the shoes of older people. These people have worked hard all their lives and dedicated their lives to their families and the workplace. From my work with them and with people who work with older people I detect that they feel they are not needed so much when older years come upon them. Their families have grown up and they find themselves too often alone. Many find themselves in this situation but do not articulate it because it is difficult to do so. Those of us who need to know are aware that this can be the experience of the older person. In the aloneness and loneliness, the seeds of vulnerability are sown and elder abuse can thrive in that environment. The Opposition is critical today but we see the valuable reporting that occurred in one year, from 2007, when over 927 cases were reported, to double that figure the following year. It is important that the environment is created so that people feel free to report what they see and detect as symptoms of elder abuse. That takes many forms — physical, psychological, emotional and verbal. I welcome the research on this area.

No one referred to the unidentified people who arrive at the door of the older person and offer to clean the shoots, repair the roof and cut the tree for a certain cost. When the work is done, the cost trebles and the older person feels he or she cannot resist or take on the dishonest individuals. Instances of this are reported across the country and the Garda Síochána does its best to track down the offenders. It is a real example of elder abuse. It has occurred through the years but people did not have the vocabulary to articulate it. At least we have uncovered it. We must uncover the silence where older people feel too vulnerable to report abuse because it will damage the relationship with the daughter or son who has the PIN of the ATM card. The son or daughter may use it without consulting the older person. We could elaborate on other instances today.

Good points were raised by colleagues. Senator Twomey referred to Leas Cross, St. Mary's Hospital, Phoenix Park, the institution in south Tipperary and the hospital in Clonmel. He referred to abuse taking place in institutions. The review undertaken by the elder abuse national implementation group does not cover elder abuse in institutions but that will be the next step. There is a procedure for staff members who are suspicious of alleged elder abuse of a person in an institution. Those steps are clear and the procedure must be followed to the end. The accused has the right of appeal. Instances of this, where an investigation has taken place and an outcome has been reached, have been overseen by me. I am pleased that the procedure is in place.

The commission of inquiry established to report on Leas Cross will report in May 2009. The Garda Síochána is following up on criminal matters and should Senator Twomey need further information on this I am happy to provide it.

Senator Mullen referred to financial abuse. Towards the end of 2007 round table discussions took place with the financial institutions. We identified that elder abuse includes financial abuse, where families access accounts belonging to older family members, who may not be aware of it or feel so vulnerable that they cannot take on the family member accessing funds. That is the next step of our work on elder abuse. It is a major challenge and I hope the financial institutions will work with us and those who work with older people to tackle the issue. We do not have a clear measure on it at the moment. Many non-health issues must be progressed.

Senator Mullen referred to the euthanasia debate in UCC. I support him in his deliberations. I respect the ethics forum and freedom of speech when sensitive and difficult issues must be addressed. However, the title used by those who organised the debate, "Why Euthanasia Should Be Legalised", leaves much to be desired. It was insensitive, if not distasteful. It flies in the face of Government policy for older people. We want to enable people to live as long as possible in their homes, with independent lives full of quality experience. This has no place in our policy. Professor Len Doyal and those who organised the debate do not define the policy and laws of this country. That is done by the Members of these Houses. Euthanasia is illegal and has no place in our medical ethics debates. People in Cork University Hospital and the HSE do not devise policy, the Members of these Houses do.

The suspension of older people schemes is regrettable. The Minister of State at the Department of Community, Rural and Gaeltacht Affairs, Deputy Curran, made that difficult announcement this morning. It was suspended rather than abolished and, when funds are available, it will be reintroduced. I will not be found wanting in seeking the restoration of the fund. I know the benefits of this fund as enjoyed by older people.

We acknowledge that much work remains to be done in the area of abuse. We have made progress on it. The new procedure for dealing with elder abuse is only one component of the challenging work programme set by the Government. A review of the existing service will not only identify gaps but examine types of abuse not covered in the original report. This is a challenging time and I am pleased to be part of the changing environment. I have emphasised to the Taoiseach the need for the office for older people to continue its work.

Senator Mary M. White

Hear, hear.

Deputy Máire Hoctor

I may not be in this position in two weeks' time but much good work has been done by those in the office for older people, including the National Council on Ageing and Older People and the staff, who are dedicated to promoting quality of life for older people. I wish the staff well in making progress on this work. The office should remain as one dedicated to address the needs and concerns of older people and to promote greater quality of life for older people.

Acting Chairman

We were told we could ask questions. I do not know if the Minister of State was aware of that.

Senator Frances Fitzgerald

I agree with the Minister of State that the continuing focus on the elderly in our society is important. We have an aging population and there are many issues requiring attention, some of which we have touched on.

Have the findings of the Mental Health Commission inquiry report, specifically the section 55 inquiry into St. Luke's Hospital and St. Michael's unit, been referred to the Department? The report came out on Friday and it is extremely important that it be referred to the Department and that there is a follow-up from it. Many elderly people are affected by it, some of whom are intellectually disabled and have a range of mental health issues, and it is extremely important that the Department is involved in the follow-up. It raises most serious issues about care of the elderly in our society, particularly in institutional settings where people are most vulnerable.

We have discovered in child abuse cases as well that in residential settings, people can be extremely vulnerable to abuse. This is a complex issue and it is not all about abuse. There is also concern regarding institutional neglect. What action does the Minister of State intend to take in this regard?

With regard to the report presented to the Department last year on the development of guidelines, how will these be implemented and what has the Department been able to do with regard to the HSE policy responding to allegations of elder abuse? Will the Minister of State provide an update on the implementation of that policy, how is it going and whether mechanisms are in place to monitor implementation? More cases are being reported but we have seen in cases of child abuse that there does not always appear to be uniform implementation of the guidelines, which is a key issue to be sure of. Senator Mary White mentioned that also.

I wish to return to the St. Michael's unit and St. Luke's Hospital case. There was a September 2004 report, the recommendations of which were supported by orthopaedic specialists. These have not been systematically addressed, with an apparent delay of three years of action being taken from the time this was reported. The report only came out on Friday but it has serious implications for people in our hospitals. The hospital and residential setting has had a spotlight turned on it but there are other residential units which have not been examined like this. The worry is that if proper guidelines and monitoring are not in place, other elderly people could be at risk of institutional neglect, which is a very serious issue as we have seen from Leas Cross and other reports.

With regard to the community grant scheme, is there a possibility that some flexibility could be introduced or that the scheme could be brought back? The Minister of State seems to be suggesting she is very unhappy about it going. It supported vulnerably elderly people who were living independently alone.

Deputy Máire Hoctor

As Senator Fitzgerald has outlined, the report of inquiry under section 55 of the Mental Health Act 2001 into the services at St. Luke's Hospital and St. Michael's unit in Clonmel highlighted very significant deficiencies in the mental health services in Clonmel. The report highlighted the aspects of the service provision that were described as being unacceptable in a modern mental health setting.

The Clonmel service requires considerable development. However, we are advised that sufficient staffing resources are already in place in the region to enable the adult mental health services to be reconfigured and reorganised in line with Government policy as set out in the document A Vision for Change. I welcome the fact a detailed project plan for the development of mental health services in south Tipperary, which will be time bound and have clear lines of responsibility for implementation, will be submitted by the HSE to the Mental Health Commission.

The Department of Health and Children will work with the HSE and the Mental Health Commission to ensure that any issues arising from the inquiry are properly addressed. The publication of the report demonstrates the robustness of the Mental Health Act 2001 and the independence which the Mental Health Commission has. It has an important role in safeguarding the standards and quality of care in mental health services.

Mental health services are the responsibility of the Minister of State, Deputy John Moloney, although it is in the same Department and there are a number of older people in those facilities in Clonmel. It is an area of interest for me.

The Senator had other questions. With regard to the development of guidelines on elder abuse, we have made great strides with the HSE in the upskilling and training of staff and trainees in the medical field and public health nurses in particular to be able to identify the symptoms of elder abuse. I was in Galway last year for the launch of a HSE DVD for distribution to the training courses of personnel within the HSE so symptoms could be clearly identified and training and upskilling done. That is one of the areas in which great progress has been made.

There are very clear guidelines for the managers and employees of such facilities. Every employee is aware of the procedure to be taken and through the regulations, employees feel they will be supported if they report what they believe to be abuse. Procedures will be followed so that a person suspected of inappropriate action is given every opportunity to articulate his or her point of view of the experience. It is important that action is taken in the interests of fairness and, ultimately, the interests of the patient or the resident in a residential setting.

I have mentioned the community support scheme and the withdrawal of the funding is a disappointment, although I understand the reasoning behind this. There has never been as much consultation with our parliamentary party as there was regarding the budget which was announced yesterday. There was a very clear voice for older and vulnerable people, along with their carers. The relevant Department — it was not the Department of Health and Children — made what was indicated as being a very tough decision, which I accept.

I know many older people have benefited over the years from this scheme, an average of 10,000 per year. The Minister of State, Deputy Curran, in his decision making with the Minister, Deputy Éamon Ó Cuív, indicated it was a suspension of the scheme for the moment. Many schemes have been suspended across Departments but not abolished. I will make contact with that Department to ask that the issue be addressed again and to see that the funding be restored as soon as possible for this very important scheme.

Senator Frances Fitzgerald

That would be very important. The scheme is under the remit of another Department and perhaps the information was not there. Tens of thousands have benefited from the scheme and there are 26 community groups in Dublin working with elderly people across the city and giving support. It is extremely important and while I appreciate the Minister of State's comments, I look forward to a reversal of the decision.

Senator Liam Twomey

I listened to the Minister of State on the monitor and I heard what she said with regard to Leas Cross. Is there a Garda inquiry going on as I believed the inquiry was suspended until the report awaited by the Department and due to be published in May was completed? I believe that report is by a senior counsel.

Deputy Máire Hoctor

That is the report from Professor Desmond O'Neill.

Senator Liam Twomey

Is it not Mr. O'Donovan, SC?

Deputy Máire Hoctor

Professor Desmond O'Neill is to report in May.

Senator Liam Twomey

There is a report due from Mr. O'Donovan, SC, and the Garda inquiry has been suspended. Has that report been completed? That is the report we are waiting for.

Deputy Máire Hoctor

I appreciate this is an issue dear to Senator Twomey's heart and it is not his first time raising it. Professor Desmond O'Neill is due to submit his report on Leas Cross next month. As I understand it, the Garda is still investigating certain criminal aspects relating to this matter. I will communicate directly with the Senator in respect of the issue to which he refers.

Senator Liam Twomey

I was informed that an inquiry is being carried out by a senior counsel and that on completion of his report, the Garda will resume its investigation. Perhaps the Minister of State will clarify whose report is being awaited.

Deputy Máire Hoctor

I will communicate further with the Senator in respect of that matter.

Seanad Éireann debate - Wednesday, 8 Apr 2009

Elder Abuse: Statements.

Seanad Éireann debate -
Wednesday, 8 Apr 2009