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Seanad Éireann debate -
Wednesday, 9 Mar 2022

Vol. 283 No. 8

Brain Health and Dementia: Statements

I welcome the Minister of State, Deputy Butler, to the Chamber.

I note we had a very engaging debate yesterday in the audiovisual room with Ms Siobhán O'Connor, CEO of the Alzheimer Society of Ireland, and many eminent speakers. I thank the chair of the all-party committee, Senator O'Loughlin, for organising that and for the engagement that happened. I ask the Minister of State to open the debate; she has eight minutes.

Dia is Muire daoibh go léir. Tá an-áthas orm a bheith anseo. I welcome the opportunity to update the House on the measures the Department of Health is taking to ensure older people in Ireland benefit from advances in modifying therapies and research around brain health and dementia. I specifically welcome our visitors in the Gallery. They are currently taking part in an Erasmus project on dementia rights. We have representatives from Portugal, Spain, Greece and Turkey, in addition to St. Joseph's in Shankill, who are leading the way in the provision of dementia supports in Ireland. They are all very welcome. I also welcome my colleague, Deputy Cormac Devlin, who is present.

I acknowledge at the outset the hard work that my other colleague, Senator O'Loughlin, is doing as chair of the all-party committee on dementia. I previously co-chaired that committee with former Senator Colette Kelleher. A lot of good work has been done. I thank Senator O'Loughlin and all the people who engage on that committee. Politics are left at the door and the only provision is to try to enhance the supports we have for people living with dementia in this country. I thank the committee very much for that.

I have long been an advocate for the development of dementia services and supports. Since being appointed Minister of State with responsibility for this area, unprecedented levels of investment have been ring-fenced specifically for dementia services and supports in this country. Sláintecare reform is transforming how we deliver healthcare in Ireland. It places people and their families at the centre of the health system. Through the development of new models of care it will support older people, including those with dementia, to stay healthy in their homes and communities for as long as possible. To support this reform, the National Dementia Office has been developing a model of care, which works towards the vision of the national dementia strategy 2014, of timely diagnosis for dementia and integrated post-diagnostic support, including for family carers. With the prevalence of dementia expected to rise by 134% by 2045, it is essential we have these services in place. The model of care will look at the needs of the person with dementia, with a strong focus on brain health interventions that can benefit the whole population.

Disease-modifying therapy is a major goal for research around dementia. Of the 126 agents currently under trial for Alzheimer's disease worldwide, about 83% are disease-modifying therapies. The potential future impact of modifying therapies is very hopeful. These treatments may allow us to treat, slow or prevent a disease that can be devastating for the people diagnosed and their families. There is great optimism that these therapies will become available in the coming years. Our health services will need to be ready for the potential future of these modifying therapies for dementia along with the projected increase in people living with dementia. It is anticipated that the introduction of these therapies would result in increased referrals of people with cognitive difficulties to our services. This will require future development of our diagnostic services, which will include neuroimaging and specialist testing.

I was delighted to secure additional funding in 2021 and 2022 to develop a number of specialist diagnostic services throughout the country. Of note, funding allocated across 2021 and 2022 will allow for the development of two specialist regional memory clinics in Cork and Galway and nine new memory assessment and support services. Establishing these essential services will ensure that there is timely access to care and a reduction in waiting times. Early diagnosis will be key in the treatment of dementia, with advances in modifying therapies and brain health interventions key tools to slow progression of the illness and maintain a person's quality of life.

Recent areas of additional investment have also focused on brain health and reducing the risk of dementia. It is estimated that up to 40% of dementia worldwide is preventable. Recent funding has supported the dementia Understand Together campaign to improve public awareness and understanding of dementia, including how to reduce risk factors. In 2022, additional funding will allow for the recruitment of a brain health project manager to support a dementia risk-reduction working group and collaborate with clinical programmes to promote brain health. We should be encouraging the whole population to actively prioritise their own brain health. A campaign on dementia and brain health will be run as part of brain awareness week from 14 to 20 March by the national risk-reduction working group to include key messages around brain health for the public through social media, press releases and newspapers. National campaigns, such as Quit Smoking, Ask About Alcohol and healthy eating and active living campaigns, all help to address risk factors associated with dementia.

Once people have received a diagnosis of dementia, additional supports are in place to support people with dementia to live well for as long as possible. A key focal point of the post-diagnostic pathway is the dementia advisor service. I was delighted to launch the expansion of the service in November 2021. An additional 11 dementia advisors allowed this vital service to be expanded nationally. I was delighted to build on the work of my predecessor, former Minister of State at the Department of Health, Jim Daly. We had many conversations about increasing the number of dementia advisors and we now have 28 throughout the country, which is fantastic.

Funding in 2021 also allowed for an enhancement of memory technology resource rooms. These services provide practical ways of managing the challenges of dementia and improving independence, safety and quality of life through various assistive technologies and occupational therapy guidance. I was delighted to travel to Tralee before Christmas to open the 30th memory technology resource room in Tralee, which was purpose-built. We have come such a long way in the past four or five years. To now have 30 memory technology rooms throughout the country is amazing. I thank everyone who worked on that because it was a collaborative effort, which is fantastic to see. In addition, the proportion of new home support hours that will be ring-fenced for people with dementia will more than double in 2022 to 11%. This will provide support for family carers of loved ones living with dementia and enable people living with dementia to remain living in their own homes.

To improve the outcomes for people living with dementia in acute care settings, I was pleased to secure additional funding through budget 2022 for the provision of a dementia assistant director of nursing post in each hospital group and four additional dementia clinical nurse specialist posts. Funding in 2021 also allowed for the implementation of the national clinical guidelines on appropriate prescribing of psychotropic medication for non-cognitive symptoms in people with dementia.

I will address more of the points when I reply to the debate later.

I thank the Minister of State for all her work and her acknowledgement of the former Minister of State, Jim Daly, who was very well regarded.

I thank the Acting Chairperson and the Leader of the House for giving us time to discuss this very important subject. I thank the Minister of State for taking the time to attend this incredibly important debate. I add my voice of welcome to Deputy Devlin, who plays a key part in the all-party committee, and to Ms Emma Balmaine and Ms Siobhán Grant, together with Elaine and Norma, from St. Joseph's, Shankill. I also welcome those who are representing Alzheimer Portugal, Alzheimer Hellas in Greece, the University of Oviedo in Spain, the institute of St. John of God, Portugal, and the Association of Social Inclusion and Education, BUHAYAD, in Turkey.

As we know, and as the Minister of State has pointed out, St. Joseph's, Shankill, has vast experience in the field of dementia and is collaborating in the development of a charter of rights for people with dementia and their caregivers. We all look forward to hearing and seeing the results of the Erasmus project and possibly having the opportunity to debate it, either within our all-party committee or back in the Chambers of Leinster House.

It has been a privilege to initiate this debate as chair of the all-party group on dementia. Today, we speak in the House on behalf of more than 64,000 people in Ireland who are living with dementia and, of course, their families who are bearing the brunt of caring.

At the outset, I pay tribute to the Alzheimer Society of Ireland, ASI, for organising such a moving and empowering briefing for us in the audiovisual room yesterday and for the incredible work and support it offers to people with dementia and their families. It was clear from that briefing that significant strides have been made in the area of brain health and dementia in this country. I thank Professor Sean Kennelly, Professor Mary McCarron, Professor Iracema Leroy and Samantha Taylor from the ASI, as well as the strong and powerful dementia advocates, Kevin Quaid and Helen Rochford-Brennan.

It may be a surprise to many that, according to the WHO, up to 40% of dementia cases are potentially preventable if we work to support and maintain our brain health. We can all take action to protect our brain health. Dementia has become much less taboo thankfully in recent years, which is very important in terms of early intervention. In years gone by, dementia was a hush-hush disease. People did not talk about it and many were afraid of what others might think, how they might be viewed, how their lives would change, and that people would see the dementia and not the person. However, as was eloquently presented in yesterday's briefing by Professor Leroy, advancing the historical journey of dementia is key in achieving a dementia-free society. We have now become a dementia friendly society, and that is clear from the work the Minister of State has done and from the commitments she achieved in budget 2022. I pay tribute to her for the clear focus in last September's budget for this year on enhancing community-based services to enable older people to continue living in their homes with dignity and independence for as long as possible.

The €150 million funding secured in 2021 for 5 million additional hours of home support has been maintained for this year. In addition, the proportion of these new home support hours that will be ring-fenced for people with dementia, will more than double from 5% in 2021 to 11% in 2022, which is just incredible, and we want to see that maintained in years to come. I got a strong message from Siobhan O'Connor from the Alzheimer Society of Ireland to press that point today. For many people and their families, the option to remain in their homes is key to their quality of life. I thank the Minister of State for engaging with us and other stakeholders, for listening and delivering for those living with dementia.

I know there has been talk about and work done in extending the fair deal scheme to homecare in the home. I would appreciate if the Minister of State could give an update on that, because it is a very important piece of the jigsaw. Points were very well made at her briefing yesterday, notwithstanding the excellent work that nursing homes do in terms of caring for their patients, that stimulating patients, particularly those with dementia, is hugely important, as is looking at different models, such as the butterfly model used in St. Joseph's in Shankill. In addition, the extra education for those in the health business and nursing for dealing with patients with dementia is very important.

In many cases, dementia is preventable and while being a dementia-friendly society is important, we need to move to a healthy brain society. We need to focus on preventive measures and working on our brain health to ensure that we achieve a healthy brain society and, therefore, delay the onset of dementia. According to The Value of Delaying Alzheimer’s Disease Onset report of 2014, any intervention that delays the onset of dementia caused by Alzheimer's disease for five years, will result in 41% lower prevalence of dementia and the associated cost will reduce by 40% by 2050.

We all know the importance of a healthy heart, maintaining healthy cholesterol levels and exercise to support cardiovascular health, but do any of us really know how to maintain brain health? Do we even know what it is? We need to support a mass communication campaign on the importance of brain health and how to promote healthy brain function. Brain health is the preservation of optimal brain integrity, mental and cognitive function, and the absence of overt neurological disorders. The landmark report of The Lancet concluded that 40% of dementia is due to just 12 risk factors, such as a lack of physical activity, smoking, social isolation and many others. This shows that we can and we must do everything we can as a legislative executive body and as a society to tackle those factors head-on.

There is no doubt that we can reduce the prevalence of dementia in our society, but we must act now. I am confident that the Minister of State will be the Minister who makes the difference. I am proud of what we, the Fianna Fáil Party, have already achieved through her and the Minister, Deputy Stephen Donnelly, in Government in terms of delivering the enhanced memory technology resource rooms on nine sites, dementia diagnostic services delivered through a specialist regional memory clinic in Cork, four new memory assessment and support services in Mayo, Wexford, Waterford and Sligo, and the enhancement of acute care pathways for people with dementia through the recruitment of more clinical nurse specialists.

What was clear from yesterday's briefing, particularly from the contribution of Kevin Quaid, was the fight, grit and determination of those living with dementia to advance the cause and to push for treatment, innovation and preventive actions. Again, I have no doubt - no pressure - in the Minister of State's ability to drive this forward. I appreciate the Acting Chair's indulgence.

As acknowledged already, Senator O'Loughlin is chair of the all-party committee, and I thank her for her work in that regard.

Cuirim fáilte roimh an Aire Stáit. The Minister of State is very welcome. I apologise in advance for the fact that I will not be able to stay to hear her response, but I will certainly read it later, because this is an important debate. I compliment all who have been responsible for bringing it to the floor today, including Senator O'Loughlin and her committee, which I commend for its important work, and the organisations and people who advocate on the issue of brain health for people with dementia, in particular, the Alzheimer Society of Ireland and champions, such as Helen Rochford-Brennan, who have been mentioned and rightly so. I pay tribute to their important work in growing awareness.

I can remember when I started thinking about this issue properly a number of years ago. The figure at the time was 50,000 people and I remember it being said that the figure would grow to 150,000 within a couple of decades. We all know why that is the case, or at least we know some of the reasons, such as the fact that people are living longer, and the population and demographic trends make that inevitable to a degree. However, it is interesting that the figure is no longer 50,000. Now we are in the 60,000s and we are talking about an increase of 11,000 a year in the number of people getting a diagnosis or living with dementia of one kind or another. That highlights the importance of this issue, not just for those who might be affected, by that I include those who are living with and caring for persons living with dementia, but for wider society. This includes everything from health budgets to the care demands being made on society as a whole, and the loss of opportunity in terms of the talent and the ability a person loses to contribute to the working world when he or she is affected by a diagnosis. It is very important that we as a society recognise what remains. What remains is a person with real dignity and, in the words of Professor Des O’Neill, who has done wonderful work in the area of gerontological care, the inner life of the person.

I sometimes think that we talk too much about our personal experiences as politicians when it comes to these kinds of debates. On the one hand, we are conscious of how these issues connect us with others when we have that experience ourselves but we are all tempted as politicians to engage in personal discussion to an extent that sometimes could border on narcissism. That is a temptation we all have to resist.

Nonetheless, in my own experience of being part of a family caring for my father through his near decade of dementia, I learned an awful lot. I learned a lot about my own capacity to make mistakes, to fail to recognise my father's inner life, perhaps my own fears and unwillingness to accept the limitations that had come into his life and, by definition, into our relationship with him. I am also glad to say that I learned, as I think we did as a family, how to love my father more in a way that I had not learned throughout our life up to that point and we had a good family relationship.

In reflecting on what people like Professor Des O'Neill have to say about respecting the inner life of the person or in other words, respecting the person's capacity to express their will, desire and needs even at a point where we think they are no longer capable of making those kinds of decisions is a real challenge. We see that in our advanced-care related legislation that we are moving from a rigid ward-based model of dealing with a person to a situation where you assess the person in his or her individuality and needs and the kind of assistance he or she needs with decision-making and at what point and what decisions. You are dealing with a much more kaleidoscopic picture. I think that applies when we think of dementia and how we care for persons with dementia. I still have moments when I find myself worrying whether I was too interventionist. Was I too much of a dictator in the way that I cared for my dad? I even worry about the way I was feeding him on the day he died. Because there were times when you just had to make decisions because it was what good care required. Yet even in those moments you found yourself wondering "am I dealing with my own impatience today? Am I dealing with my own frustration today?" rather than what my father would have needed in that situation. There is a real need to always be ready to learn; to learn to shut up, to not just contradict or bring the facts when something mistaken or erroneous is said. At the same time you have to forgive yourself for the moments when you are just human and you fail to be as patient or selfless as you ought to be. And you must also recognise that there are moments where you have to make the best decision you can in the circumstances. We have learned a great deal about moving away from coercive care to that more reflective approach. That is really important.

It is also really important for society that we think about how we think about dementia, as well as frailty and dependency of other kinds. It intersects with that very difficult debate around euthanasia and assisted suicide, which comes up from time to time. Very often those debates start out from a place of fear where we, in the whole of our health, say "I would hate to be in this situation". I think what we learn when it comes to palliative care, and I was involved in doing a report for the Council of Europe on that, and dealing with dementia, we need to learn to not presume about how things might be in the future. Through accompanying those affected, we can perhaps learn something about our own future frailty and how we would like to be able to cope with it ourselves. I saw with my father, that he would not have liked to think in advance about the level of dependency he was going to have on his family and loved ones in the future in their giving of intimate care and so on. Yet, as I can say looking back, as I would have said on the day of his funeral, that many people looking in from the outside would say that it is a terrible affliction and even that can be stigmatising. It can be very difficult where there is change in personality and where there is anger and all sorts of things where you just have to say "this is not the person I love. It is not them". We have to try and understand that. Nevertheless, there are also moments of laughter and joy. There was tremendous consolation for us in the fact that we worked to keep our dad as happy on the outside as he appeared to be on the inside. In that way, we had it very good. We also received great support from the State and from the Alzheimer Society of Ireland. It may be uneven across the country, and there may be patchiness that needs to be addressed, but there are other areas where people are dependent with sickness or other kinds of disability where the services might not be as good or available. We have to be open to that.

We must never presume too much about what it is like. We must work to grow in our understanding but to always recognise that there continues to be that dignity in the person in ageing and where dementia is. There is dependency but there is also dignity. There is also an inner life and a need to respect that inner life that continues, that is not over.

I thank Senator Mullen for detailing his own experience.

It is humbling listening to Senator Mullen sharing his experience of the on-the-ground reality of his father having dementia. I regularly spoke to him in the latter years of his father's life. Rónán always bore the challenge, which it is and was, with dignity and compassion. I really admired the way he and his family did that over the years. It is a lesson to everyone. It is not the end of the world. There are ways and means. It is a matter of being creative and different and thinking outside the box. It is heartening to hear the Alzheimer Society of Ireland and the State agencies were able to give assistance. Services probably are patchy around the country. We all receive calls from people who are very frustrated particularly in the early stages when they are trying to put a care plan together. That is very difficult. First, people have to accept the new reality and that it will become progressively worse. I am very happy that two new memory clinics are to open. That is good news. That is in addition to the diagnostic services it has improved enormously in recent years and State funding has improved enormously too. It is an ageing population and we will have many more people who will suffer from dementia. I was not at the briefing yesterday because of other commitments. However, I am fully aware of the work that is being done by the phenomenal volunteers and the dedicated people, as well as the people who are suffering from dementia who want things to change for them.

There is also a lesson about lifestyle. It is about people working towards preventing dementia and acute dementia. It is about trying not to drink too much, not smoke and try to live a healthy lifestyle. That applies to many things but particularly dementia. Research has shown that the onset of dementia could be reduced by 40% or 60% and it takes longer if people have lived a healthy lifestyle. When people are diagnosed that is the critical time. That is when they need the care plan and the support. I often say when someone has been diagnosed with something that is life-changing, the initial step-down engagement is extremely important. I have campaigned successfully in this House to have five clinical liaison contacts appointed around the country. I think one will be appointed in Waterford very soon. The same kind of model is needed, regardless of whether people are diagnosed with cardiac problems, dementia, blindness or deafness. There needs to be a caring human being who knows how to navigate the system and how to advise a family who might not necessarily have dealt with that before and would not necessarily have had any knowledge or experience or a family member with knowledge or experience. That needs to be there.

The State needs to fund those advisers to hold out the hand of love, tell people what the range of services are and advise them on whether A, B or C suits them better than D, E or F.

I congratulate the Minister of State on the significant amount of work that she and her predecessor and my party colleague, former Deputy Jim Daly, have done. The concept of brain health is important. During Covid in particular, we have had many conversations about mental health. If I sprain my leg, it will swell, I will not be able to walk on it and I will be in pain. How do we know when we are affecting our brain health and mental health and what the differences and correlations between the two are? Work needs to be done through an information campaign and by resourcing people to look after themselves. We know about eating better, getting more exercise, not over-drinking - or not drinking at all - and not smoking. These are things that we know to do but we do not know, and are not resourced or equipped, when it comes to mental health and brain health.

Turning to dementia, I thank Senator Mullen. Apart from the sharing of the experience, his sense of self-reflection and reflective practice within the care of his father is a good model and template for others. I am sure it reflects the experience of other families as they second-guess themselves in their love, compassion and service of the people whom they love.

The prospect of dementia is a frightening one. While accepting all that has already been done, I urge us to consider from a policy perspective whether we are co-producing mental health and research programmes, capturing in our research the lived experience of those who have dementia and their families and carers, and using it to inform our policy. How are we gathering data? Are we gathering data? We must look through the correct lens when considering our policy and practices. Organisations like the Alzheimer Society of Ireland are at the table, but we must ensure the idea of nothing about us without us is practised and that our policies are based on their perspectives. I hear that in the programmes that the Government is rolling out.

Are there social care programmes that we could be running in other areas, for example, youth work and community groups, that would give information, talk about the experience, take away the fear and point to how we have significant interventions and how there have been considerable developments in medical treatments? In this way, we could ensure that we were equipping all actors dealing with dementia with information on all of these experiences and that our policy on resourcing those actors reflected what they needed.

It is good to see the Minister of State. She is always welcome. I will begin by acknowledging the good work she has done in this area.

According to the Alzheimer Society of Ireland, there are more than 64,000 people living with dementia in Ireland. The estimate is that 141,000 people will be living with dementia by 2050. These are stark figures. Research tells us that not all dementia can be prevented, and while not all the research and evidence is exactly clear on what dementia prevention works, many evidence reviews provide useful guidance and have identified important factors that, if addressed, could modify dementia risk by up to 40%. These include health behaviour factors, cardiovascular factors, psychosocial factors and developmental factors. Some of these are common health problems that we are familiar with, for example, hypertension, hearing impairment, obesity, depression and diabetes. There are also lifestyle and socio-economic factors such as lower levels of education in early life, social contact in later life, smoking and excessive alcohol consumption. In particular, lack of physical activity can, if addressed, improve brain health as well as helping with cardiovascular health, mental health and mobility in later years. We know that if we are to modify dementia risk, addressing these factors needs to start in middle-aged people, not among older people. Most of these risk factors are preventable and treatable with a healthy lifestyle and proper access to healthcare. The first point that springs to my mind is the relationship between some of these risk factors and poverty and access to health care.

I wish to speak about intellectual disability as a particular risk factor. Professor Mary McCarron, who spoke at the all-party Oireachtas group briefing yesterday, highlighted that, for people with intellectual disabilities, the risk of developing dementia was five times greater than for their peers in the general population. Many people with Down's syndrome have the hallmarks of Alzheimer's disease by 40 years of age and have an 88% risk of developing the clinical symptoms of dementia by age 65. As such, the promotion of brain health and the diagnosis of disease must begin at early ages.

Toxic proteins that cause Alzheimer's disease build and accumulate up to 15 to 25 years before clinical symptoms present, but cognitive reserve education, exercise, cognitive stimulation and social engagement at any age will help to slow or counteract these changes. It is possible to reduce the risk of dementia.

Actions to promote brain health in people with intellectual disabilities is needed now and at all ages. I acknowledge the Minister of State's work, particularly her support for the development of the national intellectual disability memory service for people with intellectual disabilities. Further memory support services are needed throughout Ireland and I hope she will provide more services and funding to address the particular risk of dementia for people with intellectual disabilities, who have an increased risk of developing dementia.

Awareness is important in dementia prevention. I acknowledge the work of the Understand Together campaign, the Alzheimer Society of Ireland and the all-party Oireachtas group on dementia. However, it is important that Government policy does not just talk about brain health and dementia prevention, but also actively seeks to improve our health system to support those prevention measures.

Severe brain injury is a risk factor for dementia. Recently, my Sinn Féin colleague, an Teachta Dála Cullinane, highlighted the lack of neurology nurses. By the HSE's own reckoning, we only have approximately 30% of the specialist neurology nurses that we need, which is making their job difficult. We need 100 more. University Hospital Limerick is the mid-west regional centre for neurology but it is short on neurology nurse specialists. Patients are unnecessarily waiting longer for diagnoses and treatment. Based on the catchment area, national and international guidelines recommend that there should be 11 neurology nurse specialists, but there are only three. Patients deserve better and I hope that we will hear a positive response in terms of how this issue is being addressed locally in Limerick and nationally.

There are many problems in our health service that will hinder the prevention of dementia. There is a large gap in the provision of mental health services across the country, shockingly long waiting lists for outpatient hospital appointments and GP shortages. None of this is helpful when we are talking about addressing risk factors for dementia or minding our brain health.

During the pandemic, day care centres for people with dementia were closed. This put considerable pressure on carers, with many telling us that they were at breaking point. Most of the centres have reopened, but I hope that more will be done to increase the number of day care centres and services in the community. They are important not only to people with dementia, but to their families and carers, who need this support. The work of carers was highlighted over the past couple of tough years and we need to do better for them.

Preventing dementia means promoting brain health and preventing common risk factors. It also means tackling the wider issues of poverty and the healthcare crisis. Awareness of the risk factors can be helpful in the first instance and I do not want to take away from the good work that has been done, but there is clearly much more to do.

I welcome the Minister of State.

This is an important topic and it is great that people have spoken about us moving towards being a dementia-friendly society. Like some others, I attended yesterday's briefing, which was organised by Senator O'Loughlin, on the topic of dementia and brain health. It was an eye-opening experience for me. Many young people tend to think of dementia as being far away and as having nothing to do with them because they are invincible and will skip through life without having to worry about it. Hearing about some of the measures we could take at every age to help our brain health was interesting, so I thank Senator O'Loughlin for organising the briefing.

Senator Mullen has left the Chamber, but I thank him for speaking so eloquently about caring for and loving his father during his illness due to Alzheimer's disease.

I know the bond and closeness created when one shifts from being a child to being the carer of a parent. It is an experience like no other.

Given that we have just completed the statements on International Women's Day 2022, it would be apt to think about how dementia disproportionately affects women. I know at the presentation yesterday it was said that 65% of people living with dementia are women. As we know, women are in the majority among those who provide all aspects of caring, formally and informally. As I said, we tend to think of dementia as being other or happening to someone else, far away from us, and not as something that will affect us. People with dementia are individuals in their own right. They have rights. In the past, the issue was pushed away and dealt with elsewhere. There were two people with different forms of dementia at yesterday's briefing. They talked about living their own lives fully, their empowerment and experiences. That made me shift my thinking in terms of who has dementia and what a dementia sufferer looks like.

Another thing I took away from yesterday's briefing was the message that brain health affects us all. We have a responsibility as public representatives, as has the Minister of State's Department, to spread awareness around brain health, both our future selves and for society at large. Some people have talked about the possibility of cutting costs by delaying the onset of dementia by five years and so on. We have also talked about the fact that evidence suggests up to 40% of dementia is potentially preventable. Representatives of the Alzheimer's Society of Ireland told me yesterday that they are delighted with the funding for the brain health project manager in the dementia office within the HSE. As I have said already, the important element in that regard is that brain health is an issue for young people. There are steps or actions that those of us in our 20s, 30s and 40s can take in order to reduce the risk and hopefully delay symptoms of dementia.

I was trying to think of the appropriate phrase and having discounted "changeable factors" and "moveable factors", I got to grips with "modifiable risk factors". Such factors include smoking, obesity, alcohol, exercise and hearing loss. I was struck by the importance of making sure to stay on top of one's blood pressure. It occurred to me I do not even know how to get a blood pressure test. As a young person, I have never had my blood pressure tested. I do not know how I would go about doing that. I will ask my GP the next time I am in. As a young person, that is not something I have had to do. I do not get check-ups on a regular basis. That has gone into my mind.

I was also struck yesterday by the fact that social isolation and a lack of social connection are risk factors. That is important as we emerge from the pandemic. Social isolation is very bad for our brain health. As we emerge from the pandemic, we need to think about that. We need to consider it individually and reflect on who is socially isolated in our networks and communities. Social isolation is also an issue for Government. We need a national conversation around tackling loneliness and social isolation. We must create connections.

I keep mentioning things that struck me yesterday but it was a very striking session.

Another of the things that struck me was the link between hearing loss and the development of dementia. I was surprised to hear that. I looked it up afterwards because I wanted to know what the story with it is. A 2020 report in The Lancet highlighted that people who live with hearing loss have a greater risk of developing dementia. That is something I would not have had a clue about. I did not know anything about it. A message for us all today is that we need to get our hearing tested in the same manner in which we get our eyes tested, particularly as we age. That was a good example of modifiable risk factors about which we do not know. We tend to think that dementia is an old person's disease, that it is far away and there is nothing anyone can do in their 20s, 30 or 40s to take proactive steps to try to reduce the risk. We should all get our hearing tested.

As we move into being a dementia-friendly society, the idea of opening up a conversation about brain health is a useful one. It was not something with which I was overly familiar. Yesterday, when I went home, I was googling how to look after my brain health. I wanted to know if we should be doing Sudoku or what might help to stretch our brains. I was struck that it is all about the daily things we are told to do and look after, including exercise, social connection, reducing our alcohol consumption and not smoking. We always think about some of those things as part of our physical health. I never understood the link between them and brain health. I again thank Senator O'Loughlin for organising that briefing yesterday. It was incredibly helpful for me in how I think about my own health and that of our communities, and health in general. I also thank the Minister for Health for all the work she is doing in this area. It is an important topic.

I warmly welcome the Minister of State to the Chamber. This is a very important debate on which I am glad to make a contribution. I thank Senator O'Loughlin for all her work in this area. I also commend and acknowledge the ongoing work of the all-party Oireachtas group on dementia, which I believe was established by the Minister of State and former Senator Colette Kelleher. I know this is an area about which the Minister of State is very passionate. She has done phenomenal work in the area.

There are many people across this island living with dementia and they deserve our support every day of the year, not just during brain health week. I want to highlight the figures that others have highlighted. Some 64,000 people in Ireland currently live with dementia. Those numbers are predicted to rise to 150,000 by 2050, which is shocking. It is essential that we adequately plan to support these people who are our loved ones, parents, siblings and partners.

I will also use the opportunity presented by brain health week to once again raise the urgent issue of adult safeguarding. I have spoken many times in this Chamber about the urgent need for the Government to progress adult safeguarding legislation to support and safeguard adults across the State who are at risk of abuse. Adults at risk of abuse include those living with dementia. Indeed, those living with dementia are likely to be impacted more by particular forms of abuse. It is important that we develop legislation which safeguards and supports the rights of all adults living with dementia.

I will read out some facts and statistics from the most recent annual report of the national safeguarding office of the HSE. In 2020, there were 3,412 notifications of safeguarding concerns for persons aged over 65. For those people aged over 65, the most significant categories of alleged abuse are psychological abuse, physical abuse and financial abuse. Alleged financial abuse and neglect increase with age, with the highest level of reporting in those over 80 years of age. Among those aged over 65, it was immediate family members who were most commonly the subject of safeguarding concerns, which is very sad, to be honest. The rate of alleged abuse of adults aged 65 or over is more than double that for younger adults.

As the prevalence of dementia increases dramatically for those over 65 years of age, we must, therefore, consider how adult safeguarding can support the rights of those living with dementia. The HSE safeguarding report also notes that persons with dementia were significantly impacted by the pandemic, as I am sure we are all aware, and all the disruptions to care that resulted from it. The importance of adult safeguarding legislation was highlighted by the situation in nursing homes during the pandemic and we heard recently that a wrongful death claim had been lodged against a nursing home in Cork in respect of a 64-year-old mother of three living with dementia who died of Covid-19 while in that nursing home. Those living with dementia have a higher rate of Covid-19 and so failures in care have very serious consequence in this context.

Introducing rights-based and person-centred adult safeguarding legislation is going to be key, going forward. The Law Reform Commission review of adult safeguarding legislation is due to be completed soon. I urge the Government to progress that legislation as soon as possible.

Aside from legislative steps we can take to safeguard and support the rights of those living with dementia, we can also implement a number of practical measures to improve the experiences of people living with dementia in our healthcare system. I welcome the Government's announcement last week of a new programme to upskill healthcare workers in dementia care.

It is essential that healthcare workers are trained and supported to develop competency in dementia care. This is in line with the national dementia strategy and I am very happy to see that being rolled out. I hope it will not only be continued but expanded as time goes on. However, more can still be done at a practical level within the health system and our hospitals. For example, in an article which appeared in The Irish Times this week, Professor Rose Anne Kenny, a geriatrician, called for dedicated spaces and systems in emergency departments for older people, which is a wonderful idea. She notes that some older patients have intimidating or frightening experiences in emergency departments where they may not be able to clearly hear or understand questions and communications. Some may be confused as a result of their illnesses, while others may be living with chronic cognitive issues such as dementia. I remember bringing my mother into hospital and seeing elderly people wandering around the hospital, not knowing whether they were coming or going and not knowing where to go. It is very frightening.

I cannot speak on dementia and brain health today without bringing up the issue of carers and our duty to support them. It has been acknowledged that the bulk of care for people with dementia in Ireland is being provided free of charge by family caregivers, many of whom are adult children and spouses. The value of informal care for those with dementia is estimated at €807 million per annum. The widening of the eligibility net for carer's allowance last year was very welcome but as was highlighted by Family Carers Ireland, the additional €5 per week simply did not go far enough. I ask the Government to review the allowance to see how it can be increased and to outline what other innovative measures could be considered to support those who give care free of charge to their loved ones living with dementia.

Positive steps are being taken to support those living with dementia and I know how passionately the Minister of State feels about the issue. While the national dementia strategy is progressing, the Government needs to prioritise adult safeguarding legislation. The Government must consider what particular provisions should be included in future adult safeguarding legislation to support the rights of those living with dementia. I also ask it to consider the other practical steps that can be taken within our health services for those living with dementia, how supports can be expanded for our carers and how we can tackle early risk factors for dementia by improving child safety online, an issue I would love to discuss further with the Minister of State at some point in the future.

I welcome the Minister of State to the House today for this very positive and timely debate on how best to move forward in this country in looking after people with dementia and on the wider topic of brain health. Senator Hoey referred to the briefing we attended yesterday which was so positive and enlightening. I learned so much from it and got a different view of how to care for my own health and that of my parents and my partner. It was really enlightening and I thank those who organised it.

I want to acknowledge the work that the Minister of State has done since assuming office and the work of my party colleague, Senator O'Loughlin, as chair of the all-party Oireachtas group on dementia and Alzheimer's disease. As a member of that group, it has been a pleasure to work with all of the members alongside the Alzheimer Society of Ireland. The Minister of State served as chair of that group previously and what better ministerial post to have, having worked so hard on this issue? She has brought forward many of the proposals made at meetings of the group.

Senator Mullen spoke passionately, kindly and delicately about his experience of caring for his father when he developed Alzheimer's disease. A diagnosis of Alzheimer's disease or dementia can be so frightening for the individual and his or her family. People wonder how they are going to give the individual the life they deserve and how they will meet all of life's struggles and challenges in the context of the diagnosis.

One of the main messages from yesterday's meeting was that there is so much hope. It was so positive and empowering. The briefing outlined what we can do to prevent dementia, what we can do to help and what is happening in the area of research to make outcomes better in the future. Alzheimer's disease and dementia affect so many families and communities. There are over 64,000 people in Ireland currently living with dementia, with the numbers predicted to rise to 150,000 by 2050.

It is very important to acknowledge the family carers, who are often women. Having just had statements on International Women's Day, it is important to acknowledge that most family carers and home carers in this country are women. We must all support advancing the rights of carers. Another strong message from yesterday's briefing was that up 40% of dementia could be preventable. It is important to address early risk factors such as hearing loss, high blood pressure, diabetes, smoking and depression. There are interventions that can reverse cognitive decline through education, exercise, stimulation, and social engagement. Further to this, there is a suite of significant new medical treatments becoming available which slow down early onset.

Addressing Oireachtas Members yesterday, the consultant physician in geriatric and stroke medicine at Tallaght Hospital Professor Sean Kennelly said that dementia is the most significant health condition globally for which we have no definitive treatments but that we are on the cusp of a new era of better interventions to prevent, diagnose and treat Alzheimer’s disease and other dementias. He added that it is imperative that we educate people in order that they understand what a brain-healthy lifestyle is and they take action to reduce the risks. Despite all of the struggles and the very real difficulties and challenges faced by those with dementia and Alzheimer's disease, there was such optimism at that briefing yesterday about working on brain health.

I really welcome the Minister of State's work on brain health awareness. A new working group has been convened by the national dementia office. The HSE's health and well-being unit will run a brain health awareness week in March and will collate important information on brain health from a public attitude survey on dementia. In addition, the brain health project manager will commence work in 2022 to support the delivery of those actions recommended by the working group and will support national campaigns and programmes to incorporate dementia risk reduction. There is so much work being done, with much more to do. I congratulate the Minister of State on securing additional funding for 11 new dementia advisers. I acknowledge the work done by the Minister of State, the Alzheimer Society of Ireland and all of the people across the nation who are working really hard, not least the family carers. I also acknowledge the patients with dementia who are upping their own marks and making their own brain health better every single day.

I thank the Minister of State, Deputy Butler, for coming to the House to discuss this all-important topic. Having served on the all-party group previously with her, I am fully aware of her dedication to the area. I also thank Senator O'Loughlin for organising the briefing yesterday on behalf of the all-party group. It really was a very enlightening briefing, particularly with regard to brain health and preventative measures in the context of dementia. The importance of feeding the brain and making sure that it and the heart are healthy were two clear takeaway messages from the briefing.

I pay tribute to the many carers who look after their loved ones at home. The longer we can keep people at home, the better. I welcome the increased funding and additional home care hours for people with dementia that the Minister of State announced recently. The longer we can keep people at home, in familiar surroundings, the better.

I would also like to pay tribute to the dementia nursing home outside Bruff in County Limerick. I know the Minister of State was due to visit. I am not sure whether that is still on the cards. The work it does by keeping people in a surrounding similar to what they were used to growing up in certainly has helped in keeping people with dementia fit and tuned into what is going on around them. I thank the Minister of State.

I also welcome the announcement of extra hours for home help for people with dementia. I agree with what loads of people said today. I only have a minute and a half to speak so I will focus on one topic in terms of home help and carers. The work they provide is phenomenal. I have seen it myself. My uncle passed away last year from dementia and the care he received was phenomenal. We need more people, however. We need more carers and people working in that sector.

I am the spokesperson on enterprise and trade, and one of the challenges we have is work permits. We need to speed up the process of work permits for people who can come in and work as carers in this country. We can put as much money as we want towards dementia and Alzheimer's disease but we need people on the ground. To get as many people as possible, we need to speed up the work permits that are coming through the system in the Department. Anything the Minister of State can do from her side to emphasise the important role that would play in terms of carers and the hours they can provide would be really important. Having seen her work on this for the last two years, I know the Minister of State is totally committed and will provide solutions to this issue. It is very welcome. I acknowledge the work she has done over the last two years in that regard.

I also welcome the extra hours. One of the figures I took from yesterday's discussion was that 40% of dementia is preventable. That translates in current terms to 30,000 people or 30,000 families today. By 2045, that could be 60,000 families unless we put the investment in now. It was proven by yesterday's discussion that dementia is treatable and if steps are taken, we can reduce the numbers of people.

As Senators will know, I spoke before about the issue of home care. It is something about which I am extremely passionate. I refer back, and I also mentioned it yesterday, to when my late mother was diagnosed with dementia during Covid-19. I will always remember what was said to us as a family when we were told, and she was there with us when she was diagnosed with vascular dementia, that the only options were five hours' home help or the fair deal scheme. I said before that I do not think the fair deal scheme is a fair deal for families. The fair deal we would need to give families is more support in the home. Families can then work and keep their loved one at home. Unfortunately, because of that, we were not in a position to do so and my late mother received fantastic care in St. Joseph's Care Centre in County Longford. We would have preferred to have her at home, however. I appeal again that we work on putting in those resources to make sure families and the persons concerned can be at home, as has been said by other Members, in familiar surroundings where they might live a little longer.

I call on Senator Blaney, who has three minutes.

I thank the Acting Chairperson very much for the meeting she arranged yesterday, which was very useful. The Minister of State is very welcome to the House. I am very much aware of the work she has done prior to the role she is in now. I am also very aware of the esteem in which she holds her brief but also the priority she affords the whole area of brain health, dementia and Alzheimer's disease.

Like Senator Carrigy, I am all too aware of the condition of Alzheimer's disease. My father suffered from it as did three of his brothers and two of his sisters. I suppose my knowledge is based on my father's time. Much of the time, we think about the individual who has Alzheimer's disease but in many cases, there is a carer behind the scenes who keeps the show on the road. They are the full-time carers and in many instances, they are not getting the support they deserve and need.

I remember in days gone by the pressure and the need for respite my mother needed when my father was coming towards the end of his time. In many instances, people like her in that position do not get the support they need. This is a massive strain on their mental health in their condition. In most cases, we are talking about individuals in their later years.

Whatever package the Minister of State can now bring about must be in recognition of that fact. The fair deal scheme has the ability to provide that package and those supports to people caring for a patient in the home in many cases. The scheme is there to give families the support, particularly in terms of respite. Respite is as important to those carers as it is to the care of the patient. It has to be all in. We look forward to any proposals the Minister of State has in this regard. I thank her for being here with us today.

I thank Senator Blaney. I now move to our penultimate speaker, the Leader of the House, Senator Doherty, whom I believe is sharing her time with Senator Ward. She will take three minutes and Senator Ward will take two minutes. Is that agreed by the House? Agreed.

I thank the Acting Chairperson for her commitment to this particular topic. It is very evident that she cares about it. I also acknowledge the Minister of State's dedication and commitment. What she said she would do before she was Minister of State and what she has done match each other perfectly. Her determination to do even better says an awful lot about her. I thank her.

At the risk of being accused of what Senator Mullen said earlier about being narcissistic and talking about myself, I really believe that all politics is personal. For me, one of the 64,000 people who are living with dementia at the moment happens to be my 86-year-old daddy. Therefore, it is very personal. I do not think I could ever speak as eloquently as Senator Mullen did because we are angry and sad. We are going through a tough time, but actually he is going through the tough time. We just have lost him even though he is still here. It is a horrible disease.

When I read that it could be prevented and that we are not doing enough, we kind of feel robbed that we did not know. Senator Hoey said earlier that she is so young and does not think about it. I am not young and I still did not think about it. We are very lucky that daddy is almost 87 and we have had him for 80 years, but we do not have him anymore other than the physical person whom we love to bits. It is horrible and I would not wish it on anybody. To hear it said that in a number of years we are going to have twice the number of people living with dementia is really disheartening.

One thing I will acknowledge is that all the carers who look after people are absolute saints. My mother is a saint. She has the patience of St. Jude. I really do not know how she does it. She has also lost her husband and she has now become his carer. It is hard. The people who support us, such as our public health nurse, community team, the psychiatric team that come from Drogheda because we live in County Meath and the staff in the Holly Day ward in Blanchardstown are absolutely wonderful people. We have a day care centre in Navan for which he is on a waiting list. That is only because it was affected so badly by Covid-19 that people are still in their pods. It had a massive impact that he was not able to go outside the door other than to walk around the back garden. When one does not get to meet the people one used to meet while out walking then, obviously, one deteriorates even further. I want to say a special thanks to the Alzheimer Society of Ireland and ask the Minister of State to keep up the great work. She is doing really great work.

I thank the Leader of the House very much. We know her words are very heartfelt. We are with her in spirit. We understand what she is going through and absolutely empathise. I thank her for agreeing to give us this time in the Seanad because it is also within her gift.

What we see and have seen in this debate is just how much dementia and Alzheimer's disease affects every family and household in this country.

I, for one, do not have a difficulty with talking about it. Every family, including my own, has suffered from it to one degree or another. We all have personal contact with people who ring us to tell us about the problems they are having getting home help, respite or whatever it is, and those stories make politics. They are the reason that most of us are here and the things that occupy our daily lives.

I am privileged to have the Alzheimer Society of Ireland near where I live in Blackrock, the area I represent. I have worked with it for a number of years. I have nothing but the height of respect for the work it does, not just in terms of providing logistical support to people. The advice, counsel and help it gives people who ring up with problems is enormous, in addition to the day care centres and all the rest.

As we have heard from Senator Doherty, so often, that responsibility for care for somebody in a family falls on another family member, often another elderly family member. That can never be described as a burden in many respects because they are our loved ones. Of course, the family member does it and would not have anyone else do it, which is why he or she ends up doing it. However, it is a strain and an extra responsibility. Many of these people are at a time in their lives when they should not have to be taking on such significant new responsibilities.

I first want to acknowledge the work that has been done by the Minister of State and the commitments she has shown and the work the State has done to help people. However, it is still not enough. There is an extent to which it will never be enough but we must still do more. So many families throughout Ireland care for an elderly relative, parent, spouse or a brother or sister and do not have the capacity to do it in real terms. They are forced into a situation in which they have to take on a responsibility for which they are very often ill equipped.

I ask that we put in place greater measures to provide home help and respite for those people and that we recognise that the provision of home help is not necessarily altruistic. It is not a gift from the State to an individual. It saves the State money. If those people go into full-time care in a professional context, in a nursing home or whatever it is, that ultimately subtracts from the State's capacity to do that for other people.

To the greatest extent possible, we should facilitate people who care for relatives and facilitate people who want to continue to live at home. It is absolutely worth investing the money - because that is really all we are talking about - and human resources into that to ensure people can do that. It is the least they deserve. So many of these people have contributed for a whole lifetime to this country and it is absolutely right and appropriate that we should do everything we can to look after them if and when they are afflicted by something such as dementia or Alzheimer's.

I have to say Regina, as opposed to Senator or Leader, because I have to reach out to you woman to woman and colleague to colleague, I wish you well on the journey that is ahead of you, your dad and your loving mum. Regina has often spoken about what a strong person her mum is and what an inspiration she is to her. I have no doubt of the toll this is taking on her mother or of the love with which she is carrying this out. I am with Regina and her family in spirit.

I will hand back to the Minister of State. On behalf of all the Senators here, as Acting Chairperson, I especially thank the Alzheimer Society of Ireland for all the work it does with so many throughout the country. I thank it for organising yesterday's briefing. There are very strong messages in what we heard today. One of my strong messages, about which I will be colloquial, is the need for a dedicated day care centre in Kildare. We have spoken about that before. We do not have such a centre. We have had a number of different ones up to the time of Covid and we desperately need one in the centre of Kildare.

The five steps the Alzheimer Society of Ireland has identified for all of us to reduce our risk of developing dementia and to improve our brain health are being physically active; taking care of our heart; eating a healthy diet; taking part in social activities and challenging our brain. I am not sure how the rest of the Members feature on all five but I am not great. I am approximately halfway there and I need to work on the others. That is a strong message. We very much appreciate the Minister of State's time to be here for the full debate. We know how precious her time is. Equally, we know how committed she is to her work on this.

From the outset, I thank everybody for their words here today. I always love to come over to the Seanad. I always find the debate very constructive and learn a lot. Hearing Senators Mullen and Blaney and Senator Doherty, the Leader of the House, who were prepared to share their personal journey with regard to dementia, makes it very real. Every day in Ireland, 11 people are diagnosed with dementia. There are probably another 11 people who are not diagnosed in Ireland every day. When I started this journey with regard to dementia, there were 55,000 people. Now, we hear there are 64,000. I will be honest in that I think there are more. Some 70% of all people in nursing homes have dementia.

As of September 2021, only one quarter of countries worldwide had a national policy strategy or plan for supporting people with dementia and their families according to the World Health Organization. It is hard to believe that it is only one quarter. In Ireland, the national dementia strategy published in December 2014 seeks to progress the dual and overarching principles of personhood and citizenship, recognising identity, resilience and dignity.

I thank the National Dementia Office for all the work it has done. I also thank the Alzheimer Society of Ireland. It would be remiss of me not to mention its former CEO, Mr. Pat McLoughlin. He has stood down for health reasons. I wish him very well. Mr. McLoughlin has worked very hard and had a great approach. I miss working with him.

One of the words that was not mentioned here today was stigma. Unfortunately, a stigma is associated with dementia. That is the point of all 28 of our dementia advisers throughout the country. The day one gets that diagnosis, whether it is one's mum, dad, aunt, uncle, or oneself, is absolutely shocking. There is a dementia adviser in every single constituency, two in some and more to come. One can pick up the phone and talk to that adviser who will signpost where one has to go. Some people have rapid onset dementia and may have to put their affairs in order very quickly. They might have to engage the service of a solicitor. It can be very difficult and to have that dementia adviser in place is very important.

Senator Black raised adult safeguarding. I am working very hard on that legislation. I will bring it into both the Dáil and Seanad before the end of the year. Significant work is involved, not only with regard to older people. I have been taking the lead on it in the Department. Considerable work will be done before I bring it to the Houses. Sometimes, the heads are brought and then considerable work has to be done. It is the reverse in this case. When I bring it, I will look forward to the debate. Senators will have to do prelegislative scrutiny on it as well. There will be significant work but considerable work is being done.

Many people spoke today about carers. It is important to acknowledge that for every one person with dementia, three carers and family members are directly affected and many more are indirectly affected. The Minister, Deputy Humphreys, has done considerable work in trying to recognise carers. The caring profession will be recognised for pension status going forward. There will also be a €2 million carers' guarantee fund, provision of carers' well-being interventions and a pathway to support family carers. It is important that is put on the record.

Senator Ahearn raised work permits. I will move on to statutory home care in a few minutes. Work permits are not available. These are permits for people outside the EU. Work permits are available for people who work in nursing homes. According to the Department of Enterprise, Trade and Employment, one has to be able to guarantee someone two years work and pay him or her €27,000. Home care is a different profession. Some 75% of people who work in home care are part-timers. They may not normally earn €27,000. I have been speaking to my colleague, the Minister of State, Deputy English, about that. We will look at it again.

I am lucky, as Minister of State, to have a massive budget for home care.

Last year, we were able to deliver 2.9 million more home care hours than the previous year. Some 20.5 million home care hours were delivered to 55,000 people. We are challenged at the moment, although not financially. There are not many Ministers or Ministers of State who could say they are not challenged financially. Previous Ministers did not have the budget for home care. I have the budget but what we have a shortage of at the moment is staff. That is the main challenge. Just before Christmas there were approximately 5,000 people waiting because they were funded for home care but we could not deliver it due to staffing challenges. I got new figures yesterday and that figure has dropped by 500, which is great to see. That is progress.

A strategic workforce planning group has been put in place and we held the inaugural meeting last week. It is working with all the different partners to see what we can do to make home care and caring an attractive and viable career option. A neighbour of mine is a carer. She started caring in the home and then went on to care in a nursing home. Now she is a qualified nurse in University Hospital Waterford. People can progress. They might not have had the leaving certificate results to do so at the time but there are pathways forward for everyone. We want caring to be recognised as a profession and for people to be able to upskill the whole way through their careers. There is a huge amount of work being done there to think outside the box to see how we can encourage more people into caring.

I just want to touch on dementia-specific day care centres. Some €2.5 million was made available for dementia day care centres last year. Most of that is delivered through the Alzheimer Society of Ireland and Western Alzheimers. Today, 26 of the 34 centres have reopened. People ask why the rest are not open. The other eight will be open by the end of the second quarter of 2022. The Alzheimer Society of Ireland did not own all the premises. Some of them were rented facilities or halls and were not suitable for infection prevention and control measures. I am delighted to say that we will have them all back open again by the end of June.

Statutory home care so important. It is like the fair deal scheme but in the home. A huge amount of work is being done on it. It is part of the programme for Government and Sláintecare and we are fully committed to it. We are running four pilot projects at the moment to test how to bring the care into the home as opposed to only having the option of going into a nursing home. The funding has been provided for 128 assessors of need and we are currently recruiting them. However, recruitment is a challenge. There is no doubt about that. These assessors will be put in place. They will use interRAI tools to will assess people's loved ones to determine exactly what care they need. They will assess whether they have an intellectual disability, whether they are best suited to be cared for at home, or whether they need nursing home care. The national home care office will be opening in June in Tullamore, creating 15 new jobs. We will have a one-stop shop for home care. Last year, I also provided funding of €5 million for an IT system because, unfortunately, we do not currently have an IT system that follows the older person. I want a system whereby a carer can log on in the morning and see whether a person is at home, was transferred to hospital overnight, went into a nursing home or passed away. These are all key enablers to getting the statutory home care scheme up and running.

All any older person wants is to live at home safely and securely with the correct wraparound supports. That is the one thing I want to achieve if possible if I continue in this role, and that is exactly what we are trying to achieve. We have a fantastic system called the integrated care programme for older persons, which means people do not have to be sent to accident and emergency departments. Again, it is like a one-stop shop. These teams look at everything, including people's memory, frailty, whether they are at risk of falls, their gait and all the different things to see how they are doing. I also secured some funding this year to try out three pilot projects to include mental health as part of these teams. It is very difficult for some people. I again refer to the stigma. If someone is being looked after by one multidisciplinary team, they should not be told they have to go to another appointment on another day for their mental health. We want it all to happen together in the one facility, which would make life an awful lot easier for people.

I will turn briefly to brain health, which we have heard so much about today. Evidence about brain health and risk reduction is very new and still emerging. We will have to wait until we get a lot more data and information on that. This is not new for people who have dementia in their families. There is no doubt that having a happy and healthy lifestyle, being fit, reducing the amount you drink, not smoking and looking after yourself plays a big part. We all know that. That is the most important thing we can do to look after ourselves going into the future.

The national risk reduction working group has been convened by the national dementia office. A brain health project manager post will commence in 2022 to support the actions of this group and support national campaigns and programmes to incorporate dementia risk reduction. Next week, the group will run a campaign as part of brain health awareness week from 14 to 20 March and it will be the most extensive campaign to date. It is very important that we reduce the risk of dementia.

Professor Mary McCarron is just the most amazing advocate in this area. She always talks about people with Down's syndrome. There are about 700 people with Down's syndrome and dementia in Ireland who are living at home with ageing parents. I am very conscious of that, especially when it comes to funding. We made a small breakthrough this year but I hope to make a more significant breakthrough for 2023. For these ageing parents, their only worry is what will happen to their son or daughter if they pass away. It is a very complex issue.

It is great to be able to stand here knowing that I have the full support of every colleague in the House. I have the full support of the Dáil and the Seanad, the Department, the HSE, the national dementia office and the Government, which has the budget for this. We can make a difference by having everyone pull together. It can be done. I thank all the Senators for listening for so long today. I thank Senator O’Loughlin for her work in organising this debate. We have made fantastic strides in the past few years and we will continue to do so. I tell people in these situations not to be too hard on themselves. It is very difficult to have a loved one with dementia, but they are still there with you.

Cuireadh an Seanad ar fionraí ar 3.48 p.m. agus cuireadh tús leis arís ar 6.15 p.m.
Sitting suspended at 3.48 p.m. and resumed at 6.15 p.m.