On behalf of Age Action I thank the committee for the invitation to address it today. Age Action is a national charity which works to promote positive ageing and better policies and services for older people. In the context of today's presentation, our vision is to make Ireland the first country to apply fully the 1991 United Nations Principle for Older Persons into our national way of life. That would mean Ireland would be a country where: no older person lives in consistent poverty; no older person should die from cold in their home; no older person should be required to leave his or her home through lack of community services; and no older person should be excluded from society through lack of public or private transport.
There is a lack of realisable human rights in Ireland, particularly social and economic and economic rights. They are often spoken of as "a right to apply", as opposed to "a right to receive". An older person's human rights in Ireland are not guaranteed by statutory rights, but more so in soft-law generic statements of commitment - for example, in the programme for Government. Unfortunately, many commitments are political commitments and, as such, lack the legal grounding that statutory guarantees would provide.
This causes problems for implementation and provision of services and policies. A good example concerns two reports in 2009 on home care packages, one by PA Consultants and the Department of Health, and the other one by the NESF. Both reports found that the implementation of this important community service was defined mostly by the bodies implementing them, as opposed to a clearly defined need or clearly defined rights.
A good illustration of the problems that this lack of clarity creates was the Ombudsman's report last year, entitled "Who Cares? An Investigation into the Right to Nursing Home Care in Ireland". In that document, she examined more than 1,000 complaints based on individuals at their wits' end trying to access public nursing home beds. We have the legislation but because they did not have a specific right to those beds, they had all sorts of difficulties acquiring them.
At the international human rights level, human rights for older people derive from general hard-law strategies, such as the UN Universal Charter of Human Rights, and the UN Convention on Economic, Social and Cultural Rights, through to the more soft-law strategies such as the UN Principles for Older People and the UN International Plan of Action on Ageing.
More recently, the UN has furthered its commitment to developing measurements to protect the rights of older people by setting up the open-ended working group on ageing. This group works alongside the recent Universal Periodic Review of Ireland and the forthcoming Irish report on the UN Convention of Economic, Social and Cultural Rights.
In that context, Age Action recommends that this committee considers the incorporation of the International Convention of Economic, Social and Cultural Rights into domestic law. We also suggest that this committee should consider the ratification of the UN Convention on Rights of Persons with Disabilities. We ask the committee to consider the progress and output of the UN open-ended working group on ageing for the purpose of strengthening the protection of the human rights of older people in Ireland.
Article 11 of the Convention recognises the right of everyone to an adequate standard of living for themselves and their families, including adequate food, clothing and housing, and to the continuous improvement of living conditions.
Over the past ten years, significant progress has been made to curb the very high rates of poverty among older people. They have fallen from 44% in 2001 to 10% in 2009. However, certain trends are endangering this progress during the recession. We have overall deflation but there is also itemised inflation for specific items upon which older people depend. These are rising while general inflation is falling. These include: rising taxes, both direct and indirect; broadening the tax band to include those on low income; and income needs are having to go further as basic services are reduced or abolished.
In addition to the 10% of older people who are deemed to be on incomes below the poverty line, many others are on incomes that hover around the poverty line. For example, 70% of older people living alone live on incomes in the bottom 20% of the income distribution. Therefore quite a number of older people are on very low incomes.
We are trying to emphasise the importance of the State pension, which has a key role in keeping people out of poverty. As Mr. Jim Keegan said earlier, the national pensions framework is committed to maintaining the State pension to 35% of gross average industrial earnings. Currently, the rate stands at 33% which continues to be a worry, as many of our members are struggling to make ends meet.
We have done an analysis of the consumer price indices data from the CSO. In the 2008 to 2010 period inflation has gone down by 3.7%, but key costs such as heating, health insurance and medical costs are soaring. That is causing huge difficulties for older people.
The net effect for older people from the crisis we have faced in recent years includes reduced spending power of the same welfare benefits they receive, in addition to rationing when the cost of basic living is more than available income. This is particularly the case for older people living in rural areas who are hit by a carbon tax, and incomes are generally lower. They also have higher costs, such as home heating and transport.
In recent months, we have been campaigning on the issue of fuel poverty, which is a good example of the difficult decisions that those on low incomes have to make. Figures are due out in the next few weeks from the Dublin Institute of Technology and the Institute of Health on the excess winter death rates in Ireland from 2006 to 2007. Those figures make for shocking reading. We still have a serious fuel poverty issue; in 2011, people are dying because they cannot afford to heat their homes.
Article 12.1 of the convention recognises the right of everyone to enjoy the highest attainable standard of physical and mental health. Article 12.2 refers to the creation of conditions which would assure access to all medical service and medical attention in the event of sickness. The type of care older people require is less acute and tends more towards the management of chronic health conditions, including rehabilitation and a mix of health and social care services. This is largely due to the high rates of disability and chronic disease at the latter stages of life.
Financial access to health care has been the Achilles heel of the Irish health service, with right to health determined to some degree by privately funded arrangements. Health insurance has jumped in cost by 62% over the past three years, while at the same time pensioners' incomes have reduced.
TILDA, the Trinity College longitudinal study, shows that 11% of older people do not have coverage by either health insurance or a medical card. This is the unacceptable reality for some older people in Ireland. We have some hope in that the Government is talking about universal social health insurance. The nearest comparable system is the Dutch system. We are somewhat worried in that success depends on the design of the health insurance package as part of that. The policy planners need to ensure that this insurance element is adequate to meet the needs of older people for the specific services they require.
There is systemic violation of rights in the Irish health care system, principally, the reliance on emergency care in hospitals while simultaneously the reduction in the number of available beds has led to gross overcrowding and significant outpatient delays. The introduction of the prescription charge is counter-intuitive to good public health and preventive health policies. The changes in the dental care entitlement mean that treatment is refused unless it is for emergency cover, which is particularly worrying when we consider that the average cost of a routine examination is €44 and that represents a fifth of the weekly State pension. Opting not to go to the dentist leads to issues of malnutrition and neglect and all of these are avoidable violations of older people's rights to physical health.
At the other end of the spectrum the fair deal scheme and funding crisis in the HSE earlier this year stimulated a large number of calls to Age Action from older people who shared the experience of being unable to access nursing home care. At the time we rang around some hospitals and on 18 August 2011, we got data back from six hospitals. On that date, there were 266 older people in Irish hospitals with a clinical assessment that nursing home care was needed but they had no nursing home to go to. This fiasco has been added to since with the changes in the scheme where older people cannot draw down the fair deal funding until their financial assessment has been completed. That can take on average about six weeks. To stay in a nursing home for six weeks, while waiting for State support, at a cost of €1,000 a week will cost €6,000, which is beyond the means of some older people and their families.
The fair deal scheme has been subject to criticism for not covering many of the basic essentials of care, such as incontinence pads, therapy services or social activities in the contract. Some nursing homes are now imposing a flat fee to allow residents to pay for these items, in some cases this is happening regardless of whether the resident needs those services. We ask the committee to actively promote the planning and delivery of health and long-term care for older people in Ireland within a rights-based framework.
Article 15 of the International Covenant of Economic, Social and Cultural Rights, adopted by the UN also recognises the right of everybody to take part in cultural life. Services available in the community are the backbone of independence for older people. Since the hugely popular and effective home help and home care packages were introduced the budgets have been progressively increased over the years as the schemes have rolled out nationally. In the period 2009 to 2010, that trend was reversed. For the first time we saw home help hours planned for 2009 and 2010 falling short. It is interesting to note that in 2010, a reduction in the allocation of home help hours of 700,000 hours was made on the provision for 2007. Although the scheme is being rolled out, when one compares the figures from the HSE on what was provided in the time period from 2007 to date, 700,000 less hours were provided in 2010 than in 2007. We are concerned at the reports of further HSE cutbacks to its community based services in order that it stays within its budget.
I had planned to discuss transport but as the Centre for Ageing Research and Development in Ireland, CARDI, has done a very good presentation on it, I will skip over it.
My final point is on the right of older persons to live in their own homes. The budget for the home adaptation grants suffered a 23% cut in last year's budget. In June 2010, Age Action contacted 30 county councils to establish the impact of the cut and the funding restructuring on the grant provision. Of the 30 local authorities who responded, six were not taking on new applications, 20 had significant waiting lists some of which were up to a year long, some councils had more than 1,000 plus older people on the waiting list for the home adaptation grants. This grant is of major importance in supporting older people in their communities. As the country's hospitals grapple with a bed capacity crisis and the issue of delayed discharges, community support infrastructure for adapting homes to be suitable to an older person's needs is crucial. We must remind people that in all the surveys and in all the opinion polls, the place where older people want to live out the latter years of their lives is in their own home. Those community services are vital to that.
We are very grateful that this committee will examine the rights of older people in its first report. It is a very important issue, more so in the present climate.
