11 Mr. R. Bruton asked the Minister for Health the estimated cost of providing long stay care facilities for an elderly person; the way in which this compares with the expenditure of this Department in supporting this person and their carer in the home; and if he will make a statement on the matter.
78 Mr. Nealon asked the Minister for Health the estimated cost of providing long stay care facilities for an elderly person; the way in which this compares with the expenditure of his Department in supporting this person and their carer in the home; and if he will make a statement on the matter.
I propose to take Questions Nos. 11 and 78 together.
The average daily cost of maintaining an elderly person in long stay care facilities at the end of 1990 are as set out hereunder:
(a) a geriatric hospital £26.00
(b) a district hospital £41.00
(c) a welfare home £14.00
These costs are exclusive of capital outlay.
While there is no precise figure available for the expenditure incurred by health boards in supporting an elderly person and his-her carer in the home, any calculation would involve taking account of costs associated with the provision of the following services:
—Meals on wheels and home helps;
—Transport to day care;
—Respite care;
—Visits by public health nurses; and
—Paramedical services such as physiotherapy, chiropody and occupational therapy.
In addition, the circumstances of the individual elderly person must be taken into account, as the more dependent the person is, the greater will be the level of support required in the home.
My Department have commissioned the Economic and Social Research Institute to carry out research on the comparative costs of caring for the elderly in long stay institutions and in the community. The results of this research are expected shortly.
My Department are committed to the development of services for the elderly as recommended in the report of the working party on services for the elderly —"The Years Ahead — a Policy for the Elderly". TheProgramme for Economic and Social Progress includes a commitment to improve health services for the elderly as recommended in “The Years Ahead” over the seven year period of the programme. We are working with the health boards to expand the range of support to elderly people and their carers at home and in the community and in ensuring that the elderly receive a high standard of specialist care in hospital and extended care appropriate to their needs.
In 1990 the Government made a special allocation of £5 million to develop home and community support for the elderly and their carers. This year the Government made an additional £3 million available under theProgramme for Economic and Social Progress. The priority this year is to improve hospital and extended care services for the elderly.
Will the Minister agree that the comparison of £280 per week to have someone in care as against available funds, such as the carer's allowance which is a maximum £50 and received by only 3 per cent of carers in the community, shows a complete lack of attention to their problems? Will he agree to the publication of a charter for carers which would guarantee them specific levels of service across the range of home help, therapy and so on, so that carers would have accessibility to them and which the report on carers has plainly shown they do not now have?
It is very hard to draw comparisons between the cost in the community and in an institution and that is why the ESRI are carrying out research on this matter. I referred specifically to health care costs but there are other costs involved in social welfare. The Deputy referred to the carer's allowance and it is to the credit of the Minister for Social Welfare that he introduced it.
Involving 3 per cent.
Fair enough, it was a new scheme but a very worthwhile one.
It is a fiasco, a con job.
The Minister for Social Welfare introduced a new scheme which extended considerably the range of people who can apply for a carer's allowance whereas formerly, under the precribed relatives allowance, a very small number of relatives were entitled to apply for the scheme. Indeed, the rate of payment in relation to that scheme was £28 per week but the Minister for Social Welfare brought in a new scheme which not alone extended the range of people who could apply for the carer's allowance but also increased the figure to £45 per week the year he introduced it. He further extended the range of people who would qualify for the scheme by including those in receipt of the disabled person's allowance this year by increasing the rate to £50 per week.
Will the Minister agree that if he liberalised the means test for the carer's allowance the savings to his Department for institutional care would be considerable and that the people who look after relatives at home would be compensated in some way for what they are doing?
Matters appertaining to the carer's allowance are the responsibility of another Minister, not the Minister in the House at present.
It is a valid question.
How can the Minister for Health stand over a situation where home helps — who are supposed to be the power house of community care and vital cogs in the care of the elderly — are treated as slaves? They are paid 75p per hour by some health boards. If the Minister is serious about care of the elderly, what does he propose to do to rectify the situation to make the whole system of home help and care more attractive to those committed to the care of the elderly?
The Deputy has made his point.
What will the Minister do about slave labour in some health boards?
If we have brevity I will facilitate Deputies Jim Higgins, McCormack, Sherlock and others.
May I have an answer?
The home help scheme has been in operation since the mid-seventies and was introduced as a recognition of good neighbourliness. It was never meant to be a salaried scheme. I do not have the up-to-date rates of payment but I accept the point the Deputy made.
It is 75p per hour.
That does not apply in all health boards areas and I should like to have the rates of pay in front of me before I discuss the matter with the Deputy. However, I should like to point out that it was introduced, as I said, in the seventies as a recognition of good neighbourliness and not as salaried employment. That has been the position the boards have taken throughout the eighties.
That is what is wrong.
We provided funding in 1990, and again in 1991, to considerably increase the number of home helps to assist with the care of the elderly in their community.
The Minister is abusing the good neighbours.
Is the Minister aware that a pilot scheme, the boarding-out allowance scheme, whereby elderly people are integrated with domestic homes of non-relative families in the Western Health Board area is on the point of collapse because the board have been authorised to pay only £25 per week per patient? This, coupled with half the old age pension, brings to a mere £60 the contribution which these people receive. The 70 elderly people in Counties Mayo, Galway and Roscommon are literally on the side of the road and will be knocking on the doors of health boards from next week unless the amount is increased. It seems to be short sighted, socially regressive and economically draft, in the context of the figures the Minister quoted today, that this is the figure for the maintenance of people in public geriatric wards.
That is not included in the question.
It is relevant.
It is a matter for the Western Health Board. I understand that my colleague, the Minister of State, dealt with that issue last night.
He did not.
Will the Minister agree that there should be uniformity in the area of home help and payments to them as there is a great disparity?
Hear, hear.
With regard to the programme for the care of the elderly, the Minister has not made provision for extra beds in geriatric hospitals. This means that beds used for long stay patients are being used as respite care beds. People have to sign a form to say that they will take the patient home after a fortnight or so, irrespective of their condition. Is the Minister aware that families who can no longer cope with an elderly person have a problem? If a relative has been discharged from an acute hospital they are likely to refer him or her to a nursing home which they cannot afford. It is a very serious problem at present.
Facilities for the elderly have been substantially improved during the past two years. I have already mentioned that £5 million was provided in 1990 while £3 million is being provided in 1991 in addition to the £5 million. I accept that most but not all of the improvements have taken place in community care services. It has long been recognised that if extra facilities were provided in the community a greater number of the elderly would be able to live in their own homes or in the community. I am sure every Deputy will accept that it is only right and proper that the elderly should be able to live in their own homes or in their community for as long as possible and should only be cared for in a nursing home as a last resort. It is important to point out that only 5 per cent of the elderly are being cared for in long-stay residential centres but this should only be as a last resort. Money is being provided in the current year under the nursing homes legislation to allow the health boards make payments to private nursing homes in respect of patients.
When will the Minister make the order?
Can we come to finality? I call Deputy McCormack. The final question will be from Deputy Richard Bruton.
I indicated at the outset that I would like to ask a question.
I am aware of that, Deputy.
I have not asked any question as yet.
I will not disappoint the Deputy but we have dwelt unduly long on this question. We have made little or no progress at Question Time today.
That is not my fault.
This is the first time I have spoken at Question Time today. The Minister stated that it is very difficult to compare the cost of caring for the elderly in long-stay residential centres with the cost of paying carers to look after them in the home 24 hours a day, seven days a week. Is the Minister aware that only 1,600 people out of a total of 60,000 are in receipt of the allowance at the maximum rate? If the Minister paid this allowance to all carers there would be less demand for places in long-stay residential institutions.
As the Ceann Comhairle rightly pointed out, the carer's allowance is a matter for my colleague, the Minister for Social Welfare. Information on the number of carers is not available in my Department.
May I ask the Minister to what extent the allocation given by his Department to the health boards represent a planned response to the need to provide accommodation for the elderly in the community? Surely his Department have information on the age profile of the population. There is a lack of suitable accommodation for the elderly in the community. Their relatives are no longer in a position to care for them and they cannot afford the fees charged by private nursing homes because of the failure of the Minister's Department to provide an adequate allocation to health boards under the nursing homes legislation to pay subventions in respect of public patients to private nursing homes. The Department have failed to adopt a planned approach to this matter.
I would not accept——
May I ask a relevant supplementary? When will the Minister make the order to allow payments to be made under the scheme referred to?
May I get a reply to my question?
It is usual to hear the Minister.
The Minister referred to the scheme under which subventions will be paid by health boards to private nursing homes.
Deputy Creed has raised some questions and he is entitled to the courtesy of a reply from the Minister.
When will the Minister make the order?
Funding has been provided in respect of patients in acute nursing homes.
Will the Minister make the order?
Can I have a reply to my question?
The Chair has sought to facilitate the Deputy as best he could and is on record as having said so. A final question from Deputy Bruton.
Would the Minister accept that it is scandalous that 66 per cent of carers are not allowed to avail of the public health nurse scheme, that 50 per cent cannot avail of the home help services and 97 per cent receive no income supports from the Government in respect of the task of caring for an elderly person 24 hours a day, seven days a week, 365 days of the year?
What is the Minister going to do about that?
I do not accept that, and it is an indictment of the health board.
The Minister would not.
All the evidence suggests that people are extremely happy with the public health nursing service being provided. Deputy Creed raised the question of planning. I agree with him that planning is necessary but I disagree with him when he says that we have not made any plans. Not alone have we made plans but the working party have produced the report "The Years Ahead — A Policy for the Elderly". We have also incorporated in theProgramme for Economic and Social Progress our plans for the next seven years in relation to the elderly. I am very proud to be the Minister who has improved facilities during the past two years in the community to ensure that as many of the elderly as possible can continue to live in their own homes or community and are only cared for in long-stay institutions as a last resort. I would also point out that we do not see caring for the elderly in the community as a cheap option. It is not, it costs just as much to care for them in the community. Whatever it takes we must ensure a high quality of life will be provided for the elderly.
That disposes of questions for today.
On a point of order, I sought permission to have a question to the Minister for Health concerning the Tallaght Regional Hospital included on the Order Paper.
That is not a point of order, Deputy. Would the Deputy allow me to proceed with the business of the House? Information appertaining to Adjournment debates——
I put down a question about the Tallaght Regional Hospital. Would you permit me to complete my point? All I want to ask, seeing that you have denied me the opportunity to raise it under other guises, is how I can raise the matter of the abandonment of the Tallaght Regional Hospital in the House. I seek your guidance——
Deputy Rabbitte, please allow me to answer. There are no marks for shouting.
I am not being heard.
The Chair does not yield to shouting. Deputy Rabbitte's feigned ignorance of how he can get information is not acceptable to me. Deputy Rabbitte knows that the Ceann Comhairle's office is available to him or anyone else who needs direction as to how they can pursue, in accordance with the Order of the House, any matter that is regarded as appropriate.
I was asked to put down a question in relation to the completion of the Kingston report——
If you consult with the Ceann Comhairle's office they will give you all the information you require.
I cannot understand the reason it was ruled out of order. The Kingston report has been completed——
I have given you the answer and we are not going to have a debate on it now. The Deputy should allow me to proceed with the business of the House.
