I would like to tell the Minister a thing or two about the elderly because it is clear he knows nothing about the matter. When we speak about the elderly we are talking primarily about people over 75 years old. People are living longer and there will be many more elderly in the future. Old age is a time of particular need, very often related to loss, either the loss of a relative, the death of a spouse or even the loss of income.
Old age is not a question of death but a question of degeneration, the degeneration of cognitive faculties, of the intellect, sight, hearing, taste and smell as well as the reduction of independence and the loss of mobility. Incontinence is a major feature in relation to the elderly. It is estimated that 40 per cent of elderly people suffer from incontinence and carers have to provide for that particular need. The Minister of State, Deputy Stagg should know this; if for no other reason, he should know it having displayed such incontinence of language. I wonder how much experience of incontinence he has had in his life; and how many incontinence pads he has changed and, in particular, how many double incontinence pads he has changed. There are many thousands of carers who have had that experience on a daily basis and I would trust their views on the care of the elderly more quickly than those of the Minister of State. These are the unsung heroes and heroines of Ireland. Their role in society is one of anonymity and it has never been given full recognition. It has a low status and will continue to have unless there is a radical transformation in the way the State acknowledges their job and the important role they play.
At a personal level, we hold the elderly in high regard but at public level we do not and those who care for the elderly are not regarded as important people. The work is very often carried out by women alone at home, for whom the provision of a carer's allowance is denied or, when granted, so minimal as to reinforce the view that their job is unimportant. These people are vital to the good of society and to the health of families.
Ministers and Ministers of State are cared for. Their needs are met by a whole range of carers, be it the driver, the secretary, the person who cooks the meals or answers the telephone, the adviser, the civil servant. These people all bolster and reinforce the message that Ministers and Ministers of State are important people. Who provides that message for the carer? Who supports them when they fall ill or are at the end of their tether? Who provides them with the ego massage that Ministers enjoy? An individual may spend years caring for an elderly relative who may be cranky, disoriented, physically strong yet mentally feeble and who requires constant daily attention, but who cares for the carers?
Many elderly people do not experience problems in old age and live full and active lives right up to the end. There are many families who, when the health of an elderly relative starts to degenerate, take on the role of caring in a willing, able and loving way. Obviously, the ideal for everybody concerned is that the elderly person should live out his or her days being well looked after and in familiar surroundings in the family home if possible and surrounded by those who love them. That is the best of all possible worlds and Irish people have shown that they are in accord with it. At a personal level, families have shown a tremendous sense of responsibility towards the elderly but unfortunately this respect is not matched in the public arena. However, that kind of arrangement is not always possible as it is not always possible to keep an elderly person at home.
There are many needs that must be met including the frailty of the elderly. Some persons require special nursing care that simply does not exist in the home. We are talking about a group in society who are subject to all the chronic diseases of the heart, the circulatory system, strokes, which are extremely incapacitating, arthritis, brain damage, digestive conditions, Parkinson's disease and, in particular, Alzheimer's disease. Alzheimer's disease is now a major factor in old age. In America, the number of people over 85 years of age with Alzheimer's disease is now 50 per cent of this category. This has major implications for future health care. Our elderly population is growing and requires professional services that can be provided in nursing homes along with the care that can be provided by relatives. This growth in the elderly population is a phenomenon that has to be faced up to. It is a feature that should be included in the national health strategy. Goals need to be set. The care of the elderly requires a whole range of services which must dovetail with one another, from the general practitioner to the public health nurses to the home help service and the district units of meals on wheels. The objective of the care must be to maintain the independence, dignity, health and happiness of elderly people in familiar and loving surroundings, wherever they be.
What was so shocking about the Minister of State's comments was his depth of ignorance about the whole question of the care for the elderly. He represents a Government who, with such fanfare, introduced the year of the elderly, that mouths aspirations about solidarity across the ages but when the mask slipped we heard the views expressed by the new found Right as represented by Deputy Stagg which is sending out the message to keep your elderly at home, this is a private solution to a private problem and people should not lean on the State.
Let me tell the Minister that the reaction of nursing home owners — I live in Bray where there are a great many nursing homes — is one of sheer and unadulterated rage that the Minister should display such ignorance and such arrogance. He complains that nursing homes operate by making a profit but I would like him to show me a nursing home that could operate by making a loss and still continue to provide a decent service for its residents. The Nursing Homes Act is beginning to make a difference. I, for one, would never defend the rogue nursing homes that have created a bad reputation for nursing homes throughout the country. However, they are a minority and the Nursing Homes Act is making a difference. The majority of nursing homes are providing good quality care and the better ones, which unfortunately are more expensive, are providing an extremely high quality of life for their residents.
The Minister also ignores the fact that many residents in nursing homes choose to live in them. They do so out of choice rather than out of compulsion. He prefers to feed the understandable guilt that many families have about choosing a nursing home option. He has also stirred up fears among the elderly. I do not believe that Irish people need to be told how to care for their elderly and they certainly do not need lectures from the Minister of State about their responsibilities. The evidence is that people willingly and lovingly take up that responsibility but they need support in making the right decision. Indeed, the elderly themselves need support in making the right decision. The misinformation and the unjustified attack that the Minister indulged himself in is an example of how far we are from a decent service that supports the elderly and is based on essential principles that are in tune with the needs of people, both the elderly and the carers, and are also appropriate to the demand that will continue to grow into the next millennium.
We have a carer's allowance, a pittance which is offered to people who spend many long hours caring for relatives, sometimes even up to 24 hours a day, watching over relatives who are in need of care. Yet, not all carers get their allowance. In 1992 the number of people who applied for the allowance and were refused was almost as high as the number who were granted it. We have only to look at the home help service to observe the low status this kind of work has, where grown women caring for elderly people in their own homes are being paid less than a 14 year-old baby-sitter.
An ESRI report in 1992 described the reality, not the sentimental sludge I heard from the Minister last night, of caring for the elderly. The care is almost always provided by one individual, usually a woman who is found to work on average 46 hours a week and as the age of the elderly person rises the number of hours worked rises to 85 hours a week and even more. The carers were found to suffer physical stress and physical and emotional strain. The level of stress was found to be so high in many of them that they required medical attention. This reality is what led the authors of the report to recommend that health policy should ensure that the elderly are not institutionalised because of lack of community support. They also recommended that a carer should not be obliged to undertake the caring role, that it should be a question of choice.
Last night Deputy Cullen gave the impression that health spending here was high compared with other European countries, but that is not the case. We are cost effective considering our population profile. Our problem has to do with equality rather than overspending. Equality also relates to nursing homes. Our problem is not with the nursing homes but with the cost of keeping patients in nursing homes and the fact that many people cannot afford the cost of good quality nursing home care particularly as many families are caring for their young as well as caring for their elderly at the same time.
At the end of the day the elderly, and their families, have the right to choose what kind of care they wish to have without feeling guilty or fearful. That right must be protected by the Minister for Health. This right was undermined in a most despicable way by the Minister of State, Deputy Stagg, and the Government should disown his statements in relation to carers and nursing homes. The Minister for Health carries a particular responsibility to disown those statements. The dignity and peace of mind of the elderly and their carers demands nothing less.