In supporting these amendments, I believe the long-term care arrangements for older people are unplanned, inadequate, inequitable and underfunded. All older people wish to continue to live in their own homes and, fortunately, the vast majority succeed in doing so. They mainly live healthy and active lives, with some support from general practitioners, community care services, their families and communities. They are able to make and implement decisions about their lives and do not need constant or sustained care.
We are speaking about people who require long-term care. Those who must leave their homes and enter long-stay institutional care are among the most vulnerable members of our society. Our society is civilised, respects human rights and promotes human dignity. It should be judged on the way the care is provided and the quality of life facilitated within the care system.
There are major shortcomings in this regard. Any objective judgment on our care system would be harsh. We have a stated policy in the context of this section of the Bill. It demonstrates that we have a stated policy which favours community or home care. The practice makes such care extraordinarily difficult and effectively supports institutional care more than it supports home care.
We do not have a fair and equitable system for financing care, and we do not have a fair and transparent set of rights and entitlements. In the context of the Bill, the Minister has stated he is just regularising the situation. He has also indicated that fundamental changes are proposed in legislation, which would reflect on many of the concerns and points expressed by other Deputies during the course of the Bill. If we are to believe what the Minister has stated and accept that the primary piece of legislation will be in place before the next general election, why are we proceeding down this road and not putting all the resources of the Department into finalising the primary legislation?
The explanatory memorandum to the Bill states the purpose of the subvention scheme is "to provide financial assistance to persons towards the cost of maintenance in a private nursing home". The Bill defines subvention as a payment towards the cost of care and maintenance of a dependent person in a nursing home. The 1993 regulations simply state that the payment of subventions was towards the cost of nursing home care. There is a fundamental difference between this Bill and previous regulations.
The financial assessment of an applicant's means is to include all income and investments, including life policies and any assets transferred within the previous five years, for nominal considerations. It will also include up to 5% of the market value of one's house. Some 80% of the income from the State non-contributory pension is also included in the means test. In the previous regulations, assets may have been taken into consideration when taking means. They do not state assets shall be taken into account. In the Bill "the first €11,000, or the prescribed amount, whichever is the greater, of the applicant's assets" is also excluded from the financial assessment of means. However, for the social welfare means test, the exclusion amount is €20,000. The social welfare means test allows for earnings up to €100 per week to be disregarded. There are further exclusions under social welfare, including income from renting a room where a person would otherwise live alone. None of these exclusions is included in the Bill. Furthermore, for the social welfare means test the principal residence is not considered in the financial assessment of means. If one sells a house to buy or rent more suitable accommodation or enters the care of a nursing home, the first €190,460.71 of the sale proceeds are disregarded. The Bill makes no reference as to whether such income will be considered for the nursing home subvention means test. Let us be clear in the comparison between the Bill and other legislation. The exclusion of the home where a relative is residing makes no provision for cohabiting couples in the same section. This should be included in another section and an amendment is required.
The difficulty of setting upper limits for the income level and the valuation of houses in primary legislation poses major difficulties. Given the spiralling cost of houses, should amounts be reviewed annually? Reviews of eligibility can be made at any time and 60 days' notice can be given of withdrawal or reduction of subvention. That is an inconsistency.
The limit of €9,000 on income before housing assets are considered for means testing is already exceeded by the State non-contributory pension. Is this equitable and fair for elderly people? What does €9,000 represent? Should we believe the Minister of State's statement of 12 October 2006 when that "the HSE will not implement existing rules in such a way that people would lose their houses"? Where is this reflected in the Bill? It is not the Minister of State's commitments, nor those of his successor, that are relevant but the Bill. If such discretion is given by the HSE, what is the use in setting up percentages in the first place?
An appeal against the decision of the HSE will be heard by someone who may be an employee of the executive and who must comply with guidelines set out by the executive. There is no independent appeals system or advocacy service for an appellant. Both services are proposed in the case of other Bills. They should be set up before the Bill is enacted. The Bill should clearly state the decisions of an appeals officer should be reviewed by the Ombudsman.
There is no reference to those in nursing homes with low dependency. Reference is only made to those with maximum, high and medium dependency levels. No further clarity is given regarding enhanced subventions or fully contracted beds. It is easy for the Minister of State to give the impression he is doing something by referring to enhanced subvention and contract beds. We all know that availability of enhanced subvention is minimal and fully contracted beds are no longer in existence in some areas.
Older people who raised their children, allowing them to be part of the Celtic tiger, cannot be cared for at home. They cannot be given a commitment because of the waiting list. I have attended the funerals of many constituents who were told they could be on a waiting list for nine years before a public sector bed became available. They died at home rather than receiving care to which they were entitled under legislation as citizens of the State. The Minister of State refers to implementing policy. The Government made a commitment to providing 2,000 extra long-term public beds. The health strategy referred to a lower figure of 800 but none has been delivered.
This section of the Bill allows a high degree of discretion to the executive. The intention of a standardised system of assessment will not be achieved. On the basis of comparisons with the means testing of the Department of Social and Family Affairs, efforts to introduce standardised eligibility criteria will be further frustrated by the lack of consistency in means testing across Departments. This will result in allegations of unfairness and inequality. This is the last thing we want for people concerned about their final years in the world. The necessity of staying at a long-term, private facility means they have used up the nest egg and are faced with the threat — implicit in the Bill — of their house being sold over their heads.
Older people are not treated in the same way as everyone else. A young child coming into the world is entitled to care and attention in a public hospital. The care to which someone aged 65 years or over is entitled under the Constitution is not available. If one has the money, one can go into a private nursing home. There are three degrees of subvention for others but if one earns over €11,000 per annum, one has a problem. If one's house is worth more than the valuation stipulated in the Bill, one is not entitled to a subvention. House values in rural areas and Dublin are inconsistent.
The Minister of State and his officials are well aware of the problems encountered. Court cases are pending on the issue of elderly people's constitutional entitlement to care. Many reports outlining the need for action have been placed before the Minister of State or someone else in his Department. The result is a commitment from the Government and the Minister to regularise the existing arrangement rather than deal with the problem. This at a time when we are told the resources of the State are not always available, or there is a staff shortage. The Minister of State should be ashamed.
While the Bill is an attempt to incorporate a 1993 regulation in primary legislation, other legislation and regulations have superseded many aspects of the 1993 regulations. For example, the assessment of a child's income was provided for in the 1993 regulations but ended in 1999. It makes no sense to include old regulations in new laws, notwithstanding that the old regulations were bad law in the first instance. New legislation requires new regulations. The elderly are entitled to legislation that will protect them and provide the care and attention they deserve. The Bill does not meet that need. I fully support the amendment.
