Health (Nursing Homes) (Amendment) Bill 2006): From the Seanad.

The Dáil went into Committee to consider amendments from the Seanad.

Amendments Nos. 2 and 13 to 18, inclusive, are related to amendment No. 1 and all may be discussed together.

Seanad amendment No. 1:

Section 3: In page 5, lines 36 and 37, "degree of dependency of the applicant" deleted and the following substituted:

"need for the applicant to be maintained in a nursing home".

These amendments relate to a range of interim measures that have been put in place for 2007 and are now being transposed into primary legislation. In brief, the main changes are that levels of dependency no longer exist. Persons are now simply deemed to be dependent or not dependent; in other words, the person needs to be maintained in a nursing home or not and one single maximum subvention rate of €300 has replaced the previous three levels of dependency.

Before Christmas, the Minister for Health and Children announced a new nursing home care support scheme which will be introduced on 1 January next year. The purpose of the changes being introduced for this year is to pave the way towards the new scheme and render an increased number of people eligible for subvention in the short term. An additional €85 million was provided to fund these measures for 2007 and it is expected that approximately 2,000 extra people will benefit from the changes.

Amendments Nos. 14 and 15 are consequential on amendment No. 13 and amendments Nos. 16 and 18 are technical amendments that are necessary on foot of amendment No. 17.

We can welcome the fact that the Government has changed the limit to €300 but serious concerns remain about costs in private nursing homes. There is a big increase in the number of patients having to use private nursing homes as opposed to nursing homes. The Government has not moved to provide public nursing homes even though a clear commitment was given to provide more high dependency nursing home beds. The figures being talked about by the Government are inadequate, which means that patients will still require private nursing homes.

The €300 is an improvement but the three subvention rates that are being abolished had been the same since 2001 and €300 is not much more than the upper level of high dependency subvention offered by the Government. This is being discussed in the House with the idea of 5% of the house value being taken into consideration, making it even more difficult for the elderly to access the nursing home subvention.

The Minister of State said there will be improvements in January, which are really the proposals being made by the Minister for Health and Children that patients will be assessed before they get nursing home care next year. There will be a NEPS style system for elderly people getting nursing home care. I am amazed some of the organisations representing elderly people are so sanguine about the Minister's proposals that they are not looking for more detail on what the Government has in mind. Many of them are already concerned, however, about the death tax the Government wants to impose on the elderly and the fact they are taking 80% of the income of anyone who is an inpatient.

We are debating three major health Bills — this Bill, the Health Bill, which will establish the Health Information and Quality Authority, and the Medical Practitioners Bill. The cutbacks in time to discuss the legislation are only outdone by the cutbacks the Government has made to the health services. It is ridiculous. This debate can finish at 5 p.m. because we are only dealing with these amendments and we already know the Government has no interest in hearing the Opposition's views, but the Health Bill is also being guillotined and that legislation is seriously flawed. Some Fianna Fáil backbenchers know more about the flaws in that Bill than members of the Cabinet. I have also heard that Second Stage of the Medical Practitioners Bill will be taken between 10 a.m. and 2.30 p.m. on Friday, 23 February. We waited 30 years for legislation to protect patients from bad doctors. We have all heard of Harold Shipman and doctors who have been struck off in Britain coming here and practising. Fianna Fáil has been in power for most of those 30 years and now the Government tells us the full Second Stage debate will take only four and a half hours. It is ridiculous.

The Government should have offered the elderly more. The Minister of State knows damn well that €300 is not enough.

I agree with Deputy Twomey. The Minister and the Department have not worked out a fair position on residential care for elderly people. There is a perception of action while the reality is that restrictive arrangements are in place on how people are assessed and unfair methods of assessment in terms of the family home.

The Minister for Health and Children is also promoting the idea that somehow all the issues raised by the Leas Cross nursing home have been resolved and a bright new day has arrived. If we look at the published standards, they are just photocopies of the British standards and there is no clear determination of staffing levels. I would expect that accommodation in the private nursing home sector will be improved — there are many excellent nursing homes — but in certain nursing homes, standards are not high enough and anything that is being done to improve accommodation is, of course, welcome. The sector, to be fair, has sought standards but when there are no staffing regulations to set baselines, it raises concerns about the protection of elderly people that have not been addressed by the Minister. In public nursing homes, the level and qualifications of staff are generally higher and probably more expensive than the private sector but the Minister and the HSE are relying to an ever greater degree on the private nursing home sector. The onus is on the Minister to set certain standards and she has ducked it, as did her predecessors.

We have already expressed our opposition to the family home being taken into account when assessing eligibility. This is unprecedented. The policy pursued by the Government of over-dependence on the private nursing home sector leads to severe anomalies in the acute hospital sector. Beaumont Hospital has more than 100 people inappropriately in hospital beds because they simply cannot move out of the acute hospital sector into step-down or nursing home care. That places extraordinary pressure on that hospital and it is not the only one in that situation. Patients are in hospital when they do not need to be but cannot move on because the nursing home beds do not exist in the local area. It is extraordinary that Government policy has been so remiss that in a part of the city with an older population there is far less capacity in private or public nursing homes than in other areas. In Bray there is good private nursing home capacity but our elderly population is not sizeable, it certainly does not compare with the north inner city.

There is a mismatch and the lack of Government planning to ensure proper provision of step-down and nursing home beds leads to problems in the acute hospital sector. I was shocked today to find that St. James's Hospital is cancelling operations for cardiac patients. This is a chronic crisis at St. James's Hospital and it demonstrates the Government's failure to provide capacity at acute hospital level and in the community.

The private nursing home sector has a role to play but that there is an over-reliance and a lack of planning to ensure that provision meets need. Ultimately that is not the fault of private nursing home owners because they have their own considerations; they are not charities, they are providing a service and people are paying for it. The HSE and the Minister must bear responsibility.

Looking at the inspectorate, which relates to the charges being levied by nursing homes, we can see complete inconsistency across the country. There are nursing homes where residents who have been living there for some time suddenly found the fees had rocketed because the inspectorate from the HSE determined that increased staffing levels are required. Extra costs must be borne by the owner who passes them on to the residents and their families. Many people are genuinely shocked by the increases which are as a direct result of the HSE inspectors determining that certain changes must be made in a nursing home. It may well be that those changes are necessary — I am not arguing that point. However, down the road in another county or region a completely different approach may be taken and private nursing homes may be protected from such pressure on costs. It is a bit of a mess.

I believe the Minister of State promised the interdepartmental review would be published in 2005 and yet we are still waiting for it. It is hard to have confidence in any proposals of the Minister of State to resolve the issue of care for the elderly. Most important is to determine the cost of such care in a fair way that does not attack the family home. We need to ensure that people are cared for in a way that recognises their dignity, with respect, and that recognises that they in their time paid taxes. Those rights are recognised when patients attend for acute care. Nobody assesses the value their family home before they access hospital care or if they qualify for a medical card. It is a unique arrangement that is causing great fear and trepidation. The Government's record is inadequate and I do not believe this legislation will ease the pain in any way.

I intend to press the first amendment to a division, as I believe it changes substantially what we had discussed. The Minister of State said "degree of dependency of the applicant" has now been deleted and has been substituted for "need for the applicant to be maintained in a nursing home". We have no idea who will decide what is meant by "the need for the applicant to be maintained in a nursing home", as that will come in a year's time. Any right-thinking Member of the House would need to oppose the amendment, as we have no idea what it means.

I do not think it does the health service any justice if people keep knocking it all the time.

I object to that. The Minister of State should talk about the legislation and not make such comments. The legislation is totally wrong.

I have listened and the Deputy should let me make a few comments.

The Minister of State should be allowed to speak.

I will not stand here and pretend that everything is fine in the health service. Difficulties exist.

What is the Minister of State saying? He has just contradicted himself.

I appreciate the Opposition has a job to do in pointing out areas where difficulties exist. I am not referring specifically to what the Deputy said in his contribution. In general, for some time we have heard continual knocking of the health service. The majority of people who avail of our health service have a pleasant experience. The difficulties are being addressed. Perhaps in some cases results are not being achieved as quickly as people would like. It is not fair on the people working in the health service to see newspaper reports and hear reports on the news or radio shows, in which people continually knock what they do. Ultimately these people make a contribution and try to do their best to improve the service and provide a level of health service care for their colleagues in the community. There is no real appreciation of what they do.

We did not make a number of changes at Christmas and that is why we have tabled some of these amendments. When the scheme was introduced in 1993, it was not intended that it was to cover the cost of the care. It was to assist in funding the cost of care. It is now proposed to eliminate the three rates and have one rate of €300. We have discussed the subvention scheme and nobody said it was not without its faults, including me.

Assessing the family home was introduced in the scheme in 1993 and despite many different Ministers occupying the seat in Hawkins House since then, it has not changed. What we are now introducing will only last until 31 December. On 1 January 2008 a new scheme will be in operation. There is no guarantee that the two Deputies who contributed today will have the responsibility to introduce that legislation. Regardless of what side we are on, if we are lucky enough to be returned to the House we will have an opportunity to contribute to that and to decide on the scheme to be introduced. We have studied the funding of long-term care upside down and inside out. The time has come to introduce a new scheme and we have indicated that we intend to introduce that legislation in the House in the autumn to take effect from 1 January 2008.

The Deputy's throwaway comments on cutbacks serve no purpose. I pointed out that an additional €85 million will be provided this year and that we expect an additional 2,000 people to benefit from the changes we will announce for this year alone. In the new scheme public and private will be treated in the same way. A number of measures are being taken to address the inappropriate use of beds. The investment we have made in home care packages will contribute significantly to resolving that issue. We have a history, which people accept, of people with an income contributing to the cost of the care. We do not ask them to pay for the total cost and that is what we are doing with the new scheme, a fair deal on nursing home care, to be introduced in the autumn.

This obviously represents the new way for Ministers and Ministers of State to react to criticisms from the Opposition. The Minister of State has accused us of criticising those who work in the health services. During a recent private Members debate a similar comment was made by the Minister of State, Deputy Brian Lenihan. I made it clear then that we do not criticise those who work in the health services. For instance, as with the doctors, nurses and everybody else in the health service, when I did my 10,000 or 12,000 consultations each year as a GP, I did not see myself as implementing Government policy. I looked after patients. Every nurse, physiotherapist, occupational therapist and cleaner within the hospital system sees himself or herself as doing a job to look after patients.

When we criticise the Government we do so on its total failure to provide enough acute beds in the hospital system to look after those same patients and to provide enough step-down beds to look after elderly patients within the public system. We criticise the Government for giving public land to developers and for sending premiums for private patients through the roof. We are talking about the Government's failure to give direction and leadership in dealing with MRSA. We do not criticise the people who work in the health service. If those who work in the health service behaved in the same manner as the Minister and Ministers of State responsible for it, the health service would collapse in the morning. Their hard work is keeping it together.

The Minister of State should withdraw the stupid remarks he has made about Members of the Opposition. We are criticising the Government's performance and not the performance of those who work in the health services. With 12 or 14 weeks to go to the general election it shows the Government's failure that it is fighting with the consultants, nurses and every allied health professional within the health service who are threatening to go on strike because of the Government's failure.

I read an article by Professor Drumm which clearly states that senior HSE management needs more training and is probably not up to the job it is doing. That is some admission two years after the establishment of the HSE. Those are the criticisms we make. It is extremely disingenuous of the Minister of State to try to suggest that the Opposition is attacking those who work in the health service. I know people working in the health services, probably better than the Minister of State does. They do not read those headlines in the newspapers as criticisms of themper se. They read those headlines as criticisms of the system and of the poor leadership they are getting not just from the Government but also from the HSE. This is a sign of that.

The Government has changed the nature of this legislation. Nobody trusts the Government. Everybody is afraid about the interpretation of something like the "need for the applicant to be maintained in a nursing home". The Minister, Deputy Harney, said everybody who needs an urgent colonoscopy, like in the case of Rosie, will be seen within two weeks. What is an urgent colonoscopy? The Minister of State does not know and I do not know even though I have been in medicine for 20 years. There is a need for the Minister of State to stick with what he is supposed to be doing and not throw out wild allegations.

Speaking of wild allegations the Deputy made a statement that the Government is giving away land to developers.

Acting Chairman

I ask the Minister of State——

Will the Deputy give one example of where the Government is giving away land to anybody?

The Government is going to give away land to private developers to build the co-location hospitals. That is Government policy.

Acting Chairman

Deputy, please. There is a tight deadline for this legislation. We should address the issues and not the wider issues.

Amendment put.
The Dáil divided: Tá, 71; Níl, 58.

  • Ahern, Dermot.
  • Ahern, Michael.
  • Ahern, Noel.
  • Andrews, Barry.
  • Ardagh, Seán.
  • Blaney, Niall.
  • Brady, Johnny.
  • Brady, Martin.
  • Brennan, Seamus.
  • Browne, John.
  • Callanan, Joe.
  • Carey, Pat.
  • Carty, John.
  • Cassidy, Donie.
  • Collins, Michael.
  • Cregan, John.
  • Cullen, Martin.
  • Curran, John.
  • Davern, Noel.
  • Dempsey, Tony.
  • Dennehy, John.
  • Devins, Jimmy.
  • Ellis, John.
  • Fahey, Frank.
  • Finneran, Michael.
  • Fleming, Seán.
  • Gallagher, Pat The Cope.
  • Glennon, Jim.
  • Grealish, Noel.
  • Hanafin, Mary.
  • Harney, Mary.
  • Haughey, Seán.
  • Hoctor, Máire.
  • Jacob, Joe.
  • Kelleher, Billy.
  • Kelly, Peter.
  • Killeen, Tony.
  • Kirk, Seamus.
  • Kitt, Tom.
  • Lenihan, Brian.
  • Lenihan, Conor.
  • McDaid, James.
  • McEllistrim, Thomas.
  • Martin, Micheál.
  • Moloney, John.
  • Moynihan, Donal.
  • Moynihan, Michael.
  • Mulcahy, Michael.
  • Nolan, M.J.
  • Ó Cuív, Éamon.
  • Ó Fearghaíl, Seán.
  • O’Connor, Charlie.
  • O’Dea, Willie.
  • O’Donnell, Liz.
  • O’Donoghue, John.
  • O’Donovan, Denis.
  • O’Flynn, Noel.
  • O’Keeffe, Batt.
  • O’Keeffe, Ned.
  • O’Malley, Tim.
  • Parlon, Tom.
  • Power, Peter.
  • Power, Seán.
  • Roche, Dick.
  • Sexton, Mae.
  • Smith, Brendan.
  • Smith, Michael.
  • Treacy, Noel.
  • Wallace, Mary.
  • Wilkinson, Ollie.
  • Woods, Michael.

Níl

  • Allen, Bernard.
  • Boyle, Dan.
  • Breen, James.
  • Breen, Pat.
  • Broughan, Thomas P.
  • Bruton, Richard.
  • Burton, Joan.
  • Connaughton, Paul.
  • Cowley, Jerry.
  • Crowe, Seán.
  • Cuffe, Ciarán.
  • Deenihan, Jimmy.
  • Durkan, Bernard J.
  • English, Damien.
  • Ferris, Martin.
  • Gilmore, Eamon.
  • Gormley, John.
  • Gregory, Tony.
  • Hayes, Tom.
  • Healy, Seamus.
  • Higgins, Joe.
  • Higgins, Michael D.
  • Hogan, Phil.
  • Howlin, Brendan.
  • Kehoe, Paul.
  • Kenny, Enda.
  • Lynch, Kathleen.
  • McCormack, Pádraic.
  • McEntee, Shane.
  • McGinley, Dinny.
  • McGrath, Finian.
  • McGrath, Paul.
  • McHugh, Paddy.
  • McManus, Liz.
  • Morgan, Arthur.
  • Murphy, Catherine.
  • Murphy, Gerard.
  • Neville, Dan.
  • Ó Snodaigh, Aengus.
  • O’Dowd, Fergus.
  • O’Keeffe, Jim.
  • O’Shea, Brian.
  • O’Sullivan, Jan.
  • Penrose, Willie.
  • Perry, John.
  • Quinn, Ruairí.
  • Rabbitte, Pat.
  • Ring, Michael.
  • Ryan, Eamon.
  • Sargent, Trevor.
  • Sherlock, Joe.
  • Shortall, Róisín.
  • Stagg, Emmet.
  • Stanton, David.
  • Timmins, Billy.
  • Twomey, Liam.
  • Upton, Mary.
  • Wall, Jack.
Tellers: Tá, Deputies Kitt and Kelleher; Níl, Deputies Kehoe and Stagg.
Amendment declared carried.
Seanad amendment No. 2:
Section 3: In page 5, lines 49 and 50, "degree of dependency" deleted and "need to be maintained in a nursing home" substituted.
Amendment agreed to.

Amendments Nos. 3, 5, 7 and 8 are consequential on amendment No. 9. Amendments Nos. 3, 5, 7, 8 and 9 will be discussed together.

Seanad amendment No. 3:

Section 3: In page 7, line 20, before "the" where it firstly occurred, "subject to subparagraph (vi)," inserted.

These amendments provide that where 5% of an individual's property is taken into account as part of the financial assessment for a subvention, it will only be taken into account for the first three years in which the person is paid a subvention. This limit of three years is being provided for in this Bill as part of the range of measures being introduced in 2007 in advance of the new scheme taking effect next year.

As I have already mentioned, these measures have already been provided for by way of regulations made before Christmas. Therefore, this measure is already in force and is now simply being transposed into primary legislation.

Could the Minister of State clarify matters? What is the purpose of amendment No. 9?

The house of a person who has been in receipt of a subvention for a period of longer than three years will no longer be taken into account. Under the new scheme we are bringing in for next year, it is proposed that the maximum period for which one's house can be assessed is three years. Equally, we are saying that if a person has been in receipt of a subvention for more than three years during which time his or her house was assessed, it will no longer be assessed for the future.

So amendment No. 9 relates to taking 15% of the value of a house from elderly people going into nursing homes. The Minister of State is saying that this is just to cover the fact that if they are there beyond three years, they will not have 15% of the value of their houses taken from them. Are any of these other amendments related to the fact that the Government plans to take 5% of the value of the house for three consecutive years off everybody who goes into long-term nursing home care from 1 January 2008? Are any of the other amendments related to what we consider to be a death tax on people who need long-term nursing home care?

When we introduced this legislation, we said we would put this scheme in primary legislation on the advice of the Attorney General. On foot of a few changes we made before Christmas, we have made amendments which we will bring before this House. This legislation will cease as and from 31 December 2007 and it is our intention to have a new scheme operating from 1 January 2008.

So does it relate to the fact that the Government is taking 15% of the value of a house? I am only trying to get clarity on this matter.

What we are saying is that if a person who is in receipt of a subvention has been in the same nursing home for three or more years, as and from now, their house will no longer be assessed.

Is that after three years?

Yes, where there is a maximum——

Is that when the 15% has been applied?

Three years is the maximum time, which is what we propose in the new legislation which we will debate in the House in the autumn.

So we are debating the 15% in respect of three years. I am just trying to get clarity about whether this amendment is about this.

It is the same idea in that we will not ask people for any more after the three-year period. This is the maximum period of time during which their house can be assessed.

The Minister of State is not explaining this in a way we can comprehend. The whole thing is a bit of a mess. We had a Bill. The Minister of State then came out with a new plan. Is he saying that the 15% scheme is now included in this amendment? I think this is what Deputy Twomey is trying to find out. If it is included, I suggest the Minister of State clarifies that——

Could we have silence in the Visitors' Gallery? Deputy McManus to continue.

The more the Minister of State says, the more unclear is this issue. It is becoming quite opaque. The initial legislation was introduced and the Minister subsequently decided the system was unfair and that she would introduce a new scheme. Are these amendments, which are being tabled at the 11th hour, related to the 15% proposal or the 5% contribution? If so, this is not the way to produce legislation. We are on Report Stage, which should be about tidying up technical matters, but we are trying to tease out this issue. Perhaps the Minister of State's officials will give him a briefing note so he can outline to the House what he is trying to do in these amendments.

This is one of the most dreadful Bills to come before the House and this section remains intact, despite the Minister tinkering around its edges. The principle will be established that the family home should be assessed in the means tests for services. The family home is not assessed in applications for higher education grants, medical cards or social welfare payments. It is exempt from any payment. If I fall ill and enter hospital, there is no question of the value of my family home being taken into account when assessing the cost of my stay but if I am over 65 years and I am too ill to stay at home, the family home will be assessed as means against my costs and I will also be liable for 80% of my income and all my valuables, including jewellery. These will be taken into account as means against the full cost of availing of a largely privatised service. The State has decided to privatise services for the elderly which are bought and sold as a commodity, which is immoral.

This is the first and only time this has occurred and the Minister of State is providing that in certain circumstances he will reduce or write off the liability. However, that will not address the principle involved. For the first time in the history of the State, a means test will require the sale of the family home in certain circumstances. For example, I refer to a brother and sister who live together with the sister having been left the family home by her parents. He is working for the county council as a road worker and she requires long-term care. The family home would have to be sold to pay the State the costs it would levy against her when she died. That is cruel and savage and it is unbelievable that it would be so. The Labour Party has undertaken that if it is returned to Government following the election, it will repeal and abolish this rotten legislation. I appeal to the Minister of State, who is in a difficult position, as he must do the bidding of more senior people. I do not blame him personally for this problem because his inclination would be similar to mine in this regard but I appeal to him to refer the legislation to his principals and not to force it through using the Government majority.

Between now and 1 January 2008, the Government is saying 5% of the value of the family home will be considered as income when an individual applies for nursing home subvention. As of 1 January 2008 the Government will take 5% of the value of the house from elderly people who need long-term nursing home care. To which of these measures do the amendments apply? The legislation lacks clarity but it will be passed in 25 minutes. It might be a saviour for the Minister of State but somebody will have to clean up this legislation if the lack of clarity remains.

When the subvention scheme was introduced in 1993, the family home was assessed as part of the means test and this provision has remained part of the scheme since. While the scheme is not without its faults, we put forward a new plan for the funding of long-term care last December but that involves separate legislation and the Deputies could be in office next September. We are proposing that there will be an imputed income equal to 5% of the value of the home but the maximum period for which this can be calculated is three years. If somebody is in receipt of subvention for four years, for example, only three years can be assessed under the means test.

That is 15%.

Yes, 5% annually for three years.

The amendment will apply for three years. Will the plan announced last December be implemented at all?

An imputed income of 5% of the value of the family house is provided for in the scheme and, in cases where people are in receipt of subvention for more than three years, the income calculation will cease. We will no longer impute an income on the basis of the value of the house.

However, when the Minister announced her plan last December, she stated no assessment would be needed and if a person needed nursing home care, he or she would receive it. Is the Minister of State saying 5% of the value of the house will be taken regardless under the new plan? It is as confusing as hell. I do not know why he is inserting this provision. It either dies on 1 January 2008 or it does not.

We are introducing measures that will cease. The scheme as we know it will cease on 31 December and it is our intention to introduce the scheme announced last December.

Why was that not inserted in the amendment? This is a different story altogether.

We have been quite clear.

The Government has been far from clear.

We were clear in what we proposed about a fair deal and the amendments we intended to make, including no differentiation between private and public care and the role of the National Treatment Purchase Fund. The Minister outlined our plans in this regard in detail but that legislation is yet to be debated in the House.

If the Government was serious that the plan announced last December was its policy, these amendments would fall on 31 December 2007 but that will not happen. The Minister of State has not explained what is involved. People are confused because, according to last December's announcement, the State will take 5% of the value of the family home but, according to the amendment, the State will treat 5% of the value of the house as income until the new plan kicks in on 1 January 2008. I can see how people outside the House might be confused. The Minister of State is introducing a three-year rule. The theory underlying the amendment is that the provision will apply for three years. The aim of the amendment should be for the subvention scheme as we know it to fall on 31 December 2007. That would indicate the Government is serious about what it announced last December. This appears to suggest the Government is not sure what it will do on 1 January 2008 and that an opt-out clause is provided for the Government, if it is in power.

This is very unsatisfactory. It is not clear what the intention is here. I would have thought the Minister of State could shed some light on this matter. When the Minister, Deputy Harney, floated this idea of getting money back from the dead, I understood it was to be a voluntary scheme, and that one had a choice about whether to embark on it.

To which scheme does the Deputy refer?

The scheme by which money would be paid back to the HSE from people's estates after their death, and that the family house would then be sold to pay for the cost of residential nursing home care. Is the Minister of State aware of that scheme?

I did not know whether the Deputy used the word "voluntary".

I heard the Minister, Deputy Harney, state on the radio it would be voluntary, that there would be a choice. I do not know whether to believe her. She said there would be public-only consultant contracts and now they are turning out to be public and private consultant contracts. It is like grabbing mercury. One does not know what is on offer here. My understanding is that the scheme was to be voluntary. Perhaps I am wrong. Is the Minister of State saying people in nursing homes for three years will be assessed on the basis of the potential income from their family home, that the person in the bed next to them who is there four years will not be penalised in that way, and that there will be a third person in the future lying in the bed next to them who will be on the scheme that would require the family to pay, by way of selling the family home after the person's death?

I have deep concerns about the overall structure of what the Minister, Deputy Harney, has proposed to become operational from 1 January 2008. I refer the Minister of State, Deputy Seán Power, to Article 45.4.1° of the Constitution which states: "The State pledges itself to safeguard with especial care the economic interests of the weaker sections of the community, and, where necessary, to contribute to the support of the infirm, the widow, the orphan, and the aged." That is very clear. The proposed amendment does not subscribe to the duty of looking after the weaker sections of the community. In effect, the infirm and the aged have been singled out as a special group and, just because they are ill, it is planned to take 80% of their income and ultimately sequester 50% of their property. Foreign invaders did not get away with this, let alone an Irish Government. It is unclear how this can constitute looking after the economic interests of those people who have worked hard over the years. As far as they are concerned, they have made their contribution and are entitled to nursing home care.

The reason we have reached this impasse is that the balance between public and private long-stay beds has changed radically. In the 1960s, four out of five beds were in the public sector, now approximately 52% of beds are in the private sector. That is the malaise that has set in. I am not sure the Minister or her colleagues ever looked at the reports that are available. They should not tell us there is a crisis because, despite significant changes in the population, the percentage of people in need of full-time care is remarkably stable. In the 1960s and 1970s when we did not have a shilling, when Deputy Stagg's brother and others were sending home money from England and elsewhere to keep us going, about 5% of the population were aged over 65 and required long-term care but today that sector constitutes only 4.6% of the population and money is coming out of our ears. That argument is fallacious. It is predicated upon a rush to the ostensible privatisation by stealth of the health care system.

The Minister and her colleagues should look at Professor Eamon O'Shea's report — it is not ours — and the National Economic and Social Forum's action plan to reform care of the elderly. We have a plethora of analysis and information. This proposal does not relate to 250,000 people or even to 50,000 people, we are talking about 20,000 people. In 2011 the numbers will rise to 22,000 people. This is not a case of a genie escaping from a bottle and exploding. By 2050 both Mercer and the NESF predicted Ireland will have fewer over 65s as a percentage of population than the European average. The most recent CSO statistics show our fertility rate is the highest in Europe so we will have more young people coming on-stream to pay taxes and ensure that when I get old I will have a bed.

Reference to long-term care is a misnomer. According to the O'Shea report, 77% of those requiring such care are only in nursing homes for three months or less. The Department's statistics show that of those discharged from nursing homes in a given year, 20% die but 63% are discharged back into the community. Therefore, very few people stay for years in nursing home care. The average length of stay in a nursing home is three years yet the Government decides to plunder and rob people. The intention is to make people pay for what is, essentially, the average period spent by elderly people in nursing homes. One could talk about daylight robbery. This time it is our own vulnerable people who are being done. It is an absolute disgrace to perpetrate such an act on anybody. It is a shame on any Government for coming forward with such a proposal.

The angst and annoyance out there has to be seen to be believed. This is a crisis. The response of the State to the future burden of providing adequate residential care for older people is an example of ageism at its worst. The Minister of State should read the National Economic and Social Forum's report with great care, especially the section on rooting out ageism in society. Older people remain quite healthy and independent and are able to enjoy life to the last yet the Government is picking on them. This is the worst form of ageism. As Deputy Stagg said, people's homes are not used in calculating means tests for so many entitlements, rightly so, yet people who have given their all and worked hard to build the State into what it is are being penalised. It is a shame on the Government. Many people are out there waiting in the grass to give their verdict on this issue.

I see from today's newspaper the leader of the Progressive Democrats is advising politicians not to let people into their family homes. This legislation is letting the State into the family home. We are taking ageist action against the most vulnerable people in society. The previous speaker alluded to the Constitution, which appears to have been set aside by the Progressive Democrats in particular. The Minister of State has listened to the Progressive Democrats. It appears to be a case of the tail wagging the dog here, unless Fianna Fáil agrees wholeheartedly with this view. I suspect the Minister of State, Deputy Seán Power, has reservations about this himself.

In a week which saw the Progressive Democrats apparently giving to the elderly, the party is in effect, giving with one hand and grabbing the family home with the other. That is the reality. The Minister of State will hear this from people on the doorsteps in the next few weeks. The statistics are available. Many of us will be affected by this provision in the future. So many people have contributed generously to the State in the past through their taxation and now they have been singled out with the intention of taking the family home from them. The Minister of State is probably aware of how sacrosanct the family home is in our society. This provision would cause untold difficulty and suffering for many people. This is an attack on the most vulnerable in society.

The legislation has now been before both Houses of the Oireachtas but it has not improved with age. The major problem is the inclusion of the family home. It should not be included. This is an attack on the one thing a senior citizen can offer to a family member. I find it difficult to link the amendment to the Bill. How will the amendment be applied to make sense of this matter? It does not make sense with regard to those excluded and the reasons for the family home being excluded. Can the Minister of State explain what this means? If a person is in long-term care for more than three years, who must pay the relevant amount? This is not clear.

On the first day of this debate I argued that the family home is precious to all families and should not be taken into account where someone is resident in the home. Deputy Stagg and I visited Naas General Hospital and met an employee of the HSE whose mother was in hospital. He was concerned about the family home being under threat. Before we vote on this amendment I ask the Minister of State to explain the thinking behind it.

I beg the Minister of State to back away from one of the most draconian measures since I was elected to this Houses, which is not today or yesterday. Whatever the reasons behind it, this legislation will split families. Heretofore house ownership had been sacrosanct. Many people aspire to owning a house. When people spend a lifetime working to own a house and arrive at the most vulnerable stage, is it right that someone else will own part of the house if they must enter a nursing home? I suspect that an increasing number of Fianna Fáil backbenchers will have nothing to do with this. I do not know if the Progressive Democrats are driving this but I can provide a guarantee from the Opposition benches. This legislation will never be implemented in this country and there is a good reason for that. It runs against principles held by every party and every group in society. What one has, one owns.

In the past, an elderly person would sign the house over to a son or daughter. Included in the agreement was a room in which the elderly person could live. There were many rows in rural Ireland over this. The elderly people could not be put out of the house but had to endure a living hell within. Every family is entitled to own the kingdom, which is the family home. Many elderly people believe this Bill is afait accompli and that this measure will happen regardless of the Bill being enacted. Retired groups and everyone who has an understanding of the principles we value oppose this legislation. Before the year is out I hope the Minister of State will be in Opposition.

I would be happy to be under this roof on either side.

The Minister of State is trying to take the roof from over elderly people. In the Chamber there is a roof for us all, as long as it lasts. This is a serious matter and it surprises me that the Fianna Fáil Parliamentary Party has allowed it to reach this stage.

I wish to restate points made on earlier stages of this Bill that arise now. One cannot construe the family home as an asset. If the Government wishes to acquire tax revenue from those who own assets, why not pursue those who have multiple houses here and abroad? Instead, it pursues the main residence of a person of advanced years. It is going after the home as if it were simply an asset for disposal. I reject that.

It is time to accept the concept of universal provision, that one is entitled to home care as a citizen. The home is an accumulation of all one has experienced through life but because one is frail and dependent for a period between a few months and less than three years, the State has the right to grab part of the home.

As Deputy Connaughton states, it will be totally destructive. If any one of the exempted categories remain in the house they will have mitigated the State's clawback. What will be the relationship between the elderly people and the beneficiaries of the estate? One can project the nightmare it will create. This is misery and it is time it is stopped. I hope every Deputy — including those on the Government side — breaks rank and states that this is a push over the line from the Progressive Democrats, a party that is quickly evaporating, thankfully, from the Irish political scene. Hasten the day.

I am surprised at the reaction from my colleagues. Two issues are being discussed, one of which concerns legislation that has not yet been published. The other is criticism of having the home assessed but it was a former Labour Minister, Deputy Howlin, who introduced it. His colleagues have become hysterical because we are a few weeks from an election.

That is not true.

It is true. We have a history of people contributing to the cost of long-term care and they are happy to do so.

What is the cost of the means test?

This scheme is not without its faults, which we have identified.

That is true.

We live in the real world and meet families who seek subvention.

The Government has terrified them out of their wits.

That is the reason for bringing in a new scheme. Listening to the debate, one would think things were going swimmingly and there was no need for new measures. There are no simple solutions. Long-term care is very costly and has been examined by experts outside the House. Many Members are also experts.

That is not true. Long-term care is not nearly as costly as hospital care. Only 20,000 people are affected by this.

We proposed a measure in December that will be debated in the autumn by whatever party is lucky enough to be in government. We have explained what we are doing. We are not making any major changes to what already existed. Neither the principle of the 5% being imputed nor the 15% maximum imputation will finish on 31 December 2007.

The 80% of income will not finish.

From 1 January our proposal that they change from a home will become a deferred charge.

Will the Government apply the two?

It is a deferred charge and Deputy McManus asked whether it will be voluntary. If a family wishes to contribute that 5% each year for three years it may do so but it is a deferred charge that will be collected only from a person's estate.

I am now required to put the following question in accordance with an order of the Dáil of this day: "That the Seanad amendments not disposed of are hereby agreed to in Committee and agreement to the amendments is accordingly reported to the House."

Question put.
The Dáil divided: Tá, 73; Níl, 61.

  • Ahern, Dermot.
  • Ahern, Michael.
  • Ahern, Noel.
  • Andrews, Barry.
  • Blaney, Niall.
  • Brady, Johnny.
  • Brady, Martin.
  • Brennan, Seamus.
  • Browne, John.
  • Callanan, Joe.
  • Carey, Pat.
  • Carty, John.
  • Cassidy, Donie.
  • Collins, Michael.
  • Coughlan, Mary.
  • Cregan, John.
  • Cullen, Martin.
  • Curran, John.
  • Davern, Noel.
  • de Valera, Síle.
  • Dempsey, Tony.
  • Dennehy, John.
  • Devins, Jimmy.
  • Ellis, John.
  • Fahey, Frank.
  • Finneran, Michael.
  • Fitzpatrick, Dermot.
  • Fleming, Seán.
  • Gallagher, Pat The Cope.
  • Glennon, Jim.
  • Grealish, Noel.
  • Hanafin, Mary.
  • Haughey, Seán.
  • Hoctor, Máire.
  • Jacob, Joe.
  • Kelleher, Billy.
  • Kelly, Peter.
  • Killeen, Tony.
  • Kirk, Seamus.
  • Kitt, Tom.
  • Lenihan, Brian.
  • Lenihan, Conor.
  • McDaid, James.
  • McEllistrim, Thomas.
  • Martin, Micheál.
  • Moloney, John.
  • Moynihan, Donal.
  • Moynihan, Michael.
  • Mulcahy, Michael.
  • Nolan, M.J.
  • Ó Cuív, Éamon.
  • Ó Fearghaíl, Seán.
  • O’Connor, Charlie.
  • O’Dea, Willie.
  • O’Donnell, Liz.
  • O’Donoghue, John.
  • O’Donovan, Denis.
  • O’Flynn, Noel.
  • O’Keeffe, Batt.
  • O’Keeffe, Ned.
  • O’Malley, Fiona.
  • O’Malley, Tim.
  • Parlon, Tom.
  • Power, Peter.
  • Power, Seán.
  • Roche, Dick.
  • Sexton, Mae.
  • Smith, Brendan.
  • Smith, Michael.
  • Treacy, Noel.
  • Wilkinson, Ollie.
  • Woods, Michael.
  • Wright, G.V.

Níl

  • Allen, Bernard.
  • Boyle, Dan.
  • Breen, James.
  • Breen, Pat.
  • Broughan, Thomas P.
  • Bruton, Richard.
  • Burton, Joan.
  • Connaughton, Paul.
  • Costello, Joe.
  • Cowley, Jerry.
  • Crowe, Seán.
  • Cuffe, Ciarán.
  • Deenihan, Jimmy.
  • Durkan, Bernard J.
  • English, Damien.
  • Enright, Olwyn.
  • Ferris, Martin.
  • Gilmore, Eamon.
  • Gormley, John.
  • Gregory, Tony.
  • Hayes, Tom.
  • Healy, Seamus.
  • Higgins, Joe.
  • Higgins, Michael D.
  • Hogan, Phil.
  • Howlin, Brendan.
  • Kehoe, Paul.
  • Kenny, Enda.
  • Lynch, Kathleen.
  • McCormack, Pádraic.
  • McEntee, Shane.
  • McGinley, Dinny.
  • McGrath, Finian.
  • McGrath, Paul.
  • McHugh, Paddy.
  • McManus, Liz.
  • Murphy, Catherine.
  • Murphy, Gerard.
  • Naughten, Denis.
  • Neville, Dan.
  • Noonan, Michael
  • Ó Snodaigh, Aengus.
  • O’Dowd, Fergus.
  • O’Keeffe, Jim.
  • O’Shea, Brian.
  • O’Sullivan, Jan.
  • Penrose, Willie.
  • Perry, John.
  • Quinn, Ruairí.
  • Rabbitte, Pat.
  • Ring, Michael.
  • Ryan, Eamon.
  • Sargent, Trevor.
  • Sherlock, Joe.
  • Shortall, Róisín.
  • Stagg, Emmet.
  • Stanton, David.
  • Timmins, Billy.
  • Twomey, Liam.
  • Upton, Mary.
  • Wall, Jack.
Tellers: Tá, Deputies Kitt and Kelleher; Níl, Deputies Kehoe and Stagg.
Question declared carried.

A message shall be sent to the Seanad acquainting it accordingly.