Dáil Éireann díospóireacht -
Wednesday, 18 Feb 2009

Vol. 675 No. 2

Nursing Homes Support Scheme Bill 2008: Second Stage (Resumed).

Question again proposed: "That the Bill be now read a Second Time."

Deputy Paul Kehoe

I appreciate the opportunity to speak on this Bill, which I welcome. However, we will oppose it on a number of bases.

I checked the Citizens Information website regarding nursing homes and found informative web pages. Were every nursing home to be of the standard referred to on that website, every elderly person in a nursing home would be happy. Unfortunately, that is not the case. The Bill tries to set certain standards, but I will address this matter later.

The care of the elderly is important because they are the people who built the State. Unfortunately, some are not being cared for as they should be. In some homes, they are being neglected. The Minister of State is aware of a number of the homes in question. Deputy O'Dowd deserves praise for the due diligence he displayed in going about his business highlighting the Leas Cross issue and many other cases in which the elderly were not looked after.

Like every Deputy, I visit nursing homes frequently, albeit not regularly. The minute I walk through a home's door, I can judge whether people are being cared for correctly. It is obvious when people are happy. Other nursing homes do not have nice surroundings and the people therein could be cared for much better.

I will compare public and private facilities. Some of my colleagues from County Wexford have already mentioned care of the elderly in the public geriatric hospitals in our county. For example, when I was elected to the House in 2002, I campaigned for the new St. John's Hospital in Enniscorthy. Thanks to my work and that of my colleagues, construction on the hospital is at an advanced stage in phase three. Given the care and attention provided in a public nursing home, there is a considerable difference between the public and private sectors. The care and attention afforded to patients at St. John's Hospital, as the Leas-Cheann Comhairle will agree, are second to none. However, I criticise the other care centres and geriatric hospitals in my county. While doing so would be expensive, the Minister of State could use St. John's Hospital as a template for every major town.

For example, although the top floor of Ely House, Wexford, is used to provide care for elderly geriatric patients, it is completely unsuitable for such a purpose as it is up four storeys. Although the care and attention provided by its staff are second to none, it is not a suitable facility for the care of the elderly. Deputy D'Arcy also referred to Gorey in this regard and the Minister must consider the care centres, facilities and hospitals that are available to the elderly in those locations.

Since becoming a public representative following my election to this House in 2002, I hear of subvention cases in my constituency office that are an absolute mess on a weekly basis. Some previous speakers have noted that one person may receive a particular amount of money while someone else, who lives down the road or perhaps is a relative of the first person, receives a different amount. The variation in the sums of money that people receive as subventions is amazing. As Deputy D'Arcy noted this morning, the amount of subvention often depends on whom one happens on within the HSE while making a case for the person concerned. Although the proposed fair deal should make a great difference in this regard, I fear the Minister for Health and Children is being shortchanged, in that a sum of €110 million was to be put aside for this purpose but it has been reduced to €55 million. The elderly will suffer because of this shortfall and this is one reason people are highly annoyed. While they welcome the Bill, people become annoyed when promises are made by the Government but shortfalls arise months later. Ultimately, the elderly will be affected.

I wish to raise a number of issues pertaining to subvention and Deputy D'Arcy referred to loose wording in the legislation this morning. I refer to an elderly person who goes into care but who has a son or daughter living in the house who is less than 21 years of age. Will this 21 year old be kicked out of the house when the person passes away and when the HSE looks for 5% of the property? A 21 year old may not have a job, as he or she could be a student or whatever, and will not have the money or financial support to give 5% of the holding to the HSE. Similarly, what of a case in which a disabled person, who was in receipt of disability allowance of some kind, lived in the house? No straight language is being used and this will cause enormous problems in the future after this Bill has been enacted. All Members have raised delays in subvention for families and huge delays have occurred. I have dealt with people in nursing homes who were admitted months before any major decision was made on their subvention claims. I already have mentioned the varying amounts that are being awarded and the existing shortfalls, which ultimately will hit the elderly.

I refer to respite for families. Undoubtedly, all Members are familiar with families being given grants for respite care for two weeks annually. This is very little to any family who cares for either an elderly person or one with a significant disability. Throughout the economic boom and for many years, the Government neglected this issue and people have been left without proper respite facilities. In my native county, I fight and make representations on behalf of constituents to ensure their families are being looked after, especially those with serious disabilities rather than the elderly. Two weeks in the year is not much to offer to a parent or guardian who cares for a child or an adult with a disability and this issue is not being addressed properly within this Bill either.

I also wish to raise the issue of sheltered housing. My native town of Enniscorthy has an excellent facility for sheltered housing for the elderly, which is run by a voluntary group. In many cases, voluntary groups and organisations have come together to try to put in place a sheltered housing facility. Although they do their best, they happen upon a complete brick wall in respect of the amount of red tape through which they are obliged to go. This has not been made any easier for them although sheltered housing offers an alternative, whereby people can have their own independence while living in a small community village in which doctors, care assistants and care facilities are available to them.

This is an excellent facility for elderly people and 90% of such facilities are run by community organisations. If more sheltered housing in our communities is to be encouraged, matters must be simplified for the community groups and other applicants. In the main, these voluntary organisations meet at night because those involved are in full-time jobs but, for the good of the community and for the care of the elderly, give up their free time to try to get such facilities up and running. However, they are not encouraged to so do by the red tape through which they must go with the Department when trying to draw down different stages of funding. This process could be made considerably easier for such groups to facilitate sheltered housing in their localities.

Previously, I referred to Deputy O'Dowd's role in highlighting neglect in the care of the elderly in some nursing homes. Regrettably, I do not believe sufficient progress has been made in respect of checking nursing home standards. Sadly, some nursing homes are still in a similar position to that which obtained in Leas Cross and other nursing homes that have been highlighted in recent years. Undoubtedly, some nursing homes are perpetrating the same neglect in respect of the care of the elderly. While this issue has been highlighted in "Prime Time" and so on, it is sad to encounter cases in which the elderly are being completely neglected, even though cash-strapped families are paying for their elderly mothers, fathers, aunts, uncles or the elderly in their households to be cared for in such nursing homes. While the best display always is made for the benefit of visitors, major work is still outstanding in respect of standardisation of nursing home practice nationwide when no visitors are present, during night-time care and when nurses or care assistants are on duty. Undoubtedly, given the tax incentives that were made available for the building of nursing homes in recent years, the standards that should be in place are not.

The Minister of State's closing remarks should outline to the House how the shortfalls will affect the implementation of this Bill. As for the care of the elderly in some public hospitals, the Minister of State should examine care of the elderly in Wexford and Gorey towns in particular because excellent facilities exist in New Ross and Enniscorthy. However, the Leas-Cheann Comhairle will agree that the Minister must examine the existing facilities in Wexford town and in Gorey, because families from the southern end of County Wexford travel 30 or 40 miles to visit their elderly family members in St. John's Hospital, Enniscorthy and people from the north of the county travel south to Enniscorthy.

Distance may no longer be the obstacle it once was but it nevertheless presents a significant difficulty for some of the relatives of patients in St. John's Hospital. If such patients could avail of care facilities in Wexford or Enniscorthy, it would be of great benefit to them and their families. The current economic situation undoubtedly presents significant challenges. However, there are also opportunities through public private partnership and other means by which the Minister may be able to explore the possibility of providing these facilities. Such a facility is an absolute necessity for Wexford town, in particular. Its provision must be fast-tracked.

I referred to the prospect of family members being presented with demands from the Health Service Executive and the Department for their share of the family home when the elderly person passes away. There are major faults in the Bill in this regard which must be clarified. The language must be more straightforward so that it is clear what will happen in cases where a relative is living in the family home. These people may include persons with a disability or other type of dependency who are cared for in the family home. Will the Minister of State clarify this aspect?

There remains an issue in regard to the standardisation of care in residential facilities throughout the State. While some people receive excellent care in privately-owned nursing homes, other facilities are getting away with providing an inferior quality of care. The elderly are the most important people in this State. It is they who built the State and raised our living standards to the level we enjoy today. This is an issue about which I have strong views.

Deputy Joe Costello

I am pleased to have the opportunity to contribute to the debate on this Bill. Not many of us on this side of the House agree with the Minister that the so-called fair deal lives up to its name. The Labour Party has major concerns about some of the unfair aspects of the scheme.

The purpose of the scheme is to provide for those requiring long-term institutional care. The legislation is explicit in stating that it is intended almost exclusively for the care of the elderly. Individuals will be assessed on the basis of their care needs and also on a financial basis, and the scheme will be administered by the Health Service Executive. As Deputy Kehoe observed, the legislation envisages a funding allocation of €103 million, but only half that amount will be made immediately available. In total, the estimated funding requirement is €820 million. Therefore, the scheme is labouring under a negative equity before it is even operational, despite the fact that we have been examining this issue for a considerable time.

Section 5 of the Bill includes an enigmatic reference to the capping of resources, with the implication that the scheme will come to an abrupt end if there are insufficient resources to fund it. This is a strange way to put in place a scheme that is designed to deal with long-term institutional care and has many far-reaching implications for the individuals concerned and their assets, ancillary services and so on. It is a strange statement to include in the legislation. Will the Minister offer reassurance in terms of the viability of the scheme, with reference to how the subvention is being put together and the issue of resources being capped?

The provision of long-term residential care is a critical issue. All Members frequently encounter constituents who are experiencing difficulty in accessing long-term care, respite care in their homes and so on. Families are doing their best to provide support and to finance the care needs of their elderly relatives. In fairness to the Minister, she has at least made an effort to deal with this issue. However, it is ironic that virtually everything the Minister has touched has turned to dust. She has not been successful in dealing with any of the issues she identified as requiring action when she assumed her Ministry almost six years ago. Her first action was to produce a ten-point plan to deal with the crisis in accident and emergency services. After six months she said the crisis could not be resolved in such a short timeframe and that she needed another year or two to address it. Six years later, she is still addressing the problems with accident and emergency services. Reports in yesterday's newspapers indicate that the situation has deteriorated substantially.

The basic issue of management has not been addressed. Accident and emergency services continue to operate in a dysfunctional fashion. I am well aware of what is happening in my local hospital, the Mater Hospital, where the situation is worse than it was when the Minister came into office. If, after six years, a Minister is unable to address what is essentially a management issue, we cannot be confident when she attempts to address something as complicated as long-term institutional care. There is little hope of her devising a solution that will be adequate in this case. All that is required in regard to the accident and emergency situation is to provide proper access to hospitals, proper treatment therein and proper discharge mechanisms. Patients are entitled to that but they are not getting it. This is not rocket science, it is merely a question of management.

The Minister made her first fundamental mistake in introducing the Health Service Executive in the manner in which she did before finding herself unable to modify it in a manner that might allow it to become a functional entity. Every effort she has made has worsened the situation. It is amazing to comprehend that in 2009, some 30 to 40 people are on chairs and trolleys in the Mater Hospital on a daily basis. In 2008, on average, 80 people were waiting to leave the hospital but could not do so because the Minister has done nothing to provide for step-down facilities, adaptation grants and so on. The Minister talks a good talk but she does not deliver.

The situation is similar in regard to the Minister's plans for co-located hospitals. She has made reference to 1,000 private beds being taken out of the public sector, thus increasing capacity for public patients. However, today's report by Goodbody Economic Consultants indicates a further 25% increase in the cost of private health insurance, which is expected to pay for the Minister's co-location plans. That is combined with a 23% increase since last November. In the space of four months there has been an increase of almost 50% in voluntary health insurance and very little to show for it, as well as the enormous annual budget given in this House to the health service. The situation regarding co-located hospitals is turning into a mismanaged exercise that will not provide extra beds but will simply mean that the subsidy goes to the private sector and ordinary patients in the ordinary hospital will lose out.

I would like the Minister of State to answer whether the private sector will pay the full costs of private health care in private hospitals. Will co-located use remain as a major subsidy to the private sector? Does the Minister of State mean what she says or is this another guise for tax breaks to the private sector in terms of property and profit that the Progressive Democrats ideology is so good at providing? An example of this is in legislation concerning the pensions levy. It is amazing that the private sector, in the form of private schools, will not be subject to the pension levy. The State provides the subsidy but staff will not be subject to the pension levy. An anomaly exists that the State has not bothered to address whereby the private sector receives a State subsidy that should be considered for pension purposes but is not being treated in the same fashion.

The Minister's grand plan for private health is fundamentally flawed because it exists on ideological grounds, which is part and parcel of the overall Thatcherite and Reagan economics and thinking. Everything private is good and everything public is bad. This results in the denigration and degradation of the public sector. The idea is that there is no such thing as society or social solidarity, therefore, everything that can be privatised is privatised. The concept of free education and universal free health does not come within the Minister's ambit. That is the fundamental flaw in her thinking. There is nothing in the Minister's book about a caring social order that requires universal health care to be provided by society.

This is why it is particularly inequitable that the current proposals single out the elderly. The elderly were singled out in the 2008 budget in terms of the loss of the medical card to those over 70. That was the Minister's first step towards balancing the books. The elderly have been targeted to an inordinate degree by this Minister as if they are a burden on the State that she is not prepared to tolerate. The Health Act 1970 makes provision for free health care but it is more honoured in the breach than in its implementation.

The elderly in need of long-term care are the new pariahs in our society. This includes the over-70s and the elderly who are in hospital, who are bed blocking as it is put by the HSE, and those in need of long-term institutional nursing home care. These people will be treated in a different fashion to any other sector of society in need of health care. Anyone else who requires health treatment is treated in the normal fashion but the elderly must be dealt with in terms of their means and their assets. That is the fundamental flaw in this argument.

However, from the Minister's point of view this is the strength of her position because she can avail of the assets before or after the death of the patient in institutional care. Let us imagine how cold and calculating this is. Anyone facing long-term care is also facing the family home being taken from the person, either before or after death, in deferred payment and the assets must be dealt with in such a way as to make payments according to the assessment of the HSE. In a caring social order this should not be part of the solution to a difficult problem.

The elderly have been singled out and it imposes an extra burden on them. They are now seen as problems and pariahs in society. They are a burden on their children and on their inheritance. Elderly people who want to see how this legislation will operate and what they will leave behind as their children's inheritance and legacy in their final days will see themselves as depriving their children the longer they live. This is what long-term institutional care will do under this legislation. It will make the elderly, in their own eyes, a burden on their families. Their health will deteriorate because they see themselves as part of the problem. That is the uncaring aspect of this legislation. It has a negative impact on the elderly, who see themselves as part of the problem rather than part of the solution. This is why Age Action Ireland and the Senior Citizens Parliament have expressed concerns about this legislation. On the one hand they see the benefit of it but on the other hand, they also see the human imposition and the damage that might be caused by it.

How is the scheme resource to be capped? There was an initial contribution of €103 million, which dwindled down to half that amount. The Government is reneging on its resource commitment. Is it possible that the scheme will run out of money? It seems that under the terms of the legislation the HSE is in a position to recoup sufficient funds from the estate of the patient through its financial assessment. However, the State does not provide further subvention. Is the State admitting that the capping is as a result of scarcity of resources and that it can pull the plug at any time if it does not wish to make a contribution? What are the implications for the HSE assessment and what are the parameters of the assessments of the individual's means? There are criteria and there is a formula. How far can they go and how far can they meet the failure of the State to fulfil its side of the bargain? There is a major question over this part of the scheme currently. If the money runs out, does the care run out? How robust is the scheme from the Department's perspective?

The question from the other side is what happens to the people who do not qualify for the scheme when they are not sufficiently dependent to meet the criteria. There are very few health care packages in the community currently as all that funding has dried up. If one operates with a local authority, one may find it very difficult to find one that is prepared to put any adaptation package together for a home, whether it is to adapt a bathroom or toilet or install a ramp for somebody who is seriously ill or in need of any kind of long-term care. The HSE does not seem to have the funding to provide the service either.

This is part of the reason there are so many bed blockers, as there is no integration of services for people coming out of hospital. The term "bed blocker" is terrible as it implies it is the patient's fault for blocking a bed. It is in the best interest of everybody to get out of hospital as quickly as possible after treatment. There are no step-down facilities in the community or adaptation grants available. There is no integration of services either — the biggest issue — because there is no line of communication between the HSE and any of the community-based services. Nobody bothered to establish it so the health service operates in a limbo.

Tax relief relating to nursing home care, as I understand from the latest budget, is now at a standard 20% rate rather than the previous rate of 41%. That will be detrimental to the earner's finances in providing care. All the nursing homes which come within the ambit of this legislation must be approved separately by the HSE. This will be a major issue because we have had so much fall-out from so-called approved nursing homes, which were not very well approved. We need a strong code of conduct, criteria and standards in this area. There are no provisions in the legislation dealing with approval, the criteria for the HSE to assess all the homes that will be approved and how to ensure that in the future, the level of supervision and monitoring will be up to the required standard for a service that is not currently provided.

Deputy Michael Ring

A number of my constituents have contacted me who are concerned about this Bill. Some were confused, others did not know what was proposed by the Government and some were very worried about what the Government would propose. Going back a very short time, I remember the Minister for Health and Children and the Government making big announcements relating to home care packages. In my county last year the programme had to be abandoned as no new applications could be accepted nor funding guaranteed this year for people who got the packages.

Elderly people are very worried about their future. With regard to home help, surveys have shown that many people would like to stay, be supported and die at home. The Government and the Minister have produced much talk but there is little action. This Government has let down the elderly, particularly with regard to home help and home care packages. Many people would love to stay at home and their families would support them if they got some back-up from the State.

As a practising politician I am contacted every day or weekend by somebody who cannot get support from the health authorities that they need. Nevertheless, Ministers issue press releases and programme managers are feeding the media, telling all the good news. It does not translate to action on the ground.

There are two or three points regarding nursing homes that worry me. I attended a meeting recently between representatives of the HSE and local representatives. One issue relating to care needs assessment is significant now and will continue to be significant in the future. Who will make that decision? We already have problems in the system where people may know they are not mentally or physically able to go home but a doctor may not think the person is entitled to a State bed. The person in question may have nobody to go home to or may require other support and may need and want the bed. The problem is the person in question will not get a bed because an assessment has been done. In future there will be more stringent assessments. There will be funding pressures on the system and a directive will be issued — we do not yet know who will do the assessment — to make the procedure as tough as possible in order to keep as many people as is required out of nursing home care.

Another issue relates to means. People are already confused about this and feeling pressure. Elderly people have made a contribution to the State and look forward to the State providing for, helping and protecting them in whatever way is possible in their last number of years. That is not happening and people are worried about it.

In rural Ireland there are many brothers and sisters and people who never married living together. If a brother or sister, or a mother or father, goes to a home, there may be family members living at home who are over 21. If the mother, father, brother or sister dies, such people would have to find funding for the State. Everyone here knows the pressure this will create for people who do not have the necessary resources.

Many people who have come to me over the past few months have put a lot of money away. Some invested in Anglo Irish Bank, Allied Irish Bank and Bank of Ireland. These were very bad decisions. These people were living off those investments and hoping that the money they had worked hard for and invested, which they gave to the banks, would be protected in their interest. We have seen what has happened in that respect.

Even if people's income, land or property value or shares were to be examined since this Bill came to the Dáil, one would find that every single one has devalued in the last number of months, with many at a crisis stage now. People have entered into agreements with private nursing homes and they do not know what will happen in the future. They are worried, nervous and afraid and they wonder what will happen to them or if they will be thrown out on the road.

I have discussed this before with Deputy James Reilly, who was a practising doctor before his election to this Dáil. Some people need to go into a nursing home because of medical or mental health reasons. People may have no loved ones or relatives at home. They may be feeble and they may feel the best place for them to be looked after is in a nursing home. They might fall under these criteria and find themselves in a position where their medical need does not match the case for them.

The Minister has indicated that this will not affect those people currently in nursing homes but we could go through all the promises made in the last election and the promises from the Department of Health and Children in the past ten years. We would tick them off one by one and find that the vast majority of them would have been broken or not carried through. Those in the Department of Health and Children, and the Minister in particular, speak well but do not deliver on the ground, which is part of the problem.

People pay their taxes, from which they get a PPS number, and work hard. They are beginning to wonder if they are a burden to the State and if it has any obligation to them. I am glad we oppose this legislation because it will not work and we will be back again to deal with the very serious problems in it. Elderly people who have put money away and who have to go into a nursing home will be under tremendous pressure, as will their families. They paid taxes all their lives and will pay death duty when they die. Now they will have a further death tax, which is precisely what this is. They will have to go through probate and if they die in a nursing home, they will have to pay a further death tax. This puts pressure on families. If there was help from the State, many people would not need to go to nursing homes or be dependent on nursing home care. This is anything but fair; it is unfair and will cause many problems. We will be back discussing this within two years if it is passed.

Many years ago, when Gay Mitchell was senior spokesman for Fine Gael and I was junior spokesman, I used to raise on a regular basis the idea of an inspectorate for public nursing homes. There is an inspectorate for private nursing homes but where is the inspectorate for public nursing homes? Even ten years later we have done nothing about this. People in public nursing homes deserve the same protection as people in private nursing homes.

I once raised a case in my constituency and received a lot of flak from the health board. I saw the conditions people were living in and I raised the issue in the Dáil, getting the health and safety inspectorate in and, lo and behold, the Western Health Board was able to spend £600,000 on the facility. The people on the ground knew I was right, even though the PR people did a clean up job and brought the local radio station down. They did not cod anyone though and in the following election I increased my vote by 500. At every house I was told that I was 100% right and that they were embarrassed when they went to see their loved ones in this facility. When people highlight problems they are lashed for it, but we want an inspectorate to protect our elderly.

There is an inspectorate for the Prison Service. No one will ever look for any taxes from someone who is in prison for life and they will not have to pay the State for their upkeep. They are well looked after and protected, there is no doubt about it. Our elderly people should be looked after, protected and assisted. If they have paid their dues to the State, the least we can do is look after them.

I compliment Deputy James Reilly on raising so many important issues in this Bill. I am concerned about our elderly. They have made a major contribution and it is serious that they have to worry about more taxes after their deaths, having paid taxes all their lives and provided for their care. Now it is possible that their homes must be sold and their families will not be able to inherit them because they will owe so much money to the State. There are many questions to ask about this Bill and I know Deputy Reilly will raise them on Committee Stage. In a perfect world, the State would provide a bed for everyone and although that is not possible, the State has a duty to ensure people who want to make a contribution to their own upkeep are supported and helped instead of taxing them after their deaths.

This Bill is not good legislation and it will not work. We will be back to discuss it again in the future. I would prefer it to work. I would like people to be assured that if they go into a State home or nursing home, they will not have to look over their shoulders, wondering if their resources will be taken and what will happen to their property and their families after they die. It is wrong and that is why this will be proven to be bad legislation.

Minister of State at the Department of Health and Children (Deputy Máire Hoctor)

I thank Deputies for their contributions to the debate — more than 40 Deputies spoke, an indication of the interest in this Bill that addresses the care of older people in the future.

As mentioned at the outset, the purpose of the Bill is to establish a new scheme which will equalise State support for public and private nursing home residents, ensure that long-term care is affordable and anxiety-free and that no one has to sell his or her home during their lifetime to pay for their care.

The Bill addresses the reality that two thirds of all nursing home beds are in the private sector and puts in place for the first time a uniform system of financial support for individuals in public and private nursing home beds. We have worked hard to ensure that this system contains strong safeguards not only for the care recipient, but also for his or her spouse or partner.

The new nursing homes support scheme, however, is only one component of the overall Government commitment to ensuring access to quality nursing home care for all who need it. While the new scheme addresses the issues of access and affordability, the new draft standards will address the fundamental issue of quality; I know many Deputies alluded to the standards in their contributions.

A core principle of the health service reform programme is to put the users of health and personal social services at the centre of the services. We must ensure the protection of residents, safeguard and promote their health, welfare and quality of life, and ensure that there is a focus on the dignity and autonomy of older people. These are the core objectives behind the draft national quality standards for residential care settings which are currently under consideration within the Department of Health and Children. Regulations will be required to underpin the standards and the Minister plans to approve those standards and have the necessary regulations in place in 2009.

As is evident, this is a time of great change within the nursing home sector. In 2009, for the first time, there will be a single comprehensive system of registration and inspection for all nursing homes — public, private and voluntary — and a single comprehensive system of financial support covering all nursing homes. Moreover, both systems have the nursing home resident firmly at the heart of their service.

This is also a time of great change within our population; life expectancy in Ireland is increasing. This longevity is something to be celebrated, but it also presents policy challenges which we must recognise. The latest statistics tell us that today 11% of people living in Ireland are aged 65 years or over. It has been estimated that this figure will rise to 20% by 2036, and to 29% by 2056. Thus, over the years ahead, our nation's age profile will change. It is now, while our nation is still young, that we must consider the long-term care services needed to support us over the next half-century and the funding model that, by virtue of financial sustainability, might ensure the long-term provision of such supports.

The fair deal represents a response to the immediate situation faced by private nursing home residents. The Government is also committed to further analysis to identify a financially sustainable funding model which will support the future infrastructure of all long-term care services, both community and residential. This work is critical to all our futures, both as the recipients of care services and as taxpayers.

I would now like to respond to some of the points raised by Deputies in the course of the debate. Unfortunately, there is not sufficient time to address all the issues raised.

There appears to be some concern regarding the care needs assessment and people of medium dependency. I emphasise that all current residents in approved nursing homes on the commencement of the scheme will be eligible to apply for State support regardless of dependency. They will not have to qualify under the care needs assessment.

The nursing homes support scheme, in line with Government policy, is based on the premise that long-term residential care is not an older person's first choice and should only be considered as a last option. As such, the scheme encompasses a care needs assessment to determine whether a person needs to be in long-term residential care.

The care needs assessment is holistic in nature. In addition to medical needs, it provides for a person's family and community supports to be taken into account, thus allowing for social factors to be taken into consideration. For example, a person who historically may have been classed as being of medium dependency, but who lives in an isolated area, may be assessed as requiring long-term residential care.

I have been asked to clarify a number of points in regard to the treatment of assets. First, there seems to be a concern that the HSE will have sole authority for valuing assets. This is not the case. The Bill provides that a person will submit a valuation with his or her application form. The HSE also has the authority to undertake its own valuation at its own expense. If a person is subsequently concerned about changes in the value of his or her property, he or she can seek a financial review from the HSE at any time during his or her stay in care.

Second, where a property has multiple owners, the financial assessment will only relate to the actual interest of the applicant or applicants in the property. Third, I would like to clarify that foreign property is not excluded from the financial assessment. The assessment takes account of all relevant assets, including foreign properties. However, it is not possible for the State to offer ancillary State support in respect of foreign assets. Ancillary State support, or the loan element of the scheme, can only be availed of in respect of Irish land-based assets.

Fourth, the repayment of ancillary State support will be the responsibility of the Revenue Commissioners. Revenue will only seek to recover moneys actually paid by way of ancillary State support in respect of the cost of care. However, in order to take account of the time value of money, the amounts will be adjusted in accordance with the consumer price Index. This is what is meant by the references to interest in Schedule 2 of the Bill. Where repayment is overdue or problematic, Revenue will have the power to apply interest or to apply its existing care and management procedures. However, in line with the provisions of the Statute of Limitations Act, the power of recovery will expire 12 years after the debt falls due.

On the issue of quality of care, the Leas Cross Commission of Inquiry has been raised in the course of the debate. I can confirm that the commission is due to report to the Minister for Health and Children at the end of March and the report will be published after consideration by the Minister. I wish to confirm that an applicant to the scheme has recourse to the Ombudsman. The latter can examine complaints against the HSE under the Ombudsman Act, as amended.

I thank Deputies again for their contributions. I look forward to the further Stages of this legislation at which time the views put forward will be considered in detail. I, therefore, commend the Bill to the House.

Question put.

The Dáil divided: Tá, 71; Níl, 66.

Tá

• Ahern, Dermot.
• Ahern, Michael.
• Ahern, Noel.
• Andrews, Barry.
• Andrews, Chris.
• Ardagh, Seán.
• Aylward, Bobby.
• Blaney, Niall.
• Brady, Áine.
• Brady, Cyprian.
• Brady, Johnny.
• Byrne, Thomas.
• Carey, Pat.
• Collins, Niall.
• Conlon, Margaret.
• Connick, Seán.
• Coughlan, Mary.
• Cregan, John.
• Cuffe, Ciarán.
• Cullen, Martin.
• Curran, John.
• Dempsey, Noel.
• Devins, Jimmy.
• Dooley, Timmy.
• Finneran, Michael.
• Fitzpatrick, Michael.
• Fleming, Seán.
• Gallagher, Pat The Cope.
• Gormley, John.
• Grealish, Noel.
• Hanafin, Mary.
• Harney, Mary.
• Haughey, Seán.
• Healy-Rae, Jackie.
• Hoctor, Máire.
• Kelleher, Billy.
• Kelly, Peter.
• Kenneally, Brendan.
• Kennedy, Michael.
• Killeen, Tony.
• Kirk, Seamus.
• Kitt, Michael P.
• Kitt, Tom.
• Lenihan, Brian.
• Lenihan, Conor.
• Lowry, Michael.
• McEllistrim, Thomas.
• McGrath, Mattie.
• McGrath, Michael.
• McGuinness, John.
• Mansergh, Martin.
• Moloney, John.
• Moynihan, Michael.
• Mulcahy, Michael.
• Nolan, M. J.
• Ó Cuív, Éamon.
• Ó Fearghaíl, Seán.
• O’Brien, Darragh.
• O’Connor, Charlie.
• O’Dea, Willie.
• O’Flynn, Noel.
• O’Hanlon, Rory.
• O’Keeffe, Batt.
• O’Keeffe, Edward.
• O’Rourke, Mary.
• O’Sullivan, Christy.
• Power, Seán.
• Smith, Brendan.
• Treacy, Noel.
• White, Mary Alexandra.
• Woods, Michael.

Níl

• Allen, Bernard.
• Bannon, James.
• Barrett, Seán.
• Broughan, Thomas P.
• Bruton, Richard.
• Burton, Joan.
• Byrne, Catherine.
• Carey, Joe.
• Clune, Deirdre.
• Connaughton, Paul.
• Costello, Joe.
• Coveney, Simon.
• Crawford, Seymour.
• Creed, Michael.
• Creighton, Lucinda.
• D’Arcy, Michael.
• Deasy, John.
• Deenihan, Jimmy.
• Doyle, Andrew.
• Durkan, Bernard J.
• English, Damien.
• Enright, Olwyn.
• Feighan, Frank.
• Ferris, Martin.
• Flanagan, Terence.
• Gilmore, Eamon.
• Hayes, Brian.
• Hayes, Tom.
• Higgins, Michael D.
• Hogan, Phil.
• Howlin, Brendan.
• Kehoe, Paul.
• Lynch, Ciarán.
• Lynch, Kathleen.
• McCormack, Pádraic.
• McEntee, Shane.
• McGrath, Finian.
• McHugh, Joe.
• McManus, Liz.
• Mitchell, Olivia.
• Morgan, Arthur.
• Naughten, Denis.
• Neville, Dan.
• Ó Caoláin, Caoimhghín.
• Ó Snodaigh, Aengus.
• O’Dowd, Fergus.
• O’Keeffe, Jim.
• O’Mahony, John.
• O’Shea, Brian.
• O’Sullivan, Jan.
• Penrose, Willie.
• Perry, John.
• Quinn, Ruairí.
• Rabbitte, Pat.
• Reilly, James.
• Ring, Michael.
• Sheahan, Tom.
• Sheehan, P.J.
• Sherlock, Seán.
• Shortall, Róisín.
• Stagg, Emmet.
• Stanton, David.
• Timmins, Billy.
• Tuffy, Joanna.
• Upton, Mary.
• Wall, Jack.

Tellers: Tá, Deputies Pat Carey and John Cregan; Níl, Deputies Paul Kehoe and Emmet Stagg.

Question declared carried.