Dáil Éireann díospóireacht -
Tuesday, 11 Nov 2014

Vol. 857 No. 3

Nursing Homes Support Scheme: Motion [Private Members]

Deputy Billy Kelleher

I move:

“That Dáil Éireann:

recognising that:

— the rate of growth for Ireland’s over-65 population is nearly double that of the EU as a whole;

— the number of over-65s is projected to increase by approximately 20,000 per year between now and 2021; and

— the number in the 80-84 age group is forecast to grow by approximately 20,300 people, or 29%, and the number of people aged 85 years and over will increase by 26,800, or 46%, between now and 2021;

noting that in July 2014 the Department of Health:

— briefed the new Minister for Health that these demographic pressures equate to an additional funding requirement of the order of €200 million per annum over the coming years;

— further briefed the Minister for Health that demographics indicate increased demand for long-term residential care; and

— estimated that it would appear that a minimum of an additional 7,600 beds for long-term residential care will be required between now and 2021;

further noting:

— that the 2014 Health Service Executive (HSE) Service Plan reduced funding for the Nursing Homes Support Scheme, ‘Fair Deal’, by comparison to 2013;

— that the HSE provided for 700 fewer placements under ‘Fair Deal’ in 2014;

— the consequent increase in both the numbers waiting for a nursing home place under ‘Fair Deal’ and the time spent on the waiting list;

— that in February 2014 there were 654 people waiting four weeks to get financial approval for ‘Fair Deal’ support; and

— that in October 2014 there were 2,182 people waiting 15/16 weeks to get financial approval for ‘Fair Deal’ support; and

calls for:

— the 2015 HSE Service Plan to reverse the reduction in support for ‘Fair Deal’ implemented in 2014; and

— long-term residential care to be adequately resourced to take account of demographic changes.

I will share time with Deputies Seán Fleming and Barry Cowen.

This motion, in the name of Fianna Fáil Deputies, is about the nursing home support scheme, commonly known as the fair deal scheme. It recognises that the growth in the number of people aged over 65 years in Ireland is almost double that in the EU as a whole, and that between now and 2021 the number of those aged over 60 years is projected to increase by approximately 20,000 per year; the number of those aged between 80 and 84 years is forecast to grow by approximately 20,300, or 29%; and the number of those aged 85 years and over is forecast to increase by 26,800, or 46%. The motion also notes issues with regard to the Department of Health in July 2014.

We must start with where we are now, when more than 2,100 people have been waiting 15 weeks or more to be assessed and granted a nursing home bed through the fair deal scheme. This is an indication of extremely bad planning at the very least. One could also say it is heartless policy. This did not come about by accident or without the Government being aware it would happen. Many people on this side of the House, those involved in advocacy groups, professionals catering for people who need nursing homes and those who provide nursing homes forewarned this would happen. It was highlighted as far back as last year when the budget for the HSE service plan for 2014 was announced, which stated the number of beds would be reduced by up to 700 during the year.

At present only 22,061 beds are available for the fair deal scheme in 2014. This has decreased by 700 since last year as a direct result of the intended policies of the previous Minister for Health for dealing with funding for the nursing home support scheme. This was forewarned and foretold. I will read the figures into the record because they are stark to say the very least. One must bear in mind that behind every figure is an individual and a family waiting for approval from the HSE for a nursing home support bed. The number of people waiting to access the fair deal scheme has seen a fourfold increase since the start of the year. In January 2014, 512 people were awaiting funding and approval was taking four weeks. In February 2014, 654 people were awaiting funding and approval was taking four weeks. In April 2014, 913 people were awaiting funding and approval was taking six weeks. In May 2014, 1,265 people were awaiting funding and approval was taking seven to eight weeks. By June this had climbed to 1,465 people awaiting funding and approval was taking 12 weeks. By September 2014, 1,753 people were awaiting funding and approval was taking 14 weeks. By October, 2,114 people were awaiting funding and approval was taking 15 weeks. In nine months we went from the wholly unsatisfactory situation of 512 people awaiting funding and an approval time of four weeks to where we are now with more than 2,100 people waiting 15 weeks or more for approval.

It is often said inside and outside the House, and rightly so, that we judge society by how we care for older people. By any stretch of the imagination this record shows the Government has steadfastly refused to put in place funding to ensure older vulnerable people can have the dignity of being assessed in time to be approved for a nursing home support bed. They are not asking a lot after many years contributing to society. At the end of their time they should not have to wait an inordinate length of time to be assessed. A wait of 15 weeks for a bed to be organised puts a burden on the individual waiting for assessment and approval. It has an impact on families. Deputies are approached by huge numbers of people at their wits' end because they are liable for increased nursing home costs in advance of receiving a bed under the scheme. They cannot wait for the scheme; they need the bed today, tomorrow or next week and not in 15 weeks time, as is now the case because of the policies pursued by the Government.

We can finger point and blame all we like, but this is down to priorities. Funding was diverted from the nursing home support scheme to community care and home care packages. People outside the House have referred to this on many occasions. Money is being taken from one cohort and being given to another, but this does not mean the waiting list for the nursing home support scheme is being reduced because those on it do not necessarily require home care packages and increased home help hours. Home care packages themselves should be funded. The number of home care packages available has increased by 20%, but there is no direct correlation between increasing the number of home care packages and reducing the number of people waiting for nursing homes or high support units. This increase has not led to a corresponding decrease in the number of people waiting for assessment and approval for the fair deal nursing home support scheme.

There is time for the Government to rectify this. It has from now until the publication of the HSE service plan. We must see an increase in the amount of money available to the nursing home support scheme. If this is not done we will start 2015 with more than 2,000 people already waiting since this year and an escalation of the numbers in 2015. Nothing in policy or recent comment from the Government, Ministers or the HSE indicates a concerted effort to try to address what is now a crisis in the fair deal scheme.

Four years ago the now Taoiseach and then Leader of the Opposition, and the former Tánaiste and then leader of the Labour Party, stood on a truck on Molesworth Street and spoke very passionately about the need for us to ensure older people had all supports available to them.

Deputy Barry Cowen

Hear, hear.

Deputy Billy Kelleher

The echo from Deputy Enda Kenny at the time was shame on the then Government, with regard to the change from automatic entitlement to a medical card for those aged over 70 to a means test which set the benchmark at €1,400 per week. This has been reduced to €900 per week for a couple, which is having a devastating impact on older people. Day in and day out people highlight that they are losing their medical cards. They are being stripped of them by the thousand. In the past month alone approximately 7,000 medical cards have been taken from those aged over 70. They tell me quite clearly they feel betrayed with regard to what was said and the commitments made some time ago and what is being done now. Most of these people must pay the first €144 per month for medicines and medication, which is having a huge impact on the quality of life of many people. Coupled with the gratuitous insult to older people that they must wait up to 15 weeks to be cared for in a nursing home, it is an indication the words shouted on Molesworth Street four years ago were not words of passion but weasel words, because nothing in Government policy over recent years indicates it cares one whit for older people.

While the Government set great store by the fact that it maintained the rate of pension payment, all the ancillary services have been denuded and cut away. The cull of medical cards at an alarming rate indicates the Government has lost any compassion it had in terms of looking after older people in their time of need.

I was going to speak about the problems of the country's changing demographics. In the coming years the number of people aged over 65 will grow exponentially - the age cohort that will need nursing home support. On average, 4% of the population will require nursing home support at some stage. We are well off that mark in terms of ensuring we have enough nursing home beds in coming years to cater for the increased demand. There seems to be no strategic planning to increase the number of nursing home beds. The audits on public nursing homes, which need to comply with HIQA guidelines by 2016, indicate that the vast majority of them will not meet those guidelines. Up to 90% of them will not quality given the requirement for single or dual occupancy with en suite services and facilities, which is not available in public nursing homes at present.

Major capital investment is required in coming years. However, my immediate concern is that the Government cannot even plan for the week ahead or the month ahead. It certainly did not plan for this year in the budget the Dáil passed last year. We repeatedly highlighted that the amount of money available for the nursing home support scheme would not be able to sustain the level of demand for this year. That has been proved by the figures I have outlined - we now have more than 2,100 waiting for 15 weeks.

I know that the Minister of State, who has responsibility for older people, does not want to see this happening. We tabled the motion tonight to ensure that the senior Minister and his Cabinet colleagues will provide the necessary funding. That can be done by prioritising within the budgets already set. One could even leave aside the impact it has on an individual and just look at it coldly and clinically from the point of view of the impact it has on the acute hospital system and the fact that 700 people are in hospital beds throughout the country who cannot be discharged because no step-down or nursing home facilities are available to them.

Last night Cork University Hospital had over 60 people who should and would have been discharged but that there was nowhere for them to go. At the same time there are queues at outpatient appointment clinics and for elective surgery. Every week those numbers escalate at an alarming rate. The throughput in our acute hospitals is being stymied because of the inability to discharge owing to the lack of step-down and nursing home facilities. Even if the Minister of State were to park the compassionate and humanitarian side and to look at it coldly, clinically and dispassionately, the Government is pursuing a false policy.

I do not expect the Minister of State to come in and defend the previous Minister. However, last year the Government decided that the budget would be capped at a lower rate than applied in 2013. By dint of that decision the Government was certain to find itself in the position in which we now find ourselves. It was foretold well in advance. All the Minister of State needed to do was to look at the demographic trends. Anyone should have known that we would be facing a crisis in October, November and December this year. However, it is not the Government that is facing the crisis, but rather the older people who depend on the State. These people, who have made a contribution and will also make a contribution to that care through the fair deal, are the ones who are in crisis. They are the people who are suffering most. If no more comes of this Private Members' motion tabled by the Fianna Fáil Deputies, at least the Minister of State should go back to her Cabinet colleagues and point out that she can no longer stand over what is happening to people every day in terms of supports for people who now need them.

When we look at what the Government has done in other areas of supports for older people, while the words are expressed eloquently and there seems to be a compassionate verbal outlook, nothing in the Government's policy convinces me other than it has prioritised other groupings that do not need the State's support as much as older people over those who need it. While it is a harsh thing for me to say, when I come in here every week I genuinely believe that the Government, particularly the Fine Gael element of it, seems to be focused on focus groups and poll results to find out where it will alleviate the burden on people and where it will place additional burdens. It seems that older people have fallen into the category of "to hell with them" based on the Government's policies across all Departments. Deputy Sean Fleming just spoke about this in the social welfare area as well. The Government set great store by the fact that it preserved the level of pension payments, but what about all the secondary benefits and the whittling away of those that were build up over many years?

This motion calls for the 2015 HSE service plan to reverse the reduction in support for the fair deal scheme implemented in 2014 and long-term residential care to be adequately resourced to take account of demographic changes. The Government's term has approximately 17 months remaining. I know the Minister of State is committed to older people. However, we now need the Minister of State to convince the Cabinet to address immediately two priorities facing us: the 2,100 people waiting for 15 weeks for approval and also the longer-term strategy to ensure that in years ahead, older people will not be waiting a very long time to get a nursing home place - or maybe not able to get a nursing home place at all. We need policies in terms of planning and incentivisation to ensure we have adequate nursing homes in the years ahead.

All the statistics are there and many reports have been carried out by various organisations, some of them with an interest in this area, but others completely impartial and looking at this in a dispassionate way. They highlight the inadequacies in terms of how policy makers act to ensure we will have extra nursing homes in the years ahead.

We did not table this Private Members' motion simply to embarrass a Minister of State and throw a few verbals across the floor. We tabled it because there is a crisis in our communities. Families are at their wits' ends. We have come across families who have had no choice but to place a family member in a nursing home and make the contribution while they are awaiting approval. They are being billed extraordinary sums because they have no choice. That is wrong and it is up to the Minister of State and her Government colleagues to act on that to ensure that adequate funding is provided. We tabled the motion to ensure the reversal of the HSE service plan, which contains all the necessary detail for this area.

That will always highlight the deficiencies of Government policy and the difficulties that will be faced by certain cohorts of the population. Last year was no different. It was evident from the get go that not only would the overall budget be in crisis as the HSE faced a budget deficit of approximately €500 million, but there would be a deficiency of funding under the nursing homes support scheme with large numbers of people having to wait extraordinary durations to be assessed and approved for a nursing home place. That is wrong and unfair. It is inherently indecent to ask people who are often near end of life and their families to go through this trauma. I commend the motion and I hope the Minister at least acts on its spirit to ensure we do not have this problem next year.

Deputy Sean Fleming

I thank Deputy Kelleher for tabling this important motion regarding the care of the elderly and, in particular, the fair deal scheme. As he stated, everybody should recognise that the rate of growth for Ireland’s over 65 population is almost double that of the EU as a whole and the number of over 65s is projected to increase by approximately 20,000 per year between now and 2021. That speaks volumes and should set alarm bells ringing to identify the task that needs to be addressed in caring for the elderly, especially those who require access to facilities under the nursing homes support scheme. A minimum of an additional 7,600 beds for long-term residential care will be required by 2021. Important work is taking place in the community and that is the other side of the house in the context of the operation of the HSE. I have never witnessed another organisation with two separate silos similar to hospital services and community services. Last week, the Minister for Public Expenditure and Reform talked about people working together and getting out of the silos, including all the Secretaries General, Departments and the HSE. However, there is a strong silo mentality even within certain Departments and this needs to be eliminated.

This year, the HSE service plan reduced funding under the fair deal scheme by comparison to 2013 and provided 700 fewer placements under the scheme this year. That is the reason problems are being experienced. Deputy Kelleher pointed out that at the beginning of the year approximately 500 people were waiting to have their applications approved under the scheme. However, it is not a question of having one's application approved. One is approved and informed where one is on the list. One then has to wait for the funding to come through. The average waiting time is 16 weeks but the majority of cases I deal with take up to 20 weeks. That means that a few applications might get through quickly in some parts of the country where people might be lucky but in other parts it means people must wait at least 20 weeks.

The final paragraph of the Government's amendment states the review of the scheme, which is under way, will consider the future funding and sustainability of the scheme as well as how community and residential services should be balanced. The review will be completed in the coming months, following which the Government will consider how best to meet the needs of older people in the future. It is important that the Minister talks to the service providers and people who run nursing homes as part of the review because they provide the front-line service. I have met a number of them over recent months and they feel they are being locked out of the consultation process that is required. They have been told they will be informed about the details but they are being treated like subcontractors. However, these are the people the families of Ireland, and not just the Government, are relying on to provide places. The Government has tried to outsource the provision of care of the elderly to the private sector in nursing homes over the past few years rather than providing care through the State and HSE services, which used to be the case historically.

People are not looking for something for nothing. When the scheme was introduced, applicants had to pay a 5% contribution for up to three years. They could pay 15% of the cost of their care or it could be deducted from their estate when they passed away. The contribution was increased to 7.5% some time ago, giving an overall contribution of 22.5%, which means it has increased by 50% over the past few years. It is as if the Government is using the access to the additional money that has been made available as another reason to cut the HSE's budget and that is not fair. The stress for families and their elderly relatives is enormous. The problem this has created is people are being kept in hospital beds because there is nowhere to discharge them.

I blame the Economic Management Council and not the Minister or the HSE for the budget cutbacks introduced by the Department of Health and the HSE. The council cuts the daylights out of the HSE budget every year. When the executive went over budget, the Minister came back to the House with a Supplementary Estimate. The same has happened this year with approximately €600 million required. If one planned properly, one could achieve a more even and consistent outcome throughout the year. The Minister not only needs to reverse the cuts introduced this year, but to provide additional funding to address the increasing numbers of elderly people trying to access the scheme.

I could not believe the Minister when I participated on an interview panel with him on RTE television a few weeks ago. When the presenter asked why he was not providing more funding, he replied that the budget is capped. It was almost as if he had nothing to do with it. He is a member of the Government that capped the budget. On live television he said it had nothing to do with him because the budget is capped. Thankfully, the Government had choices in the budget which is one the of the first times in recent years it had the opportunity but it chose to give tax increases to higher income earners. That is where the Government parties went wrong in the budget. Everything that has flowed from it has been wrong. As I said during the debate on the Social Welfare Bill half an hour ago, the budget can be summarised in one simple sentence. When I was asked the day after the budget what was in it, I said it was simple. If one is in a household with an income of in excess of €70,000, one will be better off but if one is in a household with an income of less than €800 a week, one will be worse off.

I refer to the story of one family to illustrate the silo mentality in the HSE. I was contacted by a family who brought an elderly relative into hospital two weeks ago. She was weak and the staff in the accident and emergency department were fearful that the family would leave her in there overnight because a number of people were sleeping there while other elderly people who should have been discharged were on the wards upstairs. The staff told the family that they needed to contact the community health nurse, have a hospital bed installed in their house and seek home help. Are these staff living in the same world as the rest of us? It is next to impossible to secure these services at local level but the staff just wanted the elderly woman out of the building because they could not cater for any more elderly patients. This is the result of the reduction in the number of places.

I visited the accident and emergency department in Naas General Hospital last Thursday. I could not get in the door because trolleys were lined up end to end on both sides of the corridor. The unit was a fire risk, a health and safety risk and so on because it was so full. There is such overcrowding that elective surgery ceased in the hospital last month, which has caused chaos. This is because people have nowhere to be discharged. The Government's solution on budget day was to give a tax cut to the wealthy, which will trickle down and help old people if they live long enough.

I refer to another classic example, about which the Minister of State will be well aware. Two or three years ago I was thrown out of the House for raising the issue of Abbeyleix Hospital, which had 30 patients at the time while having a 50 bed capacity. The hospital has been run down and there are only a few respite care patients using it now. The same happened in St. Brigid's Hospital, Shane, County Laois.

There are many facilities throughout the country which, with a little investment, could not only cater for the small number of respite patients they have but up to an additional 50 patients. With a little investment the two institutions referred to could be brought up to HIQA standard. The decision must be made to keep these units open. If the only patients in these units are respite patients then the decision will be made to abolish respite care some Monday morning. We know that is the plan, which is senseless given the lack of beds in the private sector for elderly people.

I am asking that the Minister of State confirm that the unit concerned will remain open and that Abbeyleix Community Hospital and St. Brigid's Hospital, Shane, will be upgraded as soon as possible. The people about whom we are speaking are in the main elderly and they should be treated with dignity and respect. We all know that one can judge a society by how it treats its elderly people. By that criterion, this Government is not passing any test.

Deputy Barry Cowen

I thank Deputy Kelleher for bringing forward this motion. Following receipt of many representations from families in my constituency on this issue, I raised it some six or eight weeks ago with the Minister by way of Topical Issue.

As stated by Deputy Kelleher, this is unfortunately a real crisis borne out of a financial or accounting trick which has blown up in the face of Government. It is, unfortunately, deplorable that the Government would allow this crisis to develop and thus target the sickest and most vulnerable elderly people in our society. I was puzzled, amused and amazed to hear the Minister, Deputy Varadkar, when questioned about this issue here and in the public domain blame the budget cap. Who set the budget cap? Was it not the Minister and his Government? Who is responsible for the budget cap? Is it not the Minister and his Government? Who is accountable? The Minister and this Government are accountable for the way in which they spend taxpayers' money, the manner in which they set caps across the board and the way in which they deliver services to society. The Minister and the Government can supplement the budget cap and rectify the wrong now that it has been exposed.

Under this Government waiting lists in respect of the fair deal scheme have tripled in one year. We have the figures to prove this - I am sure the Minister of State is well aware of them - by virtue of responses to parliamentary questions tabled in recent times. These figures range from 280% in respect of counties Limerick, Clare, north Tipperary and east Limerick to 300% in many other counties, including Offaly and Laois. This is one of the greatest sins of this Government. The continuing procrastination by Government must stop. The people need to understand that the Government is spending more money on keeping elderly people in hospitals than it would cost to have them placed in nursing homes. It should be noted that this Government has also made a conscious decision not to pay applicants from the date of application but from the date of approval, which is 14 to 16 weeks later. There is wide acceptance among the general population that many people cannot afford to pay the property tax and impending water charges yet this Government expects these people to fork out up to €14,000 over 12 to 14 weeks.

Earlier today, I surveyed the nursing homes in Shinrone, Birr, Banagher, Ferbane, Clara and Tullamore. There are up to 30 beds available at these units awaiting fair deal applicants, most of whom are currently in acute hospital beds. It costs €750 per day for a hospital bed and €750 per week for a nursing home bed. The cost per week in my county of keeping these people in hospital is €135,000. Over 15 weeks, this amounts to €2.125 million. If these people were in nursing homes the cost would be €675,000. The wastage in my county under this scheme is €1.45 million, the majority of which I expect is attributable to Tullamore Regional Hospital. This wastage could be used to support house adaptation grant applicants in Offaly. I understand there are 70 people over and above the 30 people already referred to in my county who are awaiting approval under this scheme and have been told that approval may take up to five years. If that money was used in this area - I understand the average grant is €15,000 - there would be further savings of €15 million in my county of Offaly. These people are being told by the local authority and, by association, the Government that they must wait five years for approval of applications yet the cost associated with fair deal for them in respect of those five years, by virtue of the fact that they cannot adapt their homes, would be €15 million. That is the new politics that is prevalent in this country today, in the greatest small country in the world in which to do business.

The facts of the matter are damning. This Government is overcrowding hospitals when it does not have to do so. It is penalising jobs in nursing homes and crippling families who cannot cope with the expectations on them. This Government is depriving the elderly of a dignified, caring and fulfilled existence and is, by virtue of the example of what is happening in Offaly, wantonly wasting taxpayers' funds. It is penalising quality nursing homes and removing the prospect of economic activity in communities by virtue of the delay in processing house adaptation grants. It is not allowing those that might have had the possibility of remaining in their homes and communities the opportunity to do so. There is no getting away from the facts in this regard. Some form of joined up thinking would address those issues but this Government is failing to do so and continues to waste money.

This motion had to be tabled in order for people to realise what is happening across the country. It pains me to say, as I am sure it pains the Minister of State to hear, that this scheme has been discredited and demeaned. It is time, now that this Government has been found out, that it was put right. People should not be taken for fools any more on this issue. I am conscious when saying that of the explanation that has been offered, which is very lazy one, namely, that this is the fault of the budget cap. The Minister of State's colleagues and the Government set the budget cap. They are responsible for the budget cap. They have an obligation to meet the demands of this scheme. Next time the Taoiseach wants to tell people throughout the world that this country is, as I said earlier, the greatest small country in the world in which to do business he better be conscious that it is not the greatest small country in the world in which to grow old gracefully as one will be deprived of the services associated with that in the absence of one's family being able to afford them. I commend the motion.

Minister of State at the Department of Health (Deputy Kathleen Lynch)

I move amendment No. 1:

To delete all words after “Dáil Éireann” and substitute the following:

"recognising that:

— the Government is very aware of the future projections and of their implications for services and supports for our future older population, this includes not only residential provision but also community and home based supports; and

— people should be supported in the care setting that is appropriate to their needs and that most older people prefer to stay in their own homes and communities for as long as possible; it is incumbent on Government to take account of this in decisions on how services and supports are structured;

and acknowledges that:

— in 2014 the budget for the Nursing Homes Support Scheme is €939 million and this is supporting over 22,000 people in residential care; the budget for community services is €315 million and this is providing home help and home care package services to some 56,000 people at any one time; and in addition community and home based supports were strengthened in 2014 by a further €23 million to allow more people to stay in their own homes for longer;

— in July this year the Health Service Executive (HSE) allocated €5 million for an initiative to improve access to appropriate care for older people; to date, this has funded over 300 transitional care beds for patients in acute hospital from the placement list for the Nursing Homes Support Scheme and over 200 home care packages to assist patients in the acute hospitals who require a home care package to be discharged;

— the Government has provided additional funding of €25 million in 2015 to address delayed discharges, which will include provision for an increased allocation to the Nursing Homes Support Scheme; planning for this initiative is well advanced; and details will be finalised in the HSE’s Service Plan later this month, with a view to their early implementation; and

— the Review of the Nursing Homes Support Scheme, which is currently underway, will consider the future funding and sustainability of the scheme as well as how community and residential services are balanced; this Review will be completed in the coming months, following which the Government will be considering how best to meet the needs of older people in the future."

I wish to share time with Deputies Patrick O'Donovan and Pat Deering. Deputy Kelleher and I represent the same constituency and in my view we have virtually the same approach to politics in that we usually play the ball rather than the man or woman. I do not normally engage in this House in bandying around insults. I am very solution-focused. Where I see a problem I try to find a solution. The contributions of Deputies Fleming and Cowen were very hard to stomach. That they can come in here and say that they cannot accept that as the Minister for Health said this problem arises because of a cap on the budget, as if somehow Fianna Fáil had no part to play in the collapse of the economy and this country, which, by the way, has led us to this point, is amazing.

It is amazing but Deputy Barry Cowen's expertise with figures was greatly missed by the last Fianna Fáil-led Government. Do any of them remember the Minister for Finance, Charlie McCreevy, who told us all that we were pseudo pinkos and to party on? At long last we have a plan in place to deal with the demographic issues which are coming down the line. We knew all of this in 2005-2006 when the Fianna Fáil-led Government was awash with money and did not know how to give it away. Where was its planning? Where is Fianna Fáil's health strategy now? As far as I can see, it does not have one. It is all about this awful Government. This awful Government has steadied the ship which Fianna Fáil managed to hole below the water. If there are difficulties in this economy and we do not have enough money to put things right, Fianna Fáil is part and parcel of the reason for that. A friend of mine used to say to me: "If Fianna Fáil can go out and knock on doors with that brass neck, surely you can." I concur with that. It is very difficult to listen to this kind of claptrap from Fianna Fáil.

I genuinely thank the Deputies for raising this serious issue, with which we must deal, and for providing me the opportunity to highlight some key elements of our approach to the care and support of our older people, in particular the issues around the nursing homes support scheme. The budget for the health service in 2014 was €12.7 billion. For 2015, there will be an increase in Exchequer funding of €305 million, bringing the Exchequer contribution to more than €13 billion. Further once-off revenue measures of €330 million will also be available to support services. This means that there will be an increase of €635 million in current spending for the health services compared with the start of 2014. The total capital budget for 2015 will be a further €382 million. Notwithstanding the additional resources in place for next year and the improving economic environment generally, it is important to remember that resources remain tight and many areas continue to face real challenges in meeting the demands on their services.

Those over 75 years of age and especially those over 85 years of age tend to have the biggest health care needs and the greatest dependencies. The HSE provides for the care of older persons through both community services and the nursing homes support scheme. Care is provided through a variety of community supports, specialist services and long-stay residential care.

From the community perspective, the main supports available are the home help service and home care packages, the budget for which is €315 million in total. The traditional home help service consisted of domestic chores, such as help with cleaning and cooking. In recent years, however, the emphasis has been on assisting with personal care. In 2014, the HSE will provide approximately 10.3 million home help hours which will benefit more than 50,000 clients. The service is not means tested and allocation of hours is based on need and availability of resources rather than ability to pay, which is how it should stay.

In addition to mainstream home help, home care packages are provided to persons with higher dependency levels who require a higher level of assistance. A home care package will assist with personal care, such as bathing and dressing, as well as more medical-type care, such as nursing and physiotherapy. These packages facilitate clients to remain at home for as long as possible.

Home care packages are provided within the budget available each year. In 2014, 10,870 people were targeted to receive a home care package at any one time. At the end of August 2014, more than 13,000 persons were in receipt of a home care package, which is 20% ahead of target and despite the tight resources.

The nursing homes support scheme is the focus of this motion. Despite what Deputy Barry Cowen said, I believe this an excellent scheme introduced by the previous Government. This scheme provides financial support for those who need long-term residential care. Residents contribute according to their means with the State paying the balance. It is worth highlighting that the State contribution is normally the greater part of the total cost. More than 22,000 people are supported under the scheme, which has a budget of €939 million this year. This is a massive commitment by the taxpayer to the welfare of older people.

The population under the age of 65 years is expected to grow by 1% between 2014 and 2017, while the population aged 65 years and over is expected to increase by 10% during the same period. The Government is very aware of these future demographic projections and of their implications for services and supports, both residential and community-based, for our future older population, but we knew this ten years ago.

The fact that more of our people can expect to reach old age should be seen as a great achievement and something to be celebrated. Not only are people living longer but they are staying healthier and living better for longer. Society is already benefiting and this will continue and increase in future. Voluntary organisations will gain volunteers, grandparents will have more time to spend with their grandchildren and businesses will expand to cater for older people. There are new opportunities.

There is also a challenging side to this demographic change. Older people have more need for supports and services and we are already seeing increases in demand for health and social care services, in particular for those most specifically relevant to older people. The number of people with conditions like dementia will increase significantly. It is estimated that there are 47,000 people with dementia in Ireland. These numbers are expected to increase significantly in the years ahead, with a projected growth to more than 140,000 by 2041. As a result, the programme for Government for 2011 to 2016 committed to developing a national Alzheimer's and other dementias strategy to increase awareness, ensure early diagnosis and intervention, and develop enhanced community-based services which was long overdue. This strategy will be brought to Government shortly for approval. In the interests of social cohesion and of older people themselves, resources will have to be deployed efficiently and services will have to be well designed and thought out. It is too simplistic to suggest we can solve the problem by a straightforward expansion of services across the board, in line with projected increases in demand, as suggested in the motion. It would be extremely expensive for future Governments and taxpayers, but even if the resources could be found, it would be the wrong thing to do.

Some older people will always need long-term care while many will need it for some period in their lives, and we must try to meet this need where it exists. Older people consistently say they want to stay at home in their familiar surroundings, within their communities, and to retain their independence. Mary Harney was the first person to say that and it certainly rang true, and it still does. We must look at the future in a more nuanced way and in a way that is open to new approaches.

The single assessment tool, which will provide a consistent basis for assessment of need and allocation of services, is in development by the HSE and is expected to become operational by the end of 2015. This will be of benefit across all care approaches to ensure that need is accurately and consistently assessed and that we provide what is needed in so far as this is possible. Community supports are provided and are being developed further, and increasingly it will be necessary to direct our focus into community and alternative models of care for older people. This means providing a range of flexible supports, including better home supports, increased use of technology, supported living models and quality residential care, both short-stay and long-stay. All of these services contribute to support the person in their journey of care.

For example, there is clear evidence that greater access to rehabilitation services both within hospital and community settings can lead to better outcomes for older people. Short-stay and rehabilitation beds are another important element. Telecare services and the use of technology have been developing for some years and are now widely recognised as enabling people to remain in their own homes as opposed to entering long-term care. The range of technologies and services available, such as mobility aids, sensors and alarms, can assist in ensuring the wishes of older people to remain at home can be facilitated for as long as possible.

International experience suggests that new residential models that would bridge the gap between independent living at home and full-time nursing home care should be considered. The contribution that supported housing schemes, which are linked to appropriate community care services, can make to the welfare of older people is widely recognised. These assisted facilities can also provide rehabilitative care to older people following a hospital stay. The issue before us this evening revolves around the nursing homes support scheme which supports residential care. To match the funding available at any given time to demand, the HSE operates a national placement list. All applicants who are approved for funding are put on this placement list in order of their approval date. Funding issues to applicants in this strict order to ensure equity nationally. Unfortunately, it can happen that demand exceeds the amounts of funding that can be released, and in these circumstances waiting times get longer. This has been an issue during 2014, and the current waiting time is about 15 weeks, with 1,993 people on the list awaiting release of funding. That has changed because as of today the HSE has released funding for an additional 180 new places. The figure is not low enough yet but we will get there. In July 2014, the HSE allocated €5 million for an initiative to improve access to appropriate care for older people. To date, this has funded over 300 transitional care beds for patients in acute hospitals who are on the scheme's placement list and over 200 home care packages to assist patients in the acute hospitals who require a home care package to be discharged. We moved €23 million. We did not take it from one cohort and give it to another. We used it for the same cohort of people and it is disingenuous to say otherwise.

This year, an additional €25 million has also been provided in the 2015 budget, aimed at hospital and community services which can effectively address the specific needs of delayed discharge patients and improve timelines for admissions from emergency departments and waiting lists. It will include provision for an increased allocation to the nursing homes support scheme. Planning for this initiative is well advanced. Details will be finalised in the HSE's 2015 service plan later this month, with a view to their early implementation. The review of the nursing homes support scheme, as well as considering how the scheme has operated to date, is expected to identify some of the issues that will need to be considered and tested more fully into the future, including the future financing of the full range of supports for older people. Work is well advanced on this review, and it will be completed and published by early 2015.

Whether we respond successfully to the aging of our population will depend on the willingness of every sector of Irish society including the statutory, community, voluntary and private sectors, to adapt in good time to the changes that population aging will present in the coming decades. The health reforms which the Government is working to implement are intended to ensure that everyone, including older people, receives safe, timely and efficient care and treatment, at the lowest level of complexity and as close to home as possible. The Government believes that the challenges ahead can be met and opportunities in health care exploited by planning now to ensure that Irish society is an 'age-friendly' one in the years ahead.

That type of planning should have been done when this country was awash with money but Fianna Fáil thought it would never again see a poor day so it did not need to plan. It did not care. It could throw as much money at it as it liked. In response to Deputy Kelleher, the average waiting time for assessment is still four weeks. It is the release of the funding that takes longer. I readily admit that but we need to get the facts right.

The health budget has increased. I will detail the planning for long-term residential care needs. We are well aware of the demographic factors. We knew this ten years ago but that did not matter to Fianna Fáil then. The population over the age of 65 years will increase by nearly 220,000 over the next decade. There will be 60,000 more people aged over 80 years in the same period. We need to consider seriously what we will do. Mount Carmel will be part of that. It will provide rehabilitation, short stay and respite care, and long-term care. Next year we build on that to 65 beds, specifically for the north side of Dublin because that is where the demand is in the city. We need to do more of that. As Deputy Fleming said, there are old community homes and hospitals which, with a bit of forward planning and capital, could have been made useful for dealing with our aging population. We are planning for that. The budget is very tight. We have to be very careful about how we spend our money. Fianna Fáil was awash with money and did not know what to do with it. People were getting increases every week but it did no planning and that is why we are at the point we are now at.

Deputy Sean Fleming

This is four years on.

Deputy Billy Kelleher

The Minister of State’s party has been in Government for four years.

Deputy Kathleen Lynch

I commend the Government amendment to the House.

Deputy Patrick O'Donovan

This motion is an opportunity missed because instead of the very narrow motion it put down, the Opposition should have considered care of the elderly in a broader way. I speak from personal experience. Many who have personal experience of caring for elderly relatives will be aghast at some of the earlier contributions tonight and wonder are these seriously the same people who cut the blind pension and are now talking out of both sides of their mouths. It is as if Fianna Fáil has undergone some Damascus-like transition in the past three years. Elderly and vulnerable people, those who look after elderly relatives at home and those in community hospitals that have been starved of capital investment over many years have not forgotten what it did. There are many who will never forget what it did. The motions that appear before the House every three weeks lack credibility. Fianna Fáil’s research office would want to do something about that. Coming from the party that destroyed this country the motions have no credibility-----

Deputy Billy Kelleher

The Deputy’s party opposed the fair deal scheme, if he is talking about credibility.

An Leas-Cheann Comhairle

Deputy O’Donovan without interruption.

Deputy Billy Kelleher

He is being argumentative.

Deputy Patrick O'Donovan

-----when it talks about what it is going to do now with its 19 seats.

One of the points missed in this motion is that care of the elderly is multifaceted. It includes public, community-based facilities, private nursing homes, community-based facilities owned by the voluntary sector and the home-based services. I have raised before with the Minister of State and her predecessor the amount of money paid year in year out to the private home care packages. I feel strongly about this issue. The person coming into one’s home is paid €9 an hour but a company is charging the HSE €27 an hour. That is a huge discrepancy. We are only waiting for another “Prime Time” programme investigating private home care providers and the disparities between them. Some are excellent and some are hopelessly inadequate. I implore the Minister of State in respect of the HSE service plan, which is included in the programme for Government, to consider that issue as a matter of urgency to ensure that the remit of HIQA is extended into the private home care provision sector and where possible it is used only as a last resort. I have seen it in my own home. The Law Reform Commission brought forward proposals on legislation.

There are challenges in each area. I commend those in the community and voluntary sector who have done much, particularly in the community hospital network. Many of our community hospitals are old union and county homes and in many cases old workhouses. I cite the example of St. Ita’s Hospital in Newcastle West which has been revamped by the community. The friends of the hospital have put it far ahead of the HIQA requirements for 2015.

There is a looming time bomb within the Department for the other community hospitals around the country that will need to come up to HIQA standards. I urge the Minister of State's Cabinet colleagues to examine the capital programme as a matter of urgency. I invite the Minister of State to visit Dromcollogher and district respite centre in my constituency, which is unique in Ireland in the provision of short-term respite care. Many of her constituents from Cork North-Central and the adjoining constituencies of Cork East and Cork North-West avail of its services through Mallow General Hospital. If such services were not provided, there would be more bed-blockers, or elderly people who cannot be released from general hospitals because there is nowhere for them to go. I think there should be more of these centres, rather than fewer of them. A legislative framework should be put in place to cover them. That, in turn, should be adequately reflected in section 38 and 39 service level agreements.

There are challenges. It is not acceptable for elderly people to have to wait 15 weeks. In many cases, they are left in acute general hospitals because their family members cannot look after them or because they have no family. A neighbour might apply for the fair deal in some cases. While the system is not perfect at the moment, I think it is as good as it can be for the budget that is available. That is why it behoves all of us to make sure the budget is adequate. If the Minister of State will be looking for efficiencies, as I believe she will, she should examine the private care providers that are contracted to the Department of Health and are charging an average of €27 an hour, in some cases, while paying their staff €9 an hour. The efficiencies that are to be made in that regard can be put back into the fair deal scheme. I think that is the first place the look. I ask for that to be done.

It is very hard to listen to the proposers of this motion. I think there is a willingness on behalf of the Minister of State. She has not run away from this issue. She has not buried her head in the sand. This will not be fixed overnight. People who look after elderly people at home are lying awake at night wondering what will happen to them. They are concerned about the day when they will be unable to put those they look after on the toilet, or change their incontinence pads. They worry that a catheter or a hoist will have to come when they become physically incapable of doing certain tasks. Those people are looking at this debate and wondering whether a solution will be found to assist them. That is all they are interested in. They are not really interested in the politicking of it. They want to know whether beds will be available for their loved ones when they are taken out of regional or general hospitals like those in Limerick and Mallow and have to go into nursing homes. They want to be reassured that their loved ones will be looked after and allowed to die with dignity. For too long, our elderly people have been allowed to die undignified deaths in many cases. We need to correct that wrong.

Deputy Pat Deering

Like the previous speakers, I am delighted to have an opportunity to say a few words on this motion. It is an appropriate time to discuss this matter. I concur with Deputy O'Donovan that the Opposition has missed an opportunity to discuss the care of the elderly in a more detailed manner. They only solution they are proposing is the return of the funding to the situation. They have not proposed how actual plans or structures can be put in place so we can build for the future in this respect. I have to acknowledge that the fair deal scheme that was introduced in 2009 was a big improvement on the subvention scheme that was in place previously.

Deputy Billy Kelleher

The Deputy's colleagues opposed it.

Deputy Pat Deering

I am acknowledging that.

Deputy Billy Kelleher

They engaged in scaremongering.

Deputy Pat Deering

This fair system is a vast improvement on what was in place previously. Those who can get into the system can get nursing home care. This allows families to prepare for the future. It is important to acknowledge that there is a particular difficulty at the moment. It is unfortunate that there are long delays in allocating funding. Money was reallocated last year because people like Deputy Kelleher and me wanted more money to be provided for home care so that people could be looked after in their homes. That was appropriate at the time and it is appropriate for the future as well.

The main problem at the moment is not caused by a lack of funding; it is caused by the increased demand on the system. Unfortunately, a recent ESRI report suggested that an additional 888 places will be required each year between now and 2021. We have all heard those real figures. We need to remember what we are spending our money on at the moment. We are spending €1.3 billion per annum on nursing home care and community services. It is quite a lot of money. It is important to remember that it accounts for 10% of the overall health budget. I am speaking from personal experience, as Deputy O'Donovan was previously, when I ask whether we are getting value for money. I would like to mention another interesting statistic. As I have said, we are spending €1.3 billion annually to look after 78,000 people, which is a large number of people. We spend €5,500 per person in home care packages, whereas we spend €42,000 per person in nursing homes. Is that a fair way of allocating funding?

I remind Deputies that the Government amendment to the motion before the House recognises that "people should be supported in the care setting that is appropriate to their needs and that most older people prefer to stay in their own homes and communities for as long as possible; it is incumbent on Government to take account of this in decisions on how services and supports are structured". The vast majority of people I know - I am sure this applies to most Deputies - would like to be able to stay in their homes for as long as possible. That is where we should be spending our funds. It is possible that some people stay in nursing homes for longer than they should. We should try to encourage more people to stay in their homes. We can get far better value for money in that way. We need to be having this discussion. Should we be putting more money into the community, rather than into institutions like public or private nursing homes? I think we should be encouraging more people. We will need to have this discussion going forward. It is not just a matter of putting money into it and hoping it will all go away tomorrow morning, because that will not happen. We need to plan for the future in a structured way, by putting money into the system where it will have a better effect.

The people and associations involved in nursing home care previously sought the creation of a discussion forum involving all stakeholders to consider where we are going for the future. I ask the Minister of State, who previously opposed this proposal, to reconsider it. It would be important for all the stakeholders to come around a table to discuss in small, detailed terms where they see themselves in the future. I refer not just to next year and the year after, but to the period ten or 15 years from now. It has been pointed out that the demographics are going in one direction only. We need to plan for that. As the Minister of State said and as Deputy Kelleher acknowledged, no plan was put in place in the past. We had the money ten years ago, but it did not happen. We now need to make sure we have a structure in place to ensure our parents and all the elderly people who kept this country going over the last number of years will be looked after in the future.

It is important to remember that there are a number of very good facilities in this country. Deputy O'Donovan spoke about step-down facilities. The district hospital in the town of Carlow, which is in my constituency, is very important. It is used as a step-down facility. If older and smaller hospitals that were used for certain purposes in the past were used as step-down facilities now, it would take the pressure off the main hospitals and alleviate the problems caused by bed-blockers, which is a phrase I do not like to use. If we could upgrade the facilities to the standard required to ensure spaces are available in these hospitals, it would take the pressure off the main hospitals. We need to have a discussion about where we are going with our elderly for the future. It is not sufficient to table a short-term motion about returning the money that was supposedly taken out of the system previously to be put into another part of the system. I encourage the Minister of State to facilitate a genuine discussion, involving all stakeholders, about where we are going for the future. I commend the amendment to the House.

Deputy Caoimhghín Ó Caoláin

I would like to share time with Deputy McLellan.

Acting Chairman (Deputy Brian Walsh)

Is that agreed? Agreed.

Deputy Caoimhghín Ó Caoláin

Táimid ag plé leis an scéim seo, a cuireadh ar bun ag Fianna Fáil agus an Páirtí Daonlathach ar dtús, arís eile anocht. Ní raibh cearta na seandaoine san áireamh ag an am sin, faraoir géar, agus is cosúil nach bhfuil anois ach oiread. Is oth liom a rá go bhfuil an fhadhb sin ag éirí níos measa. An é nach gcuireann an Rialtas tábhacht ar sheandaoine?

The number of people awaiting payment approval under the fair deal scheme has increased by over 300%, which is a staggering number, since January of this year. As of 9 October last, some 2,182 people were approved for the fair deal scheme but were awaiting payment approval. Waiting periods now exceed 15 weeks. To add insult to injury, we have been informed by the HSE's performance report that 75% of people classified as delayed discharges within Irish hospitals are awaiting long-term residential nursing care.

This means that not only are our older citizens not getting the care they deserve, other unwell citizens are also being denied access to care in our hospitals.

The Minister, Deputy Varadkar, when referring to this group stated in the Dáil on 15 October:

These are people who are well enough to leave hospital, but do not have a nursing home or home care package in place for them to do so. They are often elderly people and are citizens, not bed blockers. They should not be left in hospital, where they are at a higher risk of a fall or developing an infection.

I fully agree.

The Fianna Fáil motion lays out some of the major challenges that face Ireland. The rate of growth of Ireland's over 65 population is nearly double that of the EU as a whole. The number of over 65s is projected to increase by approximately 20,000 per year between now and 2021. If God spares me, I will be among them. It has been recognised for some time that this increase in our older population will lead to an increased usage of services, and I want to emphasise that these are deserved and totally necessary services. These demographic pressures equate to an additional funding requirement in the order of €200 million per annum over the coming years. A minimum of an additional 7,600 beds for long-term residential care will be required between now and 2021. This comes at a time when the 2014 Health Service Executive service plan reduced funding for the nursing homes support scheme by 700 placements under the fair deal scheme when compared with 2013. Let me say that again - 700 fewer placements at a time of increasing need. Where is the logic in this? Where is there any modicum of the fairness that is referred to in the title of the scheme?

We need investment in social care packages specifically to ensure that we can help someone who does not need a hospital bed to move to a more suitable setting. This is not only beneficial for our older people, it is also cost effective. Also needed is hospital release planning through links with primary and community services, as well as short-term community nursing home beds and more funding for long-term nursing home places. We are unsure as to what the Minister and Minister of State intend to do despite their assurances that they have a plan. I would ask the Minister of State, Deputy Kathleen Lynch, that she and her senior colleague might reassure this House and all those families who are waiting on news what concrete steps they now intend to take.

We need to move the focus to entitlements of care. The fair deal scheme was fundamentally flawed since its conception. From the outset the scheme effectively removed the universal eligibility for a place in a public nursing home as provided for under the Health Act 1970. The Minister of State will recall making the same case at the time. On debating it in 2008, I raised concerns that I and many others, including the Minister of State, had with the scheme at the time. I am sad to say our worries have been confirmed again and again. Perhaps we should not be overly surprised as the Bill was framed without consultation with older people and older people's representative organisations.

The scheme itself is intrinsically flawed, as it does not cover short-term care such as respite, convalescent care or day care, although these types of care may be available in some nursing home settings. In budget 2015, some €25 million has been allocated to address the problem of delayed discharges from acute hospitals. I understand that the Minister, Deputy Varadkar, cannot provide specific details on how this funding is to be utilised. What portion of this fund is to go towards the fair deal scheme? Is there to be any additional funding for home care packages and what of additional funding for community intervention teams?

The saddening vista we see is one where our senior citizens are not given the supports they need to stay in their own homes. Often, they end up deteriorating both physically and mentally and cannot stay at home, the place that is best for them and where they would be most happy. This short-sighted failure is a further example of a penny wise and pound foolish policy.

When this Bill was introduced originally, we flagged concerns about funding. The capping and cutting of funding has shown that neither this Government nor its predecessor was serious about caring for the older members of our society. It is extraordinary that it was not set up with a budget linked to easily predictable population need.

Sinn Féin could not support the 2008 Bill as it was a move away from universal entitlement. It was also not rights based. Nor was it comprehensive in terms of providing for the wide range of care that older people require. It is no substitute for comprehensive State-provided care of older people, including fully supported and resourced care in their homes, in the community and, where necessary, in nursing homes.

I have had many constituents contact me and outline the great difficulties they have with this scheme. Many of them have been waiting for over 15 weeks and have even been informed by the HSE that the scheme itself is "broken". How terrible a system is that it requires for others to pass away before someone can access the care he or she needs. Families have reported to me that it costs up to €14,000 to cover care in private nursing homes. When family money runs out, what sometimes happens is that the older person is returned to an acute facility, an entirely inappropriate place for him or her and a very poor use of acute service beds. It makes no financial, moral or, indeed, common sense for these elderly citizens to be placed on these waiting lists. I implore the Minister and Minister of State to ensure that this will not be the case in the hopefully not too distant future.

Access to quality services enables older patients to return home after a hospital stay. Unfortunately, we see that there were 2.3 million fewer home help hours last year when compared with 2008. Last year, an extra €5 million was allocated to social care packages specifically to get delayed discharges out of hospitals. Unfortunately, this dealt with only a relatively small number of cases.

I understand that the review announced by the former Minister for Health, Deputy Reilly, in 2011 has reported but that the findings have not yet been released. Someone somewhere has decided that the public cannot be allowed to see a report into the functioning of this scheme. I for one had thought that we had moved on from a culture of cover-up and subterfuge. Unfortunately, it seems in this regard that I was incorrect. This is very concerning. Surely it would be in the public interest that we would have access to the findings of this report so we might focus on the shortcomings of the scheme to ensure improved care for those needing long-term residential care.

What needs to happen is that we move entirely from this flawed scheme to a rights-based system whereby those vulnerable citizens can receive long-term care when they need it and thereby reduce the reliance on acute hospital beds. These serious shortcomings are indicative of short-sighted planning, a problem that has beset our health services historically and one that punishes both young and old alike.

For those who are currently awaiting funding approval, we in Sinn Féin urge the Government to ensure the waiting lists are ended. We demand the publication of the review of the scheme and we strongly urge the Minister and Minister of State that they make us aware of the plans they have to remedy this very serious and worrying situation. A Airí, iarraim oraibh gníomhú ar son ár seandaoine agus cinntiú go mbeidh cúram ar fáil dóibh.

Deputy Sandra McLellan

I welcome the Fianna Fáil Party motion. It must be noted, however, that this ill-fated scheme came about under the watch of the Fianna Fáil-Progressive Democrats Government. It is a case of better late than never. It must also be noted that Sinn Féin flagged serious issues with the funding of this scheme from its inception. Unfortunately, these issues have not been dealt with to date.

I support the reversal of the reduction in support for the fair deal scheme implemented in 2014, as set out in the 2015 HSE service plan. I agree that long-term residential care should be adequately resourced to take account of demographic changes. Furthermore, I call for the €25 million earmarked in budget 2015 for alleviation of delayed hospital discharges to be directed towards dealing with the problems in this scheme in particular. The capping of the funding for the fair deal scheme means that those who are most vulnerable in our society are at great financial and health risk when they are most in need of care.

This situation cannot go on any longer.

Members must ensure these valuable and valued members of society are facilitated to stay in their homes. It is in this setting, with help from family, friends, neighbours and the health and social services provided by the State, that people are most comfortable. The nursing home support scheme was heralded on its launch in 2009 by the then Minister for Health and Children, Mary Harney, as "accessible, affordable, and anxiety-free". A mere five years later, the so-called fair deal is grinding to a halt in a situation that was completely inevitable from its flawed inception. It is no secret that the Government has failed people from all backgrounds of all ages throughout this State. It should come as no surprise that more than 2,000 older people are waiting for 15 weeks or longer for nursing home care. It is also clear these people also have been failed by the austerity measures implemented by successive Governments. These waiting lists have tripled since January of this year, which is entirely unacceptable. The fair deal scheme budget has been capped for this year and was cut last year, despite Ireland having the fastest growing ageing population in Europe.

Nursing Homes Ireland has stated the excessively long waiting times for State funding for nursing home places is putting patients' health at risk. It claims that some patients have even passed away while waiting for this financial support. What a disgraceful way to treat those most in need. What is the point of Government if not to protect the most vulnerable citizens who elected it? These older people have a right to be cared for after many years contributing to the running of this State. It is Members' duty, as legislators and representatives of the communities which gave them the seats they hold in this Chamber, to ensure that older people do not have to spend their lives worrying, fretting and riddled with anxiety about getting their care needs met.

Moreover, as a result of these delays, older patients are staying in acute hospitals for longer than necessary but must remain there because their complex care requirements cannot be met in their home environment. In 2012, it was estimated that more that 40% of beds occupied in acute public hospitals were taken by people aged 65 and more and 243,512 hospital bed days were lost during 2012 due to delayed discharges. In that same year, the ESRI projected an additional requirement for 888 long-term residential care places per annum to 2021. The situation has become worse each month since then and action must be taken. Nursing home care is provided by dedicated specialists, and an inability to access this in a reasonable timeframe can lead to a deterioration in health. The funding delay is causing financial hardship for some families, who must pay up to €1,000 a week for private nursing care for family members while waiting for payment under the scheme. The solution to this growing problem is not simply an increase in fair deal funding to facilitate admission to nursing homes but must also take into consideration that home care is the preferred option for a majority of people in need. If Members are trying to balance the books, it is also a significantly less expensive option. Investment in social care packages is needed specifically to ensure the ability to transition someone who does not need a hospital bed. This is both beneficial for older people and is cost-effective. In addition, hospital release planning is also required, through links with primary and community services, short-term community nursing home beds, as well as more money for long-term nursing home places. These solutions must be put in place urgently and without any more delay. As mentioned by my colleague, Deputy Ó Caoláin, it is time to move to a rights-based model in which those who need care are entitled to it and can exercise that entitlement, as to do anything else would be to fail them.

Deputy Catherine Murphy

I welcome the opportunity to make a contribution to this debate and I believe a wider debate is needed. In an example that graphically displays the issue, a couple of weeks ago I was contacted by a constituent about his father who has been a patient in Naas General Hospital since last July. All Members will appreciate that it is a very emotional matter to come to the conclusion that a parent, who may not wish to enter a nursing home, must do so. This is a major hurdle many families are obliged to go through. The man in question was approved for supplementary funding and the family found a private nursing home bed, which was held for him. Within days of this supplementary funding being approved, the family was advised that no funding was available for the nursing home bed. The nursing home costs approximately €1,000 per week, while the nightly cost of a bed in Naas General Hospital is somewhere between €850 and €1,000. Therefore, one would accommodate seven people in nursing homes for the cost of accommodating one person in an acute hospital bed.

While I understand this scheme has been capped, people can understand when there is no money. However, what really offends them is when money is spent in the wrong ways. It makes no sense for this hospital, which really is under pressure. Last week, 17 people who were there had been fair deal scheme-approved, whereas this week the number was 12, because there had been a protest and there was some movement as a consequence. However, in the context of Naas General Hospital, 17 patients is like having 50 patients in Tallaght hospital and is a very large number. Moreover, there are quite a lot of nursing homes in County Kildare that are receiving patients from a catchment outside the county, quite a number of whom are from the Dublin area. Consequently, one gets a more dependent group of people who then ultimately end up in Naas General Hospital. This is putting a kind of dual pressure on that hospital and the protest yesterday was about demonstrating that the hospital has become unsafe because of the overcrowding. This should be taken on board in its own right.

There is a lot more that is wrong with the system, some of which the Minister of State herself has outlined with regard to trying to keep people at home for longer or sometimes having respite or partial arrangements. Such a suite of measures is needed but people must see them functioning. In addition, I wonder whether the design of the HSE in hiring companies, which then take care of the responsibility, is about outsourcing the responsibility or not having the layer of management that would take care of it. This is a missing piece in all this and between the amount paid to the individual who provides the care and the amount the care-providing company actually gets, this is costing quite a lot of money.

There are some really good examples of best practice and in my own constituency, the Nás na Ríogh Housing Association is an absolutely superb example of people moving from their home into a sheltered environment, and more of that must be seen. There is a lot of living to be done by people who are older but who are not ready to go into a nursing home. However, they may be happy to go into a sheltered arrangement in which there are support services. Members must think in this way, in which a range of different things are available. As for the fair deal scheme at present, the obligation on people who have been approved to spend such long periods waiting to go into nursing homes - when no other approach is open - is putting financial strain on the hospitals. Moreover, it is putting a severe numerical strain on them as well with regard to catering for people who require elective surgery. However, it is also levying a terrible emotional toll on the families who were obliged to make that decision. Often, such families were obliged to have a major family gathering and to go through all of that. Members must accept this is a serious problem. This is not saving money but when one considers the cost of having somebody in an acute hospital bed as opposed to a nursing home, it is costing a lot of money, which simply does not make sense.

Debate adjourned.