I thank the Chairman for the invitation to discuss the implications of this very important piece of proposed legislation. I am joined by Ms Peggy Cumberton, director of Age Action Ireland, Mr. Eamon Timmins, head of advocacy and communications, Ms Emer Begley, social policy officer, and Mr. Noel Grace, one of our youngest volunteers.
Age Action Ireland is an advocacy organisation on ageing and older people. Our aim is to assert the rights of older people to comprehensive, high quality services and to represent their views and experiences in all their diversity, with top priority given to the most disadvantaged older people in all our work.
Age Action Ireland believes that, if implemented, the so-called "fair deal" legislation will seriously erode the public entitlement to essential health care for older people. If it is not introduced in a comprehensive manner, alongside the adequate provision of home and community services, it could discriminate against older people, especially the most vulnerable. I will outline Age Action Ireland's concern that the proposed legislation may erode the public entitlement. I will address the issue of attempting to introduce the fair deal in a piecemeal fashion, with the danger that vulnerable older people may fall through a number of gaps in the system.
Age Action Ireland recognises that the fair deal is a genuine attempt by the Government to address an issue of serious concern to older people. Many older people who are currently paying upwards of €50,000 per annum for a private nursing home bed are struggling to meet the bills, and in some cases the financial pressures have forced them to sell their homes. On the other hand, the deal includes an increase of almost 50% in fees to be paid by public patients.
While Age Action recognises that the fair deal is an attempt to address this issue, we profoundly disagree with the solution the Government is proposing. We are not seeking to delay the introduction of legislation but we are urging an open debate about the many issues before any conclusion is arrived at. However, today's discussions are based on scant information released about the fair deal proposals in the past 18 months. We are still very much in the dark about the Government's plans.
We wish to raise a number of issues. This is a new departure for charity and health services. After the 2004 Supreme Court ruling on nursing home funding, legislation was introduced which established that older people, determined to be in need of nursing home care, were entitled to a publicly funded bed, less 80% of their pension, a provision that has neither been clearly transmitted nor facilitated for many older people. The inequity of the current system relates to the failure of the Health Service Executive to inform the public adequately and to provide this care, leaving the most vulnerable and ill-informed, or in many cases relatives of those patients, to dispose of their assets to pay substantial amounts or else follow the less well funded discretionary and subvention route. While offering welcome relief to people in private nursing homes, some of whom — or their relatives — may have to sell their property in order to pay nursing home charges, the proposed fair deal represents an erosion of the entitlement to State funded long-term care in public nursing homes through the State's proposed claim to a proportion of all disposable income as well as up to 15% of the estate after death. If, as we are being told, the cost of various therapies such as physiotherapy or speech therapy are not covered by the National Treatment Purchase Fund but will be added to the residents' bill, this is a further erosion of public entitlement and takes away any notion of rehabilitation in long-term care.
While in a democratic society debate on health care funding must be open and vigorous, there are particular concerns on what appears to be a selective inheritance tax on stroke and dementia. No other form of public health care currently involves a charge after death. Such approach is not only ageist but flies in the face of the life cycle approach, the basis of the social partnership agreement Towards 2016. We are all future older people, if we are lucky, and have a direct stake in ensuring that access to care, the standards of care and the costs of that care are no different for stroke and dementia and other forms of illness than for cancer and cardiac disease. Older people should not be charged any differently for the costs of vital health care from any other section of society.
The next major concern would be piecemeal introduction. When it was announced in December 2006, there were three elements to the fair deal — charges, the use of the National Treatment Purchase Fund to negotiate the costs of beds with nursing home owners, and the fact that only homes approved by the Health Information and Quality Authority would be entitled to participate in the scheme. It was significant at the time, coming within three months of the publication of Professor Des O'Neill's report on the Leas Cross scandal, that emphasis was placed on ensuring that only homes that met stringent independently inspected standards would be entitled to participate in the scheme, surely an issue reinforced by the recent rapid increase in the cases of elder abuse reported. Despite the Government's deadline of 1 January 2000 for the introduction of this legislation, the process of implementing standards and inspecting them is not yet in place. While HIQA published the standards in March, the regulations to enforce these standards have not yet been enacted. They will not be enacted until the HSE has completed the regulatory impact assessment for the Department of Finance. Only at this stage will the decision be taken as to which of the standards recommended by HIQA are mandatory and which will be developmental. This delay has meant that HIQA has delayed the recruitment of its inspection team. I should add that any comment we make about the lack of consultation and participation does not apply to HIQA, which in developing its quality standards set an exemplary model for consultation that could well be followed by others.
Age Action stresses that a fair deal cannot be implemented in a piecemeal fashion. Charges must not come before standards. If older people are charged 80% of their disposable income during their lifetime and up to 15% of the value of their home after their death for essential health care, it must be health care of the very highest standard. Although much focus has been on the legislation and the difficulties it is facing, the structures are not yet in place to decide who would be admitted to a nursing home bed under the fair deal or which nursing home would qualify to participate in it.
Our third major concern would be about vulnerable older people falling through gaps. As part of the fair deal, applicants will be means tested and dependency tested. The latter will ensure that only those who are dependent enough will be entitled to a bed under the scheme. However, we foresee that this could create problems. At the moment we do not know who will qualify for a bed under the fair deal as the dependency criteria have not yet been decided. However, it is possible that an applicant for a nursing home bed could be refused on the basis that he or she should be able to live an independent life in their own home with sufficient community care. Adequate community services are therefore essential if the fair deal is to operate effectively, but unfortunately these services are inconsistent around the country, with resources still available in some parts while services have been suspended in others. If applicants do not have the required community services in their area, they could be left in the worst of both worlds, unable to get a nursing home bed, yet unable to live with dignity and independence in their own home.
Information currently gathered by the Irish Association of Social Workers, social workers and other health professionals indicates that funding for home care packages was not available in six of the 18 areas where information was available. This information is contained in an appendix to our note. Funding for home care packages has run out in five areas, it was being recycled in eight areas and provision was being reduced in two other areas. How can there be a national common assessment when these essential services are not being provided uniformly across the State? The reality is that despite longstanding Government policy to enable older people to live independently in their own homes for as long as possible, we are spending more on the 5% of older people in residential care than on the 20% of older people who need home and community care. For every euro we spend on community care, €2 are spent on residential care. Some 10,500 people are being assisted by home care packages, yet there are 21,000 people in nursing homes.
It is worth noting that the interdepartmental committee which reported to the Cabinet on the funding of long-term care in 2005 recommended that co-funding should not be confined to residential care but should be extended to those receiving community care. It is recommended that a national standard financial assessment framework should be developed to apply for both home care and residential care. We are unclear if the Government is planning to charge for community care, although recent correspondence from the office of the Minister, Deputy Mary Harney, suggested that this was under consideration. Despite the introduction of the home care package initiative two years ago and the provision of an extra €10 million for home care packages this year, we still do not know the extent of the need or the impact of these packages, or how they are linked to continuing services like home help services.
Ireland spends less than half of the OECD average on funding long-term care. We should look at other funding options. There is a need to support individuals in nursing homes to meet their costs. There are several options in other countries, including private savings, private insurance, public sector tax-based support and social insurance. Denmark and Australia fund long-term care from general taxation. Germany opted for a ring-fenced social insurance contribution. Japan partly funds long-term care from ring-fenced social insurance and general taxation. The Mercer report recommended that the RSI model was the best approach to funding long-term care in Ireland. The interdepartmental committee which I have just mentioned believed that this warranted further consideration, yet that committee proceeded to recommend the fair deal without any consideration of the RSI model.
Age Action Ireland is concerned at the lack of consultation that has taken place around such important legislation, which has been delayed by legal difficulties and has been with the Attorney General since December. When the Taoiseach announced in December that the legislation would not be introduced in the Dáil, he said the delay was to allow consultation with interested groups. That consultation has yet to take place, although plans for the fair deal were first announced 18 months ago. Considering the huge implications of the fair deal for older people, such consultation is essential.
The funding of long-term care is vital to the long-term planning of our health services. Age Action Ireland is seeking a full, reasoned debate, involving older people and their carers, that will come up with a system that will establish the right of older people to high quality, equitable and affordable services which gain the full support of the entire population. This would be an enormous step forward in making Ireland the best place in the world in which to grow old, our vision for the future. I thank members again for their invitation and their attention. We would be happy to answer questions.