Léim ar aghaidh chuig an bpríomhábhar

Seanad Éireann díospóireacht -
Wednesday, 25 Jun 2008

Vol. 190 No. 6

Older Persons: Statements (Resumed).

I welcome the Minister of State, Deputy Hoctor, and thank her for returning to the House today for the conclusion of statements on older persons. I wish to highlight once again a number of issues which are of grave importance to our ageing population. In a fast-paced society such as we have today in Ireland, it often seems that the needs of older persons can be all too easily forgotten. I have raised some of these matters on previous occasions but as was expected, progress has been dreadfully slow.

Health will continue to be the single most important issue to older people and their families. As we get older there will be an increased need for involvement with the health services, either in the acute hospital setting or in long-term nursing care. The present state of the health service does nothing to reduce the anxiety of the older person when we hear constantly of the lack of hospital beds and the hours spent on hospital trolleys in draughty accident and emergency departments with the accompanying lack of privacy and dignity. This is the service we provide to the people who built the prosperous Ireland in which we live today and yet all we can offer them is uncertainty and a second-class health service. Waiting times and the delay in gaining access to mainstream health care continue to be a problem. While the Department of Health and Children prides itself on the fact that waiting times are reduced, in my experience I find this is not really the case. Now, instead of a long delay in the hospital setting, there are extended delays between the initial referral from the general practitioner and that first appointment within the hospital.

I know of one lady who was in urgent need of a hip replacement. Her mobility was severely affected and she was in constant pain. Her GP referred her to Waterford Regional Hospital in July 2006 and by the time she contacted me in April 2007, she had heard nothing with regard to an appointment. When I contacted the patient services manager, whom I have always found to be very efficient, I was informed this lady was categorised as a routine patient and that she could be waiting up to four years for an initial appointment with the consultant. This is simply not good enough and it is an insult to people to refer to this inadequate response as a service. Service implies that a level of care and standard is being upheld. This was not the case in this situation which is mirrored throughout the country.

I recently had a call from a lady who, having been seen in South Tipperary General Hospital, was referred to the Coombe Women's Hospital for investigations and treatment. This lady is chronically unwell and has a dismal quality of life. She was referred to the Coombe in October 2007 and given an appointment with a consultant for September 2008, which is almost one year waiting just to be seen. We can undoubtedly assume that a further delay is imminent should she need surgery and further treatment.

The fair deal plan is money-centred as opposed to being people-centred. The State's plan to apply a levy of up to 15% was bound to create constitutional difficulties and will have to be reconsidered. We need to look at the needs of our ageing population, ensuring those who wish to stay at home will have the opportunity to do so for as long as possible and for those for whom long-term nursing home care is the best option, we need to ensure they will be able to receive this care in a secure, safe and fair manner.

While the fair deal plan advocates allowing people to remain in their home for as long as possible, it is not clear that the measures are in place to support this approach. It is well recognised that home care would continue to rely for its success on informal carers, and families who are already in this situation would argue that the level of respite care available to them is minimal. This will need to be addressed as most family carers have their own young families to look after and, more than likely, the carer is also working full-time. The level of support will have to increase to sustain caring for the elderly over an extended period, perhaps years. The fair deal scheme needs to be taken back to the drawing board and given deeper consideration with further reference to the Mercer report, in particular with regard to looking at PRSI funding of long-term care.

The final issue I wish to raise is the status of women who were precluded from working by virtue of the marriage ban. This occurred in an Ireland of a different time but this small but significant number of women continues to be affected by this ban. Their old age pensions are invariably non-contributory pensions, despite that if they had been allowed to continue working, they would be entitled to a full contributory pension. This subject is raised frequently by women who feel disaffected since their careers were cut short without their consent. These women consequently went on to rear, nurture and educate the men and women who benefit from the prosperous Ireland of today.

I recall one lady who worked in the sugar factory in Thurles in the 1950s. She was personal assistant to one of the managers and both enjoyed and valued her career. When she married in 1961, she was forced to vacate her position. This lady went on to have six children, all of whom were reared and educated on her husband's wage. Money was scarce and although she managed to ensure the family's basic needs were met, she told me that money was so short at times, she could not afford iron tablets when pregnant. It is clear that had she been able to continue working, the family's quality of life would have been quite different.

When this lady applied for the old-age pension, she was informed her contributions fell below the required level to secure a contributory pension and when she highlighted her concerns relating back to the marriage ban, she was told by officials in the Department of Social and Family Affairs that plans were afoot to deal with this issue. However, eight years later there has not been one word about these forgotten women whose children fuelled the Celtic tiger.

I have made a submission to the Green Paper on pensions on this matter. This issue should be dealt with once and for all. These women were not allowed to have a voice in the past but they certainly have a voice now and it must be heard. It behoves us all to compensate these women, albeit in a small way, by ensuring a provision is made through notional assessment to allow this diminishing group to avail of full pension rights. I thank the Minister of State for taking time to attend the House as I appreciate she has a very busy schedule.

I welcome the Minister of State, Deputy Hoctor, to the House and to compliment her on being reappointed as a Minister of State. I welcome the opportunity to speak on the subject of the elderly. In my former profession I had a lot of dealings with the elderly. I agree with much of what Senator Prendergast said as she also has a background of knowledge in this area.

I have always been a strong proponent of community care. I agree with the view that care of the elderly in their own home, wherever possible, is infinitely preferable to hospital care. I have spoken about this matter in the House on other occasions and I know I have incurred the ire of some people. The truth may hurt but so be it. When old and not so old people are placed in care, they can often be forgotten about, although not in all cases. After yearning to go home, an institutional malaise sets in which is called institutionalisation. This is because, of necessity, they must adapt themselves to their surroundings and they make new friends. Many of the people we are talking about, if not all of them, built up this country. They paid their taxes and dues and it is now society's responsibility, especially of their own relatives, to ensure wherever possible that they are cared for in an appropriate setting, preferably the home.

Day care centres contribute greatly to the care of the elderly and we have one such centre in Mullingar. I have already spoken to the Minister of State about day care centres that have closed for a number of weeks during the year. I take the view that they should not close at all. In many cases people come from remote rural areas and the only people they interact with are those they meet in the day care centres. I hope that, if possible, St. Mary's day care centre in Mullingar will be kept open all year because it is providing a pivotal service to those who avail of it. People come from as far away as Castletown, Finea, Castlepollard, Collinstown and Delvin in north Westmeath, as well as places south of Mullingar.

Elderly people in care should be visited as often as possible, but regretfully that is not the case. In a former professional practice, I had much experience of working in the community and carrying out domiciliary visits to my clients. They would say: "Nurse, it's great to see you. I have not spoken to anybody since I last saw you". It is not a very nice thing to hear but that is the situation in some cases. We are fortunate in Mullingar to have a retirement club. When it was set up they checked the numbers and found that it comprised 1,428 members, so it is now called the 1428 Club. The club organises trips, including one that I sponsored to Leinster House. I am sure other Members of the Oireachtas from County Westmeath have done likewise. Such visitors are always welcome. Retirement clubs provide a marvellous service for older people.

I encountered a very fine model in London when my brother-in-law's mother was in care there. It is a two-storey facility with younger people upstairs and the elderly downstairs. It works very well but I do not have time to develop the point because I note that the Leas-Chathaoirleach has shown me the yellow card. I had better sit down before I get the red card.

I wish to share time with Senator Healy Eames.

Is that agreed? Agreed.

I warmly welcome the Minister of State, Deputy Hoctor, to the House. It is good to see her again. The last time I met her was in Mullingar. I agree with Senator Glynn about the closure of day care centres. The centres in Athlone and Longford are both affected in the same way. I welcome the intervention for St. Mary's day care centre in Mullingar, which was closed for two weeks. That is two weeks too long, however, as Senator Glynn said. The centre should be revived and should not be closed at any time during the year.

Home care packages should be re-examined for those who are leaving acute hospitals. Very few drop-down beds are available so home care packages should be put in place for people returning home alone who may have little support in their community. I am aware of one man who suffered a stroke and returned home even though there is no support for him there. He has a very good family, but the public health nurse is put to the pin of her collar to assist and very little home help is available for the individual concerned. The burden is falling on his wife who is also elderly. If we are to keep such people out of nursing homes and hospitals, it is incumbent on us as legislators to provide proper home care packages. I am referring to physiotherapy, speech therapy and even somebody to spend time with an old person to give the carer a break.

The budget for the carers' association in County Westmeath has been completely spent and it is no longer accepting any new applications for carers, which is a terrible situation. If we are trying to sort out our acute hospitals and keep them free of elderly patients, we should put home care packages in place for them.

I also wish to raise the issue of fuel poverty. Last week we had freezing weather and on one night the temperature fell to 4° Celsius. Fuel allowances are very welcome but they are cut off from April to October. Older people should be able to accumulate fuel allowances to use them in cold weather. The minimum temperature for older people to live in is 16° Celsius, otherwise they are at risk of hypothermia and invariably end up suffering from pneumonia and being hospitalised.

The Minister of State is very welcome. I wish to discuss the abuse of older people. The Minister of State addressed a conference on the topic of elder abuse last week in Galway, so she knows that it is an area of major concern for families. I will explain why financial institutions and the social welfare system are putting older people at risk of abuse. Elder abuse can take many forms, including physical, financial and psychological. A good definition of such abuse is when an expectation of trust is violated and harm or distress is caused to an older person as a result. How widespread is elder abuse? Nationally, some 1,500 referrals have been made to the HSE, with 60 of them in my own county of Galway. Some 150 of these cases have been referred to the Garda Síochána, and 83% of them concerned people living at home. This is why I am calling for a public awareness campaign to tackle the abuse of older people. In 96% of such cases there was a familial relationship between the older person and the person allegedly causing the concern. Most reports of elder abuse are made by health care staff, including GPs, public health nurses or home helps. It is good to see, however, that 10% to 11% of such reports are made by the elderly person's family.

The abuse can involve shouting at an older person, restricting visits, threats, instilling fear, neglect, leaving them alone all day, inadequate nutrition or dehydration. I am aware that it is difficult for families to mind older people because it is not always an easy relationship. Issues can arise on both sides of the coin, but the elderly are particularly vulnerable. It is all the worse when the situation is compounded by illness, such as early Alzheimer's, which does not provide for an easy relationship in the home.

Financial abuse may occur when a person's mobile phone credit is used by someone else, or their change is not returned after shopping. Even greater financial abuse can take the form of pressure concerning wills and the question of inheritance. A public awareness campaign needs to tackle attitudes to elder abuse.

I ask Senator Healy Eames to conclude.

I want to mention the issue of abuse by the financial institutions. Some 10% of the cases coming before the Financial Services Ombudsman, Mr. Joe Meade, are of uncaring, unthoughtful financial institutions selling unsuitable financial products to older persons, for example, the case of a 94 year old woman being sold a six-year bond. I spoke to the Ombudsman's office this morning——

I must ask Senator Healy Eames to conclude.

——and he stated that we have a consumer protection code but what is needed here is professional and competent people selling products, particularly in the case of older persons. I thank the Minister of State, Deputy Hoctor, for listening to me.

I welcome the opportunity to make a statement on older persons. This is a key issue for the Government because it is important that we start planning for aging in Ireland and ensure that we make it a positive experience. There is none of us here who will not experience the aging process and it is important that with advance knowledge of the extent to which our population will age, we put in place proper policies and do the necessary planning to support that.

In 2002, the proportion of Ireland's population aged 65 years and over was 11.1% but, according to population projections prepared for the National Council on Aging and Older People, this proportion will rise to between 14.8% and 15.3% by 2021. The number of Irish people aged 80 and over is projected to increase steeply, from 100,583 in 2002 to 137,305 in 2021.

I was in discussions with the Age Action Ireland group before this debate to get their views on what they felt were the priorities in terms of the delivery of services for older persons. They emphasised the area of community care and the fact that, from their point of view, the Government has every reason to support and develop community care services for older people. They pointed out that for every €1 spent on community care, €2 is spent on residential care, and also that many older persons who have been surveyed want to remain and be cared for at home. Unfortunately, access to community care at present is a little like a lottery, they argue, depending on what part of the country an older person is living in. In certain parts of the country the services are satisfactory but in other parts they leave much to be desired.

The issue of rising fuel price was also highlighted by Age Action Ireland as an area of major concern. As the House will be aware, ESB and Bord Gáis have made an application to the energy regulator to increase both fuel and oil prices in this country. Age Action Ireland pointed out that it is far more expensive to live alone than to cohabit. Many older persons live on their own and the inability to afford adequate home heating can result in premature mortality among older persons. They also pointed out that Ireland has the highest levels of fuel poverty in northern Europe for the category of lone pensioner households. The Irish National Survey of Housing Quality found that older households are more likely to be characterised by having an open fire, with 25% of older households having no central heating.

Senator de Burca has one minute remaining.

Age Action Ireland asked that the Government would ensure proper measures are put in place in anticipation of these price rises and that the next budget might look at the issue of fuel allowance for older persons to match the increases in energy bills. Age Action Ireland proposed that energy providers could play their part in easing hardship for pensioners by deferring any increased charges until after the budget to complement what the Government can do, and also that energy providers should work to promote weekly payment schemes for low-income customers to help them to budget for the increased cost of fuel during the winter.

Age Action Ireland also expressed some concern about the fair deal legislation. It pointed out that although the legislation is being prepared for the past 18 months, as an organisation it has not been consulted. I ask the Minister of State, Deputy Hoctor, to indicate whether that might happen.

I thank all the contributors to this debate and commend the Senators for their interest in what is an exciting area, most certainly for me as the recently appointed Minister of State with responsibility for older people. I want to return to some of the issues raised by Senators, both last week and today.

The issue of elder abuse was raised. It was the main topic for discussion at a conference in Galway last week, as Senator Healy Eames stated. It is an area that is high on my agenda. As Senator Healy Eames stated, elder abuse takes many forms — psychological, physical, sexual and financial. No doubt it thrives on secrecy and subtlety. One of my concerns would be to raise the awareness of its existence, first and foremost. Senator Healy Eames is correct that it is a significant challenge for all of us. We must acknowledge that the findings to date show that the vast majority of elder abuse cases are carried out at home and by people the person knows and who the person may care about and depend upon. It is an area that must be handled with great sensitivity. It was to the credit of the HSE in the region that it highlighted the issue to mark World Day on Elder Abuse. The large attendance from the stakeholders on that day is a clear indication of awareness and that this is an area on which we must work.

Senator Healy Eames mentioned Mr. Joe Meade. The Financial Service Ombudsman is among the many other bodies such as the financial institutions with which we must work to uncover potential areas where elder abuse may occur. That issue needs possibly more time than the few minutes that both Senator Healy Eames and I have been given today here in the Seanad, but we are still grateful for the opportunity.

Nursing home inspections was raised on the previous occasion I was here in the Seanad. I want to give assurances on the levels and numbers of inspections. In this area the facts speak for themselves. The HSE has a target of two inspections per private nursing home. The public ones are not yet inspected but they will be shortly. On the question of private nursing homes, over 870 nursing home inspections, that is, two inspections per nursing home, were carried out in 2006, all of which were unannounced. The HSE confirms it completed 812 statutory inspections in 2007 — 93% of its target — with the remainder completed in January 2008. The statutory inspections may result in further follow-up inspections. In April 2008 the monitoring report documents that 292 inspections were carried out between January and April of this year. The Health Act 2007 provides for the establishment of the Health Information and Quality Authority, HIQA. Among its functions, HIQA will take over the independent inspections of all nursing homes, both public and private, early next year.

With regard to the expansion of services, nearly all speakers referred to the recognition that must be given by everybody that older people want to remain at home as long as possible. It behoves those of us in a position to ensure that is done, and that every service and support is provided.

I appreciate that the area of older people is increasing in volume and complexity and I want to place on record the amount of funding that the Government has already put into this area over the past years. Over 2006 and 2007 the Government has put in an additional €400 million into the largest ever expansion of services for older people. This has provided overall funding, in terms of current services, for a total of 4,350 home care packages benefiting over 11,000 clients in 2007.

Some Senators expressed concern about a particular individual in the midlands who was sent home as a stroke patient without any supports. I would be very concerned on hearing that because it would be the duty of the staff at the hospital as well as the public health nurse to arrange the necessary temporary or long-term home care for that person to be supported at home. The idea of home care packages was to support people to remain at home for as long as possible. More than 23 million home help hours have been provided nationally since 2005 with 11.3 million hours in 2006 and 11.7 million hours in 2007. This benefits approximately 53,000 people per annum.

The Bill providing for the fair deal scheme is being finalised by the Office of the Attorney General. The legislation is complex and requires careful drafting to ensure the interests of older people requiring residential care are fully protected. My colleague, the Minister for Health and Children, intends to publish the Bill as soon as possible following finalisation by the Attorney General and Government approval and to bring the legislation through the Houses of the Oireachtas thereafter. As the timeframe for bringing the legislation through both Houses is contingent on finalisation of the Bill, more definitive information is not available at this stage.

I fully acknowledge the situation outlined by Senator Phil Prendergast in regard to women who had to leave work under the marriage ban. The pensions strategy group invited submissions from the public. We acknowledge the need for that recognition. The findings of the pensions strategy group will be published shortly. We hope deficits in that area will be recognised in the future.