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Dáil
‹ Leaders’ Questions.

Long-term care funding and contributions

Summary

Kenny attacks the proposed care scheme as a new tax on elderly people who need nursing-home care, and questions whether adequate home and community services will exist. The Taoiseach says the scheme will standardise contributions, protect homes from being sold to pay for care, and have the State cover the balance; he cites increased funding and planned expansion of services, while Opposition members dispute their adequacy.

The Government has always proclaimed itself a low-tax Government, but it has introduced a raft of stealth charges and new taxes in the past few years. Last week in the budget, the health levy was increased by 25%, there was an increase in the cost of private beds in public hospitals and the Government voted through a measure requiring 5% of the notional value of a person's home to be assessed for the purposes of a claim for subvention.

Yesterday, we saw the introduction of a new death tax on the elderly. It appears the Government intends to wash its hands entirely of the future care of the elderly, those who built up this country, worked in far more difficult times than now and paid their taxes and PRSI, but now find they will be subject to a death tax after they have gone, in some cases requiring the sale of the family home. The Government's proposal is built on three pillars, namely, an inspectorate regime for nursing homes, community services and this funding proposal. The Government seems completely unaware of what is happening in respect of the provision of community services. It is some years since those in psychiatric institutions were abandoned in communities with no facilities to support them, but I see something similar happening now.

Is the Taoiseach aware that, in respect of the provision of community services for elderly people, we do not have sufficient general practitioners, nurses, occupational therapists, physiotherapists or home helps? To expect those services to be in place by 1 January 2008 is complete and utter fantasy. If the Taoiseach has been unable to prevent the serious abuse of some elderly in some licensed nursing homes, where a monitoring regime is supposed to exist, how does he expect that a community service to look after those elderly who are semi-highly dependent can be put in place by that date? How can he justify that as one of the fundamental pillars of this new programme, which also includes a death tax which was introduced yesterday?

Comment on this

Providing safe and decent residential care for older people is one of our key long-term challenges. As people live longer, the number who will need residential care will increase. The Government's response is twofold. We want to provide home help and qualified assistance to allow as many as possible to live as independently as possible and for as long as possible in their own homes. An enormous range of measures has been put in place and funded in the recent past. An outline has also been given by the Health Service Executive and the Department of Health and Children of what they want to achieve in the short term.

Second, we want to ensure that those who must go into residential care have the assurance of a quality place in a nursing home, where there is now a new and fair deal on how everybody pays. Long-term issues facing us such as care for the elderly and pensions are very important. As Deputy Kenny knows, the system that has been in place for the past decade and a half for supporting nursing home residents is deeply unfair. People with the same means and care needs can face different costs in public and private homes. We have decided on a new and fair deal for older people, a scheme that must be——

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The Government did not consult members of the public.

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——in effect by 1 January 2008. In accordance with the agreement reached through the lengthy discussions on Towards 2016, the scheme will ensure the same level of support for public and private nursing home residents and involve co-payments between care recipients and the State. Unlike the current system, it will ensure that care is affordable for all and no one will be asked to sell or mortgage his or her home to pay for care.

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Jim O'Keeffe Mr. J. O’Keeffe Fine Gael

One would wonder who has been in Government for the past ten years.

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A major change is that in the future, a person will make his or her contribution and the State will meet the balance of the costs and take on the risk of price increases. The scheme will be transparent with the same standardised needs assessment for everyone.

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There is no home care package.

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Everyone knows that the cost of care of the elderly has increased dramatically and will continue to do so. However, the individual contribution will be based on income and assets. At the time of receiving care, the individual will be expected to contribute 80% of his or her disposable income. Contained in the documents provided yesterday were details of the calculations, how the figure is capped and the residential sector matters that have been addressed, legislation on which will be discussed here in the new year.

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Saying one thing and doing another.

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From the Taoiseach's reply, it seems that there is no more a foregone conclusion in respect of this matter than there is regarding a number of other policies referred to by the Taoiseach.

The persons who will need nursing home care in the next ten to 15 years are those who worked in the 1960s, 1970s, 1980s and 1990s, built the Celtic tiger enjoyed by the Taoiseach and paid their taxes and PRSI. They find themselves in a situation whereby the State says that this proposal, which is supposedly revenue neutral, will leave a legacy of a new death tax of 15%. It will not be acceptable at a time of such economic strength when the Tánaiste says that the €2.4 billion received by the Government is not necessary.

The Taoiseach has not referred to the complete failure of community services to deal with this issue.

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Rory O'Hanlon An Ceann Comhairle Fianna Fáil

The Deputy's time has concluded.

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What will happen in the case of a person who is unable to avail of home supports and is required to go to a nursing home, but is refused for not being high-dependency? Are these people being told to get lost and go back where they came from? If they are refused the option of nursing homes, where will they go? Many years ago, psychiatric patients released from mental institutions were abandoned in the community.

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Deputies

Hear, hear.

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The Government is proposing that by 1 January 2008, there will be community services to look after elderly people in their homes and communities. The service's current rate of provision makes a mockery of this issue. The Taoiseach is living in fantasy land if he believes the service will be provided. There are not enough general practitioners, nurses, occupational therapists or home helpers and the State cannot employ the physiotherapists it has trained. Where will the Government find the personnel to provide cover to people refused entry to nursing homes?

In a country of considerable wealth, why are we facing a situation——

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Rory O'Hanlon An Ceann Comhairle Fianna Fáil

I ask the Deputy to give way to the Taoiseach.

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——in which the Exchequer will no longer contribute to care of the elderly and a 15% death tax will be imposed on those who have built up the country led by the Taoiseach?

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Deputies

Hear, hear.

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Jim O'Keeffe Mr. J. O’Keeffe Fine Gael

People will be afraid to die.

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I do not know where Deputy Kenny has got the notion that the Exchequer is no longer funding care for the elderly.

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The Taoiseach said it.

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This year, the State's expenditure on long-term residential care is €648 million. There has been an additional——

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The Government is freezing the contribution.

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Deputy Kenny asked me a question. Deputies should stop interrupting.

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The Taoiseach is not answering the question.

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In addition, €117 million will be provided in 2007. Some €85 million of that amount will support improvements in subventions and the balance will be used for the provision of 1,250 beds, mostly public, during 2007 and 2008.

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Mostly private.

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The amount of €85 million was added in anticipation of the care support scheme. Residential care is only one part of long-term care that requires funding. Care in the community — while the Deputy has claimed it is not present, it is — also needs to be funded.

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It is not there.

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People cannot get home helpers.

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It is rubbish.

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There has been an increase of €400 million in services for older people in the past two years, all of which——

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Does the Taoiseach believe that amount is sufficient?

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——has been used in respect of staff to look after the elderly in the community. There is a whole range of new HSE facilities for the elderly across the country, which I am sure Deputy Kenny has seen in his travels.

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The elderly cannot find them.

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The facilities are staffed by nurses and others.

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Jim O'Keeffe Mr. J. O’Keeffe Fine Gael

With all that money, why is the Government grave-robbing?

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Home help services are operating——

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They have been cut by 30%.

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——and will continue to provide care to people at home.

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Breeda Moynihan-Cronin Ms B. Moynihan-Cronin Labour Party

One hour per day.

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Two hours per week.

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They will require additional funding over the years. Yesterday, the Minister made it clear that she envisages a further expansion in home-based care.

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Jim O'Keeffe Mr. J. O’Keeffe Fine Gael

The Government is grave-robbing.

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Government backbenchers will not be happy.

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We have made provision for a large increase in the number of professionals in all of the related services so that we will have a greater cadre of people in terms of occupational therapy, physiotherapy and other health professions. Far from——

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The State cannot employ physiotherapists.

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It is a skeleton service.

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One cannot get the services.

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I can understand why the Opposition does not want to hear about the services or the figures.

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The Taoiseach only——

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Jim O'Keeffe Mr. J. O’Keeffe Fine Gael

We do not want to hear about grave-robbers.

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Unlike the old system in which someone would need to sell his or her house, the current system set out for people is fairer and more certain.

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Jim O'Keeffe Mr. J. O’Keeffe Fine Gael

Legislation was introduced last week——

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The Taoiseach is misinforming the House.

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Rory O'Hanlon An Ceann Comhairle Fianna Fáil

I ask Deputy Stagg to desist from interrupting. If he does not desist, the Chair will deal with him.

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Jim O'Keeffe Mr. J. O’Keeffe Fine Gael

The Minister of State introduced legislation one or two weeks ago.

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The Taoiseach might be inadvertently misinforming the House.

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Rory O'Hanlon An Ceann Comhairle Fianna Fáil

The Taoiseach is entitled to the same courtesy Deputy Kenny was afforded.

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Jim O'Keeffe Mr. J. O’Keeffe Fine Gael

We have a problem. Bertie and Harney are the new Burke and Hare.

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Rory O'Hanlon An Ceann Comhairle Fianna Fáil

Deputy Jim O'Keeffe should also desist.

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Last week, the Minister of State, Deputy Seán Power, introduced legislation concerning the sale of one's house.

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Rory O'Hanlon An Ceann Comhairle Fianna Fáil

If the Deputy interrupts again, I will ask him to leave the House. We will have an orderly Leaders' Questions. The Taoiseach is entitled to the same courtesy as every Member of the House when he is called.

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Hear, hear. It is only fair.

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All of the resources I have mentioned — the €400 million in the past two years and the resources outlined in the budget — relate to staff working for the elderly and more home care packages. The organisations have acknowledged the considerable increases provided to home care and community care people.

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They have not.

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Given what has happened in other services, we must continue to try to provide a better service.

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Rory O'Hanlon An Ceann Comhairle Fianna Fáil

The Taoiseach's time has concluded.

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It has often been pointed out that what has happened during the past 14 years has been unfair and unbalanced. The new system will be seen as being fair and far more compassionate.

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The Government is legislating to rob the dead.

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Where there are difficulties, they can be ironed out with legislative changes.

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Olivia Mitchell Ms O. Mitchell Fine Gael

People will be turfed out of communities.

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They will have no right of appeal.

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Jim O'Keeffe Mr. J. O’Keeffe Fine Gael

People will not be able to afford their gravestones.

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Unlike the off-the-top-of-the-head remarks made by Deputies who do not understand the system, the services were negotiated during the past year in the context of Towards 2016. We will see them implemented next year.

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The Government is following people down the line.

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