Sinn Féin - On Your Side

Nursing Home Support Bill removes universal entitlement - Sinn Féin to oppose

13 November, 2008 - by Caoimhghín Ó Caoláin TD


Speaking in the Dáil today on the Nursing Home Support Bill Sinn Féin Health Spokesperson Caoimhghín Ó Caoláin said his party cannot support the Bill as it moves away from universal entitlement. He said the Bill 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.

Deputy Ó Caoláin said, "While this Bill does clarify much that is very unclear in terms of the care entitlements of older people at present it also introduces a complex new system that is hugely problematic. I believe that it effectively removes the universal eligibility for a place in a public nursing home as provided for under the Health Act 1970.

"The delay in publishing this legislation has caused great concern to older people and their families and left many thousands of people in doubt about how nursing home care will be provided and paid for. I regret to say that the system put in place by the Bill is certain to give rise to new concerns and will create new forms of inequity.

"The statutory eligibility to a bed in a public nursing home has never been vindicated in terms of the provision of the resources to make those beds available. This has led to a huge reliance on the private nursing home sector and the current complex and inequitable system of State subsidy for nursing home care. Undoubtedly this had to change but I believe the Government, in doing so, has gone in the wrong direction.

"Simply put, if a person suffers a heart attack he or she is entitled to a bed free of charge in a public hospital. But, under this Bill, if a person becomes so dependent - say from the effects of a stroke - that they need constant care in a nursing home, their entitlement to a public bed free of charge is effectively gone and they must pay. The Minister will argue that the places have never been there and will not be there to provide full provision for universal entitlement but that is not the point. A fundamental shift is taking place and the implications for the whole health service are profound.

"Sinn Féin cannot support the Bill. It is a move away from universal entitlement. It is not rights-based. It is not 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." ENDS

Full text of Deputy Ó Caoláin's speech follows:

Nursing Homes Support Scheme Bill 2008

This Bill has been long promised and long awaited. It has huge implications not only for the care of older people, but also, I believe, for our entire system of health and personal social services. While the Bill does clarify much that is very unclear in terms of the care entitlements of older people at present it also introduces a complex new system that is hugely problematic. I believe that it effectively removes the universal eligibility for a place in a public nursing home as provided for under the Health Act 1970.

The delay in publishing this legislation has caused great concern to older people and their families and left many thousands of people in doubt about how nursing home care will be provided and paid for. I regret to say that the system put in place by the Bill is certain to give rise to new concerns and will create new forms of inequity.

The statutory eligibility to a bed in a public nursing home has never been vindicated in terms of the provision of the resources to make those beds available. This has led to a huge reliance on the private nursing home sector and the current complex and inequitable system of State subsidy for nursing home care. Undoubtedly this had to change but I believe the Government, in doing so, has gone in the wrong direction.

Simply put, if a person suffers a heart attack he or she is entitled to a bed free of charge in a public hospital. But, under this Bill, if a person becomes so dependent - say from the effects of a stroke - that they need constant care in a nursing home, their entitlement to a public bed free of charge is effectively gone and they must pay. The Minister will argue that the places have never been there and will not be there to provide full provision for universal entitlement but that is not the point. A fundamental shift is taking place and the implications for the whole health service are profound.

I was alarmed to find that the Bill as published was framed without consultation with older people and older people's organisations, including Age Action. I urge the Minister to study closely Age Action's detailed submission which all TDs and Senators have now received. That submission and the many concerns about the Bill raised by others should cause the Minister to pause and reconsider before the legislation goes to Committee Stage. I urge her to do so.

To put this debate in context I refer to the report 'Care for Older People' published by the National Economic and Social Forum in 2006. That Report exposed how our system of care for our senior citizens is skewed towards residential options and how there is a funding bias towards nursing home subventions. It pointed to the lack of a general model of assessment and rehabilitation.

The figures in that 2006 Report, and I doubt if they have changed much, make stark reading. The 5% of older people who are in long-stay care account for 55% of the overall budget for care of older people of about 1 billion. This State ranks lowest of the EU 15 in terms of social spending per older person. We spend one third of what Denmark spends per person aged over 65.

Describing the barriers to the development of community services for older people the NESF Report referred to 'Perverse Investment Incentives':

"The present official funding of services is not consistent with the policy objective of encouraging community-based responses; considerable resources are invested in nursing home care responses, some of which are unnecessary and inappropriate."

To speak plainly we all know that the worst nightmare for the vast majority of older people is to have to leave their homes and enter long-term residential care. The best option is for people to be cared for in their homes with the help of their family, friends, neighbours and the health and social services provided by the State. The Minister claims that the Government is providing for improved support for older people in their homes but the reality is that current provision is totally inadequate. Despite the claims of the Minister and the HSE the experience on the ground is that home help hours have remained static since 2007. We receive reports frequently of older people's home help hours being reduced or cut off entirely. Research carried out by the Irish Association of Social Workers this year exposed the lack of adequate provision of home help across the State as well as the cutting of hours.

The NESF Report identified the weakness of community care, the poor integration between systems and between sectors, under-resourcing, lack of responsiveness to the needs of older people, poor co-ordination and the fact that care is not embedded in local communities.

Community-based care requires both resources and legislation. This Bill should have been a much more comprehensive piece of rights-based legislation setting out the entitlements of older people to all forms of care - in the home, in other community-based settings and in nursing homes. Or, at the very least, there should be parallel legislation covering the range of care other than nursing home care.

The sad reality is that the inadequacy of support for older people to spend their twilight years in their own homes means that more of them end up having to avail of expensive nursing home care. It means that more of them become ill and lose their independence. This short-sighted failure of successive Governments to provide the essential resources for community care ends up costing the State hugely in providing for long-term residential care.

Cost is a major issue with this Bill. Government policy has led to a catastrophic fall in revenue. How is this Bill going to be funded in 2009 and subsequently? Are we going to face a long delay in its commencement? And, most crucially, are we going to see the creation of a massive waiting list for nursing home care as people are assessed as in need of such care and then find that the places are not yet available? Age Action has asked a very pertinent question. How would such a list work? Would it be on the basis of first come first served or on the basis of need, with those most urgently requiring care being accommodated first? Has this been worked out?

Another key question asked by Age Action is this. If the bill is enacted does it mean that an older person who is medically assessed as being in need of full-time medical and nursing care, but who refuses to sign up to the new charging arrangement whereby he or she would pay 80% of his or her income and up to 15% of the value of his or her estate, would be refused essential care by the State? Other concerns raised include the fact that the Bill does not recognise the situation of siblings who share the same house, although it recognises married, co-habiting and same-sex couples. It has been pointed out also that people could be charged twice in their life-time. For example, a person could pay a 7.5% share of their home on behalf of a partner who is in care and, if they sold the home and down-sized and later needed nursing home care themselves, they could face a 15% charge on their new home.

There are many more issues and questions raised by the detail of this bill which will need to be teased out at Committee Stage. Overall, though, Sinn Féin cannot support the Bill. It is a move away from universal entitlement. It is not rights-based. It is not 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.

Connect with Sinn Féin