My Speech on the Nursing Homes Support Scheme (Amendment) Bill 2021: Second Stage

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I welcome the Bill. As a member of the Government that introduced the home care system initially, I recognise that we obviously did not get it completely right. It is very hard to get it exactly right the first time around. Several deficiencies emerged which are being effectively dealt with by the Minister of State in today’s legislation, which I welcome.

I am slightly concerned that it has taken so long. I remember the fourth last Minister of State in that Department actually speaking about this particular reform. Since then we have had three different Ministers of State and now Deputy Butler is the Minister of State. Thankfully she has been able to introduce it. It is quite a complex Bill, containing several points of detail that I would like to discuss, but that will be a matter for Committee Stage.

We have always recognised that social care does not come cheap. It is very expensive system. This year the fair deal scheme will cost in excess of €1 billion to the Irish taxpayer in net terms, after taking into account the contribution from the nursing home occupants. The elephant in the room here is the absence of a system of statutory home care.

The policy of parties on all sides of the House is that people who can be cared for in their own homes should be cared for in their own homes insofar as that is possible. They should be left to live out their declining years in the comfort and security of their own homes. Only people who cannot be cared for in the family home should be taking up nursing home beds. Of course, as in many other cases, policy and practice diverge. Everybody on all sides of the political divide is in favour of people being cared for at home. Whereas the law states that if a person meets certain criteria, they have a statutory legal right to be accommodated in a nursing home under the fair deal scheme, they have no statutory legal right to home care which, apparently, is what everybody wants.

I know the Minister of State intends to introduce a system of statutory home care. I understand she is working very hard on that and it will be her next project after this Bill has been passed. However, I am concerned over how long it has taken us to get to this point. This is a significant improvement on the current system, but it has been spoken about for several years. How long will it take us to have a system of statutory home care?

First, it is recognised as being more desirable for people to be able to live out their lives in the comfort and security of their own homes if that is possible. Second, it is much less costly for the State. I have seen various figures, and while it is hard to average these things because conditions vary so much, on average maintaining somebody at home costs one third of what it costs the State to prop up the fair deal scheme for people in nursing homes. This means there is a double benefit. If people feel they can stay in their own home and can be catered for in their own home, and their family are willing to have them at home, they would prefer to be in their own home. It is much better for them. All studies tell us that it is much better for their mental health. The added bonus is it only costs the State about one third of the cost. It makes no sense that we have not moved further in providing a statutory home care system even as things stand. The home care system in the country is sporadic and inconsistent. It depends on where people live; there is a certain postcode lottery.

In the last Dáil, I introduced a stopgap measure to allow people to access home care on a statutory basis while we were waiting to put in place a statutory home care system, which needs to be carefully worked out. That legislation was passed by a large majority in the Dáil. I believe everybody in the House, bar Fine Gael Members, voted for it. It passed Second Stage. The Minister of State at the time promised me that she would hold Committee Stage within six months, but that six months has come and gone. It was about three years ago when I was promised that it would be back in six months.

Having drafted the Bill – the temporary measure I just referred to – myself, I recently sent another Bill to the Minister of State. I must give the credit for drafting the second Bill to Community Law Limerick, which comprises many learned legal people, including experienced senior counsel. Given that there are about 5,000 houses vacant whose last remaining occupant has gone into a nursing home, the Bill provides that in such cases there should be discretion to hand the house over to an approved housing body, which would then select somebody from the list of homeless to put into that house.

The arrangement between the owner and the approved housing body would be a licence arrangement so that the approved housing body did not have to act as a landlord with all the attendant rights, duties and obligations. It would operate from year to year. It would be entirely at the discretion of both sides. The central tenet is that people from the list of people who are officially categorised as homeless would be put in there, which is far preferable to the hubs and other places where they are accommodated at present. This would also be a financial benefit to the State because in 2019 the average cost to the State of providing emergency accommodation for a homeless person was €36,000, which has probably risen quite significantly since then. While I know that rents vary significantly in different parts of the country, the average rent is about €14,500 per annum. At €14,500 per annum as opposed to approximately €40,000, it would be cheaper for the State.

I have sent a copy of that Bill to the Minister of State and I know she is studying it. If she cannot incorporate it into this legislation, I hope some version of it makes its way onto the Statute Book soon.

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