Paudge Connolly (Cavan-Monaghan, Independent)
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I move:

That Dáil Éireann:

notes that:——

— approximately 440,000 people or 11% of the State's population are over 65 years of age;

— of these, approximately 266,000 are over 70 years, one third of whom live alone;

— 25,000 elderly people are in long-stay beds or nursing homes;

— a further 13,000 elderly people who need high to maximum dependency care continue to live at home;

— it is the wish of a large majority of elderly people to receive care at home or in the local community;

— very many families of the elderly make many sacrifices to provide the best possible care for them;

conscious that the inadequacy of the nursing home subvention causes grave hardship for many families;

conscious that cuts in the home help scheme have seriously limited the adequacy of the service;

believing that the failure to abolish the means test for the carer's allowance is a further attack on the most vulnerable in our society;

recognising that day care centres serving the elderly in disadvantaged communities are grossly under-resourced;

alarmed that the failure to mainstream health related community employment schemes has undermined a community-based response to caring for the elderly;

notes with extreme concern the remarks of the Tánaiste and Minister for Enterprise, Trade and Employment that families increase their contribution to supporting the elderly with a consequent reduction in State support;

calls on the Tánaiste and Minister for Enterprise, Trade and Employment to clarify her position; and

demands that the Government immediately put in place adequate resources and comprehensive infrastructure for the care of the elderly.

I wish to share my time with Deputies Gregory, James Breen, McHugh, Sargent, Boyle and Ó Caoláin.

Pat Carey (Dublin North West, Fianna Fail)
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Is that agreed? Agreed. Is the Deputy sharing his time equally? We have a software problem here with the clock.

Paudge Connolly (Cavan-Monaghan, Independent)
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It is not quite equal. It is proposed to give five minutes each to Deputies Gregory and James Breen, four minutes to Deputy McHugh, five minutes each to Deputies Sargent and Boyle and ten minutes to Deputy Ó Caoláin.

Although most older people wish to remain at home, State policies are directed towards their leaving home for a nursing home bed. Families may apply for subventions for private nursing homes but the only funding available for maintaining a relative in the family home is the carer's allowance.

Home helps provide invaluable care for the elderly, not just in physical terms by cleaning up, but in many cases the home help is the elderly person's only contact with the outside world and looks after that person by shopping for him or her and so on. In 2003 my local health board, the North Eastern Health Board, cut 80,000 home help hours, which is equivalent to 40 wholetime jobs. The tragedy is that these jobs are at the cutting edge of service delivery, involving hands-on people providing a fantastic cost-saving service for the health board. However, this was an Anne Robinson "Weakest Link" cut which affected the two weakest links, the carer and the person being cared for. Those people are on the bottom rung of society as far as health executives are concerned. No executive positions were lost at this time.

This is the Government's way of cutting costs. The cost of home help went up so it decided to reduce the number of hours, treating the situation as an exercise in balancing the books. In this year's budget the Government realised the mistake of last year and retreated part of the way towards re-establishing those hours. It is generally acknowledged throughout the country that the North Eastern Health Board budget is totally inadequate. The per capita health budget for the region is €15, while the national average is €19 per head, which makes services very difficult to organise. In 2003 members of the North Eastern Health Board unanimously rejected the service plan and budget for the year.

This year the board took the unusual step of restoring some of those 80,000 hours, but putting back 35,000 hours still leaves us with a shortfall of 45,000 hours. The board restored those hours by raiding the reserve fund, though health boards are legally obliged to hold a 3% reserve. We do not even have that 3% reserve but I welcome the brave decision of the board to take €500,000 from that fund to restore 35,000 home help hours, even though that move is akin to selling the silverware.

Tony Gregory (Dublin Central, Independent)
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This motion deals with the failure of the State to adequately provide for care of the vulnerable elderly, particularly those in disadvantaged communities. I focus on the services provided by day care centres and the home help service as these are, to a significant degree, the two main community-based services for the elderly in the north inner city area I represent.

By coincidence, earlier this afternoon I attended the annual general meeting of the Lourdes Day Care Centre in Sean McDermott Street, which provides for the needs of very disadvantaged elderly people. The centre has been 25 years in existence and it is a great tribute to the voluntary committee that has kept it going despite a litany of cutbacks in the past year. Cuts in funding for the home help service caused chaos in the centre last year while cuts in the community employment scheme meant a loss of part-time workers which almost forced the centre to close down.

This care centre for the elderly, in the heart of one of the bleakest urban inner centre areas, survives not on State funding but through weekly lotteries, raffles, appeals and donations as well as the selfless commitment of a small group of voluntary workers. They barely make their running costs and the centre operates at a deficit, making do with equipment which has been in the centre since it opened 25 years ago. There are no funds to decorate or paint the place.

In the run-up to the last general election those in the centre were told that all that would change. They were to get a brand new building which would provide a modern facility for the elderly and, with numbers continually on the increase, this seemed heaven-sent as the small centre was finding it hard to cope. The new building was to be part of the RAPID programme and the area action plan for the north-east inner city. It was guaranteed and stamped with approval by the Taoiseach's office.

The election came and went and with it the fraudulent RAPID programme. Nothing further has been heard of the new, desperately needed centre. That was the report given today at the annual general meeting, as elderly people listened, many of them in wheelchairs. They are being cared for in the community, which saves the State the huge costs of long-stay residential care. That is how the most vulnerable of our elderly are treated by the Government.

I will refer briefly to two other local services in the north inner city to demonstrate the disgraceful inadequacy of State supports and the State's dismal failure to meet its responsibilities to the elderly. The East Wall Day Care Centre provides meals for senior citizens. It has no full-time staff but depends on its volunteers and three FÁS trainees to maintain its service, which operates five days a week. On average approximately 1,500 meals are provided each month and the only source of State funding is from the Northern Area Health Board, which provides — wait for it —€1.27 per meal, paid in arrears on a monthly basis. The senior citizens pay €2 per meal. This total, €3.27 per meal, is expected to cover all running costs, insurance costs of €18,000 per year, heating and lighting costs of €8,000 to €10,000 per year and fixed costs such as telephone repairs plus the cost of the food.

It is impossible to operate the service without fundraising and it is not surprising that the centre, in spite of using services such as the local food bank, operates at a deficit. The main limiting factor is the miserable fixed rate of €1.27 per meal, which prevents long-term, sustainable staffing options being pursued. How can any voluntary group plan and develop the services of a day care centre on that basis? I hope the Minister answers that question.

James Breen (Clare, Independent)
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There is a popular saying that our young people are our future. We have to ask how much respect and dignity does the Government afford to the elderly. Some 11% of the State's population is over 65 years of age. Why do so many problems exist in regard to the care and well-being of the sick and elderly? The Government tells us on a daily and weekly basis about the millions of euro spent on social welfare. Given such great expenditure, we must examine if our money has been squandered or spent unwisely.

I wish to acknowledge the financial help given under the capital assistance scheme to provide secure housing for the elderly, but it does not absolve all responsibility for the care of elderly people, the pillars of our communities. Frequently the burden of caring for an elderly person falls on one or more of his or her immediate family members. Such care often takes place in the home of the elderly person. Elderly people can become lonely and feel unwanted, as if they are a burden on society and their offspring. This robs them of their dignity.

There is a knock-on effect on carers, who become discouraged, lonely, angry and depressed due to the treatment they receive from this Government. Does the work they carry out not merit a wage? Carers on low incomes who satisfy a means test and provide full-time care to an incapacitated person may qualify for the carer's allowance while those providing care to more than one person may be entitled to an additional 50% of the maximum rate of carer's allowance each week. However, all carers should be entitled to an allowance and this should not be subject to a means test. It is time to abolish this system.

The Minister for Social and Family Affairs has failed miserably to introduce a fair system whereby the most vulnerable in our society have proper care and attention. Day care centres around the country ensure that the elderly are well looked after, feel part of a community, have interests, are fed and get medication and essential services. However, there are not enough centres. Why is the Government not putting more resources into this type of care? The Government wants us to acknowledge measures taken in residential and community-based care, as well as day care. However, these measures pale in comparison to what is required.

In my county of Clare, a few highly successful day care centres are in operation and another centre is due to open soon in Kilmaley. Questions must be asked of the Government about one of the centres. The management of the Clarecastle day care centre took the initiative and raised money for the provision of a dementia unit to be attached to the centre. This unit is in limbo, while the bureaucracy of the Government and the health boards gets into full swing to look for more money to provide this facility six miles down the road. Why are the wishes of the elderly not being considered? Those attending the unit in Clarecastle are happy with it and would prefer to receive their treatment there, as would the people who contributed their time, effort and money towards raising €200,000.

I wish to draw the Minister of State's attention to the village initiated by my colleague Deputy Cowley. Why has such a system not been extended throughout the country? It allows the elderly who are able to take care of themselves currently living in seclusion to be housed in a community with a day care facility until they pass away. When they become vacant the houses provided revert back into the system and are used to house others in a similar situation.

It is time for the Government to afford some respect and dignity to the elderly of this country. It is also time that the resources, be they people or infrastructure, are put in place so that people can live out their days in a peaceful, fulfilled and dignified manner. Measures are all well and good but how far they go is the issue on which the Government will be judged. As far as I am concerned these measures are not enough.

Will the Tánaiste come into the House to explain her remarks about the elderly which she made on television some weeks ago? It was a slur on the elderly to ask their families to pay more money so that facilities can be provided. The Government has failed the elderly, the most vulnerable in society. When the Minister of State responds, I ask him to explain what the Tánaiste meant by her remarks.

Paddy McHugh (Galway East, Independent)
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After the 1997 election the Fianna Fáil and Progressive Democrats parties published a joint programme for Government, An Action Programme for the Millennium. No doubt they viewed this as an exciting event. It is always good to use words like "action"; it creates the illusion of movement and progress. The document states:

Fianna Fáil and the Progressive Democrats in Government recognise that our older people have helped to build up the country into what it is today. It was their sacrifices, their taxes and their efforts which have helped to create the economic prosperity which we now enjoy. In the true spirit of caring, we propose to repay their efforts.

I want to deal with the way the Government went about repaying the efforts of the elderly, especially those elderly who need health care and assistance. This applies in particular to the elderly whose freedom of movement is restricted, whose independence is stunted, those who use wheelchairs to gain some mobility. These are some of the people who need personal assistants, carers, and so on who are employed within the health sector. Many such jobs are held by community employment scheme workers and the Government gave a solemn commitment to mainstream them, but it reneged on this. That is how it repaid elderly wheelchair users.

One has to ask why the Government let those elderly wheelchair users down. The simple answer has to be that they are seen as an easy touch. The Government believes they will not rock the boat, that they are too weak to make any noise. I attended a recent meeting of wheelchair users in Tuam who had come from the city and county of Galway and County Mayo. They feel betrayed and that they are being treated as second class citizens. They have no inhibitions about going on the streets and protesting in order to get their rights. Apart from the hardship involved in this, it will be a lovely illustration to the rest of Europe during our European Presidency to see how the island of saints and scholars looks after its elderly, especially the elderly with disabilities.

In fairness to these elderly wheelchair users, they put forward two options: that the Government either honours the commitment to mainstream, or else provides the resourses to implement the findings of the Harmon-Bruton report. This report was commissioned by the Department of Health and Children in 2000 with the specific task of identifying the deficiencies in staffing in a number of organisations, including the Irish Wheelchair Association. This Government-commissioned report found that the Irish Wheelchair Association in the Western Health Board region was down 21 staff members from what was required to provide adequate services. In 2003 the Department made €100,000 available to the Western Health Board to implement the findings of the report. The Irish Wheelchair Association's share was €9,000. This would not provide 21% of one job, let alone the 21 jobs required. The Minister of State should either honour his commitment to streamline or else provide adequate funding.

Last Thursday's The Irish Times referred to the Tánaiste as saying that a Progressive Democrats conference heard that many improvements in services for older people could be implemented with little or no extra costs, if the views of older people themselves are taken fully into account. This statement gives rise to many questions. Why does the deputy leader of the Government have to go to a small party conference to discover such a fact? Who are her advisers and why are they not informing her of this? It begs the question of what kind of interaction exists between different Departments, including that of Health and Children which has responsibility for the elderly, that they had not already discovered this.

Having had the benefit of her party conference deliberation, when will the Tánaiste, as deputy leader of the Government, introduce the improvements in services for older people that her party conference discovered could be implemented at little or no cost? I ask her to share her new-found knowledge with her Government colleagues to ensure that whoever has responsibility in this area can have those cost-neutral improvements implemented. Will the Tánaiste outline to the House what are these improvements?

Dan Boyle (Cork South Central, Green Party)
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I regret that the Tánaiste is not present in the Chamber and that no member of her parliamentary party has chosen to listen to the debate. I hope they take the opportunity to properly respond. The Tánaiste's recent statement moved the Independent Members of the Technical Group to table this motion. Her explanations to date on the context of her statements are far short of what is required. The House requires a better explanation as to how she sees the role of the State in the care of the elderly.

In practice and philosophy, the Tánaiste's party in Government has been pernicious in the area of social policy. The term "social policy" is treated with disdain by the Progressive Democrats, a party that believes social policy to be an oxymoron. The pernicious and odious manner in which social policy has been implemented in the lifetime of this and the previous Government has resulted in reduced levels of equality and care and more greed.

Given that so many elderly people live alone and are in need of care services, and that the role of the State in providing those services is minuscule, the context in which the Tánaiste could have made this statement is so far from belief as to be utterly unacceptable. I look forward to whatever explanation she gives to the House on why she even made such a statement. We are well beyond excusing Fianna Fáil for this. It has got to the stage where the Progressive Democrats is not the tail that wags the dog; it is the personality implant within the dog that forces the dog to bite on cue. The Progressive Democrats is the dog's means of transmitting rabies.

With the viciousness that now characterises social policy, we must propose a different view. The State plays an unacceptably small role in the care of our elderly. We must provide additional resources and take different approaches to make sure these needs are properly met. In the West Gate centre in Ballincollig there is a co-ordinated, cohesive and holistic approach between departments. There is a community element in how services are provided, not only to meet long-term residential needs, but also day care and additional services in the areas of nutrition, exercise and meeting the social needs of the elderly. This is a template for services that should exist across the State.

I accept there is an argument to be made about how the State is spending money on private nursing homes and how this does not represent the best use of taxpayers' money and does not meet the care needs of the 15,000 people in such homes. As she has previously done on other issues, such as single mothers, the Tánaiste has chosen to initiate the debate from the perspective that the State is doing too much. We say the State is doing too little.

The Green Party fully supports this motion. We are confident that other Opposition Members will similarly endorse it. I hope the Minister of State, free from his busy activities under the EU Presidency, might relate this to the Government, particularly his coalition partners. The message coming from the Government benches is unacceptable for the type of society many of us want to see.

Trevor Sargent (Dublin North, Green Party)
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Credit is due to the Independent Members of the Technical Group for tabling this motion. It reminds one of Mahatma Ghandi when he said that the greatness of a nation is to be judged by the way it treats its most vulnerable. When one meets elderly people while canvassing, the issues that arise are often repeated. They include security, vulnerability, isolation, and money for heat, light and food, etc. These issues are symptoms of Government policy that has sought to push people into the workforce.

Elderly people are left isolated. In its 2002 report, the Combat Poverty Agency stated that 41% of people living alone are over the age 65 years. The Tánaiste, who has elderly relatives, should have known this — we can all speak from experience on this — yet she considered it necessary to convene a meeting of Age Action to try and get to grips with what concerns elderly people hold. This is like closing the door after the horse has bolted. The Tánaiste will not be able to meet with the carers who are providing an extremely valuable service for a pittance as they are not able to leave home very often. In view of this, I hope she will visit people in their homes and meet with carers.

The Tánaiste, to use her own language, talked about saving the country a fortune. Costs and savings are perhaps the only way in which she can grasp an issue. Only for the voluntary effort and self-sacrifice of countless people, this country would be repeatedly before human rights courts because of its abuse of elderly people.

Progress has been made on sheltered housing. However, this has been achieved by those who saw a need for it in their communities and were prepared to act. They kept pushing until it happened. I pay tribute to Declan O'Sullivan in Skerries. His efforts should be emulated elsewhere. It is because of Government failures that people are driven to making enormous sacrifices in their communities. For example, the day care centre in Swords would not have been founded were it not for the effort of the local community. In Balbriggan, senior citizens are depending on a private developer to build their premises.

This pattern is being repeated all over the country. The Government is being found out. People are realising that it is winging it when it comes to dealing with the elderly. There are more than 100,000 carers in the country and when one meets them, one will find that they feel entirely forgotten, undervalued and taken for granted. That is an indictment of the Government.

The Government needs to look at this issue more radically. The Green Party has, for many years, proposed a citizen's income scheme to meet the needs of families and elderly people, and to address the widening gap between rich and poor. Such a radical scheme is required if the Government is to have any credibility in looking after elderly people.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Ar son Teachtaí Shinn Féin, ba mhaith liom tacú leis an rún in ainmna dTeachtaí Neamhspléacha. Is ceist fíor-thábhachtach é cúram na sean-daoine agus is cinnte gur theip ar an Rialtas seo cúram ceart a chur ar fáil do an-chuid daoine aosta atá ina n-aonar agus atá i mbochtanas sa tír seo.

On behalf of the Sinn Féin Deputies, I support the motion on the care of the elderly in the name of the Independent Deputies and I join in commending them on bringing it forward. The rights of older people and their role in society is a crucial issue of growing importance. I stress the word rights, because this is not only about care for the elderly by others but about the rights and entitlements of older people as members of society. That includes care but also the right to a decent quality of life, employment, housing and health care. We must address the mentality that sees the increasing percentage of older people in our population as a burden. Instead, we should view the experience and wisdom of age as an asset and a positive force, and it is on that basis that provision should be made by Government.

I do not intend to go into detail on the controversy about what the Tánaiste and Minister for Enterprise, Trade and Employment said. Whatever she said, it has ensured a debate on the Government's performance with regard to older people. The motion sets out the inadequacy of that record. Other facts not set out in the motion and which I will mention, together with the experience of all elected representatives, tell a fuller story, which for many older people is very depressing.

It was estimated that in 2002 approximately 26% of older people lived alone. Of the 390,000 pensioners in the State, approximately 114,000 live alone. The percentage is higher for those aged over 70 with more than 33% living alone. That is a frightening statistic. One third of that section of our population is condemned to end their days in isolation, away from family and friends and reliant on State services to meet many of their needs, if they are fortunate enough to have such services available to them.

Much of the recent debate has focused on the high cost and often poor standard of residential care and other Deputies will deal with this in the course of the debate. The vast majority of older people live at home and a growing number live alone. The State and society fall down in the provision of services to them.

For example, home helps provide a crucial service for many older people and are often a lifeline and the only human contact in the lonely weekly life of senior citizens. Apart from the domestic help they render, they often provide company to older people in an isolated existence. Despite this, just a few years ago, the women — and home helps are comprised predominantly of women — who provided that service were treated disgracefully and were paid a pittance by the health boards. They had to campaign for even a half decent wage.

Now home help hours have been cut so that the little assistance that was available to many older people has been removed. It is a shame and a disgrace, and no amount of nodding of his head by the Minister will alter the fact that, in my health board region, 84,000 hours of home help were taken from senior citizens and those in such need.

Some of the people worst affected by the home help cuts are those living alone in rural areas. The Minister may not be aware that a higher proportion of older people live in rural areas. The 1996 census found 48% of the older population live outside towns and cities, and these people are now losing out most. The Government will boast of the increased pensions provision but it is still inadequate and of limited use without the services essential to supporting our older citizens in their twilight years.

The Government's amendment to the motion would be laughable if the issue were not so serious and in many cases, as we all should know, tragic. The Minister and his colleagues give themselves a pat on the back for the home help service, but they have cut it back. Yet again, they tried to deny the reality that community employment schemes have provided critical support for many sectors, including senior citizens and people with disabilities. The CE scheme was described primarily as an active labour market programme; it is nothing of the kind. To justify the cuts of some 5,000 places on CE schemes the Government attempted to deny that many of these schemes fill gaps in services to older people, people with disabilities, child care and support for those trying to deal with drug addiction. These services would not be provided otherwise, because the Government has broken a series of promises on the provision of these and other mainstream services.

Last year I raised the issue of a day care centre for the elderly in Cootehill, County Cavan, in the constituency I am proud to represent. The Minister for Finance, Deputy McCreevy, claimed that the cuts in public service posts would have no effect on frontline staff. In Cootehill a new health care centre was provided with a day care centre facility which has not been staffed. It needs four people — a nurse administrator, a driver and two assistants — to provide daily care, five days a week for the senior citizens of that town and its extensive hinterland. It would cater for 200 people in one week, yet the appointments have not been made. The senior citizens' group in Cootehill was offered access to this facility but without the essential staff and on the proviso that it would provide its own public liability insurance.

When the Minister said that cuts will not have an effect in such instances, that is not true, as is borne out in the case I have cited. This is a prime example of the kind of services needed by older people being denied by the Government in a real and substantive way, and there are many more examples similar to the case in Cootehill that I outlined.

The inadequacy of housing provision by this Government is to blame for much of the isolation and deprivation experienced by older people. More than other sectors of the population, older people need access to properly maintained local authority dwellings. They need to be in a safe environment, close to their families and their peers, and in a mixed setting where constructive intergenerational communication can take place. That needs good planning and the provision of high standard accommodation by the local authorities. The ESRI has found that one in four older people living alone has no central heating. Local authorities should have resources made available to provide such heating in all dwellings where it is needed by older people, especially those living alone.

The crisis in housing affects older people acutely, as does the crisis in our health services. We know that many older people and people with disabilities who should be in residential care occupy acute hospital beds because the alternative facilities are not available. This has the knock-on effect of depriving the hospital system of acute beds, for which people wait months and years. Instead of integrated services and the best planning for the future of our ageing population, we have a domino effect of neglect contributing to further neglect.

On behalf of Sinn Féin, my colleague, Ms Mary Nelis, last year launched a charter for older people, and I will conclude by quoting from it:

The aged are no longer willing to be marginalised, or treated as less than equal citizens. They are on the move. Issues affecting senior citizens have moved from the periphery to the centre of the political debate.

They have recognised that negative attitudes to ageing across the island, have prevented the development of policies and structures needed to address poverty, ill health, isolation and violent attacks.

It is an indictment of government policies that thousands of senior citizens die each year from cold related illness and thousands more suffer from the indifference of a cold society. It is time we brought our senior citizens in from the cold.

In putting forward our Charter for Senior Citizens, Sinn Féin pledges that we will support and actively pursue the political and legislative changes necessary to establish a decent standard of living, full access to services and the right of senior citizens to fully participate in the life of their community.

I commend the ethos of that charter to the Minister and his colleagues.

Ivor Callely (Dublin North Central, Fianna Fail)
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I move amendment No. 1:

To delete all words after "Dáil Éireann" and substitute the following:

"— recognises the importance of addressing the needs of older people, particularly as our population ages;

— restates its policy of supporting older people who wish to continue living at home in the community for as long as possible and acknowledges the role families play in supporting their older relatives in the community;

— acknowledges the significant funding which this Government has committed to the nursing home subvention scheme and to the home help service;

— acknowledges the substantial progress made by this Government in expanding the income limits for the carer's allowance and in implementing significant increases in the value of the respite care grant for carers in line with its commitments in the Programme for Government;

— acknowledges the significant measures being taken by the Government to develop both residential and community based services for older people, including increased day care provision, and the continuing commitment in this regard;

— re-affirms that the primary role of the community employment scheme is that of an active labour market programme, and recognises the need for ongoing restructuring to ensure it continues to meet the specific needs of long-term unemployed persons, together with other vulnerable groups;

— in particular, approves the Government's commitment to put in place an increased level of service provision in line with the Programme for Government; and

— commends the actions taken by this Government and the previous Government since 1997 in meeting this commitment which includes the allocation of substantial additional funding.

I wish to share five minutes of my time with Deputy Sexton.

Pat Carey (Dublin North West, Fianna Fail)
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Is that agreed? Agreed.

Ivor Callely (Dublin North Central, Fianna Fail)
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I am pleased to have an opportunity to speak on issues related to the provision of services for older people and to outline what this Government is doing to meet the needs which have been identified for this population group.

Older people represent a core priority of this Fianna Fáil-led Administration. We have delivered record increases in pensions and secondary benefits. There has also been much progress in developing new care services, and extending entitlements, such as the free general practitioner schemes and others. No other party has a record to match this, but we in Fianna Fáil want to go further. We will give further generous pension increases, will ensure that older people can live in dignity and will provide for them to receive care at home.

I can stand over our record. Since 1997, we have increased spending on care services for older people by over €200 million. Medical cards have, for the first time, been extended to all who are over 70 years of age. Others had opportunities to do so in the past, but failed. The old age pension has risen, unprecedentedly, by over 50%. Let us not go back to the road taken in the 1994-96 period when we saw the miserable increases provided by the rainbow Government.

Over 35,000 elderly people have been taken out of the tax net. I am delighted that tax exemptions for those aged 65 and over currently stand at €15,500 for single people and €31,000 for married people. We have created the carer's allowance and, since 1997, the numbers in receipt of that payment have increased by over 100% — from 9,200 to 18,700 in 2002. All our budgets have been characterised by measures designed to improve the position of older people in our society. We have made a good beginning and we want to do more. It is encouraging to talk to some older people who clearly acknowledge and recognise the good that has been done. There are a lot of good things happening in our communities.

James Breen (Clare, Independent)
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Not everywhere.

Ivor Callely (Dublin North Central, Fianna Fail)
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The significant progress that has been made in the growth of funding available for this sector in recent years, is indicative of the Government's commitment to the ongoing development of health-funded services for older people. One of the great achievements of western societies in the 20th century has been the increase in life expectancy. As the standard of living for the young and middle aged in this country has risen, so the quality of life of successive generations is improving. Modern medicine and, perhaps even more importantly, social policies, political will and community enterprise mean that more and more people are living longer and more fulfilling lives, and rightly so. The majority of older people are healthy and fit, and hold good positive attitudes.

Over 60 million people in the European Union are aged 60 or over. Figures from the Central Statistics Office collated from the results of the census, suggest that the average age of the population is increasing. Projections based on the 1996 census indicate that while in 1996 some 11.5% of the population were aged over 65 this figure will have more than doubled by 2031 so that the percentage of the population aged over 65 will be between 18% and 21%. The Government is aware of this trend and has addressed some of these issues in the health strategy entitled Quality and Fairness: a Health System for You.

The Government is committed to developing services for older people, both residential and community-based, to meet the needs of our growing older population. There are economic and financial consequences of people living longer and, more than ever before, members of each generation in their active years must accept a responsibility towards the support of the elderly so that, when they in turn grow old, younger people will support them.

The Government's commitment to the development of a comprehensive range of services for older people can clearly be demonstrated by outlining the resources made available in recent years for service developments. Additional revenue funding alone for the development of services for older people has increased significantly from €12.7 million in 1997 to an additional €111.4 million in 2003. In 2004, a total of €9.5 million in additional revenue funding was allocated to services for older people. This funding has been used for a variety of services including: the nursing home subvention scheme; the newly introduced personal care packages, in which I take great pride; the home help service; and the new elder abuse programme, which I also take great pride in because I pioneered it along with the personal care programme; and support to the various voluntary organisations.

Since 1993, there has been an unprecedented level of investment in the nursing home subvention scheme. Some €5 million was allocated for the scheme when it was introduced in 1993. Under my stewardship, total expenditure on the scheme in 2004 will be approximately €114 million. Last year we finished up with a figure of over €110 million.

In line with a Government decision, an expenditure review of the nursing home subvention scheme was undertaken by my Department in association with the Department of Finance. The review was carried out by Professor Eamon O'Shea. The objectives of the review were: to examine the objectives of the 1993 nursing home subvention scheme and the extent to which they remained valid; to assess the service delivered; and to establish what scope, if any, existed for achieving the programme objectives by other more efficient and effective means. Professor O'Shea's report, entitled Review of the Nursing Home Subvention Scheme, was launched in June 2003, simultaneously with the Mercer report, entitled Study on the Future Financing of Long-Term Care in Ireland, which was commissioned by the Department of Social and Family Affairs.

A working group, comprising all stakeholders, has been established by my Department to review the operation and administration of the nursing home subvention scheme, following publication of the O'Shea report. The purpose of the review is to develop a scheme which will: be transparent; offer a high standard of care for clients; provide equity within the system, to include standardised dependency and means testing; be less discretionary; provide both a home and nursing home subvention, depending on need; be consistent in implementation throughout the country and draw on experience of the operation of the old scheme. The review of the scheme will also need to be examined in the wider context of how we, as a society, will, in the future, fund long-term care. If anybody disagrees with this, they should please let me know.

Pat Carey (Dublin North West, Fianna Fail)
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The Minister of State, without interruption.

Ivor Callely (Dublin North Central, Fianna Fail)
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Community supports are vital in order to maintain older people in their own homes for as long as possible. Long-stay nursing care should only be a last option in care planning for older people, with the community supports acting as a real support for older people who wish to live in dignity and independence in their own communities. Numerous studies have highlighted the fact that older people would prefer to remain living at home rather than going into long-stay care. The Government is committed to developing the various community and home support schemes.

Since my appointment as Minister of State, I have encouraged service providers to introduce personal care packages and home subvention for older people as an alternative to long-stay residential care. Personal care packages, PCPs, are specifically tailored to meet individual needs and could include the provision of a homehelp service, home subvention payments, arrangements for attendance at a day centre or day hospital and other services such as twilight nursing. PCPs allow older people the option to remain living in their own home rather than go into long-stay residential care.

An example of personal care packages is the Home First scheme. This scheme, which I launched, is being piloted in the Northern Area Health Board area. This service is targeted at older people to help support the transition from acute hospital care to living at home. High levels of support are provided to the individual for the particular period such support is needed including, if necessary, assistive technology.

A home care grant project is also being piloted in the East Coast and Northern Area Health Board areas and these pilot schemes are currently being evaluated by Trinity College Dublin on behalf of the Eastern Regional Health Authority. The Slán Abhaile project in the East Coast Area Health Board, which I formally launched in early November, is being undertaken by the board in partnership with the Royal Hospital, Donnybrook, and St. Vincent's Hospital.

Members have raised the issue of abolishing the carer's allowance means test. A means test is applied to all social assistance schemes. Its purpose is to ensure that resources are focused on those in greatest need. The carer's allowance means test has been eased significantly in the past few years. Most recently, my colleague, the Minister for Social and Family Affairs, Deputy Coughlan, made provision in budget 2004 for substantial increases in the means disregard. From next April the weekly income disregards will increase to €250 for a single carer and to €500 for a couple. The effect of this increase is that a couple with two children, earning a joint income of up to €29,328 can qualify for the maximum rate of carer's allowance. The same couple, with an income of up to €46,384, could still qualify for partial carer's allowance, the free schemes and the respite care grant.

Members are aware that I set up and chair an interdepartmental group on the needs of older people. The group's brief is to examine, on an interdepartmental basis, a range of issues that impact on the lives of older people. Its goal is to bring a positive influence to bear on the various services provided to older people. Issues warranting the particular attention of the group include housing matters and the various home improvement schemes, the information-gathering process with regard to older people and the demands placed on them by that process, the consolidation and simplification of application forms, the security of the elderly, and equality matters for older people — this incorporates the recommendations of the Equality Authority report, entitled Implementing Equality for Older People.

One of the areas which warranted immediate attention was housing and housing grants. The interdepartmental group requested the Northern Area Health Board and the North Western Health Board to carry out a pilot scheme on the streamlining of the disabled persons grant and the essential repairs grant. The group is awaiting the pilot scheme results.

Paudge Connolly (Cavan-Monaghan, Independent)
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There are no occupational therapists.

Ivor Callely (Dublin North Central, Fianna Fail)
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Other areas that the group will consider include public transport, support to carers and financial incentives to encourage older people to continue working. It will also review the various schemes currently in operation. To date, the group has met on 22 occasions. Different Departments have made contributions to the group's work, including the Departments of Social and Family Affairs, Environment, Heritage and Local Government, Transport, Enterprise, Trade and Employment, Justice, Equality and Law Reform and Health and Children. Excellent and valuable contributions and submissions have also been made by a number of eminent groups. The group is reviewing submissions made to date and preparing a draft interim report incorporating a mission statement on the role of the group.

It is acknowledged that there is insufficient provision of public long-term care beds to cater for our growing elderly population with a resultant over reliance on the private nursing home sector.

Paudge Connolly (Cavan-Monaghan, Independent)
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There are empty public beds in Monaghan hospital.

Ivor Callely (Dublin North Central, Fianna Fail)
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The Eastern Regional Health Authority and the Southern Health Board areas are particularly affected because of a lack of public long-term care beds. This was acknowledged when the Department was preparing the health strategy. There is a commitment in the strategy to provide 1,370 additional beds, plus 600 additional day hospital beds. In addition, the strategy proposed the provision of an extra 800 extended care community nursing unit places per year over a seven year period which will include the provision of long-term care beds for people with dementia.

Public private partnerships, PPPs, are being piloted in the health sector. These are based on the concept that better value for money for the Exchequer may be achieved through them. Business advisers appointed by the ERHA and the SHB are in the process of finalising draft public sector benchmarks for these projects. The Department of Health and Children will examine the draft benchmarks when received with a view to submitting them to the Department of Finance for approval to proceed with the PPP projects.

Under the national development plan, capital funding of over €253 million is being made available for the provision of services for older people in the period 2000 to 2006. On a national basis this will enable a comprehensive infrastructure of community nursing units and day care facilities to be put in place as well as the refurbishment of existing extended care facilities and the replacement of older unsuitable accommodation.

Paudge Connolly (Cavan-Monaghan, Independent)
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They will need staff to run them.

Ivor Callely (Dublin North Central, Fianna Fail)
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When detailing the breakdown of additional expenditure for services for older people, I mentioned the commencement of the elder abuse programme. I will outline to the House in some detail what this entails.

The publication of the report, Protecting Our Future, towards the end of 2002 — I only took office in July, received the report in November and immediately endorsed proceeding with it — was a momentous occasion for older people in this country. They were given a blueprint to deal with the scourge of elder abuse and a pledge that the blueprint would be implemented. Up to recent times, it was felt that elder abuse did not exist in this country. However, the report confirms that as many of us suspect there is a problem, the extent and nature of which remains to be identified.

This report starts with a definition of elder abuse and recommends the putting in place of structures to deal with suspected cases. It will, I hope, give older people who feel they are the subject of abuse in any shape or form, the confidence to report their anxieties, as appropriate, to such as a social worker, a public health nurse, a member of the Garda Síochána or any professional or care worker. The report is the first important attempt to deal with elder abuse. Abuse can come in many shapes and forms and it is important to make the general public more aware of the problem. However, it is even more important to target relevant service providers so that they become aware of the steps being taken to respond to elder abuse and the procedures that will be available.

As the old saying goes, prevention is the best policy. I hope that greater awareness of the problem will lead to a lessening of the incidence of elder abuse. A national implementation group has been established, as recommended in the elder abuse report. A number of the recommendations in the report are based on experience gained from two pilot projects. I understand that without any major publicity sufficient cases, in terms of both numbers and seriousness, have come to light to justify this whole process.

I am determined to press ahead with gradual implementation of the report. Despite the difficult financial situation facing us, I made €800,000 available in 2003 and €750,000 this year to commence this process.

I concur with the broad thrust of the report which recommends that the response to abuse of the elderly should be placed in the wider context of health and social care services for older people. As the population of older people here rises, we should never forget that they have been hugely instrumental in building the State to the healthy level we enjoy today. Their contribution to the economy is widely acknowledged and the present Government is fully committed to improving all aspects of their lives by focusing on issues that affect their well-being. From a health perspective, the cornerstone of policy is to keep older people living in their own homes as long as possible. This has been shown by research to be the choice of older people themselves. Older people have a fundamental right to be treated with respect in their twilight years and the implementation of the recommendations contained in this report will help to bring this about.

The starting point for making the changes called for in the report may be for each of us to reflect on our individual attitude to older people. We must begin to question our attitude to them in order to satisfy ourselves that we do not harbour in-built negative feelings towards them. These can often be the source of unintentional abuse of older people. We now have to proceed on a journey during which we will have to absorb much and learn to cope with what may have a considerable fallout.

Some Members referred to community employment. The level of funding to which this Government has committed itself in 2004 means there will be no further reductions in overall participation levels on community employment schemes for the foreseeable future.

John Cregan (Limerick West, Fianna Fail)
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Hear, hear.

Michael Ring (Mayo, Fine Gael)
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There are 25,000 places gone.

Olivia Mitchell (Dublin South, Fine Gael)
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Is there anybody left?

Ivor Callely (Dublin North Central, Fianna Fail)
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It will be clear to the House from what I have just outlined that the Government's commitment to older people cannot be denied. We acknowledge that we must continue to develop services to meet growing needs and that we cannot be complacent. However, what cannot be denied is that the Government and its predecessor can be proud of the record to date. There is no room for complacency and we must continue with our efforts.

I fully appreciate the full, measured contribution which older people in our community have made and continue to make to our society. My desire during my term in office is to be a clear and strong voice for older people and their efforts, work, needs and wishes. Older people offer a wealth of experience which can be harnessed and embraced for the good of the country and our communities. I pay tribute to all involved in the provision of services to older people, including the tremendous voluntary army which undertakes great tasks and puts in place support structures in our communities. I also acknowledge the representative groups which constitute a powerful voice for older people.

Paudge Connolly (Cavan-Monaghan, Independent)
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There is a 99 year old man on the waiting list for health board subvention.

John Cregan (Limerick West, Fianna Fail)
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The Deputies opposite will get their chance.

Mae Sexton (Longford-Roscommon, Progressive Democrats)
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I am pleased to have the opportunity to address the Dáil on long-term care policy and the broader issues of ageing Ireland. Just over two weeks ago, my party colleagues and I organised a very successful conference on ageing for interested organisations and guests. The majority of groups representing senior citizens within the State were in attendance. To my knowledge, this was the first time an Irish political party facilitated a discussion of this type. Ageing Ireland did not have the political profile it deserved until we put it on the agenda. We are using research resources provided by State funding to accomplish this. We must be honest and acknowledge that the House would not be debating these issues tonight were it not for our initiative.

Olivia Mitchell (Dublin South, Fine Gael)
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We are debating this because of complaints about the lack of subventions.

Séamus Pattison (Carlow-Kilkenny, Labour)
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The Deputy should be heard without interruption.

Mae Sexton (Longford-Roscommon, Progressive Democrats)
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There are great policy challenges and opportunities arising from ageing Ireland. Despite continued claims by the Opposition that there is a crisis in our health service, our health status as a population is constantly improving. I ask that the Opposition does me the courtesy I have done to its Members since I entered the House and allows me to make my contribution without interruption.

John Cregan (Limerick West, Fianna Fail)
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Hear, hear. The Opposition should listen.

Michael Ring (Mayo, Fine Gael)
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It is hard to listen to rubbish.

Olivia Mitchell (Dublin South, Fine Gael)
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It is a misrepresentation.

Mae Sexton (Longford-Roscommon, Progressive Democrats)
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Is Deputy Ring to continue to interrupt me?

Michael Ring (Mayo, Fine Gael)
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It is hard to listen to rubbish.

Ivor Callely (Dublin North Central, Fianna Fail)
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We had to listen to it.

Mae Sexton (Longford-Roscommon, Progressive Democrats)
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It is difficult to listen to Deputy Ring's rubbish on a constant basis in this House as I have done.

Michael Ring (Mayo, Fine Gael)
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The Minister of State will be out on the plinth tomorrow.

Séamus Pattison (Carlow-Kilkenny, Labour)
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Order, please.

Mae Sexton (Longford-Roscommon, Progressive Democrats)
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Since entering the House, I have listened in silence day after day to the rhetoric of Deputy Ring. I ask him to show me the same courtesy and listen to me. It is wrong to be blind to progress.

Michael Ring (Mayo, Fine Gael)
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If the Progressive Democrats had their way, the elderly would all be in nursing homes and their homes taken from them.

Séamus Healy (Tipperary South, Independent)
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Listen to the hypocrisy of the Progressive Democrats.

Mae Sexton (Longford-Roscommon, Progressive Democrats)
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It is common manners and common courtesy.

Michael Ring (Mayo, Fine Gael)
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We will let the Deputy continue.

Mae Sexton (Longford-Roscommon, Progressive Democrats)
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I thank the Deputy. I appreciate it.

Séamus Healy (Tipperary South, Independent)
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A bit of honesty from the Progressive Democrats would be nice, as would a programme for Government.

Mae Sexton (Longford-Roscommon, Progressive Democrats)
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Honesty has been my mainstay as long as I have been in politics and I do not intend to address nonsense. The Opposition has been speaking nonsense constantly all evening. It is unbelievable.

John Cregan (Limerick West, Fianna Fail)
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Deputy Ring should be quiet.

Michael Ring (Mayo, Fine Gael)
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I will not take a lecture from Deputy Cregan.

John Cregan (Limerick West, Fianna Fail)
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I am not lecturing anyone.

Mae Sexton (Longford-Roscommon, Progressive Democrats)
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It is as wrong to be blind to the progress we have made in health as it is to be dismissive of plans to make the improvements which remain to be made. There are more than 400,000 people over the age of 65. By 2030, this figure will exceed 800,000. By 2050, it will be 1.1 million, representing an increase of from 11% to 24% of the population. This is neither a problem nor a threat; it is positive. The first message we must get across is that the vast majority of older people of all ages are healthy. They are neither sick nor a burden.

Unfortunately, the motion suggests otherwise. It contains no reference to how positive it is that people are living longer. Instead, after a brief opening reference to the older population, the motion refers to people in long-stay beds, nursing homes and maximum dependency care. The approach I favour to today's issues and tomorrow's challenges is positive and I invite the Opposition to adopt it.

During the tremendously enlightening debate among participating audience members at our conference of the many organisations representing older people, it was stated that we must move public debate about older people away from the exclusive focus on problems. I could not agree more. Policy for older people cannot be confined to dependency, institutional care and resource pressures. No one in this House has a monopoly on care, social justice or commitment to the community.

Séamus Healy (Tipperary South, Independent)
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The Progressive Democrats certainly do not.

Mae Sexton (Longford-Roscommon, Progressive Democrats)
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We have used the fruits of our tremendous economic success to increase incomes and services for older people. The old age pension has been increased by 60% over the past five years whereas the increase under the previous Government was less than a paltry €10 per week. A Progressive Democrats-Fianna Fáil Government introduced every initiative on carers. The carer's allowance was introduced in 1990, carer's benefit in October 2000 and respite care grants in 1999. We have consistently increased carer's allowance by 76% since 1997. In three budgets, a Labour Party Minister for Finance managed an increase of €13. Is that commitment to the elderly? There are 14,000 paid home help assistants costing €110 million per annum to support elderly persons who wish to remain at home. Nursing home subvention will exceed €110 million this year.

Focus should be on the provision of more support in the community, and that is the approach the Government is adopting. The senior citizens of the State want dignity, independence and choice. There is a broad consensus among reasonable people that a partnership between the State and family is the best way to meet the needs of older people who require long-term care. No one, least of all the Tánaiste, has suggested that all families should pay more for care or that the State has no responsibility in this area. However, she has spoken out for older people who are abandoned by relatives who then expect to inherit those older people's assets. While these are the minority of cases, every health care professional in this field will confirm that they exist. It is a problem which is swept under the carpet. While it is difficult to make rules and policies to address the issue, the least we can do in the meantime is speak out against unfair and uncaring behaviour.

Olivia Mitchell (Dublin South, Fine Gael)
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The Deputy's party is in Government. She is speaking out seven years on.

John Cregan (Limerick West, Fianna Fail)
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We are delivering in Government.

Olivia Mitchell (Dublin South, Fine Gael)
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Deputy Sexton's party is in charge.

Séamus Pattison (Carlow-Kilkenny, Labour)
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Order, please.

Mae Sexton (Longford-Roscommon, Progressive Democrats)
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That is what the Tánaiste has done, even if her political opponents wilfully misrepresent her, as they have in this House consistently for the past two weeks. I record that the Opposition is talking rubbish. The time of the House would be better spent addressing complex issues and potential solutions if only Opposition Members would bother to put their minds to it.

Olivia Mitchell (Dublin South, Fine Gael)
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The Deputy's party is in Government.

Mae Sexton (Longford-Roscommon, Progressive Democrats)
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The reports referred to by our Minister have provided strategic choices and policy options.

Michael Ring (Mayo, Fine Gael)
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The spin doctors were busy this evening.

Séamus Pattison (Carlow-Kilkenny, Labour)
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Order please.

John Cregan (Limerick West, Fianna Fail)
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Deputy Sexton is entitled to speak.

Mae Sexton (Longford-Roscommon, Progressive Democrats)
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Has Deputy Ring read the two reports to which the Minister referred? He does not even know what they are about. They provided strategic choices and policy options. Did Deputy Ring bring any to the House since the reports were published? He did not because it suits the Opposition better to speak its negative rhetoric every day.

Michael Ring (Mayo, Fine Gael)
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The Deputy should go away. If the Progressive Democrats had their way, the elderly would be put in nursing homes and their homes taken from them.

Mae Sexton (Longford-Roscommon, Progressive Democrats)
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I do not claim to have the ideal solution to the sustainability problem. A mix of initiatives is what we need.

Olivia Mitchell (Dublin South, Fine Gael)
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The Deputy thinks she is in Opposition.

Mae Sexton (Longford-Roscommon, Progressive Democrats)
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For our part, we are at least proceeding with the debate and addressing the issue. I invite the Opposition to get out of the mud bath and join in the debate in a constructive and positive manner.

Olivia Mitchell (Dublin South, Fine Gael)
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I wish to share time with Deputies Ring and McCormack.

Séamus Pattison (Carlow-Kilkenny, Labour)
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Is that agreed? Agreed.

Olivia Mitchell (Dublin South, Fine Gael)
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I welcome the opportunity to speak on this neglected issue and thank our colleagues in the Technical Group for bringing it forward. Already we are sensing a crisis in the area as social trends and the geographical dispersal of the extended family increasingly make care of the elderly something that must be planned and budgeted for in a way that did not happen in the past. One must add to that the fact that there will not only be more of us over 65 years of age; those of us who reach old age will live longer. We will, therefore, have a greater level of dependency, and the challenges for families and the State will grow to crisis proportions.

I want to speak primarily about nursing homes, but I also want to emphasise that they should always be the option of last resort. Home is best, and should always be the focus of investment in maintaining and sustaining independence for as long as possible and developing a continuum of care options for people, including home helps, community nursing, carers in the home and forms of sheltered accommodation as appropriate. The alternative to the nursing home is not just the cheaper but the better option. It is the option of choice that maintains dignity, independence and companionship for the elderly.

The erosion of existing community services and the failure to plan for and provide the paramedics and therapists needed to support people in their own homes, the failure to recognise the role and contribution of the vast majority of carers, and the almost total collapse nation-wide of the disabled person's grant are all symptoms of a lack of commitment to the home first principle and of a Government seeking to make short-sighted savings at the expense of a group that is largely invisible, silent and often very difficult to identify statistically. However, they do not remain hidden or silent, since eventually they turn up at accident and emergency departments in a crisis situation and require long stays in hospital. When they are eventually ready for discharge there is no supportive community and certainly no State supports to discharge them into. That is why we have the phenomenon of medically well people occupying acute hospital beds while their friends and neighbours are at the other end of the hospital seeking acute beds for their treatment.

I want to return to how families resolve that impasse in hospitals later. However, the lack of options for families such as community care, targeted or sometimes even temporary supports in the home is resulting in people going into nursing homes and choosing them as the first rather than the last resort. They are going into nursing homes far too early in many cases when they are well enough — or would be with a little support — to stay in their own homes for much longer. Ultimately, they end up in nursing homes leading far less independent lives than they could otherwise with a little support. At the same time, their resources are drained away, as are those of their families and the State.

The sum of €12 million was recently provided for additional nursing home places, but it had virtually no impact. The effect was once-off, after which the beds simply filled up again. It was because the turnover in nursing homes is extremely low — far lower than it should be. People are spending far longer than necessary in nursing homes. Some people will need nursing home care eventually and there will always be a percentage of the elderly population that will require a bed in a nursing home. It ranges from about 3% to 6% across Europe. As a society we must urgently address how those beds are allocated to people and how they are paid for. The crisis is developing rapidly and will get worse. Already spiralling nursing home costs are putting appalling pressure on families as the gap between the State subvention and the cost continues to grow.

Equally, I do not deny that the cost of subventions on the State is also growing. In 2001, the State paid €52 million in subventions. A scant two years later, the ERHA alone paid out €70 million in its area. Every year that burden, both public and private, will continue to grow. Already what was forecast in the review of the nursing home schemes completed in 2001 shows that we have completely underestimated the growth in costs and numbers of those requiring nursing home care. It shows the immediacy and urgency of the problem and the need to address it before the entire system collapses in tatters.

The debate that has taken place so far has been about who should pay in future. I regard that as secondary to establishing who is paying now. Unbelievably at present, we do not know who is paying, how much they are paying or why. Bed allocation and subvention decisions are chaotic, arbitrary and grossly unfair. The only determinant now of whether someone gets a free bed is luck. It is not a question of income, wealth or even knowing the local Deputy. It is not family or insurance but luck. That luck can, of course, be influenced by such things as geographic location. For instance, there is a far greater preponderance of public beds in the North Western Health Board area than in the eastern region. However, even within those regions, it comes down to luck.

That can be improved by timing, for instance, if there is a winter initiative or a crisis in hospital beds which results in money going into nursing homes. It may also be a matter of who is making the decision on the day. People with exactly the same circumstances and means are treated differently depending on where they live or what week they apply. Some get a free bed, and some get a totally inadequate subvention, even though their means may be exactly the same. Sometimes the only difference is the degree of determination of families to preserve their inheritance and keep their relatives in a hospital bed until they get a free public bed. They know that they either pay out or tough it out. The toughest people get the best deal. Others equally — and sometimes even more — entitled have to beg, borrow and steal, mortgaging their own homes and those of their families and generally making themselves into beggars to pay the costs of a private nursing home.

The Ombudsman says that everyone over 70 is entitled to a nursing home bed. The Government says that the entitlement is only to what can be provided within existing resources, and that those must be rationed out. That is reasonable, but let us do it according to some rules and a framework. The whole system at present lacks clarity, certainty and consistency, so that families are left floundering in crisis situations, not knowing what their choices are or even if they have choices. They are often without any information about what is available. Most people are responsible. They want to plan and budget, making choices within the options open to them. They do that in all other areas of their lives — education, insurance, their holidays. They want to do the same about their nursing care, and particularly regarding nursing home care at the end of their lives. They cannot, however, because there are no rules or framework. They cannot figure out their entitlements, and there is apparently no one to tell them what they are. They do not even know their own responsibilities.

We know that nursing home costs can wipe out the work of a lifetime for inmates — and not only theirs, since it can pauperise their children and their families too. The very least that we owe to the elderly is that they know their entitlements and what they are obliged to provide. The debate has focused largely on responsibilities for families, who have a moral responsibility to parents. In the vast majority of cases, people do not need to be told that. They know, and it is a labour of love for them. Most will go to enormous lengths to ensure the very best care for their families. That is as it should be.

However, that should not be their legal responsibility. Young couples with mortgages and children have enough problems, legal responsibilities and calls on their resources. If they can afford it, they will do it, but it should not be a legal requirement. Responsibility for care of the elderly should be shared by the State, to which the elderly have contributed all their lives, and where an income or asset is not being used, that should be shared with the patient.

Inheritance is a hugely emotive issue in this country, but nevertheless, the patients have first call on their assets, and their first responsibility is to themselves. People save all their lives to ensure some comfort in their old age. We would all like to think that we will do that, and we would also like to think that we will be able to pass on something to our children — the fruits of our own labours — at some point in the future. There is no reason that shared responsibility could not enable that. For instance, in many countries where assets exist, an imputed rent is calculated, and the patient pays for that for a defined number of years — three, five or whatever we find appropriate. If the patient lives beyond that, the State should take over the cost of his or her care. Such a back-loaded system would also encourage governments to develop community care services to ensure people stay out of nursing homes for as long as possible.

The important issue I wish to raise is that clarity and certainly in respect of entitlements and responsibilities is an absolute necessity. However, it is completely absent and is causing crisis situations in our hospitals. People are inappropriately placed and are not receiving good nursing care in hospitals when they could be in their own homes supported by community facilities. If an individual needs a nursing home bed, they should be able to get one but he or she must know their entitlements and responsibilities. If we do not have clarity, we will never resolve this situation.

Michael Ring (Mayo, Fine Gael)
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I wish Deputy Sexton was present because I would like to make a point to her about the home help service and the reason I get so angry listening to the rubbish coming from the other side of the House. I tabled a question to the Minister of State about a case in my constituency. I want to be careful not to identify the person who was getting the home help service for one hour per day but the health board then cut it to three hours per week. That person had a serious accident over Christmas. I will not identify the accident because everyone in the town from which I come knows what happened. Following the accident, the person had major surgery. The person fell into a fire and then fell in hospital breaking his hip. The home help service was taken away from a person who needed it. If the Minister of State is so concerned about the elderly, why is the Western Health Board and every other health board attacking the home service? Every report which has been produced has shown that elderly people want to stay in their own homes.

Ivor Callely (Dublin North Central, Fianna Fail)
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We all agree with that.

Michael Ring (Mayo, Fine Gael)
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It costs the State little money to provide the home help service. The Western Health Board spent the last two weeks of last year running around the country and my constituency holding conferences to spend the health board budget so that it would not have to send it back to the Department at the end of the year. It was wining and dining in hotels in Galway, Mayo and Westport. I can stand over that statement. Yet it targeted that person——

Ivor Callely (Dublin North Central, Fianna Fail)
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The Deputy should bring that to my attention.

Michael Ring (Mayo, Fine Gael)
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I will do so. The health board targeted the person to whom I referred and took away the home help service from someone who needed it. It is outrageous; it is a scandal and the Minister of State and his Department should tackle that matter immediately.

Ivor Callely (Dublin North Central, Fianna Fail)
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That should not happen.

Michael Ring (Mayo, Fine Gael)
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Another matter raised by my colleague and by the Minister of State relates to the abuse of the elderly. A report came out a number of years ago in which it was reported that 12,000 elderly people had been abused. Has the Minister of State put an independent inspectorate into State homes? There is an inspectorate for private nursing homes but there is none for State homes. That is something the Government should have done, especially as the report in question was published some time ago. The health boards, the previous Minister and the Minister of State have done nothing about it. If the Minister of State was serious about the elderly, a decision on the report should have been his first priority.

People wish to stay in their homes until their last day. The Progressive Democrats propose that when somebody gets sick a Progressive Democrats auctioneer will sell his or her home, take his or her money, shove him or her into a nursing home and forget about him or her. However, when an elderly person goes into a State home, he or she hopes it is for a short time and always has the wish to come back to where they have lived. They do not want to sell their home to the Progressive Democrats auctioneer. I hope that will never happen in this country.

Olivia Mitchell (Dublin South, Fine Gael)
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It is happening.

Michael Ring (Mayo, Fine Gael)
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It should not happen. I compliment the previous Ombudsman, Mr. Murphy, and I wish him well in his retirement. My colleague raised the issue of people over 70 years of age having an entitlement to a State bed. The Government recently gave every person over 70 years of age a medical card. That means, as the former Ombudsman said, a millionaire or a billionaire has a right to a State bed if they are over 70 years of age. I pose a challenge to the Ombudsman, Emily O'Reilly, who was a journalist at one time. I hope she and her office will protect the elderly and ensure whoever is entitled to a bed gets it.

If the Minister of State is serious about the elderly, he might consider a simple measure which would not be a big cost to the State. The free fuel scheme only runs from October to April, but the time has come for the elderly to avail of it for every week of the year as there are only few weeks each year when elderly people do not need to light a fire. It is the one question which comes up on the doorsteps at every election.

The free travel pass is no good to elderly people in rural areas because there is no rural transport. Why can the Minister of State, along with the Department and the Department of Social and Family Affairs, not work out a scheme to provide vouchers whereby people could use taxis or hackneys to collect their pensions? If there was a problem, at least they would know they could telephone their taxi driver who would bring them to hospital or wherever.

Pádraic McCormack (Galway West, Fine Gael)
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I thank my colleagues for sharing time. I also thank the Technical Group for tabling this motion and Members of that group for waiting in the Chamber. I came in when Deputy Sexton expressed passionate views on the tabling of the motion, but her passion was misdirected. If she displayed the same passion in her own parliamentary party, she might get some action. She seemed to forget her party was in Government. I am sorry she had to leave the Chamber.

I compliment voluntary groups working with the elderly. More is being done by them than by State institutions in looking after elderly people, particularly in their own communities. I have great respect for a new organisation set up in many towns and rural areas called the active retirement group. It does great work for elderly and retired people and keeps them active in their own communities, which is to be complimented. As most speakers have said, the greatest desire of people is to live as long as possible and to die in their own community and among their friends and family. More could be done at Government level to ensure that happens.

I compliment the great strides which have been made in respect of improvements in the carer's allowance but not enough people are getting the allowance to enable them to care for and keep people in their communities as long as possible. I have made the following point at every budget but I have not made it to the Minister of State. I have dealt with a particularly cruel case and I have asked for the past five years to have something done about it, yet it seems to be impossible. The official with the Minister of State knows what I am going to say because I have said it so often. I refer to the case of a carer who becomes a widow but who continues to be a carer. As soon as she qualifies for the widow's pension, she loses the carer's allowance despite the fact she continues to be a full-time carer for an incontinent person in her home. That is a cruel penalty on any carer. At every budget and in every debate on social welfare, I have asked that something be done to address that problem. A carer who becomes a widow and who continues to be a carer should not lose the carer's allowance simply because she qualifies for the widow's pension.

By keeping people in their communities, the carer's allowance saves the State several million euro each year. It is estimated that there are 120,000 carers, of whom about 25,000 receive carer's allowance. More people should qualify for the carer's allowance because keeping old people in the community is of much greater benefit to society and the younger generation. The person from whom I learned the best wisdom was my grandmother. The Government should make efforts to keep more people in the community for as long as possible by increasing carer's allowance and introducing less stringent qualification criteria.

Debate adjourned.