Seanad Éireann - Volume 132 - 14 April, 1992

Adjournment Matter. - Westmeath Day Care Facilities for the Elderly.

Mr. Cassidy: I congratulate the Minister for Health on his appointment. I have been a friend of his for a long time and I am delighted to see him in this portfolio where I know he has enormous expertise and experience. I wish him well and look forward to working with him during the lifetime of the present Dáil.

I am calling for a residential and day [659] care centre for the elderly of north Westmeath to be provided at St. Peter's Hospital in Castlepollard. In May last the Midland Health Board, on my suggestion, unanimously agreed to put this proposal to the Department of Health. In raising this matter on the Adjournment tonight I wish to highlight the need for this service for the elderly of north Westmeath. Castlepollard is the central town of north Westmeath, the most rural part of the county — from Clonmellon, Delvin, Collinstown, Drumcree, Fore, Castletown, Finnea, Coole, Lismacaffry, Botherquill, Rathowen, Ballynafid, Ballinalack, and the tidiest town of all, Multyfarnham. All these villages surround the town of Castlepollard, forming what we know as the most rural part of north Westmeath.

As I am aware, the replacement of St. Mary's Hospital in Mullingar has very high priority in the Midland Health Board's capital programme for special hospitals. This planned development is in accordance and consistent with the recommendation of the working party report and services for the elderly entitled “The Years Ahead”. As Castlepollard falls within the catchment area, the initiative to provide specific facilities there can be addressed in the overall context of this proposal. On this basis a strategy team has been set up by the board in collaboration with the Department of Health comprising all the various expertise available to the board.

The Department of Health have indicated that, where necessary, they will provide back-up medical and technical advice to the team. The impact of the implementation of the Nursing Home Act is another aspect to which the team must have regard taking into account the degree and intensity of service provisions for the elderly. It is vital that regard be given to the quality as well as the quantity of life.

There are many proposals to be considered in relation to St. Mary's Hospital, Mullingar, which has served the people of County Westmeath very well for over 150 years. Taking this into account, facilities [660] should, therefore, be provided locally in small centres where long term sick people can be cared for and to which friends and neighbours have ready access.

In considering a comprehensive and modern day care and residential centre for patients in the north Westmeath area, account should be taken of the current and prospective population in excess of 65 years of age. In this context the number of existing long stay beds, their location and the needs that are likely to arise over the next quarter of a century must be also taken into account. St. Peter's Hospital, Castlepollard, which is controlled by the board, has provided an excellent service for the mentally handicapped, particularly younger people. That hospital has an excellent staff of 106 people, and there are 108 beds. As the Cathaoirleach, who is also a member of the board, knows the hospital provides many facilities. There is an excellent laundry service, great kitchen staff and a recreational centre, which was opened by the previous chairman of the board.

I ask the Minister tonight to allow a feasibility study to be carried out on behalf of the Midland Health Board in relation to the elderly of north Westmeath. These people are in their golden years and have given long service to north Westmeath. In a rural area such as north Westmeath, many people live alone. Up to now incapacitated people and those who were unable to look after themselves had to go to St. Mary's Hospital, Mullingar, which is more than 20 miles from Finnea and the far end of Castlepollard parish, including Clonmellon. This is a great opportunity when considering the prospect of a new hospital in the grounds of St. Mary's at some time, to ensure that those people can live in their own environment, near their families. They should be able to enjoy visits from their family and local neighbours. Many of those patients are often hospitalised for up to ten years. It is a big change for a person who has been used to country life to be hospitalised in a big town. I am aware that the care and attention given at St. Mary's Hospital is first class. However, to be hospitalised means a [661] complete change in a person's lifestyle. If a person has lived in a small locality for longer than 20 years he or she knows everyone there. Up to 50 per cent of those who will be going to day-care centre or the long-stay hospital will have lived in Castlepollard or the neighbouring small villages all their lives, 60 or 70 years. At present in St. Mary's Hospital there are four people from our area who suffered strokes. Those people may be hospitalised for a long time but their friends can visit them. I need not elaborate on the positive elements of visits by friends.

At present we have a day-care service once a week. Only a limited number of people can be taken on the mini-bus and there is a waiting list. Many of those people will never have the opportunity to avail of a day-care facility even once a week. The day-care facility is fantastic, particularly for people who live alone. Their greatest problem is one of loneliness. In the remote parts of Westmeath I am talking about people often have to rely on a neighbour to collect their pension. To be able to meet their friends once or twice a week would be of tremendous benefit. They would have their tablets checked, could attend a chiropodist, have a meal and enjoy a game of cards. They cannot do that at present. The health board do their best but there is room for improvement.

I could talk about this subject for a long time. I seldom raise an issue on the Adjournment unless a serious matter arises in my area. I know practically every person in north-west Meath; like a doctor in a sense. I was a postman for almost five years and I know the people of the area. They have all made a great contribution to voluntary and farming organisations. As the Minister is aware many of them have old wounds from their games with the best hurling teams in the county, and many of them suffer from hip problems. It is with the greatest pleasure that I make my plea tonight on behalf of those people. The people from that area at present in the surgical ward in Mullingar Hospital could convalesce in their own environment, particularly long-stay patients and those recovering from hip operations and so on. There is an outstanding staff and tremendous laundry, [662] kitchen and recreational facilities available in the local hospital. Those people raise funds three or four times every year so that they can take patients on holidays. We have a great parents' and friends' association, who look after patients and raise funds if any facility is needed in the new centre.

It is very difficult to find employment in our area. I presume the new centre would consist of about 50 beds and would involve about 30 or 35 new jobs. In remote parts of the country, such as in my area, there is no greater employer than the Government. A monthly cheque coming under one's door for guaranteed employment is a big advantage.

The Minister should give me an assurance that he will issue a recommendation to the Midland Health Board, and his officials, to carry out a feasibility study immediately so that plans will be in place when the money becomes available.

Minister for Health (Dr. O'Connell): First, I thank the Senator for his very kind words and good wishes, which are much appreciated.

Responsibility for providing long-stay accommodation for the elderly in County Westmeath lies with the Midland Health Board, as the Senator knows. The recommendations on services for the elderly contained in the report, “The Years Ahead”, have been adopted by the Government and are being progressively implemented.

In 1990 and 1991 the Government allocated substantial additional funds to the Midland Health Board. Those funds amounted to £465,840. During the past two years the board have considerably improved services for the elderly throughout the region. In 1990 the board used the funds to enhance community services for the elderly. The home nursing, home care and home help services have benefited, while liaison nurses have also been appointed throughout the region. Respite care beds have also been introduced in the long-stay hospitals. Arrangements have been put in place for assessing applications for places in the board's long-stay hospitals and welfare homes. Those arrangements ensure that those people most in need of such accommodation [663] actually get it. Overall, there has been much improvement in the services being provided for the elderly and in the co-ordination of those services.

The traditional approach of attempting to meet all the needs of frail, elderly persons by admission to long-stay hospitals is now generally regarded as misguided. It is now accepted policy that greater attention needs to be paid to the development of community-based services so that elderly persons can continue to live, with assistance if necessary, in their own community for as long as possible.

Accordingly, I would not see us adding to the stock of long-stay nursing beds in the foreseeable future. At the same time, of course, it has to be acknowledged that some of our long-stay accommodation for the elderly does not meet modern day standards and needs to be replaced. As the Senator is aware, the replacement of the old St. Mary's Hospital in Mullingar has a high priority in the board's capital programme for special hospitals. This planned development is consistent with the recommendations contained in “The Years Ahead” document. The number, type and location of the beds required to replace St. Mary's Hospital need to be evaluated.

As Castlepollard falls within the Mullingar sector for service provision for the elderly, the initiative to provide specific facilities there can be addressed in the overall context of St. Mary's Hospital.

A strategy team to plan for the future has been set up by the board, in cooperation with my Department. My Department will also provide technical and medical advice to the team when necessary. At present there are 1,005 public long-stay places available for the elderly in the Midland Health Board region which is generous when compared to the norms recommended in “The Years Ahead” and to the level of provision elsewhere. In addition to the health board homes, there are 441 places in private and voluntary nursing homes, of which 144 are subvented by the health board.

The Senator will be interested to know that I intend to implement the Health [664] (Nursing Homes) Act, 1990, later this year. That Act provides for a new relationship between health boards and nursing homes. The health boards will register nursing homes, both private and voluntary, and will monitor standards by six-monthly inspections. The Act will also enable a health board to pay a subvention towards the cost of care in a nursing home for a person whom the board have assessed as needing nursing care and who cannot afford to pay for such care. The Act will therefore provide the health board with another option in meeting the needs of the dependent elderly, both locally and flexibly.

I must point out to the Senator that there has been a fair share of positive action in so far as services for the elderly in the Midland Health Board are concerned. I ask the Senator to accept the Government's commitment to the development of services for the elderly in the Midland Health Board area as shown by the generous additional funding for services for the elderly in the past few years.

To sum up, the need to provide long-stay beds for the elderly in Castlepollard will be considered in the context of the plan to replace St. Mary's Hospital. This matter is to be reviewed by the Midland Health Board in conjunction with my Department. While we must await the deliberations of that group I must take serious note of what the Senator says. I realise and appreciate that the Senator has put up a very good case and I recognise that he is au fait with the situation in Castlepollard. Because of that, I will ask my Department to discuss with the Midland Health Board the question of a feasibility study being undertaken. I assure the Senator that I will ask my Department to do this as soon as possible because his remarks make sense. I hope the study will be undertaken without too much delay.

Mr. Cassidy: I am happy with the Minister's reply and I look forward to progressing the matter under his stewardship.

The Seanad adjourned at 8.30 p.m. until 10.30 a.m. on Wednesday, 15 April 1992.