Mr. Tadhg Daly:

To refer to the points raised by Deputies Doherty and Fitzpatrick, they will note from the submission that I spoke of that concept of a continuum of care. It is important to realise that 4.6% of the population over 65 years, a relatively small number given the total, reside in long-term residential care. Over 65 years is something of a misnomer. In fact, if one visits any nursing home, one will mainly see people who are over 80 and 85 years because of the dependency and the complexity of care.

With regard to the debate about home care versus nursing home care, I do not see it that way. What we need is to have that continuum to ensure that at a particular point in a person's life the appropriate services are available for them. The Deputies are not comparing like with like. Senator van Turnhout mentioned the concept of people being directed towards residential care. That is a myth. People are medically assessed by a multidisciplinary team before they are approved for nursing home care. In fact, I draw the committee's attention to the report of the Ombudsman yesterday. One of the cases she took up was that of an applicant who was refused support under the nursing home support scheme even though the medical team had directed that the person was more suitable for nursing home care. It is not a case of either-or and, in my book, it should not be. My mother is 83 years of age and is living happily on her own in west Cork, and when my time comes I would like to live in my own home as well. However, when the time comes that one is unable to maintain oneself in one's own home because of the dependency or complexity, it is important to have the high standard, high quality nursing home care that is required.

On 9 July the Minister, before this committee, mentioned the fact that, at that time, 777 people had been assessed as requiring nursing home care but were not in a position to access it because the funding is not available. Add to that the figure for August of 693 people in delayed discharges in hospitals. If they could be maintained in their own homes, they would be discharged to them.

The vast majority of those are people with complex needs so they need nursing home care.

The fair deal scheme is under review and we have proposed in our submission to the review that there should be a parallel scheme for home care mirroring the fair deal scheme. Our fear is that, if the fund is amalgamated, it will remain at its current financial amount and more people will draw from it. This would create more problems in terms of people trying to access appropriate funding.

With regard to Deputy Fitzpatrick's point about vacancies, the HSE's service plan for 2013 alludes to the undersupply of residential care beds in north Dublin and other urban areas. It is difficult to get a nursing home in some areas. Our fear is that, if we do not act now to develop appropriate services for the older population, it will get worse.

With regard to staffing, Dr. Sadlier referred to recruitment and retention. It is very important for the nursing home sector. We must engage with stakeholders in what we term workforce planning to ensure we have the appropriate skills for residential and community care. As an organisation, we are active in continuous professional development and training of staff in order that they can upskill and have a career path within a nursing home. Someone who is a carer today may decide to become a nurse in five or six years time and become one of the people in charge. There are more opportunities in the private sector for people to develop their career paths.