Ms Patricia Rickard-Clarke:

Mr. Dunne spoke about regulation of home care. The 2011 report of the Law Reform Commission on legal aspects of professional home care dealt with how home care could be regulated. It contemplated HIQA setting up standards equivalent to the standards it has for nursing homes or residential care for people with disabilities. The commission also set out the different levels of care. Assessment of need is one but more important is a consideration of the outcomes, and it suggested a review from time to time as people grew older and their needs changed. The commission drew attention to the different levels involved, from low-level care such as companionship care - and many are in nursing homes because of social isolation - through intermediate level care where a person is helped with bathing and other things, to the advanced level involving nurses. These things would be reflected in the professional staff required. The service provider would be regulated and the recipient would contract with the service provider. One of the great difficulties of home care is that families, or the older person living on their own, are struggling to be the employer but that does not work. There should be a system whereby the HSE or private providers are regulated. The principles set out in the report, such as independence and choice in quality care, are very clear. The quality of home care goes from zero to very good and there is no regulation which gives rise to issues relating to safeguarding and abuse.

Deputy Madigan asked about EPAs. We have had enduring powers of attorney legislation since 1996.

We have since had a Council of Europe recommendation on people's right to autonomy and self-determination and the recommendation that all states have detailed legislation on enduring powers of attorney and advance health care directives. We have had legislation in place since 1996, but there has been no national campaign on it. In the Assisted Decision Making (Capacity) Act we have reformed legislation on enduring powers of attorney and, thankfully and at long last, a legal framework for advance health care directives. While advance health care directives have been recognised by the courts, for the most part they were disregarded in practice because we did not have a statutory framework. A commencement order to set up the working group on advance health care directives was made on 17 October; therefore, that work has started, which is very welcome. One of the causes of great delays in the discharge of people from acute care settings is the conundrum that a person's wishes are not known, there are no formal plans in place and a family are arguing with different views on the matter.

In addition, under the Assisted Decision Making (Capacity) Act the office of director in the decision support service has now been established. The first function of the director specified in the Act is to conduct a public awareness campaign. We must have a national campaign on EPAs and advance health care directives, as well as a campaign to generate public awareness of what we must all do to plan for our future. Of course, the office will also supervise the area in which in the past there was a lack of safeguards for existing EPAs. That issue is dealt with in the new legislation; therefore, the role of the director will be very important. Anybody who wishes to make a complaint about any of the intervenors mentioned in the Act such as an attorney, a designated health care representative, a decision support person and so forth can make it to the director. It does not involve a court application. At present, it involves a very expensive court application under EPAs. The director can carry out investigations formally and informally and can refer a matter to court, if necessary.

There is a final point to be made on EPAs which is extremely important. I have heard people say many times that a solicitor is required and that it is expensive to do. They do not realise the Free Legal Advice Centres can undertake EPAs. That is very important and should be promoted in order that people who ask about the matter in a community centre will be told where they should go to avail of the service or that there will be a person from FLAC visiting the community centre to facilitate those who wish to plan for their future.