Mr. Justin Moran:

I would agree with Deputy Ó Cuív. The point I was making, and perhaps not articulating particularly effectively, was that because the younger people in families are being forced into the towns for employment and housing, the supports on an inter-generational basis to which the Deputy refers are eroding a little. One of Age Action's most successful programmes is our care and repair programme where volunteers go into the homes of older people and carry out small DIY jobs, such as installing a light bulb or unblocking a sink. These are jobs that ten or 15 years ago those people would have got their sons, daughters or brothers to come in and do, but they are not there anymore as they have emigrated or are living 15, 20 or 30 miles down the road. That is an example of where we have tried to step in to fill a gap that has been created because of that lack of inter-generational solidarity that would have been there in the past.

In terms of the public transport and rural transport issue, I stated it was a pervasive comment during all of the presentations. Mention was made of the Newbridge Bus Éireann route. That is a good example of one of the bus routes that can be a challenge for people. It departs at 7 a.m. and 7 p.m., as was mentioned. We have learned from speaking to older people who might have to go to a hospital appointment - some of our members in Galway did research on the outpatient service there - that they might be able to get the morning bus in, they get taken care of and then they wait around for hours because the bus service is designed for those commuting to work for which it is effective. That is why it would be helpful if the committee, as part of the finished outcome of its deliberations, looked at whether the rural transport programme is fit for purpose and whether it is delivering the commitments in the National Positive Ageing Strategy around rural transport already mentioned.

I will take a couple of points from Deputy Tóibín. I would highly recommend the research Mr. McCafferty also mentioned by the Vincentian's on the minimal essential standard of living when we are talking about cost issues. For example, the table provided in our submission shows the income and expenses for those in urban and rural communities as defined by the CSO and how that matches with the minimum essential standard. One of the big drivers of cost - I accept I sound like a broken record going back to talk about transport - is car costs. In parts of Ireland, that can make up to 82% of the difference between expenditures for an older person living in an urban community and one living in a rural community because he or she needs the car to get to work, to get to his or her family, and to get to his or her medical appointments.

My colleagues in Mental Health Ireland are better able to answer on the primary health teams, but in our experience, they would not be at full complement. Certainly, there are difficulties in recruiting home helps that are particularly important.

Regarding community infrastructure, Geo, bingo, community nodes, one of the suggestions that we have had for a while is some way of carrying out a survey in communities of the infrastructure being under-utilised. One of the classic examples we use is where one may have buses that are used in the school bus run and once the school bus run is over, they are put away for several hours. They are not used, say, at lunchtime, to bring people from one village to the next or to bring people in to the shops. I wonder whether there is something that could be done, maybe not even at a national level but at a local authority level, to identify where there is capacity in existing community infrastructure that could be better redeployed to help, not only older people but those who might have disabilities or special needs or other forms of disadvantage.

I will briefly address Senator Warfield's point on older people and LGBT. It is something that we would have done some work on with older people in nursing homes, in particular, who have challenges there. It is something we would like to do more on. There are examples in Europe of different sheltered housing options where different groups and cultures, not necessarily LGBT, can be accommodated. That is something that is worth looking at. In Ireland we have an approach where one stays at home and then one moves into a nursing home, and it is a fairly black-and-white process. We need to be able to look at other options that are more accommodating to people and to different interests.

I will finish on home help services on which I could talk for most of the rest of the day. I agree completely with Deputy Michael Collins that the home help services in this country have collapsed and any suggestion to the contrary is simply not true. We are providing less funding for home help services today than we were in 2011. We are providing home help services to fewer people and the people who are getting it are getting shorter hours. We have many problems where home helps are in there for 15 minutes to get somebody up in the morning but one cannot build a relationship with one's client over 15 minutes and one certainly cannot do it if there is somebody different the next day and somebody different again on the Friday.

We carried out a piece of research, published in June of this year. We spoke to social workers who are telling us that if the proper home help supports were there, they estimated that as many as 50% of their clients who were in or about to go in to a fair deal nursing home could be at home. If the supports were there, they could be able to be in their community with their family where Government policy says they should be and where every political party and Deputy and Senator tells us when we meet them that they want them to be. The challenge is both about the lack of funding and, to pick up a point that Deputy Danny Healy-Rae made, around the lack of a statutory basis for the fair deal scheme. If one fulfils the medical criteria to go into a nursing home, the State will provide funding to enable one to go into a nursing home.

There are problems with the fair deal scheme but at least there is a structure. There is nothing like that with home help. There is no statutory underpinning for it. The sector is not regulated. One of the issues Age Action and every organisation in the ageing sector and many working in the disability community as well would have been arguing for is a statutory right to home help services in this country. Until we start the discussion about how we deliver that, we will have meetings about funding, an extra half-hour here and an extra 15 minutes there. It is not designed for the need of the older person. It is designed to tick a box or keep the plates spinning. Whilst we welcome the additional funding of €10 million that was announced in budget 2017, that will not cope with increased demographic demand for home help services. The HSE's figure is that 10% or 65,000 people of those over the age of 65 will require home help services. We are providing home help services to 55,000 people. There is a substantial amount of unmet need. Many of those who are getting it are not getting sufficient hours and they may not have weekend cover. We are coming up to Christmas when there could be many days without getting any kind of home help services and families or other carers will be obliged to step in. Home help and rural transports are probably two of the acute issues for older people living in rural communities.