Billy Kelleher (Cork North Central, Fianna Fail) | Oireachtas source

I have two questions on palliative care. The first has been discussed on many occasions, in this committee and elsewhere. I refer to end-of-life care in nursing homes, the complications that arise when residents die in nursing homes and the impact that can have on public opinion of the nursing home. If there is a high number of residents dying in a nursing home, it can read badly at times. In the context of assessing and supporting residents in end of life in a nursing home, it is something we should look at. There are HIQA inspections and oversight. Some nursing homes have end-of-life support facilities. Not enough of them do. Sometimes - I have tried to get to the bottom of this - there is almost an incentive to transfer residents from nursing home to hospital in end of life for a number of reasons. It is something that has to be looked at in a clinical fashion to determine why it is happening. Can the Minister support nursing homes to allow residents die on the premises, without overly complicating it and without it reflecting badly on nursing homes, if there are a high number of residents dying in them, where they are dying in the context of palliative supports, as opposed to keeping the numbers down and transferring them to hospitals? That certainly is something that we should look at.

We talk about the pressure on acute hospitals. A busy hospital setting is no place for a family to mourn their loved one. Has any assessment been made of the number of patients who die in hospital as opposed to elsewhere and whether we have a higher propensity to die in hospital as opposed to either in the home or a nursing home with supports? It is an area that should be examined, not only in the context of the emotional side of it with hospital being a busy place but, equally, in the context of resources and the pressures on hospitals.

Paediatric palliative care and palliative care have to be looked at separately. I do not mean to dismiss anybody's mother or father, or natural death, but the trauma on a family in the context of paediatric palliative supports and bereavement is significant. We all can understand that. At times, one must look beyond the immediate short term and there has to be greater supports for families of children who die. Except for a lot of voluntary work and good work being done by communities and groups that rally round, it is an area that is greatly under resourced and understaffed. There is a lack of understanding of the importance of ensuring that there is enough support, both in the short term but also in the longer term. That also includes support for siblings who are often forgotten in the context of a child's death in a family. It can have a profound impact for a long period of time. That needs to be looked at. Before we clap each other on the back, it is an area that needs a great deal more support in communities.