Professor Amanda Phelan:

There is a golden opportunity here to create the conditions of possibility for prevention, early intervention and ongoing comprehensive management of cases of safeguarding adults. We have the opportunity. We know from various approaches in other countries internationally what works and what needs to be improved. I strongly believe that independent advocacy should be a right of everybody. People do not know what they do not know. If a person who has been in a system of care where other people have been making decisions, and that is the only thing the person is familiar with, is offered a choice to move out, it may not be comprehensively understood. Things might be piloted for a while to see what can be done.

We also have an approach within nursing homes that it is a one-way system. Many older people have said that once they go in, the only way they will be coming out is in a coffin. If someone who goes in for treatment receives three meals a day and is cared for, his or her health may improve. There should always be a possibility of going out back into the community. For some people who are there for palliative and end-of-life care, it just has to be managed. There is an idea and fear for older people that going into a nursing home is not their first choice.

We need to look at the structures in community care which are not affording someone a menu of choice and there are many issues.

I would go back to the Citizens' Assembly in 2017 and listen to the testimony of a lady who was admitted to a nursing home and whose family refused to take her home. She was in Dublin and had to pay for a taxi to drive her back to Cork because none of her family would bring her. What Mr. Colfer has alluded to is that we have to take the happiness of the person into account. It is not always about the system doing the right thing. If the voice of that person is not included and if you are not listening and hearing that voice then that happiness is at risk.

I refer to the evolution of our understanding of safeguarding and protection that has happened over time. If one looks at rape within marriage, for example, it was not seen as an issue prior to the introduction of legislation on same. We need to learn and ensure we have a dynamic and flexible system that can adapt. Just because we have a policy or just because we have new legislation does not mean we should not continually try to improve there. We are not getting there. The statistics we have on safeguarding in any age group would indicate that it follows this idea of an iceberg theory and that we are only looking at the top of that. We need to make sure that people know they have rights; where to go; who to access; that it is safe for them; and that making a report will not impact them. For example, if I report that my caregiver is the person who is abusing me then the answer of the system should not be to put me into a nursing home or a congregated setting because then the system would be abusing me as well. We need to look at all of those cultural issues. An interesting study from New York shows that we are only seeing one in 20 cases in formal systems. This is a study on the elderly and it states that 19 of those cases never come to anyone's attention and those people die having been abused in some way. That is unacceptable for society in the 21st century.

The Senator also alluded to the social welfare payments and I know Safeguarding Ireland is doing a lot of work with the Department of Social Protection on how we frame that. There is the risk of those payments being abused in some way by a third party and that must be addressed. We are hoping to do some research in that area during the summer. We must always keep the happiness of this person in mind and follow his or her will, preference, values and beliefs. Supporting these people is paramount.