Dr. Karen Foley:

The point I will make may not fully relate to the Deputy's comments but adds to what Mr. Alford put so eloquently. When we talk about case management and support, it really is that wraparound support. Each person's support needs are going to be different. When the case management model is in place, not just for people with brain injury but for people with any support needs, the person is able to identify the needs for that individual and what is meaningful for them and consider what life looked like prior to living in that environment, what they want life to look like and how to get there. That should include formal, as in paid, supports if necessary and informal supports like family, friends and other informal supports the person will have in the community. It is important to acknowledge that for any individual to come out of any institutional setting where there is institutional thinking, he or she needs support to transition because the things we take for granted and do every day are now scary for that person. People have not used public transport or money, chosen their own clothes, taken their own medication or tried to shower, dress and be somewhere on time - all the things we do every day - for a long time. People need individualised support to try to navigate that journey. In the absence of that sort of support structure, we hear what happens from people like Mr. Alford, whose story echoes so many stories I have heard sitting in nursing homes over years. I had a tear in my eye listening to him, even though I have heard so many of them. It echoed the need for someone to understand him, what his life should look like and what he needed, including meaningful activity and support to link him in with all the services, supports and community activities, not just disability-focused ones but mainstream ones the Deputy and I would access.

The other important point to emphasise, which Deputy Tully touched on, is that accessible housing is not just about a structure. In conjunction with Anvers Housing Association, we recently linked in with many individuals with brain injury who access our housing or are supported by us and live in their own homes. We asked them to tell us what was important in terms of their housing needs. We heard strong responses around accessibility and so on as well as on access to community. Putting an accessible house in the middle of nowhere creates cut-off exclusion. People might have a better quality of life than they would in the bigger congregated settings but they do not have access to meaningful activities and opportunities in education and employment or to make friends, pursue hobbies and so on, in other words, all the normal activities we would all look for if we were looking for housing in the morning.

I personally and our organisation try to support people to access housing from councils and so on. Sometimes it can feel as if the priorities of the council are not aligned with the priorities of health. The councils are under significant pressure to house people. It feels like a conflict between those two pillars.

On the point around staffing, it is extremely difficult to get staffing at the moment. There is a pay parity issue between section 39 organisations and HSE section 38 organisations. It is difficult to recruit. The inability to recruit is made worse by the lack of pay parity between the organisations. There can be a significant difference in pay. Other issues with terms and conditions are also coming to the fore. If we look at that as a whole, it will enable the sector to support individuals who want individual packages to come out into the community. A whole-of-government response is needed to achieve all of those things.