Dr. Karen Foley:

In the HSE's reports on how it has met the targets, whether that is 18 in the first year and up to 69, we can see that people are not moving out of nursing homes. The targets are not being met and people are not moving on. A small number may be able to move on, but anyone who is coming from that sort of a setting, where there is 24-7 support with people there for any length of time, is not going to be able to move to an unsupported environment because they will need that support to wane over time in order that they can be as independent as possible. They need to move on to something such as our services, which are assisted living, or back to family with significant support packages. Few people get to move on and, as members will have heard during this meeting, it takes a long time. I would hate to have an accident on my way home today and think that will be my reality for however long.

The system, by which I mean the way in which the HSE is able to plan ahead, does not enable the HSE not to be reactive. In the case of all the individuals who are at home being supported by ageing parents, who we know will at some point be unable to support those individuals anymore, we are not even offering them the opportunity to access rehabilitation in their homes in order to negate future need.

The vast majority of people only get access to a personal assistant-type support, which is a service where someone comes in provides supports. The person may, by accident, have an opportunity to practise skills and gain independence in areas. We do not, as a standard, systemic approach, offer the opportunity for enablement for any age group across the life span. The people who get access to rehabilitation in the community are in the vast minority. We will have those crisis situations because we are not re-enabling people. We are creating dependence, as opposed to creating independence. If we can change the system now, we can reduce what is going to come in the future but if we keep going as we are going, we have all this pent-up demand and created dependence, and will be in a situation where we can only react and not plan forward.