Ms Sandra Broderick:

We have developed a new model of care in terms of supporting residents in long-term care facilities. We know from data from previous years that there are many people who become quite unwell in our nursing homes and that the de facto position is to convey them to our very busy EDs. Predominantly, these people are over 75 years of age and very frail.

We set about looking at our integrated care programme for older persons, ICPOP, teams, which have largely been successful in the prevention agenda around managing older people in the community. We have been working with our national clinical advisers and group leads, NCAGLs, and consulting geriatricians on rolling some of that out to people who reside in nursing homes. We have also introduced a measure whereby the access someone living in a public or private nursing home has to the aids and appliances the HSE provides is equal to that of anyone living in his or her own home. We are trying to wrap nursing homes into the overall health service support mechanisms, which is important. We also have mobile diagnostics so that, if someone has a trip or fall in a nursing home, we do not have to convey him or her from that nursing home to the ED. A mobile X-ray machine will go out to the home. Collectively, these measures have reduced by almost 50% the number of people who have to leave nursing homes and go to EDs. This is important to their quality of life.

In terms of going forward, what we are asking for is that we continue to wrap services around these people. This means advance care planning with the elderly population in residential care facilities, which will be important.

The final piece of this has to do with giving our community health networks primary care services, where appropriate to do so, that are in line with those available to anyone living in his or her own home.