Tom Clonan (Independent) | Oireachtas source

I thank everyone. It is good to see them again. I have a couple of questions but want to jump in first on something Mr. Hanrahan said that intrigued me. He said disabled people living with elderly parents was a target group that we need to reach out to and meet their needs. He can answer this at the end but how are those people identified in the Galway County Council area? Is it through the public health nurse, the housing allocation officer or the disability services manager? How do they know who is out there in the community that the council can target and plan for them?

I thank Mr. O’Regan again for his presentation. He had some very impressive figures. He said in 2011 there were 4,000 people living in 72 different congregated settings around the country and that as of December 2023, that had reduced to 1,532.

Where have the roughly 3,500 individuals gone to? Does the HSE know where they are? We had HIQA in, and it was talking about time to move on and about transforming lives. When I asked its representatives that question, they said they did not know and that they did not map that.

The numbers of people in what I would be aware of as the greater Dublin area who are inappropriately placed in nursing homes was also mentioned. Does Mr. O'Regan have a figure for how many people are inappropriately placed in nursing homes at the moment?

This is a kind of chicken-and-egg question. A disabled person who puts in an application for accessible housing, whether it is through the online portal or by filling in a hard copy, goes to a city hall, whether it is in Dún Laoghaire-Rathdown or Fingal County Councils, and hands that in. Does a care package have to be in place before the person is allocated the housing unit, or are they allocated the housing unit and then it is up to the family to try to secure hours? In that regard, and Mr. O'Regan might be able to answer this, why is it that the Dún Laoghaire-Rathdown County Council area, or community healthcare organisation, CHO, 6, which spans much of Dún Laoghaire-Rathdown and goes right down into County Wicklow and is a very densely populated area of the country, has one of the lowest number of care hours provided within any CHO? It is only a tiny fraction of the number of hours provided compared with any other CHO. I am curious as to why that might be the case.

On the packages, because this is about the national housing strategy for transition from congregated settings, a disabled citizen needs supports and a care package. As the witnesses are aware, there is a crisis in trying to get carers to carry out that work. Specifically on that, why does the HSE vary across CHOs? Some CHOs accept a brokerage model for the provision of carer hours. Some of them accept a mix of the corporate model, for example, Rehab, Bluebird Care and Home Instead. Some CHOs refuse to accept that. It seems to be a local decision taken by the disability services manager. Unfortunately, certainly in my experience, if you seek a carer through a brokerage model, there is no problem whatsoever getting a consistent, predictable and quality service. However, if you go through a corporate model, for example, Rehab, Bluebird Care, Woodbrook Care or Home Instead, it is inconsistent, unpredictable and not reliable. The disabled citizen then internalises that inconsistency and it becomes a real inhibition. Why is there that inconsistency and where are we at in having the brokerage model recognised on a national level? I am sorry about the long-winded question but I think some of the answers are pretty short.

With regard to Fingal, Meath and Galway, and I know it is probably a hard question to answer, if I go on a waiting list for accessible housing, roughly how many years will I be waiting in the various areas for an accessible housing unit to be made available? Would the average wait be three, five or ten years? I believe it is improving but I would be curious as to whether there is a regional variation in that. Again, in the witnesses' experience, does the HSE offer a unit and it is then up to the disabled citizen to try to secure supports or do the supports have to be in place? How does that work?

On disabled citizens in the community, because of greater levels of integration, the SENOs in the various county council or corporation areas, which map over the CHOs, will know how many disabled children there are in the community. Does the HSE compile a list, even in terms of numbers of those children who will be adults, and start to plan? In other jurisdictions, for example, in Schleswig-Holstein in Germany, they identify disabled citizens in the community as soon as they come on the radar. This is when a public health nurse refers them to a specialist, they go on the register and they have a primary medical certificate of some sort. They begin to plan for that citizen so that when they are 18, they have a unit there for them with the keys and the care package organised. There are about 18 years to do this in most cases, although some disabilities announce themselves when kids are a bit older. Who is it that does that planning? Is it the public health nurse? Is it the HSE that is driving that? Is it the housing allocation officers, the disability services managers, or the various disability and equality officers? Who drives it? Is it, in fact, the disabled citizen's family that has to drive that, push for it, chase it and move it along?

I think Ms Farrelly said - I may have misheard her - that last year there were 2,742 disabled accessible units made available to people in the Fingal County Council area?