Dr. Kara McGann:

I do not know the reason they are not but I agree with the Deputy that we need a continuum of care that has a range of options for people in order that they have choice in this regard. A dignified and respectful way of engaging with the individual in need of care around choice is sometimes missing from the care conversation. While the care providers are doing magnificent work, some of the choices often are taken out of people's hands, be that for financial reasons or due to the options in their area. We hear from people in rural areas in particular, regarding the numbers of available carers locally and how those options can narrow very quickly.

We need to see greater options in terms of that continuum of care. Culturally, we may not have got our heads around it yet, but we need to start looking to other models in other countries. There are some good practices that we have come across in international research. Denmark, for example, focuses on deinstitutionalisation of elderly care. It focuses more on the home care step-down retirement village approach within communities, rather than institutional care in the first sense, unless it is warranted by a particular complex need. We have seen them come with a cross-functional team whereby it looks at the functional, psychological, medical and social resources or challenges that an individual might have, and approaches it from that perspective with a view to trying to match the type of care. It can start with rehabilitation to make sure somebody is physically able to stay in his or her home longer, all the way up those retirement village arrangements. I am familiar with a couple here that are magnificent arrangements for people, which keep that community focus and engagement for people as much as anything else.