Mr. Phelim Quinn:

We can. We need to address the issue through the provision of better guidance for homes on what is a good standard to be achieved in engaging in additional activities to promote independence as part of the person-centred theme. I refer the Deputy to point 5.4.2 in the report which examines the standard for the particular element he described.

Enforcement steps were referred to in the questioning. In 2013 HIQA introduced a new enforcement procedure. The key issue in enforcement is to ensure we identify where there is a significant risk to the safety or welfare of residents, to which we must take a proportionate approach. I have mentioned that residential centres are home to a number of individuals. Therefore, it would be best if we could maintain some level of stability in such centres. In the first instance, our aim is to identify problems as early as possible in order that we can address them with the provider. However, if there is persistent non-compliance and a refusal to work with the concept of our action plans, we will escalate our enforcement activity.

End-of-life care is another theme that emerged from the questions. I have referred to the age, morbidity, illness or dependency profiles of residents in the nursing home sector. One of the key issues in anyone being cared for in a nursing home who is in his or her final months or years of life is to engage with him or her and his or her relatives on how they would like him or her to be cared for. In some instances, we hear how people at the end of their lives are placed in an ambulance, transported to an accident and emergency department and kept on a trolley. In fact, advanced care planning could enable an expression of a person's wish to be cared for within the nursing home with the support of primary care services in the community.

We place a significant importance on how we engage with people at an early stage with regard to assessing their wishes about how they will be cared for. Those are the main focuses we have on end-of-life care, as well as the links and liaisons the nursing home has with the primary carer about a holistic approach to a person's care as the person approaches the end of his or her life.