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Joint Sub-Committee on Mental Health debate -
Thursday, 20 May 2021

Services Provided to Older People

This morning's meeting will focus on the services provided to older people by ALONE and Age Action Ireland and the demands placed on them as a result of the Covid-19 pandemic. I welcome our witnesses to the meeting this morning. They will be presenting virtually. I welcome from Age Action Ireland, Ms Celine Clarke, head of advocacy and communications, and Dr. Nat O'Connor, senior public affairs and policy specialist. From ALONE I welcome Mr. Seán Moynihan, chief executive, and Mr. Andrew Mooney, policy officer. You are all very welcome this morning and I am delighted you could attend.

Before we hear the opening statements, I need to point out to our witnesses that there is uncertainty over whether parliamentary privilege will apply to the evidence of witnesses from a location outside the parliamentary precincts of Leinster House. Therefore, if you are directed by me to cease giving evidence on a particular matter, you must respect that direction. I hope that is okay. I call on Ms Celine Clarke to make her opening remarks.

Ms Celine Clarke

On behalf of Age Action, I thank committee members for the invitation to speak today. The work of Age Action for equality and rights is grounded in the lived experience of people growing older in Ireland. This informed our Covid-19 response plan, entitled Connect, Inform, Support.

In May 2020 we launched the Age Action Getting Started Kit to address the digital exclusion experienced by older people. We posted over 7,000 free digital skills guides to older people. A total of 769 people received digital skills training through the help of volunteer tutors. The RTÉ personality Mary Kennedy recorded six tutorials which were real-time demonstrations to accompany the guides, some of which were broadcast by agreement with RTÉ. Through our work we are acutely aware of the negative impacts of digital exclusion on the ability of people to access public services and information to manage their affairs. We are also mindful of the stressful situations and potential safeguarding issues this puts people in.

Age Action is advocating for targeted digital literacy supports for older people and a digital allowance as part of social protection measures to support people to overcome financial barriers associated with material access to digital devices and to promote their social inclusion and independence.

Budget 2021 saw no increase in the core State pension rates. It did not allow for any increase in the cost of living or support to people to withstand the economic shock of lockdown. Income for those who are living with other people has stood still since 2019.

Mindful of the stress and anxiety people were experiencing due to poverty, Age Action initiated a hardship fund in association with the Irish Red Cross to address small Covid-19 related financial hardships experienced by older people. Age Action raised a total of €110,000 but with 28,000 eligible applications the fund was highly oversubscribed. A total of 453 applicants were supported with small grants of up to €500 each. Applications showed the difficulties older people were facing. These difficulties included increased heating and fuel costs, costs relating to digital devices and the costs of replacing small appliances urgently. We have advocated for the Government to commission a study on the cost of ageing similar to the study on the cost of disability so that social protection measures can be better informed by the evidence.

Many older people have experienced bereavement during the pandemic but have been unable to have a traditional wake or funeral. This will affect people's mental health and we are unclear yet on the extent of the impact of this. The Department of Social Protection could take a pragmatic approach and be asked to be flexible around the means-testing of exceptional needs payments to cover the cost of memorial services where funeral costs were not sought by a person.

People who live in nursing homes carried the burden of Covid-19 in terms of the impact of the disease itself and the response measures which saw their right to life, to family life and to participation in society undermined. It is likely that many people will have had a traumatic experience given the scale of lost lives and lost connections. The recommendations of the expert panel on nursing homes and the Oireachtas Special Committee on Covid-19 Response related to residential care need to be urgently implemented.

People have a right to choice and to control over their lives, including where and how they are cared for. The proposed commission on care should be urgently established to address the long-known inadequacies in our long-term care infrastructure. As noted by the UN independent expert on the enjoyment of all human rights by older persons, while older people have become highly visible in the Covid-19 outbreak, their voices and concerns have not been heard. Age Action continues to call for the appointment of a commissioner for older persons to provide an independent voice for older people and accountability from the Government. Through our information service we have heard from many older people who took the view that the representation of all older people as vulnerable during the pandemic contributed to ageism and stigmatisation by putting a focus on vulnerability over autonomy.

To highlight the fact that ageism must be addressed in all policies, settings and practices, Age Action intends to make ageism the focus of positive ageing week, which will coincide with the UN international day of older persons on Friday, 1 October. We look forward to engaging with Government representatives, relevant Departments and broader stakeholders as we begin to apply the lessons of Covid-19. I look forward to taking questions later.

Thank you, Ms Clarke, for that fantastic presentation. Our next speaker is Mr. Moynihan.

Mr. Seán Moynihan

ALONE is a national organisation that supports and empowers older people to age happily and securely at home. We support individuals and their families and work with other organisations. We campaign nationwide to improve the lives of older people. We have a network of 80 staff and approximately 3,000 volunteers throughout the country.

ALONE provides social, practical and housing supports. We use individualised support plans to provide a connection for older people to access health, social care, housing and other services to improve physical, emotional and mental well-being.

In March 2020, more than 10,000 cases of Covid19 had been reported worldwide. The gap in community services for older people became obvious at the start of the pandemic. We now know from statistics that older people were the most negatively impacted by the arrival of Covid19 in Ireland. This gap in services throughout the country must be addressed and we must learn from it.

ALONE was invited to become a member organisation of the national public health emergency Covid19 subgroup for vulnerable people. The aim of the group is to work in collaboration with the Department of Health, the HSE and the Department of Rural and Community Development on a co-ordinated national response to support older people who have concerns, who may be at risk or who have contracted Covid19.

In March 2020, we implemented a national support line, operated seven days a week and 12 hours a day. Within two weeks of its launch, it began to receive thousands of calls from older people, three quarters of whom lived alone. This line, which was used in all Government publications, gave access to an integrated response from all our services and hundreds of partner organisations and other age organisations. There was wonderful support from civil society, the Garda, An Post, the GAA and many more but, despite these efforts, many older people were left to struggle. Calls to the national support line increased to 1,100 calls per day.

Research conducted by QJM: An International Journal of Medicine indicates that the cocooning measures may have had a significant impact on the physical and mental health of older people. Almost 40% of older people reported that their mental health was worse or much worse while cocooning, while almost 60% reported loneliness. One in 8 reported they were lonely very often, while 50% reported a decline in their quality of life. While cocooning measures may have been necessary at the time, there is no denying this had a negative impact on older people. We noticed that older people using the support line were becoming increasingly distressed by these measures.

The vaccination process has provided hope, but there are still challenges that must be addressed to allow older people to re-emerge into society. We and our partners in Age Alliance are concerned about the physical, mental and social challenges older people will now face as they break their period of social isolation and experience a loss of supports. There is apprehension, worry and anxiety about re-emerging into society and we must plan to step up services, clear backlogs in health and housing, and give encouragement and confidence to older people to volunteer and participate in society again.

Since the start of the pandemic, we have operated 365 days a year, seven days a week, from 8 a.m. to 8 p.m. We have received 81,000 phone calls to the national support line, made 138,600 calls by staff and volunteers to older people and delivered 12,500 units of practical supports to 14,800 older people on an ongoing basis.

ALONE has recently called for a re-emergence plan for older people to be developed as Ireland navigates through the Government's Covid-19 Resilience and Recovery Plan 2021. Older people have been dealing with the repercussions of social isolation for more than one year and still have a long road ahead to rebuild their confidence and re-engage in society. ALONE's primary concern is that they be adequately supported in their re-emergence, with proper care and plans in place. This can be achieved with a stakeholder group to address the issues arising as older people and the more vulnerable re-emerge into society and the vaccination programme progresses.

Loneliness and social isolation has become an increasingly important issue, particularly in the context of Covid-19, as many older people reduced their social participation. Loneliness has been linked to an increased risk of early death, with some studies highlighting that older people experiencing high levels of loneliness are twice as likely to die within six years than those who are not lonely. ALONE co-founded the loneliness task force and produced the Connected Island report, which contained five key recommendations for the Government to implement to address loneliness. The task force has recently been reformed, with a broader representation of organisations working to address loneliness. We need a strategy, an implementation plan and funding to address the issues of loneliness, and clarity is needed on who is responsible for same. This should be linked to a public campaign to destigmatise, and make people aware of the effects of, loneliness.

To help support older people as they return to society, to plan for our ageing demographic and to learn the lessons from Covid-19, ALONE calls for a strategy and public campaign to fully address and raise awareness of loneliness; more housing with onsite staff support as an alternative to nursing homes; more access to technology that supports empowerment, self-care and ageing in place; the right to home care regardless of age; and the implementation or replacement of the national positive ageing strategy.

I look forward to members' questions.

I thank Mr. Moynihan.

I welcome our guests. I thank them for their presentations and, more importantly, for the work they have done over the past 18 months. We have all followed the work Age Action and ALONE have done in supporting older people, particularly during the pandemic. It has not gone unnoticed and it is very much appreciated.

Our guests mentioned the effect the pandemic has had on patients in nursing homes. People who were resident in nursing homes were not able to have loved ones visit, and then window visits were allowed and so on. That, along with people having to cocoon and not being able to have visitors come to their homes and so on, was obviously very trying. Are there examples of specific nursing homes from which we can learn in regard to how they dealt with this and supported older people? Is there a Rolls-Royce example our guests could highlight in order that when we are preparing our report to advise the Government on how to handle and deal with future pandemics, learnings can be garnered and inform our work and that of the Government in the response it puts together? There will be an inquiry into the handling of Covid, and what happened in nursing homes will be a critical issue.

Are our guests satisfied with the engagement their organisations have had with the Government during the pandemic, in the context of increased supports for the services they provide? I am thinking of the support line that ALONE ran, and I sincerely hope the Government stepped up to the plate in providing supports for that. What are ALONE's plans for the helpline? I sit on the board of directors of the National Council for the Blind of Ireland, which set up a similar support line for its community and particularly for people suffering from sight loss who live alone. It is planning to keep that support line going into the future and is putting together panels of volunteers to help with it.

Where were the gaps in the Government supports? I acknowledge there were many, but where were the glaring ones? If we are presented with a similar set of circumstances, how can we ensure those gaps are dealt with and addressed?

Mr. Seán Moynihan

On nursing homes, having to pass away without visits or supports from family, with only window visits for such a long time, was horrendous for many people. In any review, we will have to examine the governance of the nursing home sector. It is obvious the relationship between the State and the standard of nursing homes was not there. Although much of the nursing home sector is private and is run by individual providers, we believe many more need to be provided by NGOs and the Government, as well as private providers, in order that, ultimately, older people will have more choice. On the other hand, we believe the aim and focus is the ability to age in place, in the community. That is what older people have said they really want. There is a role for nursing home care but older people want to be able to age at home, and we need that focus.

There is also-----

Did Mr. Moynihan notice a difference between how privately operated nursing homes were run, compared with those in public ownership?

Mr. Seán Moynihan

I am not an expert in the area but our experience is that many nursing homes were overwhelmed fairly quickly. That is when it comes down to the governance, the standards and the relationship with the State. We will always need nursing homes for 3% to 4% of people, but most people choose to live in their communities. They need to have good housing options in communities and the supports they need to stay at home for as long as possible. Our focus needs to be there. When the review comes, it will point out the weaknesses in the systems around governance and the relationship between the nursing homes and the healthcare sector.

On the ALONE support line, we provide an integrated service behind that. If someone rings us, we have the ability to give them public health information and advice or to move them on to a member of support staff who will give them an assessment and support plan, visit their home and help to deal with housing, health and transport issues, and to link to all the different parts of the healthcare system. Our support line will stay in place seven days a week indefinitely. It will be a support and referral line for older people and will provide access to all our services. Our services, by the nature of what we do, also work with hundreds of partners across the country.

The last thing the Senator mentioned was gaps. What happened at the start, and in fairness this is where civil society and all the NGOs across the aid sectors and other sectors really stepped up, was that the gaps in services became very obvious and there had to be a lot of reorientation to fill them. This is where the importance of Sláintecare comes in and the implementation of the changes required so that services are in the community with access to the right home care services. Much of those had to be withdrawn very early, sometimes because of a lack of PPE. To fill the gaps we need to focus on the needs of older people, listen to them and empower them to be in charge of their own health and well-being. We also need to implement Sláintecare so that our first option to provide support for health, welfare and participation is in the community.

How is the support line funded? Is ALONE getting State support for that?

Mr. Seán Moynihan

We would have got State support for that during the pandemic via Sláintecare. That funding will run out in June or July. It is unclear whether it will be renewed but we will still progress it. We always made a huge number of phone calls in and out, so we have consolidated our own services into one number.

The Chair will remember that in the last Seanad, Marie-Louise O'Donnell commissioned a very comprehensive report on ageing in this country. It was launched by the former Taoiseach, Enda Kenny, in his dying days in office in the Italian Room in Government Buildings. Has ALONE any opinion on that report? Did Mr. Moynihan read the report? What would he take from it?

Mr. Seán Moynihan

Marie-Louise O'Donnell's report is one of a series of reports, from the national positive ageing strategy to other recommendations, that have not been implemented for older people. We have an ageing demographic, which is wonderful. People are living longer, are healthier and are more active for longer. Older people are net contributors to our communities but we have not planned for this ageing society and we have not implemented that report or many other reports. Every Department, including the Departments of Transport, Health and Justice, needs to age-proof its plans as it rolls them out, as is done in the case of carbon usage. Sometimes things to do with older people are all focused on health, but it is far from that it should be.

I thank Mr. Moynihan and wish him good luck. ALONE has our thanks for the great work it does.

Do any of our other witnesses care to come in?

Dr. Nat O'Connor

Mr. Moynihan has covered many things, particularly the desire of older people to age at home where possible. There are statutory supports for people to go into nursing homes but people do not have the same entitlement to home care, so there is a gap in the system that could be re-examined. I will pick up on some specific points. On staff in nursing homes, there was an issue where some nursing homes found they could not get their staff to come into work. We have a reliance on migrants who are working in the nursing homes and an important part of the labour force there, but they are often in low-paid roles. There is perhaps a lack of resilience among the staff or a lack of training so when there is a crisis situation such as this, the whole supports might not necessarily stand up. That is something we need to look at as part of a comprehensive review of nursing home care but also home care and the home care supports that people want.

Bereavement is another thing that is important to emphasise, and how it will affect people's mental health. It is not just that people have been bereaved directly due to Covid-19. Every year about 30,000 people pass away, which affects about 200,000 or 300,000 others who are in mourning. For a year and a half, several hundred thousand people have not been able to have the normal funeral and coming together of family and friends, and that has a scarring effect and is likely to affect people's mental health and have a long-term implication. With mental health, we usually focus on prevention as the best thing, which involves socialising people and making sure they are connected. We have now had a period of disconnect where people have not been able to connect in to their friends and family, particularly those who have suffered bereavement. There will be a need to reinforce counselling services as well as mental health services, but also to fund the services that help people to get out and about and reconnect. A lot of work is needed to help people in order to avoid a long-term scarring effect on mental health. That is the core point I wanted to make.

Ms Celine Clarke

I want to reinforce the points made by my colleagues from ALONE and Age Action and also speak to the Senator's important point around people's participation in policy design. He asked whether we were satisfied with the engagement with the Government on supports. A key area is the lack of consultation and the participation of people in the design of the policy was inadequate. Many people were hearing about huge differences that were being made to their lives and restrictions that were being brought in through the news without any interaction with people or any ability to inform those decisions. Age-based response measures such as cocooning had a huge negative impact on people's mental health, not just in terms of the restriction itself but the language and narrative it created in making people feel and be perceived as vulnerable and lacking autonomy. We are really concerned about how that sort of ageist approach has undermined people's own identity, their feeling of themselves and their perception of themselves. A lot of work will need to be done to advance any advances we had already made in ageing policy through lots of reports. The Senator mentioned one, but there are several, including the national positive ageing strategy, that have no implementation plan. There is a lot of work to be done for this age cohort to try to provide mental health access to services but also to shift our mindset and thinking on how we think about ageing and older people.

I wish everyone a good morning and I thank both groups for their honesty. The Chairman knows that I cut straight to the chase. The words "quality", "rights" and "choice" came up in the presentations of Ms Clarke and Mr. Moynihan. They are probably the three most important things when one reaches a particular age in life. Age is honourable. The witnesses are right when they say that the identity of people seems to have been stripped away during the Covid-19 period and that confidence within a certain cohort of people has been completely blown away. Our witnesses hit the nail on the head when they spoke about cocooning. I have spoken to my in-laws on that point. They were absolutely terrified and did not leave the grounds of their own home for months on end. Information has always been a key and a problem.

I took it from Ms Clarke's opening statement that the Government is not doing enough and that the supports within the system for elderly or ageing people are very poor. It struck me that heat and fuel poverty is being experienced by people to whom we are trying to give an independent life at home. These people cannot afford the basics - to keep the light on, or to heat themselves. Ms Clarke spoke about foolproofing policy documents and engaging with people. People have to be consulted on these issues and this also struck me in respect of the carbon tax that is being introduced. It hits the most vulnerable straight away when they need to buy a bag of coal or a basic bale of briquettes.

The other issue is mental health. The death grant is gone, but the exceptional needs payment was mentioned. As I was listening, I was reminded that the Assisted Decision-Making (Capacity) Act could be a template or menu for how people could have a choice and a right to say what they want. They should be able to say that they want to live at home. If they person have to go into a nursing home, they should be able to specify the quality of care they require. That could be set out as a blueprint and could be tied in with needs. The problem we have in this country is that we try to treat a problem instead of trying to treat the person with wraparound services.

I believe Mr. Moynihan mentioned the Sláintecare report. I was lucky to be a part of that. I also worked on the Joint Committee on the Future of Mental Health Care report. The reports are there and are doable. The one thing that struck me about that is that it involved all parties and none. There should not be friction when it comes to doing the right thing because we signed off and agreed on it.

Mr. Moynihan also mentioned the work of NGOs during the extreme part of the Covid-19 period. I have been in love with NGOs since I was a young fellow because they are the bread and butter of people. They are the community-based helpers. They are the gang in the know and the gang with the contacts. He also mentioned An Garda Síochána and the GAA. They are absolutely fabulous. I was struck by the way An Post went out of its way to do what it did in involving everybody. It plays a vital role in society because many people are rurally isolated. I am aware that people wrote to themselves during the pandemic so that the postman would call down the country lane and they would have someone to talk to, once a week or once a month. That tells us what loneliness is about.

Mr. Moynihan also mentioned that community-based support should be supported more by the Government.

Both speakers mentioned the stigma of growing old. There should be no such stigma. It should be a story of honour, history and celebration of reaching this stage in life. I will explain what worries me in this context. All groups of this nature have to be commended. They are bringing the realisation of a human being back into a person’s soul, whether that is in a healthcare setting or at home. I agree with the witnesses that it has to be people-proofed. I will give one example of this. A number of years ago when I sat on the town council, we listened to wheelchair users. We brought them in as we were designing footpaths, and so on and so forth. We got the buy-in from the stakeholders and the users. We went on to develop a streetscape that many people did not like, but they were not aware of the reasons for it. It won a European mobility award because we listened to everybody. We are all supposed to be service providers here.

I will return to my main questions. I can nearly predict the reply to the first one. We know that mental health services are very poor. The buy-in from the Government is very poor. We hear the stories of being unable to recruit or retain staff. I have never believed that. If the Government wanted to do this, it could. I am worried about food and fuel poverty. In 2021, this should not be happening. Can our two witness groups here this morning say what would be the most important first step to get things moving? I am a firm believer in this even if they were pilot projects. If one can show that something works and is fully resourced in one area, county, town or nursing home, one has the proper right to go back to the Government to say that one has put a plan in place and that it works, and to ask whether it can be replicated. What first step would the witnesses take to get it right now? I know it is a little difficult to say. We are all aware that there are thousands of damaged people out there. I refer not only to elderly people, but also to those who have seen their parents struggling. Of course they are damaged as well. There is going to be a tsunami of mental health-related problems coming down the road. We need to prepare for it. I genuinely think we are nowhere near being prepared. Is there one thing we can do to get the ball rolling and start to plan to try to sort this before it festers?

I thank Deputy Buckley. Would Ms Clarke or Mr. Moynihan like to respond to Deputy Buckley?

Ms Celine Clarke

I thank the Deputy for his questions and for his acknowledgement of the work that the community and voluntary sector is doing. One of the first steps to secure the work that the community and voluntary sector is doing at community development level is to provide adequate and sustainable funding streams to those organisations. The community call was a rapid mobilisation of organisations that know what a community needs. This comes back to a rights-based approach to enabling all of our lives to be better. The work of the community and voluntary sector in sustaining the work that has been done and being able to develop it is vitally important. Dr. O'Connor is going to pick up on another major step that could be taken around income adequacy.

Dr. Nat O'Connor

My signal has been coming in and out. I refer to what Ms Clarke has said about income. We know that one in nine or ten older people is at risk of poverty or experiences material deprivation. One in eight older people, according to the latest survey of income and living conditions, will struggle to have meat or fish with their meal every second day. There is still real deprivation to be found in our surveys of poverty and deprivation occurring in the lives of older people. There is no doubt that if one is already under pressure with one's finances, any additional cost, such as the cost associated with cocooning, is going to have a negative effect on one's income and one's ability to cope and be resilient in the challenges one is facing. If we are going to assist people with their mental health, there is no doubt that income adequacy and having a security of income, and knowing that it is secure, is a very important step. Ireland is unusual in that we are one of the few countries in the OECD which does not have a formula for setting the State pension based on the cost of living. For that reason, Age Action has called for a comprehensive review of the cost of living and of all of the different costs that people may face. We need to have such an evidence base every year in order that the pension may increase based on that evidence. That is something we have been missing to date. It would provide the firm foundation that people need to be secure in terms of their income.

I thank Dr. O'Connor. Does Mr. Moynihan wish to join in?

Mr. Seán Moynihan

Deputy Buckley covered a lot there on equality, rights and choice. He is right about the NGO sector; we are the ones who see the emerging need and try to meet it. We need to secure funding lines. That is social innovation. We are the entrepreneurs who go out there, try to define the problems and demonstrate them. When something is working well, the difficulty can be in getting it scaled up. There needs to be some process. There are pockets of excellence, but it may not be available in another county. We need to scale those things with proven impact and keep the community alive that way.

The Deputy mentioned choice. We need to start listening to people. People want to age at home. They want to live at home in their communities and that is where we need to create the choices - choices relating to housing, home care or other supports they need along with social participation and engagement with civil society. We need to start listening to older people and provide choices.

On the rights-based stuff, it is things like the right to home care. On income, Dr. O'Connor spoke about one in nine older people. Traditionally, we have worked with older people who are more marginalised or have less resilient communities or families. Every day we see people who need to make difficult choices. The pension is at a level that allows people to survive, but if anything happens, such as Covid, an increase in energy prices, an increase in transport costs or something in the house breaking down, it has a major impact. The second or third biggest issue people raised with us relates to housing.

After they retire, people who are on the basic pension or are bereaved have one income of approximately €240 if they have 40 years of stamps. The smallest thing, such as the fridge or the cooker breaking down, affects them. People who have been on a journey over many years, using up resources and ending up in situations they never thought they would find themselves in, need the support of organisations such as ours. We use the term NGO because technically we are only allowed to register as charities and we do not want anyone to feel they are reliant on charity. We want everybody to feel they have a right to the supports and services that our organisation and others provide.

I thank the witnesses for their honesty. Mr. Moynihan hit the nail on the head. Nobody should be looking for charity especially when they have paid all their taxes throughout their lives. Dr. O'Connor spoke about index-linked pensions. That scares the living daylights out of me because the Government is talking about going in the opposite direction. We are going backwards on pensions, which raises a big red flag for me.

Some years ago, the Government was suggesting that people living on their own in three-bedroom or four-bedroom houses could downsize. While it is grand saying that, the Government is not supporting them through communal living. Again, it comes down to NGOs. A few years ago, the Lions Club in Midleton built a number of homes in a beautiful setting, with no high fences or other obvious security. Those people have lovely secure communal living where everybody works. Again, it comes down to volunteers.

Many groups throughout the country are doing fabulous work. Is there a way to get them all together to come up with one major plan? Lobbying can and does work. The organisations represented here today should come up with a concrete plan between them and pool resources. Last week we had a discussion on NGOs in the mental health service which are all doing fabulous work. It is slightly different in different areas because of the demographics. If the groups represented here cannot provide what they want to provide, because of pressure of resources, is it possible that they might pull together as a super-group to lobby the Government? What I am hearing this morning is that the pension stuff is a non-runner and so we are facing problems straightaway. Resources and funding are under pressure and so we are facing problems there. If we do not put resources in locally, we will hit a problem there.

I am delighted with the witnesses' honesty. I am very disappointed that I do not see this going in the right way. I do not envy them for trying their best but if they do not get the supports and start shouting for those supports, many more people will suffer. We do not want to see that happening. When there is an action, there is an instant reaction. If someone's physical health starts to deteriorate, their mental health starts to deteriorate with a knock-on effect on family members. We will be facing a tsunami with people asking how it happened.

The witnesses have just told us what we should be doing. I hope the Government parties are listening and come up with a post-Covid plan. I do not hear Government parties speaking about a plan for what will happen in the next five months and more importantly what will happen in 12 months or 18 months because that is when the stuff will really hit the fan. They are not going to be resourced and the Government is on about raising taxes. The money is so cheap now that we should be borrowing and investing, solving our problems now, having a major capital investment plan, giving people real jobs, paying real wages, paying real tax. The knock-on effect of that is that it reduces the demand on private rent because people will buy their own houses. The whole tsunami implodes and comes backwards and maybe in five years' time we will have everything resourced as it should be, obviously at a cost but that cost can be borne out in the long term with a population that is stronger mentally and physically.

Mr. Seán Moynihan

I think we need the local community groups - the local volunteer force with knowledge of the community - to be responding there. We have a network of partnerships and we provide technology, training and resources to approximately 50 other organisations to do what we do because no one organisation can solve any individual problem across the country, whether that is mental health, ageing, home support or combating loneliness. We share the knowledge and resources and we share our technology with people. That is something we do ourselves. Those sorts of initiatives across different sectors need to be sponsored and invested in so that we are sharing knowledge and having common training and common modules. We need to ensure that regardless of the organisation, if somebody reaches out for help with, for example, loneliness, they get a consistent response and a consistent quality of services. That means supporting communities, supporting smaller organisations and getting people to work collectively.

Ms Celine Clarke

What Deputy Buckley is speaking about, for us is about a life-course approach to policy making. When people become older, they are living on a fixed income, usually relying on a State pension. Most people over the age of 65 rely on social protection for three quarters of their income. It is important that we take a life-course approach so that the cumulative disadvantage we carry through our lifetime does not then have a sudden impact when we reach retirement and start to depend on a fixed income.

There was mention of innovative design. One of the greatest results of human innovation is that we are living longer and healthier lives. That is something to be celebrated. We also need to consider social dialogue where we can co-create and co-design solutions and policies that meet the needs of communities and people where we are at. That is why it is important that organisations that work in community development and civil society along with ordinary citizens have an ability to participate in a pathway for meaningful dialogue and participation in the policies designed for them.

Mr. Andrew Rooney

To add to what Mr. Moynihan was saying, ALONE pools resources. We are a member of the Home Care Coalition. We work and come together with a number of charities and home care providers to agree a position on home care. We lobby the Government and speak to it about how this should be implemented. There has been really good engagement with the Department of Health on that.

We have also been involved with the loneliness task force. As Mr. Moynihan said earlier, this was recently reformed with broader representation. The task force produced a report, A Connected Island, which suggests a number of key recommendations for the Government to implement to address loneliness. The report is now a few years old but the recommendations are all still really relevant. There needs to be annual funding for organisations to support initiatives that are working to address loneliness. There is also a commitment in the programme for Government to develop a plan for addressing loneliness. We are working towards that and the task force is working on updating the report. This is all particularly important in the context of Covid-19. In its interim report on cocooning, the HSE has highlighted a number of long-term consequences for both mental and physical health. The development of this plan needs to be accelerated quite quickly. The Government already knows this is a problem. I would just like to add that this commitment has already been made in the programme for Government.

I am having a few technical difficulties with the video.

Will the Deputy speak a little bit louder or move towards his microphone? We can hear him but it is a bit quiet. Does the Deputy have a headset? That may be better.

Can I be heard now?

That is better.

I thank ALONE and Age Action for their statements. I am sure that Deputies, Senators and anybody listening to these statements today would want to commend the organisations on all of the work they have been doing over the last 15 months in dealing with the ravages of Covid and what it has done to older people in Ireland. It has been extremely difficult on that age cohort, to say the least. The side effects of Covid have included isolation and the bereavements caused by this terrible pandemic. We have stuck together. We have seen the best of humanity in the way people have come together and looked out for one another. That coming together has been a very neighbourly thing on people's streets in addition to being a national and international phenomenon. People have come together and that is what makes us human. The pandemic has taken a very heavy toll on older people, though not only on older people. The majority of deaths have occurred among that age cohort. People were very scared, which had a very great effect on the well-being of older people in Ireland. I commend the work the organisations have been doing in the background. Phone calls and simple things such as communicating with people are very important. We will all come through this in the end and we will be stronger. People have suggested there will be a great reweighting of society. The old ways in which we did things prior to the pandemic will have been made redundant and we will have to look at new ways of treating the most important things in society. Family and solidarity within society are the most important things.

Having said all of that, I have two questions. The issue of age-specific housing in Ireland has obviously improved over the last 25 years but there is still a dearth of age-specific homes. Elderly and older people may want to move into a different setting. What are the organisations' views on that?

I am not sure whether the representatives can comment on this but yesterday, in speaking on the fair deal scheme, I brought up a matter that does not have much to do with that scheme. I raised the issue of a public inquiry into what happened in nursing home settings in Ireland. Half of the deaths that occurred took place within such settings. Even in Britain, there are calls for a public inquiry into how its Government dealt with this. Were these deaths preventable? It is impossible to know but every person who was in such a setting and the families of such people deserve some sort of closure and some sort of reflection on why this happened and how to prevent it ever happening again. What were the shortcomings in provision in this State for those who wanted to go into nursing homes? Nursing home care in Ireland is relatively good. Obviously, the composition of the sector has change dramatically changed. Some 20 years ago, 80% of homes were public and 20% were privately owned. Now the opposite is true. I have a problem with that. I do not agree with for-profit provision of nursing home care at all. Are a public inquiry and age-specific housing good things or things about which the organisations are neutral? I would like the representatives' views on those issues. I thank them again for all of their work over the last 15 months.

Mr. Seán Moynihan

I appreciate the Deputy's comments. To address one thing quickly, he mentioned the best of humanity. We saw a lot of civil engagement, as has been mentioned before, among An Garda Síochána, An Post and the GAA. We now need to maintain that. We need to give those organisations capacity to engage in the debate on how we support the community and to train their members in how to link in with what already exists.

We have done a lot of work and research with regard to housing choices. We are about to get a new housing strategy, Housing for All. We made a submission to this strategy. Our concern is that older people will be left out of that conversation. The reality is that we have an ageing demographic and the rate of house ownership has been dropping by a percentage point a year for many years. How does one pay one's rent in old age? How does one stay in the community in which one has lived if we are moving more towards renting? In most countries in Europe, the housing spectrum for older people includes housing with on-site support. We are very passionate in our view that we need to create that in Ireland. Under Rebuilding Ireland, there was one pilot pathfinder project in Inchicore. We are involved in building and developing that project. It will include 24 units with their own front doors built to a universal design and there will be staff on site 24 hours a day. Ultimately, it represents an alternative model to give a positive choice to older people who cannot stay at home but who do not want to go into a nursing home or older people who have far more capacity than the people for whom nursing homes are meant to cater.

In that way, nursing homes become exactly about what they essentially provide, which is nursing. In any examination or review, the governance decisions we have made during the past 20 years that changed us from having 80% public nursing homes to having 80% private nursing homes will need to be examined to ascertain if decisions were made in the past that led to the tragedy that unfolded in the past year. It would be a positive to establish that.

On the housing issue, we knew in the 1970s and 1980s and prior to that period that we needed to build social housing for older people. People who have never bought a property need access to good quality housing, safety and security. Back then older people lived in the poorest conditions and the smallest of spaces when they physically were no longer able to work or were forced to retire on age grounds. Older people do not want to go back to that. Ultimately, our welfare system is based on house ownership, but that is dramatically changing. We need to examine this area. We would argue that providing housing for older people will also provide safety and security for a generation.

I thank Mr. Moynihan for that. Does Dr. O'Connor wish to come in?

Dr. Nat O'Connor

Most older people do not live in age-specific housing. They live in all sorts of different types of housing. It is important we have a conversation on the way we can make housing suitable for everybody, but particularly for older people as they age. That involves a few factors. It involves-----

There appears to be a technical issue. Does Ms Clarke wish to come in?

Ms Celine Clarke

I think Dr. O'Connor was going to discuss universal design principles and making sure we adopt a life-course approach. It comes back to having a life-course approach to policy making, which we referenced earlier. We need to adopt universal design principles that make homes. When building homes now we need to ensure they are sustainable throughout people's life course, that there is choice within a community or a building complex, that people can live within the community in which homes are being built and that it is suitable housing. For example, it must be disability friendly or adaptable. The principle we must follow is that where we live now is where we want to live when we are 70 or 80, provided we can live independently and also be able to be supported to live at home.

Mr. Rooney is indicating.

Mr. Andrew Rooney

On the housing issue, ALONE has made a number of recommendations to the new housing strategy. Housing is often viewed as an issue that needs to be tackled right now and we do not plan for people's housing needs. Housing is a 40-year issue. We need to plan for that ageing demographic as Mr. Moynihan and others have said. We would be seeking an investment in housing with on-site supports and a funding mechanism to build those units. Those are the units Mr. Moynihan referred to in the pathfinder project. A number of people aged over 85 are renting and that number has increased fivefold in the past 25 years. We need to provide a path for long-term leasing and security of tenure for those older people. A large demographic of younger people are also renting. If we do not address the supply and demand issue, more older people will also be renting in the future. That needs to be addressed.

Ms Clarke spoke about universal design principles. All buildings should incorporate a universal design. We need to provide purpose-built housing for older people, which would allow them to right-size and which would support ageing in place. We would also seek a number of social homes - shared and supported housing units. More than 4,500 shared and supported housing units a year would be needed.

A key issue is the implementation of the joint policy statement, Housing Options for our Ageing Population. Key to supporting older people ageing at home is the implementation of the statutory right to home care. If we want to support people to age at home, support co-ordination will be key. The work ALONE and Age Action do will be key to community support for an increased number of older people living at home.

In allowing older people to right-size, we would be seeking an investment in the housing adaption grant. Currently, it is more than €70 million. That is a little short of what is required to allow older people to adapt their homes to age-friendly standards. That would require an investment of €84.5 million per year over the next ten years.

Another issue is the increase in the number of the people who are homeless in recent years. The homeless statistic for older people has remained quite static. There is still a number of older people in homeless services. With homelessness there is a risk of increased physical frailty. We need to target homeless interventions and make sure that the accommodation provided for those who are homeless meets age-friendly standards.

I thank Mr. Rooney for that. Deputy Buckley asked me to ask the witnesses how they think older people with a disability are coping. Would any of the witnesses like to take that question?

Ms Celine Clarke

If the Deputy means coping in terms of the housing situation, or during Covid, or all of it, anyone who had any sort of disadvantage was disproportionately impacted during Covid. If a person was already disadvantaged, that would have exacerbated that person's experience. Currently, there is not adequate housing stock or social housing for people with disabilities. That was been covered in the news this week. To return to what Mr. Rooney and Mr. Moynihan said earlier, a key issue is having universal design principles and building homes for people that are affordable and accessible and by accessible I mean that they can use them and get into them but also age in them. Some people will acquire disabilities as they grow older, although not everybody, and that is why we must age-proof policy. That goes back to Mr. Moynihan's point about age-proofing our policy and taking a life-course approach to everything we do now because it will affect all of us as we age and when we become older.

I thank Ms Clarke for that. Does Mr. Moynihan wish to come in on this?

Mr. Seán Moynihan

On the question on people with disabilities, the degree of resilience, independence and advantages older people had prior to the pandemic is reflected in the experience people had during the pandemic. It has negatively impacted older people. Older people who were still working, volunteering in the community or supporting families, friends and neighbours had to greatly withdraw from those roles. For older people who may be in advanced old age, frail or lonely, or who may have a disability, the impact was not equal and for that group of people the impact was even greater.

There was a probably a group of people with great energy in Departments, civil society and non-governmental organisations who made sure nobody was left out. An awful lot of older people who had been struggling on their own and not getting support may have started to get support. Ultimately, the services and supports they are currently getting may be rolled back. People who have got extra support or been "discovered" may ultimately be at a loss at the end of this. The pandemic has had a very negative impact on all older people. It has been very disempowering for all older people, especially those with disabilities. If people were frail, had a disability, were lonely or had healthcare issues prior to the pandemic, they were disproportionately affected by it.

I thank Mr. Moynihan. Mr. Rooney wants to add a comment and then I will bring in Deputy Ward.

Mr. Andrew Rooney

I mentioned the HSE interim report, which highlights a number of issues, including physical frailty and cardiovascular health. People with an intellectual or physical disability who had to cocoon are an increased risk of those health consequences.

Measures such as the closure of day services have negatively impacted people with disabilities. The Irish longitudinal study on ageing, TILDA, conducted research on older people with disabilities that showed a significant increase in distress and anxiety due to the pandemic. Again, this was due to decreased social participation such as not seeing friends or family, loneliness, isolation and fear of getting Covid.

I see Dr. O'Connor is back. Did he want to finish his point or will we move on? Does Deputy Ward wish to come in?

I apologise for being late to the meeting. I have managed to do most things as a public representative but being in two places at the one time is beyond my control. I was speaking in the Dáil. I am usually on time for meetings of the committee. I thank the witnesses for attending the meeting and for their opening statements, which I have read. I ask them to forgive me if I ask any questions that have been already asked because I might have missed them.

Based on my own observations, Covid-19 has shown the frailties in our systems, be they health, housing or community infrastructure. One thing that really enthused me and gave me a sense of warmth was when I saw how my own community wrapped around its older people, be that the community gardaí delivering prescriptions or meals or doing shopping. A group of retired Defence Forces personnel were meeting older people on a regular basis and helping them out. From listening to what the lads said when they were coming back, they were very concerned about the loneliness and isolation some of our older people were suffering. I will put it in the context of my family. My parents live in a different county so they only got to see my children for the first time since Christmas last weekend. It was when restrictions had lifted that I was able to leave the county. The sense of relief on my parents' faces at seeing their grandchildren and the sense of relief felt by my children at being able to see their grandparents was unbelievable and really emotional. I am concerned about the connection older people have had to do without. I always like to see what I can do to make things better. What are the key learnings Age Action and ALONE have gleaned from this experience and the restrictions that have been imposed on us? What can we do as legislators to improve the services for older people?

Mr. Seán Moynihan

I appreciate that. The Deputy made some good points about the contribution of the community. The phrase "key learnings" is really interesting. Coming out of this, the danger is that we will get into a situation of blame. What we have to do is learn. The gaps in the system became obvious in the community very quickly. The Deputy has described how civil society and communities rushed to fill those gaps. This is where the implementation of things like Sláintecare and the national positive ageing strategy and creating a plan around isolation and loneliness come in. We all knew before this. We had been campaigning for many years and we know that the demand for services around loneliness has been growing exponentially but the point is that we are slow to react. We must learn from this. People in the public service, local authorities and Departments worked really hard but possibly previous decisions and lack of investment and implementation of policy made things very difficult to handle. It is really important that we take the learnings. They involve things like the right to home care. Older people have said they want to age at home so if people need home care, that is what we must invest in. The public sent us all a very clear message. There was a lot of social cohesion through all of this - people listening to public health, young and old, and working together to protect and support the community. When it came down to it, people chose community, health and their family and friends. We need to invest and implement the outstanding reports like the national positive ageing strategy, the right to home care, a policy and strategy around loneliness and Sláintecare because, ultimately, the public has shown that this is what it wants. When the crisis hit, the public, civil society and NGOs rushed to fill the gap that was there.

Ms Celine Clarke

I echo everything said by Mr. Moynihan. The most important thing to recognise is that we know what needs to be done. That is the key thing. We have evidence galore that tells us what we need to do and we just need to implement the policies, do all the things we have identified that need to be done, close the gaps and make sure we do it in a rights-based way so that the people who are most affected participate in the design and implementation of the policy. This is vitally important. I am delighted that Deputy Ward's family was able to reunite so happily and that everyone came out safely the other end. That is a really nice story. We are talking about real people's lives, including our own and those of the people we represent or with whom we live. That is the key thing. It is about keeping people at the centre of the story as well.

I have a supplementary question. The witnesses mentioned closing the gaps. This committee has had numerous meetings with a lot of different agencies. In fairness, mental health agencies and services are out there and have had to adapt because of Covid and the restrictions. A lot of them have moved online. As we come out of the restrictions, some of these services will use this blended approach with some online and some face to face. I am aware that there are people who may not have access to broadband and the capacity to do things online. My parents would find it difficult to do stuff online. That was the first time I was able to see them face to face because they do not do face to face on the phone or on Zoom. I am concerned that if we start moving forward in the way we are delivering services, older people may be excluded from some of these services. What can we do as legislators to close that gap and help our older generation?

Ms Celine Clarke

This is one of my favourite topics and colleagues will say I have banged on about it from day one of the Covid-19 pandemic. Over 50% of people over the age of 65 experience digital exclusion through lack of digital skills, material access or broadband. The implementation of the national broadband plan is really important. Affordability is another issue. We must address the affordability of material access. If we depend on social protection for two thirds or three quarters of our income, we are not really going to have enough money to be able to buy the latest smartphone, maintain it because it needs to be continuously maintained and learn how to use it and maintain our skills. We need something through the social protection mechanisms. We proposed that a digital allowance be included in the past budget and we will continue to look for that in the upcoming budget to support people financially in respect of material assets. We also need targeted supports to support people to build their digital skills. We know it is most important for older people in particular - we train over 30,000 of them every year - that there is face-to-face or one-to-one training because different people have different experiences of learning and institutional learning, and different levels of literacy skills, so it all intersects. The Deputy is right.

If the Government and Departments take a digital-first approach to accessing public services, we must sure we keep people online and accessing services. Of course, we must also recognise that some people will never adopt it and they should not need to adopt it in order to access public services.

Mr. Seán Moynihan

Coming out of Covid-19, there will be a huge level of focus on this area. Many services will become more blended. In some ways, it can be done in a positive way because it may be possible to provide a digital form of assistance to somebody who may not have got a service previously.

For many years, ALONE has worked on projects across the country that empower older people to age at home using technology. We always think of Twitter and Facebook technology. In the next five years, the biggest revolution to support older people to age at home, around healthcare, safety and security, communications and social participation, will be the use of technology.

Across the country, we have a couple of tech engagement officers who train and support our staff to distribute, install and respond to technology that we have put in. During the pandemic, we worked with Beaumont Hospital with support from Sláintecare. We used technology to get 50 people who have cognitive decline or a diagnosis of dementia home from hospital. I will mention as a case study a man with dementia who is well into his 80s. He was involved with a choir for 20 years but stopped going around five years ago. His choir was meeting online, so we gave him a tablet and he was able to re-engage with them.

I will give another example. Everyone now has three or four remote controls for the television, Netflix and everything else. A man put them all away and put in an Alexa, which is a very simple available technology. Now, all of a sudden, he can ask Alexa to phone his family and friends, and to operate his television, thereby dispensing with all of the frustration and anger that might come from not being able to deal with some day-to-day things.

Approximately 1,000 people were given pulsometers to monitor their oxygen levels when they had Covid-19. The same technology can now be used to monitor people with chronic obstructive pulmonary disease. We can ensure that people in late old age, such as those in their late 80s and 90s, do not have to queue up in hospital every three months by supporting and empowering them to manage their health at home and send through the appropriate information. As Ms Clarke has described, digital skills are required to empower older people to control their data. They must have the skills to use this technology.

We can really progress technology for good in the areas of health, safety, security and communications. Ultimately, we can drive human contact and be proactive in supporting older people on their terms by using technology in the future. That time has come now. Traditionally, we have been very slow to invest in anything to do with technology. ALONE builds housing, and we are a housing provider for homeless older people as well, but you have to fund anything to do with technology yourself. It is not funded. The State needs to look at its involvement in the funding of technology for the individual but also for Departments. It needs to find ways in which we can really move forward.

Senator Aisling Dolan is working from home. Unfortunately, she cannot physically ask a question because of the rules relating to parliamentary privilege. Everyone can see her on their screens and I thank her for sending me her questions. I will be her voice today.

The Senator says that she worked previously in the area of dementia in the School of Nursing and Midwifery at NUI Galway. That work increased her awareness of the language we use when we talk about older people. The focus was on active and healthy ageing, and never using the term "elderly".

In terms of digital literacy, she thanks the fantastic volunteers with Age Action because her mother, Teresa, has had classes with a highly qualified IT consultant who gives of her time. Senator Dolan's mother has found her so helpful. Now she can order her grocery shopping online. Honestly, it is the simple things.

The Senator points out that Zoom offers the option of making calls by phone as well as having online meetings. She asks the organisations to outline how best we can encourage advocacy for older people with more and more technology. How do we make their voices heard?

The Senator believes that cocooning has been difficult. She suggests that people will need to make a huge adjustment in order for them to feel safe and engage with their communities again. She says that we all need to build up our social skills. She very much supports Positive Ageing Week, which will coincide with the UN International Day of Older Persons on Friday, 1 October.

The Senator has listed another question. I will ask it in a moment, but first I ask the witnesses to respond.

Ms Celine Clarke

I thank the Senator for her questions and comments. I am glad that her mother had a positive experience of Age Action's Getting Started Keep In Touch programme. The whole idea of the programme is to teach people what they want to learn and to support them in that context. The programme empowers people and helps them to develop their skills.

As I have said previously, a level of investment is required at a statutory level to support people to improve their digital literacy skills. A ten-year strategy under the Department of Further and Higher Education, Research, Innovation and Science is pending. We hope that the strategy contains targeted approaches and a sustainable funding stream to support people. As I am sure the Senator knows, her mother has acquired a skill that enables her to order her shopping on a specific site but she will want to develop her skills so she can conduct her business and banking in other ways. Things change all the time. We are in a continuous learning process. Therefore, people need a continuous support process.

Mr. Moynihan spoke about people reintroducing themselves into their communities. We support the calls by ALONE for a re-emergence plan. A concerted effort is needed to plan for people coming back into the community.

To return to a point I made earlier, it is important that we reflect on the narrative and language we use. I thank the Senator for raising this matter. Instead of using the term "elderly", we should use the term "older people". There is lots of other language that we need to address. We will only do that through reflecting, understanding and identifying what it means to feel like one is being ageist, to have an ageist attitude or to suffer the consequences of that in policies or practices. It is important that we begin that dialogue. We know that other organisations that are members of the age alliance are keen to address how older people can go back into their communities in confidence, and reclaim their rights and identities.

Mr. Seán Moynihan

The virus was very ageist in the sense that health outcomes were so poor for older people. The management of the pandemic and what has happened in the last year has pushed the agenda backwards because it has become a habit for people to talk about older people as one group. There are people in all age groups who are socially or medically vulnerable. Due to the ageist nature of the virus, we have slipped back into using old language and we are saying that all older people are vulnerable or in need of support. Older people are their own best resource. The language we use in public discourse and in the newspapers needs to be challenged. We need a common understanding of the appropriate language to use. We were making progress but the situation has gone backwards because of what happened with the virus. We need to focus on that in the future. We need to put older people back at the heart of their communities. We need to make sure the organisations that people volunteer for are back up and running.

We need to ensure that people who are working well into old age can link back into their jobs, from which they may have had to withdraw, and so on. We must plan for that re-emergence in order that as people are vaccinated, some of the work will start rather than end. Older people need to remain on the agenda with the supports they may require.

As for digital skills, the Senator is correct and it was great to hear the story of her mother, who represents so many people. Again, an ageist stereotype suggests older people are not interested in this. Our experience, as we roll out technology to empower older people to age at home, whether through medical, safety, security, community or social supports, is that there is enthusiasm to get involved and to learn. It is about that sense of empowerment and liberation, and of being involved in something that may be perceived as an activity in which all the other generations are involved. It is about stopping people being excluded from access to services or to participation. That is one of the learnings we need to take from this and it is one of the areas we need to move forward and learn from.

Senator Dolan has one more comment to make. She thanks ALONE and Age Action for their amazing work. Her area, Roscommon and Galway, has an ageing demographic, with one of the highest percentages in the country of people aged over 65 years. She says there is a wonderful, active and engaged group in her region but we need to support people to live independently or in supported communities.

Many questions have been asked by members, although a few members were absent due the business of the Dáil, which is sitting at the convention centre. I echo the comments of Deputy Ward in regard to grandparents and how important they are. I can speak from experience. My grandchildren are my lifeline; that is for sure. The relationship between grandparents and grandchildren is so important for people, and particularly for the grandparents. I fully agree with Deputy Ward about that.

Has research been done on our ageing population and the difference in mental health issues between those who are in nursing homes and those who are still living at home and being cared for there? Do our guests have knowledge of such issues, given their experience in working with older people? What differences do they see? Is their mental health impacted either way? I hope the question makes sense.

Mr. Seán Moynihan

We are currently finishing research on the first 40,000 calls we took after the pandemic began. We are used to working with people who may be somewhat marginalised or who may have been physically or socially vulnerable when the pandemic started. Across the range of older people ringing us, the main factors were increases in the levels of anxiety or people struggling with their mental health who had never really experienced such issues previously. We are conducting research on it, as are other groups, and I expect results to emerge over the next year. For us, mental health is a spectrum of conditions and anxieties, both diagnosed and undiagnosed. As can be seen in the work done as part of TILDA over the years, loneliness is defined as a high degree of undiagnosed low-level depression, and a person's capacity to address issues may be compromised as well. That so many people who reach out to us are lonely and in need, with the link in that regard to mental health, is why we have focused on trying to get policy, practice and a strategy in place. It has been a neglected area. Ultimately, loneliness is linked to both depression and predictors of poor mental physical health, and that is why we have focused on the area.

I thank our guests very much for attending. Our ageing population is in great hands with organisations such as theirs. It would be great to see them get more support, and I hope they stay connected with us as a committee and keep us updated on what is happening, particularly in the context of mental health and Covid, for the people they work with. It has been a powerful and informative meeting, with very helpful contributions.

The joint sub-committee adjourned at 11.06 a.m. until 11.30 a.m. on Tuesday, 25 May 2021.
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