SOME 44 much-needed hospice beds are currently lying unused because there is no money to open them.
Sharon Foley, of the Irish Hospice Foundation, said that around 29,000 people in Ireland die annually with €72m going into specialist palliative care, about €1.3bn on end-of-life care.
"But this spending is largely unplanned and uncoordinated," she added.
"Most of us wish to die at home but 43pc of us will die in an acute hospital."
She told the Joint Oireachtas Committee on Health and Children: "We know from a hospital audit we conducted that over 80pc of people who died entered the hospital via the emergency department.
"Most patients were not seen by specialist palliative care. On their last admission, patients were in hospital for over three weeks before they died. 44pc of people died in a single room.
"And up to one quarter of patients could have died at home if the community supports were in place."
She pointed out that there are plenty of strong national policies around specialist palliative care but we fall down when it comes to putting policy into practice.
"And this failing means that citizens are living and dying with an inequitable system where some people have more access to more services and choice of care while as many as 2,500 people can't access an inpatient hospice bed because they don't exist. We have 155 hospice beds today. We should have 450. We have significant deficits in hospice staff.
"There are three regions of the country with no inpatient hospice unit – the north east, the midlands and the south east – as well as Kerry, Wicklow and Mayo.
"Yet look what could be delivered. We know that hospice home care teams – and they're all over Ireland – help people to fulfil their wish to live and die at home.
"Some 26pc of us die at home. Under the care of a home care team, that number soars to 40pc."
She called for a national end-of-life and bereavement strategy to help us to plan all services including specialist hospice care.
Prof Eamon O'Shea of the Irish Centre for Social Gerontology, National University of Ireland, Galway said the availability of single rooms at time of death is a problem, particularly in public residential care and some acute hospitals.
"Neither do staff in these settings tend to have formal qualifications in palliative care, with less than one-third of all facilities reporting that their nurses hold a qualification in palliative care," he told the members.
He called for more consultation with older people in order to establish expressed needs and preferences with respect to end-of-life care, if necessary through greater use of advance directives.