Official inspections, complaints procedures and finances are delicate subjects for anyone contemplating a move to a nursing home.

Oddly, the more than 500 publicly run homes in the State are exempt from any kind of inspection, a situation that has been criticised by the Irish Association of Social Workers. Private nursing homes, however, must be inspected twice a year by the health boards and an annual report compiled by medical professionals.

But this comes nowhere near the "independent inspectorate . . . comprised of people with first-hand experience of providing high standards of care for the elderly" envisaged by the working party that drew up the government report The Years Ahead.

People within the health services who feel gagged by their positions have serious concerns about this. "If the health boards are already under fierce pressure to locate long-stay beds, it's hardly in their interests to close down a place," said one.

A leaked East Coast Area Health Authority report earlier this year about conditions in an expensive south Dublin nursing home included, for example, details of linen soiled with faeces sometimes being turned and reused and the hiring of foreign staff with insufficient English.

That situation came to light only following staff complaints, not from inspection.

Several nursing-home operators cite "a great need" for independent inspection. "They should come with very strict criteria involving the care of the client . . . They like to see a care plan," says one, with a weary sigh, "but even that isn't mandatory."

As well as being the arbiter of nursing-home conditions, the health board is the final recourse for a client or family member wishing to make a complaint. The difficulty with this was amply illustrated by a case in the Ombudsman's 2000 report, where a health board had been asked to investigate a woman's serious complaint about the treatment of her dying mother in a private nursing home. The health board duly investigated and rejected her complaint, commenting that it had been difficult to investigate, as it was retrospective - what other kind is there? - and circumstantial. The woman was then able to turn to the Ombudsman, as her complaint was now directed at a public service as opposed to a private nursing home. He found in her favour in every instance. A significant statement in his report reads: "It was . . . clear that the evidence, upon which the \Ombudsman's Investigation Team based its conclusions, was readily available to those involved in the first investigation."

The sad fact is that most complaints about nursing homes received by the Ombudsman are about people who have died; according to a source, "this is because residents are so terrified of upsetting the status quo."

It was left to the Ombudsman, too, to break the scandal by which the children of nursing-home residents were means-tested and forced to pay for parents' care. A woman whose children are making enormous sacrifices to keep her in a high-end nursing home may find that the person next to her is in a "contract bed", fully funded by the health board. One city hospital has turned to private nursing homes for 60 per cent of its patients in recent years. The system by which there is no clearly stated, consistent and transparent policy among health boards about means testing and disposal of assets has been described, repeatedly, at all ends of the services, as grossly inequitable.

In this area, according to one senior health-board professional, "one's legal entitlement is limited to a public-hospital bed". The rest, as with so much else, is at the discretion of someone, somewhere. Or if you know the right questions to ask.

There is evidence that health boards are beginning to open the purse strings. But last week's reprimand by the Comptroller and Auditor General over delays by some health boards in paying arrears to people whose nursing-home grants had been wrongly reduced seems to highlight the kind of difficulties that have arisen in this area.

The wider debate hasn't even begun. In the United States, for example, people are conditioned to plan for retirement before they even reach their 30s. It's probably no coincidence that Americans have so many retirement models to choose from. What makes us so different?

Series concluded