Each morning, the longest break between cigarettes arrives with the home health worker, sent by the 'greedy' US health system regularly flogged in this country as evil incarnate.

The health aide starts by cleaning the bedding soiled during the night.

You never really get used to the smell. With the help of my father and a hydraulic sling, she gets my mother washed, dressed and into a motorised scooter. Before she leaves, over coffee, though lifting the cup or swallowing without the liquid entering her lungs is harder each day for my mother, they watch a rerun of ER. I think this is a strange viewing choice in a gazillion-channel universe given the circumstances, but when I mentioned this, my mother just grinned. In her final months, she has discovered irony.

Dignity is a rare and briefblooming flower in her days.

But I know it could be a lot worse. In another age, my unmarried thirtysomething sister would be expected to do what the home health aide does. But I wouldn't trust my sister to look after my houseplants, much less my mom.

Never mind that the presumption that it should be my sister, not I, to take on that burden is wildly out of date.

Were she in Dublin, my mother could easily die on a trolley outside an A&E ward when a crisis arose. Or lingering in an acute bed because we couldn't get her into a nursing home, much less one we could trust and afford. Perhaps a tabloid would seize on our dysfunctional 'bed-blocking' family and scapegoat us for the A&E mess.

How much of a mess it is we don't know exactly, because our empirical understanding of the A&E crisis is contending claims from the Irish Nurses' Organisation and the Health Service Executive about how many people are lying on trolleys. An agreedupon set of data about who is in A&E departments over the course of a year, and why . . .

though a precondition to any solution . . . is a fantasy.

How many cases could be resolved with a visit to an allnight GP? How many ecstasy cases should simply be locked in a room with water and a blanket (not strictly within medical ethics but, honestly, feck the middle-class victims of their own boredom)? How many were waiting because one of the artificially low number of consultants, who should be signing out patients from beds on wards, is playing golf, visiting his holiday home in Turkey or treating private patients? How many of those are chronic but non-acute cases that could be managed effectively at home?

The answer is we simply don't know. And because Irish public culture rejoices in pain, victimhood and blame-finding, but is criminally incompetent at facing up to vested interests that block solutions, no one wants to know. Into the vacuum pour anecdotes of misery and righteous talk-show indignation.

The HSE was set up to break this impasse, but to date, its chief executive officer, Brendan Drumm, has been unable or unwilling to publicly identify the real sources of the problem and impose a solution. Instead, there are bizarre proposals about 'accommodation lounges'.

On the other side, the unions have endless opportunities to blame the government for the problem. But even they sense time is running out on that game. This week, when a private homehelp service not unlike the one that assists my family in New Jersey was launched, it was attacked by Siptu and every politician to the left of Archbishop McQuaid. (Its worst crime is that it is an "American" franchise; you know they really hate something when that adjective is tacked on. ) Siptu's Joe O'Flynn this week told a Sligo audience of nurses: "Constant adverse publicity about the crisis in A&E could open up the possibility of privatisation." His solution, surprise, surprise, was to claim that the 25% of Ireland's budget spent on health is not enough.

It is impossible to put a price on dignity, but people caring for loved ones will buy as much of it as they can afford, particularly if they conclude that a non-privatised health service will never offer it to them.