Mr. Justin Moran:

Good morning Chairman and members of the committee.

Age Action is the leading advocacy organisation on ageing and older people in Ireland. Our mission is to achieve fundamental change in the lives of all older people by eliminating age discrimination, promoting positive ageing and securing their right to comprehensive and high quality services.

I thank the committee for the opportunity to meet you this morning and acknowledge the efforts of Minister of State at the Department of Health Deputy Jim Daly, who has responsibility for older people and his predecessor the then Minister of State at the Department of Healthand now Minister of State at the Department of the Taoiseach, Deputy Helen McEntee in bringing forward the public consultation on how we can develop a statutory scheme and system of regulation for home care services. I acknowledge and thank the officials from the Department of Health when they referred to the extension of that consultation, which was something that Age Action and a number of other organisations had requested.

Goal 3 of the National Positive Ageing Strategy states that it is the policy of the Government to “Enable people to age with confidence, security and dignity in their own homes and communities for as long as possible”. Every political party and elected representative we have met have told us they support this. Yet despite this political will, we have developed a system that drives older people into long-term care prematurely and that treats home care supports more as a way to empty acute hospital beds than to enable an older person to age at home with dignity and independence.

In Ireland, we spend 1% of our total healthcare expenditure on preventative care, significantly less than other European countries. The current policy of prioritising the provision of home care packages to facilitate discharge from acute hospitals means older people in hospital can access them more easily than those in the community. This makes it harder for older people in the community to have their care needs met and, as we heard a few moments ago, it is a false economy. Frail older people who are denied home care have higher rates of admission to acute hospitals, while those who get the support they need see a fall in the number of hospital admissions.

The HSE Planning for Health 2017 report calculated that 50,875 people should be in receipt of home help in 2017. However, as indicated in Table 1 of the submission to members, the number of home help hours provided remained at 2016 levels. These figures reflect home help provided to all care groups. A HSE performance report in 2009 estimated that 85% off recipients were older people. Using this figure, it is estimated that fewer than 42,000 older people receive home help, approximately 6.5% of the population aged 65 and over.

When set against the OECD estimate that 10.1 % of people aged 65 and over need home care this suggests approximately 22,000 older people in Ireland are not getting the support they need. Evidence of this unmet need is apparent in the community. An evaluation of the piloting of the single assessment tool indicated that of 534 fair deal applicants discharged from acute hospitals, 41%, or 219 patients, were not in receipt of home support services prior to admission.

The numbers waiting for home help are increasing.

At the end of December 2016, 2,039 people were assessed as needing home help but waiting for a service. By the end of April of this year, the number of people who were waiting had increased by more than 20% to 2,456. As Senator Mullen said earlier, there are major regional disparities within these figures. A total of 554 people in the community health organisation area 9 were awaiting home help at the end of December 2016, whereas no one was awaiting home help in community health organisation area 7. People who are waiting for hours to become available can be obliged to wait until a client dies or moves into a nursing home. A social worker who was interviewed as part of a research study - Meeting Older People’s Preference for Care, which was highlighted by Senator Kelleher earlier - confirmed that "often the situation is that you are waiting for someone to die to access hours". The reality is that home help hours and home care packages are simply not available in many parts of the country. As Deputy Murphy O'Mahony indicated, we repeatedly hear about this issue from Deputies who are dealing with their constituents. When more older people are forced into nursing homes unnecessarily, families struggle to cope without home helps and more pressure is piled on family carers who are already being put to the pin of their collars. We welcome the additional home care funding that was announced by the Government in last month’s budget. We look forward to seeing this make a real difference in reducing the number of people who are waiting for services.

A flexible and person-centred approach to the provision of home care services is needed to meet the specific needs of the individual, the carer and the wider health society. We need a rights-based statutory model for the delivery of home care. If people are to enjoy the highest attainable standard of physical and mental health, as is their right under the International Covenant on Economic, Social and Cultural Rights, home care must move from a selective model in which services are allocated at the discretion of local management in each community health organisation area to a universal model that is underpinned by rights. In this context, we expect the State to continue to be the main provider of home help and home care services and to function as the bedrock of the home care system. While older people should have a choice of providers, it is critical that the State does not seek to abdicate its responsibility for ensuring all public and private providers meet certain minimum standards. We welcome the comments from the departmental officials earlier today about their commitment to ensuring there is proper regulation of home care. A statutory entitlement to care allows older people to claim their rights and steers policy and resources towards the State's legal responsibilities. Home care services underpinned by legislation can address the absence of any rigorous monitoring, regulation or quality standards. We must change how we think about long-term care. Long-term care should be recognised as a public good, rather than as an individual responsibility. As the number of older people in Ireland is set to continue to rise in the coming years, we have an opportunity to put in place a system that provides a continuum of care for our older citizens and integrates home care with primary and community services and, where necessary, nursing homes and long-term care facilities. We look forward to working with the members of the committee to make all of this a reality.