Ms Audry Deane:

As the largest representative body for older people in Ireland, Age Action is delighted to come before the committee to give a brief overview of home supports, the current context, deficits and impact on service users and their families, which is critical. We will conclude this short presentation with our key requests, which align with the Home Care Coalition, a grouping of 22 national organisations which advocate and engage with the Department of Health on this critical area of health and social care policy. We know that the deficits and challenges facing the Irish health system are complex and multifaceted, but from our experience and our direct work with older people and their families across Ireland, we are aware that older people do not receive the quality home support services they need to maintain their health and well-being and to allow them to continue to live independently within their homes and communities, and to avoid or even delay hospital and residential care stays. Home supports are critical for older people. It is clear from our work that families are not getting adequate quality, affordable home care supports. The Citizens' Assembly has dealt with this issue and the findings were clear. Some 99% of members wanted the Government to expedite the current commitment to place home care on a statutory footing. We now have the beginning of that emerging and are working closely with the Department to develop that. A further 87% of people want an increase in public resourcing to ensure this is delivered appropriately.

We all know the demographic challenges. Life expectancy is rising and people aged over 65 now can expect to live well into their 80s, with two thirds of these years being lived disability-free. However, as they age, the risk of disability increases. Some 72.3% of the population aged 85 and over will have a disability by 2038. I am not here to labour this. We all know the statistics and they are stark. The cohort of people over 85 is projected to double in the next 20 years. By 2030, the cohort of people over 65 will increase by 59% and the cohort of those over 85 will increase by more than 95%. This creates capacity challenges and has been well-signalled. We have had two key reports. The Economic and Social Research Institute, ESRI, report on healthcare projections noted that the demand for home care packages will increase by between 44% and 66% by 2030, and the demand for home help hours will increase by between 38% and 54%. The health service capacity review also flags this. Various numbers are included in it and are in our presentation. Looking at just home care packages, which the committee understands are a critical component of wraparound care for people, these will have to increase by 70% from 15,600 a month to 26,600. There will be a need for an additional 7.2 million home help hours by 2031.

Unmet need is the crux of this. Due to the dramatic demographic challenge, the projections for unmet need in home care supports are a cause of deep concern. Various research puts the level of unmet need at varying levels but it is at least between 26% and 50%. This will cost between €120 million and €205 million over the first five years of Sláintecare, which we will come back to because it is the blueprint for how we should reform healthcare systems in the country. A report by our colleagues in Care Alliance Ireland published just a few weeks ago gives very important information on the length of waiting times for home care and the gap between assessed need and the service that the person ends up getting. This report is sobering reading as, despite sending a freedom of information request to all nine community health organisations, only three responded fully to the questions asked, two gave partial information and one refused outright after an initial acknowledgement. The report found that the average time spent on a waiting list for home care supports for non-priority cases was at least 3.3 months, with the gap between assessed need and actual service provided being 15%. More worryingly, the report found an inconsistency in the approach to measuring and documenting unmet need. We in the Home Care Coalition believe that it is a cause for grave concern when the statutory health provider does not have a uniform approach to measuring, prioritising and allocating need. The figures on unmet need vary from month to month. Various reports give various statistics but we know that at least 6,100 people are assessed as in need of home care, waiting for an initial service. As I said, these figures vary.

Age Action Ireland is aware that the numbers receiving home supports in the community do not accurately reflect current and future need. Some older people opt not to reply, as they know that service provision is not sufficient and will not meet their needs. We are also concerned at the lack of data on private home care provision in the country. We know that the variety of negative consequences can badly affect the health and well-being of older people and their families. These range from minor consequences such as feeling unhappy because housework is not done, to major consequences, such as being unable to eat when hungry. Older frail people often sustain an independent lifestyle at home if they can receive appropriate, timely, quality physical and psychosocial supports. The absence of available home supports impacts fundamentally on the range of choices available to old people. Without access to home care supports, some older people are forced to move to a residential care setting, which is often not their first choice. This undermines their human right to live with dignity and independence.

On funding, as part of the Home Care Coalition, we know we need a large injection of funding into home supports to enable the service to at least meet its yearly growth in service users and to return to 2008 levels of service provision from before the austerity cuts. I have provided a graphic to the committee on research and will not go into it in detail. Members can see a significant disparity between the nursing home support scheme, which received €962 million in funding in 2018, catering for 23,500 older people in nursing homes, 4% of the cohort, while the home support element of care, including the winter initiative, receives €430 million, which covers more than 50,000 people.

That encompasses home care, home help hours, home care packages and intensive home care packages. One can see there is a big disparity.

The committee will be aware that there are serious challenges facing the planning and provision of home supports. The deficits have a serious impact on the quality of choices people make, if indeed they are able to make any choice, about where they will receive the care they need.

In summary, we know the following. The average home care package is now six hours a week and not, as we all thought previously, ten hours. It is now more difficult for over 60s to access home support than it was in 2008. The waiting lists still persist. There are now fewer hours being spread more thinly per client every week, with an increase in the provision of short 30 minute slots. There is not much one can achieve in 30 minutes.

There is an absence of legislative entitlement to home supports. There is a postcode lottery, which quite frankly is shocking, in service provision, and there is a lack of transparency and accountability. There is limited access to packages due to chronic underfunding and the eligibility criteria for supports remain unclear. Sláintecare is working hard on that issue with Ms Laura Magahy.

Overall lack of provision of supports is the key issue. At Age Action, our helpline constantly get calls from people needing to remain in hospital or who need to go to a nursing home because there are no supports at home, to where they want to return. This is a serious deficit. We face a steep increase in demand due to our population growth.

There are two clear messages I need to leave with the committee today. All of us here are asking for an increase of at least 10% in the home supports budget in each year until the statutory scheme comes on stream. We are working closely and innovatively with the Department on how we should design and deliver this service but it is not here yet. According to the Sláintecare implementation strategy, it will take three years to get this scheme in place. To maintain access and to meet the demands of the expanding demographics, funding has to increase by at least 4% to 5% per year.

Age Action Ireland's last really critical issue for the committee, as elected members, to take away is that the new statutory home care scheme must be underpinned with robust eligibility legislation and it must have the quality standards monitoring framework. Eligibility without capacity will not work and needs will not be met. The development of a robust equitable funding model will necessitate an honest conversation where collective societal values must be articulated and an agreed approach to the generation of funds to support the scheme must be reached. Age Action Ireland looks forward to working with the committee to make sure older people's needs for home supports are adequately addressed.