Dr. Nat O'Connor:

I thank the committee for the invitation to present Age Action’s views. Age Action advocates for a society that enables all older people to participate and to live full, independent lives. There is a growing consensus that the direction of policy must be to support people to age in place in their communities and to live in their own home with dignity and independence for as long as possible.

The issue of home supports was raised by many people responding to Age Action’s pre-budget survey of their lived experience. Many people told us they wanted to see more supports to allow them and their loved ones to live at home for longer and many said they did not want to be forced into a nursing home. As one person said, what is needed is "...big movement on the expansion of home care. This is critically important for older people who do not wish to be warehoused for the last years of their lives. Older people need to be valued rather than be seen as a burden.". As another person said: "The thousands of carers in Ireland should be more respected and rewarded, not taken for granted.” We need to place greater value on care in our society. If we appreciate the value of care, we will also properly value care workers, paid and unpaid.

Regarding the long-term system in Ireland, the European Commission’s country report highlights many of the problems the statutory home care system needs to overcome. One major difficulty it identified is the lack of national data on the provision of care and on the need for care, including the volume of unmet care needs. While it is important to develop training for and focus on investment in staff we also need a nationwide analysis of what exactly is needed in order that we can reimagine home care, not just patch up a system that is fundamentally not working for many people.

Another problem the European Commission report identified was the inequity between different HSE regions, where different levels of resources are available and different rules apply, for example, with respect to compensation for travel. It also raised concern about the level of unregulated care activity, including informal employment within people’s homes. It also identified, bluntly, that "the challenges ... are huge in Ireland". Specifically, the challenges it identified are to ensure "a quantitatively and qualitatively adequate ... [long-term care] workforce to meet the rising demand for ... [long-term care] and providing a choice and support for informal carers". It specified the training infrastructure and degree of professional recognition of the value of the sector are low, there are low levels of training in the sector and there is a high level of informal work in the sector. A number of barriers need to be overcome.

In October 2021, the Minister of State, Deputy Butler, reported that waiting lists for home care were greatly reduced due to extra funding during Covid but that the HSE now faced difficulty in recruiting care workers. We heard that in the earlier presentation and on the RTÉ News this morning we heard that in the early years sector four out of every ten staff are actively seeking to leave the sector and nine out of ten cannot make ends meet on low pay and conditions. Clearly, in terms of home care, this will be a problem as we move forward unless care jobs come with decent pay and conditions, commensurate with the significant value of care work, as well as the opportunities people need for training and career progression.

It is also important as we build the home care standards and training, that the provisions of the International Labour Organization's Domestic Workers Convention 2011, which Ireland has ratified, and other labour conventions about migrant workers, be adhered to and built on to ensure decent working conditions and protections. Given that Ireland, historically, has relied heavily on EU and non-EU workers in the social care field, there is a need to protect workers from exploitation, particularly in a situation where a person’s right to remain in Ireland is tied to a single employer. Equally, we should ensure any existing workers who are outside of the formal migration system have a pathway to full documentation.

The World Health Organization’s Global Report on Ageism warns there is evidence of ageism in the provision of long-term care to older people, for example, in terms of controlling language, patronising patterns of communication or making unfounded assumptions about older person’s preferences, sexuality or capabilities. Standards for home care and staff training must ensure address these issues.

Services delivering home supports, whether voluntary, private or public, should all be explicitly brought under the scope of the public sector equality and human rights duty. That, in turn, requires that staff are sufficiently trained to be able to prevent discrimination, including age discrimination, and to protect the human rights of those receiving services. Similarly, staff need training to be able to work with the decision support service under the Assisted Decision Making (Capacity) Act’s provisions. There needs to be training and standards in order that staff can do that.

Most important, the recipients of home care should be included in the co-design of the specific service and type of support they wish to receive. Services being delivered in people’s homes should fit around those people’s lifestyles and preferences and not force people to comply with a one-size-fits-all model imposed from outside. This requires sophistication in how home supports are managed in order that staff are given the necessary permission to be flexible and responsive to people’s needs. At the end of the day, home care services should never lose sight of the fundamental goal of providing people with care so that they can live with dignity and independence as long as possible. I look forward to members’ questions.