Ms Adrienne McAvinue:

My name is Adrienne McAvinue and I am a home care co-ordinator with the Alzheimer Society of Ireland, ASI. I would like to begin by reading the opening statement for Care Alliance on behalf of the executive director, Liam O'Sullivan:

I would like to thank the joint committee for the invitation to attend this morning... Care Alliance’s focus is on family carers and on supporting our member organisations and others to better support such families. For many families, home care can be a key support in keeping people well at home.

Over three years on from our attendance at this very committee, progress in the area of home care regulation has been slow. The ESRI’s recent reports on topics are welcome, and we look forward to the imminent publication of its further report on the complex matter of the financing of home care.

Our research from a few years ago highlighted the lengthy waiting times that existed for accessing home care. These lengthy waits continue today. We also know that the demand is estimated to increase by between 70% and 126% by the end of this decade.

Covid-19 has clearly impacted on home care provision, but it has also highlighted the invaluable role played by home care workers and the wider family carer community, in minimising vulnerable people’s exposure to Covid-19. This is to be applauded.

I will now move on to my own statement. As I mentioned, I am a home care co-ordinator and I have been working with The Alzheimer Society of Ireland for the past 21 years. Home care has the power to radically improve people's lives. Our organisation welcomes this opportunity to speak to the committee about staffing issues affecting home care.

As we know, it is the preferred option of most people to continue living in their own homes for as long as possible, in a familiar environment linked to their communities. Home care requires more resourcing in terms of time and investment in professional and personal staff development programmes. Due to a low funding base, some organisations are unable to offer any non-essential learning and development opportunities to home care workers. This impedes on their career progression and results in them leaving for better-funded agencies that can often offer these opportunities. A standardised training package for carers across the board, with various levels of training, should be provided.

Home care is highly skilled, yet it is generally low-paid and undervalued work. The additional skills and expertise required in delivering dementia-specific home care are simply not reflected in the remuneration. There is a critical need to standardise home care rates of pay and benefits. With respect, we have lost countless home care workers to the organisation that funds us, the HSE. We train our teams and nurture them. As a co-ordinator of home care service, it is so disappointing and frustrating when our team members leave for better terms and conditions that our funding simply does not allow us to offer.

Our struggle to retain staff has a real impact on continuity of care. Trust between people living with dementia and their families with their home care workers is essential. High staff turnover does not facilitate that trust. Home care work is most often undertaken by a person working alone. There are risks involved in lone working, and home care workers miss camaraderie and social support from colleagues.

Home care workers are not paid for travel time. This challenge is increased in rural areas where more travel is required between home care recipients. Similarly, many home care workers would like to work additional hours, but this is not possible with travel time.

In the Alzheimer Society of Ireland, we mitigate this by offering blocks of hours. While it is a solution to the fractured nature of home care work, it is also quality care. A block of hours gives the person with dementia a meaningful interaction and allows care to be person-centred and not simply task orientated or delivered in a rushed manner. This also provides the family carer with a significant break, which is so important for their mental and physical health.

To conclude today, I would like to speak about how we recognise and value home care workers. We must consider how committee members, as policymakers, value home care workers. If I were a bank manager or financial consultant looking after members' money, I would be handsomely rewarded. Yet, if I were a carer looking after the most precious people in members' lives, I would be on a wage that is just above the minimum wage.

At the end of the day, we either value this work and its people or we do not. In home care, our most valued commodity is our people. We should stop talking about how we value them and instead show them.