Mary Butler (Waterford, Fianna Fail) | Oireachtas source

I move:

That Dáil Éireann:

acknowledges that:

— it is long-standing State policy to support older people to live with dignity and independence in their own homes and communities for as long as possible;

— as of 2018, home care services are being delivered through a single funding model, combining the home help and home care budgets;

— funding allocated to enable older people to remain at home provides not only the best value for money but also the most humane result for older people;

— the Home Care Package (HCP) was introduced in 2006, and there has been a significant increase in numbers of HCPs provided since then;

— the Economic and Social Research Institute has forecast an increased demand for home care of up to 66 per cent by 2030;

— the Health Service Capacity Review anticipates an increase in demand of some 120 per cent;

— the share of population aged 65 and over is projected to increase from one in eight to one in six by 2030;

— the number of people aged 85 and over is projected to almost double by 2030;

— there will also be a major increase in the numbers of people with dementia in the coming decades;

— the availability of home care also has significant consequences for capacity in other areas of the health service;

— the number of delayed discharges in hospitals has increased from 481 to 613 in 2018;

and

— 136,239 hospital bed days were lost through delayed discharges in the first eight months of 2018;

agrees that:

— the demand for home support continues to grow and waiting lists for services have become a feature;

— there has been a significant increase in the numbers waiting for home support, from 4,481 people waiting for public home help and a HCP in 2016, to 6,287 in 2018;

— it is a matter of concern that waiting times for home support are not currently collated nationally;

— there is a lack of information around services, and geography, not need, is determining access to care;

— the roll-out of the Single Assessment Tool (SAT) for the assessment of care needs has been too slow;

— the processing of applications for the carer’s allowance is too slow;

— at around 6.5 per cent, the proportion of the population aged over 65 years receiving home support in Ireland is significantly lower than the Organisation for Economic Cooperation and Development estimate of approximately 10 per cent of this age group needing such services; and

— supported housing options must also be provided as an alternative to residential care; and

calls for:

— a sustained and significant increase in investment in home support to meet existing unmet need and future requirements;

— measures to expand the availability of supported housing for older people;

— home support to be adaptable and responsive, especially for conditions such as dementia;

— individual need to be the decisive determinant of care, not geography or funding;

— the accelerated implementation nationwide of the SAT;

— a statutory system of home care which gives priority to those who need it and is regulated fairly for both care recipients and carers;

— home support to be provided on a seven-days-a-week basis; and

— timely and efficient processing of applications for the carer’s allowance.

I welcome this much-needed debate on older persons' care. I hope it will be very constructive. The continuing challenges in meeting the care needs of Ireland's older people must be addressed by Government. We need a sustained and significant increase in investment in home supports to meet existing unmet needs and future requirements. Our motion is in direct response to what I and my Fianna Fáil colleagues across the country and, I am sure, many other Oireachtas Members see on a weekly basis. Every week, people in all of our constituencies are worried about their family members who cannot access home care packages. It is a long-standing policy to support older people to live in dignity and independence in their own homes and communities for as long as possible. As we are all aware, Ireland has an ageing populating. It is estimated that we will have 1 million people aged over 65 by 2030. As we know, we are all going in only one direction. I often liken this to a tsunami coming at us. By 2030, a large proportion of our population will be made up of older people.

Every day, 11 people in Ireland are diagnosed with dementia. This is extremely challenging for families because 63% of all our older people who have dementia live in the community. I hope the provision of dementia advisers will be addressed in the HSE service plan. I have discussed the issue at length with the Minister of State and I appreciate that. These advisers would also help the situation by providing much-needed guidance and signposting for hard-pressed families reeling from the news of a recent diagnosis. People with dementia have specific home care needs that differ from those of other cohorts. It is important that this is highlighted.

While I acknowledge that the Government has spent €411 million on home care supports, we are still a long way off of where we need to be. There is a shortfall in respect of 6,287 people. These are our mothers, fathers, aunts and uncles. They are all family members and they need our support. People want to be able to live at home in the bosom of their families with the correct wraparound supports for as long as possible.

We are facing a winter of discontent in the healthcare services. The figure of 6,287 people to which I referred is an increase of 700 on last year and an increase of 1,800 on 2016. The figures are going in only one direction, which is a seriously worry. The availability of home care can also have significant consequences for capacity in other areas of the health service. There are approximately 600 people in an acute hospital setting who cannot be released into the care of their community because the necessary supports cannot be found. If these people could be released into the care of their families in the community, it would go a long way towards solving the issues we have daily with people lying on trollies. It would free up capacity if we could put home care supports in place. Some 136,000 bed days have already been lost this year due to late discharges. In many cases, the reason for these late discharges is that the home care supports are not put in place in a timely manner when needed.

This motion calls for home support to be provided on a seven days per week rotation. I have discussed this with the Minister of State before. Currently, the majority of home care supports are provided by the HSE from Monday to Friday and by private providers such as Home Instead or Caremark at weekends. They all do a fantastic job but when a person living in a rural area needs two people to hoist him or her out of bed three times a day and help with toileting and so on, it can sometimes be very difficult to find people for these tasks on a Saturday or a Sunday. I know of people who have been put to bed at 7 p.m. on a Friday evening and have not been able to get up again until Monday morning. It is not that they do not get some form of support but that they do not get the two people required to hoist them in or out of bed. That can be very challenging for their families.

We also need to see a sustained and significant increase in investment in home support. I know the Minister of State made an announcement today and I am sure he will deal with it. We can discuss it later. It is also important that individual need, rather than geography or funding, is the primary determinant. We see demand vary between the various community healthcare organisation, CHO, areas. Some areas face significant challenges. I was struck by figures showing that Galway has 674 people waiting for home care supports, while 578 people are waiting in Wexford. My constituency of Waterford fares better with 97 people waiting for home care supports. However, one person waiting is one family too many.

Administration and medical staff are being put under extreme pressure to juggle hours. I am lucky to have a very good relationship with a service provider in Waterford. She is a fantastic lady who I can ring her on a Friday evening when somebody is in trouble in a given area and she will juggle her hours as best she can to deal with it. I am lucky to have that excellent relationship with her, but not everybody has such a relationship. It is wrong that families have to pick up a phone on a Friday afternoon to tell their local Oireachtas Member they have just been informed that only one person will be available the following day to provide supports when two people are required. This creates an awful predicament for the administration and medical staff who are trying to juggle this.

It has come to my attention that in some areas there is no budget left to provide any more home care packages between now and Christmas. The only way to provide this support is if, unfortunately, a member of some other family passes away. That might free up eight, 12 or 14 hours, which can then be allocated to someone else. That is hard on the staff dealing with the matter.

It must be acknowledged that it costs the State three times more to look after older people in a nursing home than it does to look after them in the community. It makes sense to keep older people in their own homes for as long as possible. I fervently believe that if we get the home care supports right - I will speak about community care later - the knock-on effect throughout the acute hospital sector would have to be acknowledged. If we could have people released into their communities from acute hospital settings in a timely manner, it would be a good day's work.

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