Eamon Scanlon (Sligo-Leitrim, Fianna Fail) | Oireachtas source

The House will be aware that serious challenges face the planning and provision of home care supports and services. The deficits have a serious impact on the quality of choices people make, if they are able to make any, about how they receive the care they need. The people who need the care are among the most vulnerable in society and it is the moral responsibility of the State to care for its most vulnerable citizens in their time of need.

Deficits and challenges facing the health system are complex. From my direct work with older people and their families in counties Sligo and Leitrim, south County Donegal and north County Roscommon, however, I know that older people do not receive the quality of home care support services they need to maintain their health and well-being, to allow them to continue to live independently within their homes and communities and to avoid or delay hospital residential care stays. Home supports are critical for older people but it is clear that families do not receive affordable home care supports of an adequate quality.

The Citizens' Assembly dealt with the issue and the findings were clear. A total of 99% of members wanted the Government to expedite the current commitment to place home care on a statutory footing. Life expectancy is rising and people aged above 65 can expect to live into their 80s, with two thirds of these years lived disability free.

The number of people aged over 85 is projected to double in the next 20 years. The number of people aged over 65 will increase by 59%. This will create capacity challenges and has been well signalled. The ESRI report on health care projections noted the demand for home care packages will increase by between 44% and 66% by 2030 and the demand for home help hours will increase between 38% and 54%. The health service capacity review also flagged this.

Older people can sustain an independent lifestyle at home if they receive appropriate and timely quality physical and psychological supports. The absence of available supports impacts fundamentally on the range of choices available to older people. Without access to home care supports some older people are forced to move to residential care settings, which are often not their first choice. This undermines their human right to live with dignity and independence. We know we need a large injection of funding in home supports to enable the service to meet its yearly growth in service users.

The HSE national service plan for 2019 provides for a target of almost 17.9 million home support hours to be provided to 53,000 people. Despite the significance level of service provision, demand continues and the waiting list will persist and rise. At the end of March, 519 elderly people were on waiting lists for home care in community healthcare organisation area 1. The average time spent on waiting lists for home care supports for non-priority cases is at least 3.3 months. The average home care package is now six hours a week and not, as we all thought previously, ten hours. Fewer hours are now 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 support and a lack of transparency and accountability. There is limited access to packages due to chronic underfunding and the eligibility criteria for supports remain unclear. The overall lack of the provision of supports is the key issue. My office is contacted by families and 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. I know of one case where a man has been between hospitals for more than a year. His home, which was not appropriate for him, has since been converted and now has a downstairs en suite bedroom, for which the HSE provided a hospital bed and a wheelchair. The man cannot be sent home as there are no carer hours in the area. It is far more expensive to keep him in a nursing home or hospital rather than provide a few hours to the family so this 93 year old man can come home.

See this speech in context