Louise O'Reilly (Dublin Fingal, Sinn Fein) | Oireachtas source

I move:

That Dáil Éireann:

recognises:

— the invaluable work carried out by home help workers;

— the contribution made by homecare in assisting with tackling delayed discharges from hospitals;

— that care delivered in the home is the preferred form of care for most people and their families;

— the cost-effective nature of home support by comparison to hospital care and nursing home care:— average weekly cost for home support services is approximately €165;

— weekly cost of a hospital bed is approximately €5,992; and

— weekly cost of a nursing home bed is approximately €1,048;— that the best value for money is provided by directly employed and not-for-profit homecare workers;

— that travelling between clients is work and should be remunerated as such; and

— that any form of co-payment for basic homecare is an additional burden which families should not have to bear in any form;

notes that:

— there are over 6,000 people on waiting lists for home help;

— the number of people over the age of 65 is increasing by over 20,000 persons a year;

— the proportion of people over the age of 85 is projected to double in the next 20 years;

— by 2030 the over 65 cohort will increase by 59 per cent, and the over 85 group by over 95 per cent;

— the Economic and Social Research Institute’s report on Projections of Demand for Healthcare in Ireland, 2015-2030: First Report from the Hippocrates Model noted that demand for homecare packages is projected to increase by between 44-66 per cent by 2030, while the demand for home help hours is projected to increase by between 38-54 per cent in the same period;

— in spite of increases in home support, resources have not kept pace with demand for services;

— the numbers receiving home supports in the community does not provide an accurate reflection of current and future need, with some older people opting not to apply as they know that services are insufficient to meet their need, as noted by Age Action;

— unmet need is associated with a variety of negative consequences that can affect the health and well-being of older people;

— without access to homecare supports many older people have to pay for private care, rely on loved ones to provide unpaid care, or are forced to move to a residential care setting which is often not their first choice thus undermining their human right to live

with dignity and independence; and

— research conducted by the Oireachtas Library and Research Service published in 2018, showed that while the level of funding allocated to home supports was approximately €450 million, the allocation to the Nursing Home Support Scheme, the ‘Fair Deal’ scheme, was significantly higher at €962 million; and

calls for:

— immediate steps to ensure the viability and sustainability of homecare provision;

— no reduction in the provision of home help hours and an end to the effective freeze on the allocation/recycling of hours;

— immediate investment in a recruitment campaign for directly employed home helps;

— an increase in the number of home help hours provided by directly employed homecare workers;

— an investigation into the value for money provided by private homecare providers;

— a Government commitment that any statutory entitlement to homecare will not place an additional burden in the form of co-payment for those who need the service;

— the immediate elimination of any call-out which is below 30 minutes;

— the development of a system of time management and tracking to ensure that payments for travel time are calculated fairly and transparently and related to actual time travelled; and

— the establishment of a working group or task force to examine the job of home help workers to look at:— how the job can be made more attractive to ensure the supply of a welltrained workforce;

— how the job can keep pace with the changing demographics;

— making the job sustainable as a full-time option;

— guaranteeing fair terms of employment and rates of pay across the sector;

— a sectoral employment order; and

— ensuring services are deployed to meet the need of older persons.

I welcome the opportunity to introduce this Private Members' motion on behalf of Sinn Féin and all those people who depend on the home help service. It is very well known that care delivered in the home is the preferred form of care for most people and their families. Care delivered in the home allows older people to live with dignity and respect in their own home and it is known that this has significant mental and physical health benefits as opposed to being unnecessarily stuck in a hospital bed or transferred to nursing home care.

Not only that, the home help service is one of the best value for money services in the health service, a fact to which any health economist will attest. It is timely as we have been discussing the summer economic statement and there is a failure to invest in what is the best value for money service the HSE provides. The average weekly cost to the State for an older person to be looked after under the home help scheme is approximately €165 whereas if someone is stuck in hospital and cannot be discharged home because of a lack of home help services, it costs the health service approximately €5,992 per week. I note that the Minister for Finance is here so perhaps he can assist the Minister for Health in doing those sums because it really adds up to value for money. Likewise, nursing home care costs approximately €1,048 per week as opposed to the €165 per week that home help costs. The Government's approach to the delivery of healthcare is penny wise and pound foolish. Freezing or reducing home help hours means that older people will needlessly end up in hospital and this will cost the health service more.

Age Action, The Alzheimer Society of Ireland and various other organisations have all done good work in this area. They have highlighted how unmet need is associated with a variety of negative consequences that can affect the health and well-being of older people. These range from relatively minor consequences, such as feeling distressed because the housework is not done, to major consequences such as not being able to eat when hungry, or falls, trips, slips and accidents. Older, frail people can often sustain an independent lifestyle at home if they receive the appropriate practical, physical and psycho-social supports. The absence of available home supports fundamentally impacts on the range of choices available to older people in need of home support. Likewise for parents of sick children, this is an absolute lifeline for them. Without access to home care supports, many are forced to pay for private care, or to rely on loved ones to provide unpaid care, or are forced into residential care settings which is very often not their first choice. This undermines their basic human right to live with dignity and independence.

There are a significant number of older people who are now in this exact situation and many more who will drift into this position if these freezes and reductions are not stopped. There are currently over 6,000 people on waiting lists for home help hours. That is 6,000 people whose needs are currently not being met. That is a ridiculous waiting list for a service that actually saves the HSE money in the long run. The actions of the HSE constitute going after low-hanging fruit and need to be called out. The freezing or cutting of home help hours is cutting off one's nose to spite one's face. There are better ways to save money across the health service. Money is being haemorrhaged in areas across the health service, whether the spending of more than €300 million per year on expensive and temporary agency staff, the failure to move care into the community and away from acute hospitals, the failure to roll out a proper IT infrastructure or the failure to move to biosimilar medicines to name just a few examples. Targeting a service such as home help is not the way forward.

I will touch briefly on the future and sustainability of the home help service because it is often less spoken about when this issue is raised. We need immediate steps to ensure the viability and sustainability of home care provision. There must also be proper investment in recruitment. I note, in the Government's statement, the mention of the home help contract. I fought for that contract. I do not know how many times we were at the Labour Court and we protested outside the gates of Leinster House looking for that contract. That campaign was important but there must be a campaign for directly employed home helps in conjunction with making the profession more attractive as a full-time option by guaranteeing fair terms of employment and rates of pay across the sector that are competitive. The best way to do this is to focus on directly employed or not-for-profit home helps. These provide the best value for money to the State and it is here that the future of the home help service resides. Private providers are in the business of healthcare delivery to make a profit. In the cases of directly employed home helps and not-for-profit agencies, every cent that is spent on home care goes directly into home care provision.

I call on the Government to withdraw its amendment and support this Sinn Féin motion and ensure we lay the groundwork for sustainable, fully-funded home care. We all know the way the demographics are going. We absolutely know that the home help service is fantastic and we will hear people this evening talk about how valuable home helps are, that they are valued members of the community, but we need the Government to get behind the home help service. It is good value for money and, when home helps are directly employed, they deliver great value for money.

I know the Minister will talk about the co-payment element of the scheme for statutory provision but, where healthcare has been privatised and there is an element of co-payment, that is asking people to sustain the profits of big corporations. That is not fair. People want to be looked after in their own homes by home helps who are paid decently and who can afford to work in the service. I urge the Minister to support this motion.

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