Pauline Tully (Cavan-Monaghan, Sinn Fein) | Oireachtas source

I welcome the Bill brought forward by Deputy Colm Burke and the regulation it proposes to introduce for this sector. I would fully support any policy or legislation which seeks to put in place the necessary supports to allow older people or people with disabilities to remain living in their own homes. Demand for care services is due to rise in the coming years as the population of older people grows. A capacity review that was carried out by the Department of Health estimated that a 120% increase in home care provision would be needed between 2017 and 2031. That growing demand is not being met at the moment, with some 6,000 people on HSE waiting lists. As we know, not everybody is in a position to pay for home care.

The Bill sets out provisions in section 6, which amends section 106(1)(b) of the Health Act 2007, regarding assessment of needs. I note that the needs listed under this subsection differ greatly from the needs considered when a person is applying for the carer's allowance, for example. I agree that the needs listed in this Bill should indeed be taken into account when somebody is looking for home care hours in order to stay at home. My concern is that in the case of carer's allowance, unfortunately, only those at the highest level of need are considered and it is quite difficult to secure a successful outcome.

There is also a reference in the Bill to "suitably trained personnel". Home care assistants working for the HSE are required to have a FETAC level 5 qualification as a minimum. In the private sector, some of these workers are paid less than €10 per hour, which is less than the minimum wage. Many have to travel up to 40 minutes for what might be a half-hour slot and they are not paid for the time they spend travelling. In the current circumstances, they are not reimbursed for the personal protective equipment, PPE, they are required to use. As a result of the poor pay and conditions for these workers, staff turnover is high, which is detrimental to both carers and home care recipients. On the other hand, there are some people without qualifications who are calling themselves home care assistants. This happens because there is no legal requirement for assistants and carers outside the public sector to have full formal training. That leads to gaps in knowledge and practice. I have also heard of carers being thrown in at the deep end without proper training, which is not fair to them or the care recipient. There is very little continuing or in-service education and a lack of governance within the private sector.

Another concern is that there is no register of home care assistants, which means the title, as SIPTU has highlighted, is not protected. As I said, anybody can call himself or herself a home care assistant. This means that if a carer is guilty of abusing a care recipient, there is nothing to stop him or her getting a caring job elsewhere because there is no register from which he or she can be struck. Many of the private companies are driven by profit and I suggest that strong consideration be given to supporting not-for-profit providers. The lack of regulation means the professional home care companies are not held to account by anybody. People in receipt of home care services are vulnerable and need to be supported and protected. We are behind many of our European counterparts in this regard.

While I welcome better regulation as a means of protecting home care recipients and improving pay and conditions for employees, that regulation should not be overburdensome, which might have the effect of pushing small providers out of the market. The top three home care companies, which between them received €110 million from the HSE last year, are all large, non-Irish companies. I am concerned that the potentially high cost involved in regulation could drive out the smaller companies and thereby reduce competition.

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