Peter Fitzpatrick (Louth, Independent) | Oireachtas source

I welcome the opportunity to speak on this important topic and thank my colleagues in the Regional Group for raising this motion. We have learned many lessons during the pandemic. One is that concentrated care of our older people is far from ideal. These issues are predominant and are only going to get worse. Ireland has an ageing population. The number of people over 65 years of age increased in both urban and rural areas between 2011 and 2016 and such people now account for 15% of the population in rural areas. The Health Information and Quality Authority has called for an overhaul of the unregulated sector, including the introduction of oversight and standards for home care services, as most older people would prefer to age and receive care at home but require more complex care.

To be fair to the Minister of State, she has increased the funding and cut the waiting list for new home care packages. However, the 2023 tender urgently needs to be finalised to improve care for older people who want to remain living in their own homes. At present, the HSE home support service supports people with a disability who need home help, as well as supporting people aged 65 or over to continue living at home or to return home following a hospital stay. More than 40,000 people receive care through these organisations, care that was charged to the HSE at an hourly rate of €26.50. However, while demand increases and with 6,432 people on the waiting list for home support care at the end of March 2023, an acute labour shortage of home care workers in the State is evident.

Home care is often seen as an unattractive career path due to the failure to provide guaranteed hours of work and the lack of travel and subsistence payments. Reform within the 2023 tender is essential to provide a predictable income for carers. Despite this, while the pay increase agreed last week was a long-awaited step in the right direction, several issues, including the issue of paid travel time for care providers, remain unresolved in the agreement and reform to provide a predictable income for carers has been taken off the table by the HSE. According to the chief executive of Home and Community Care Ireland, Joseph Musgrave, the HSE has refused to state what it means by a "living wage" and has refused to engage with the sector to calculate travel time. All of us here today can agree that home care workers need a predictable income, to be paid the living wage and to receive payment for travel time and mileage, as well as access to career development opportunities. Essentially, they should be respected and valued for the crucial work they do day in, day out. We need to step in and ensure that compensation for time spent travelling, motor travel expenses and pay when clients are in hospital is standardised for all healthcare and home care providers, especially those providing care in rural Ireland.

Carers do a fantastic job and, in fairness, they save the State a fortune. Almost 300,000 people currently provide unpaid care to others and 86,000 of these provide such care for 43 hours or more each week, according to census statistics. We need to increase the means test limits for the carer's allowance for family carers while also reviewing the financial threshold for people in receipt of State benefits in order that they can work and earn more money working in the home care sector. This would help with staff shortages while at the same time helping people to earn more and to have a better standard of living without being penalised by the State. It is a win-win.

The current system is not sustainable and is not meeting our needs. Our failure to provide improved pathways of home care is pushing older people into already overcrowded hospitals and nursing homes. Some 1,000 patients approved for home support had their discharge from hospital delayed last year due to a shortage of carers and the lack of community care alternatives, while the lack of regulation meant that quality and safety were not ensured.

The Government must advance vital regulation for the home care sector and should make this legislation a priority. The acute shortage of care workers against a background of rising demand is the most urgent problem in home care. The Government must liaise with carers and the HSE and take measures that will make the home care sector more attractive and a more viable career option, with the national living wage, travel time and legacy rates all being addressed, while also considering the aforementioned reforms.

Delivering proper home care would reduce the length of hospital stays, reduce the risk of hospitalisation, reduce pressures on our emergency departments and reduce the number of delayed discharges. We must deliver a high-standard and fully public model of care for older people, incorporating the use of digital technologies, especially in rural areas, for the provision of digital services such as healthcare. We need to place home support on a statutory footing in order that it is enshrined in legislation as a sector.

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