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

Home care support plays a very important role in supporting older people, as well as disabled people, to live as independently as possible. While not all disabled people need or want home care support, many do require the service, including many children as well as older people. There has been a growing crisis in home care support over the past number of years. The demand for home care has grown considerably. We see an increase, year on year, in the number of people being approved for hours and being allocated home care. I suppose that is down to the growing population. The disability capacity review shows that the growth and ageing of the disability population is likely to drive increased demand for home care services much further. The failure in home care provision is compounding further the pressure on our hospitals, because the lack of alternatives in community care has left thousands of people in hospital longer than they should be. Many people cannot return home because there is not a carer in place to provide the care that they need once they return home from hospital.

The issues confronting home care services come down to a failure of planning by the Government. Home support workers will not simply appear out of thin air. We need a proactive strategic approach to workforce planning across health and social care services. We need to see a pay agreement for the sector. We need to see public investment in the future regarding home care. We need a proper career pathway for carers with advanced skill sets, and perhaps a greater role for nurses and other health and social care professionals in delivering care in the home. What I am seeing is that there is an over-reliance on the part of the HSE on private companies or agencies to provide care. While it is paying them a substantial amount of money, the money is not being passed on to the carer. It is very difficult to get carers to work for that amount of money. When they do, they go into a house to provide care to a client and they are constantly what clock-watching because they need to be at the next house. This is putting immense pressure on them and it is also unfair on the person who is receiving the care, because they are not getting the care that they desire and require.

There are several examples of this. I have come across a 101-year-old man who has been allocated hours, but cannot get anyone to fill the middle part of the day when he requires care. His own children are in their 70s and they are not able to provide the care he requires anymore. The man is living in his own home and is relatively healthy. He just requires a little bit of extra support. I have come across two families who have children with autism who have been granted home care supports but cannot get anyone to work for the money that is being offered. The HSE has said that they can have home care support, but the families must act as the employer. They have been told that they must register as the employer, must pay the PRSI and the PAYE, and must change their home insurance policies as well. I do not know whether this is just peculiar to community healthcare organisation, CHO, 1, but I have come across it on many occasions. The pressure and strain of that on either a parent or a spouse is too much and they do not want to take it on. It is a lot of responsibility and it is just not something they want to do. While they appreciate the money that has been granted to them to provide the support, it is not something they actually can do.

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