Mary Butler (Waterford, Fianna Fail) | Oireachtas source

I thank Deputy Grealish and the other members of the Regional Group for the opportunity to discuss home care. When I was informed last Thursday or Friday morning that there would be a Private Members' motion on home care, I was absolutely delighted because we do not often get two hours to discuss what is a really important feature for so many older people living in the country. I thank the Deputies for tabling the motion and for the work they have done.

I read over the weekend what the Deputies have in their motion and believed it was very fair and balanced. Much of what is in it, especially what Deputy Shanahan referred to, is already in train. I will go through some of the things we are doing and also speak about where the challenges lie. I will speak about what we are doing more generally regarding the extensive reforms occurring in home support.

It is crucial to acknowledge the outstanding efforts of front-line carers and all those who work right across our health and social services. They have stepped up and demonstrated their outstanding commitment to meeting the needs of service users in communities right across the country.

I was struck by the comments of the last speaker, Deputy McNamara, who said home care is a difficult job. It is predominantly female led. A home carer does a split shift in many cases, working early in the morning and late in the evening. It is a seven-days-per-week job. It is very difficult at weekends in rural areas, especially if somebody needs two carers or if the person being cared for has to be hoisted or has special care needs.

If they are looking for a male carer, that is challenging as well. There are a lot of challenges there, but it is a priority for the Government. Our population is growing and it is also ageing and this means that demand for home support services is projected to increase substantially.

Older people want to age well at home and it is important that the supports are in place. I call this the triangle of supports that I deal with every day as Minister of State for Health with responsibility for older people: home care, day care and meals on wheels. We have 330 day care services back up and running. We have 46 specific dementia day care services up and running. That is nearly 380 in total. Meals on wheels provides meals to 250,000 people every month and is hugely important. It is so much more than just a knock on the door with the meal; there is a social connection. Then we have home care. I am pleased to say that regarding home care, funding has kept pace with demand. The Government delivered unprecedented funding amounting to an additional €228 million over the last three budgets. My budget this year is €723 million specifically for home care to support older people to age in place.

There should be no doubt that this investment in social care and home support is a priority for me. It is a priority for the Government and for the Minister for Health, Deputy Donnelly. When I listened to all of the contributions, some really good contributions that I will take on board, there was one person who said the system is not fit-for-purpose. I do not agree. As we all sit here this morning and debate, 56,865 people will get a knock on the door and somebody will come in and help them to get up and get dressed and deliver the care they need, more from a medical model now. We have moved away a little bit from the fact that originally, home carers, or home helps as we used to call them, helped with cleaning out the fire and maybe going for the shopping or helping with it. We have moved to a different type of model. We had no choice, because the demand was there. Almost 7 million hours have been provided so far this year. This represents an increase of about 300,000 hours on the same period last year, notwithstanding the challenges we have. We have witnessed a significant increase in the number of home support hours being delivered, but also a significant increase in the demand. That has not been spoken about at all today. There is much more of a demand, especially post-Covid-19.

Last year, around 75,000 people in total benefited from home support services. The service is highly valued by service users and by their families, because it enables older people to age in place and live with dignity in their own houses without compromising on standards. Somebody spoke earlier about standards. I will not compromise on the level 5 HIQA standard that is needed to deliver home care. One cannot do so. People have to be Garda vetted. People have to have the correct verification to go into somebody's house and offer them personal care. I will not ever apologise with regard to standards.

I also want to say something which has not been said. Ireland has the highest life expectancy in the whole of the EU, as deemed by the World Health Organization, which is almost 83 years for women, and 82 years for men. That is something that we have to acknowledge as well. We are doing a lot of work to support older people to remain at home.

On the waiting lists we have currently, and this is something that I follow on a weekly basis, there are 3,310 new applicants. They are approved for funding and they are waiting for supports. There are a further 2,884 people who are already receiving supports. I know people cobble it together and say that there are 6,000 waiting. Technically there are not. There are 3,310 waiting, which is 3,310 too many, I will add. There are 2,884 people who are receiving a package, more than likely Monday to Friday, and challenged at the weekend. We are challenged at the weekend in rural areas and where we need two providers and one cannot ask any home carer to work seven days a week. It is as simple as that, so we are challenged there.

Work is ongoing to address the waiting lists and the HSE is endeavouring to prioritise service for clients with the highest care needs. That is what we have to do when we have a waiting list. The waiting list is predominantly made up of people who have been approved for support. I have to be crystal clear here: this is not a funding issue. There are not too many Ministers who can stand up and say that. It is not a funding issue, it is a workforce one at the moment.

I will move to the strategic workforce advisory group, SWAG, and the recommendations. We put that in place last year. I compliment my Department, which did phenomenal work on it. What I want to say is that while only one of the recommendations has been put in train, there are another four in train at the moment as well. The first recommendation involved working with the former Minister of State, Deputy Damien English, in pushing it through to get 1,000 permits outside the EU, and 129 have come in so far. I think it will work, because 2,600 people have come in on permits to the nursing home sector under the same pay and conditions. It is early days yet and I think the permit will work as the year rolls on.

On legacy rates, which were a huge issue for the private providers, travel time and the living wage, that is all being worked out in the tender at the moment. I do not want to say too much about the tender, because it is at a delicate stage and negotiations are ongoing. However, those three issues are being dealt with.

Another of the recommendations is rolling recruitment within the HSE. The HSE is paying €16.50 per hour plus mileage to home carers and it is still struggling to get them. As it recruits, what is happening is that we have a lot of home carers who are retiring. They stay on even until they are over 65 or 66 and they are retiring because it is a tough job which involves lifting people. If one is doing it all of one's life, it is time to be taking it a little bit easier. The rates we are paying are €16.50 an hour from the HSE, plus mileage, and we are struggling to recruit. There is a rolling recruitment campaign across the country. That is another one of the recommendations and I look forward to the meeting on 29 June which will set out very clearly how many of the recommendations are under way.

I really want to make progress in working with the Minister for Social Protection, Deputy Heather Humphreys. I take on board 100% that there are lots of people who would do home care if they did not have the challenges with their medical card, or if the amounts they receive in social welfare were not affected. There are a lot of people who have told me that when their child goes to school in the morning, they would be able to give three or four hours. They might be able to give 20 hours a week. That is an area that we really have to progress, and we will, but these things take a little bit of time.

On reform of home care, the programme for Government commits to introducing a statutory scheme. I will have that in before the Dáil before Christmas and I look forward to the support of Members on that. I thank Members for the pragmatic approach they have taken on this. That was one of the main reasons why I wanted to accept what Members have set out. We all want the same thing. We all want older people to age in place.

I do not have much time left, so I want to turn another area. Deputy Shanahan will be aware of this, because he was with us last Friday when we had the Minister for Housing, Local Government and Heritage, Deputy Darragh O'Brien, in Waterford. A new age-friendly premises was opened in the heart of Waterford city. It was formerly St. Joseph's nursing home. There are 71 homes there for older people under repair and lease and the local authority is going to provide a dedicated person there to support people when they move in and help them with social care, for example, meals on wheels, whether they need help filling out forms, or need help in getting home care. Age Friendly Ireland will also work with them in delivering supports. We need to see one of these in every community, giving older people the options to age in place with the correct wraparound supports. I thank Members for bringing forward this motion and I am happy to support it.

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