Peadar Tóibín (Meath West, Aontú) | Oireachtas source

Last year, the HSE confirmed to me in response to a parliamentary question that 600 people were in hospitals across the State who had been clinically discharged. On any given day, 600 people who the doctors can do no more for are languishing in hospital, and the only reason that they are in hospital is because step-down care is not available to them. In many cases, that is due to a lack of home care for those people. It is horrendous for the patients themselves. Being stuck in hospital even when they cannot get treatment there is very difficult for patients. It is also very difficult for hospital capacity. It is one of the major contributors to the number of people who are on trolleys in this country. Oftentimes, the number of people who are clinically discharged but cannot be released is actually the same as the number of people on trolleys in the country, which is quite amazing. We also have the issue where a large number of people are being put in nursing homes at a time when they could be living at home. Obviously, nursing homes do fantastic and wonderful work and they are key and pivotal in the lives of so many people, but often older people do far better when they are actually at home in their own location and in environs they know well etc.

There is a major problem in this country in terms of the lack of home care, and there is nearly a fool's economics to it. While home care can be seen as expensive by the State, in actual fact the lack of home care is far more expensive to the State both in human terms and in financial terms. It is really important to say that. While the Minister of State is here, I should say that the Covid crisis underlined even further the wonderful benefits of home care vis-à-visolder people being put in nursing homes. I also want to mention briefly that we know that nursing homes are still in crisis. In fairness to her, the Minister of State has been active in trying to bridge the gap that exists but a lot of the nursing homes that are negotiating with the HSE through the National Treatment Purchase Fund still have not got the income they need to be able to cover the inflation costs and their wage costs. It is the case that more and more nursing homes are looking to close over the next while, and are looking to move patients out. We need to find a way of making sure that those clients have alternative locations or alternative home care packages.

I pay considerable respect to all the people who are involved in home care across the country, whether they work in the public or private sector. They do massive work and it is one of the most important jobs. These are the most valuable people to us and the fact that these individuals and carers are looking after these people is very important to us. However, a couple of problems that have been raised with me recently. I understand that State home care services are now refusing to bring clients for walks. Movement is medicine for older people. For physical and mental health purposes, walking is a really important part of their daily life. If an older person under the care of a public sector provider wants to go for a walk, the public sector home care provider will not bring them for a walk. They will actually let the older person go out by themselves, unaccompanied into the town or village where they live, which is an incredible situation. Often, the carer will just go home if the older person is gone. Also, in some of those packages what is happening is that the carer rings the office rather than the family if there is a difficulty at home. Where the family live in the environs and could get there to it very fast to resolve whatever the problem is, they are not being told about it perhaps until a day later because of bureaucracy involved. The job of the carer is to prompt the client to take food or medicine, but not necessarily to really make sure that the client takes their medicine or food. I know that HIQA is reviewing this. All I ask is that there is some level of public consultation to the HIQA review of the regulations in order that families can feed into what regulations are put in place in future.

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