Thursday, 11 November 2010
Care of the Elderly
I thank the Ceann Comhairle for selecting this matter on the Adjournment. For many elderly citizens who see their home help as a lifeline to some comfort in the autumn of their lives, this issue is critical. The security of knowing there is someone there for them on a regular basis improves their health and well-being and is as good as or better than a lot of the medicines they might take. There is a social dimension to the home help visit which impacts positively on the physical condition of the recipient.
Allowing thousands of elderly people to stay in their own homes with the support provided saves the State money by freeing up costly beds in hospitals and nursing homes and is also the policy of the Government. However, as result of the drastic reduction in the number of home help hours, the Government is not making adequate resources available to implement its own policy and in so doing will cost the State millions of euro in the future. If matters stay as they are, many of the people concerned will end up in acute beds in district hospitals or nursing homes.
In my constituency of Mayo 50,000 hours were targeted to be cut in 2010. The HSE advises that anyone who needs home help will not be denied, but once the criteria for what constitutes a need are changed, it will be able to come up with any figure it wants to justify it. Most people who had had their hours reduced in recent months after a review had been given the all-clear less than nine months ago. If they were approved then, why has the position changed since? The truth is that the well-being of elderly citizens is at the bottom of the agenda and the only show in town is cutting the services available to the most vulnerable in society.
I will give a couple of examples to highlight the unfairness being visited on some of my constituents as a result of the cut in home help hours allocated. An 87 year old lady who is bent to the ground with arthritis and totally dependent on her home help for everything had the time cut from one hour a day to 45 minutes twice a week. Her home help is expected or entitled to walk out after 45 minutes, even though it takes 1.5 hours to do all that is needed to be done, especially when she is visited only twice a week. Let me add that the home help is providing that service on a voluntary basis.
Another person in my constituency who has Alzheimer's disease and is living on her own has had her home help hours cut from five per week to 2.5. Her home help is greeted with human faeces around the house, yet she is not allowed to do any housework or cleaning. The new criteria are so stringent that they are in no way capable of taking account of the human cases dealt with.
The concept of providing home help for elderly people in need of care living in their own home is a good one. However, because of the inadequate resources provided to implement the scheme, it now poses a threat to the well-being of the very people it sets out to protect. The Ombudsman stated earlier this week that the State had failed for many years to provide people with their legal right to nursing home care. If the issue of cutbacks in home help hours is not addressed immediately, it is inevitable the same conclusion will be reached as regards the care of the elderly in their homes.
Barry Andrews (Minister of State with special responsibility for Children and Young People, Department of Health and Children; Minister of State, Department of Justice, Equality and Law Reform; Minister of State, Department of Education and Science; Dún Laoghaire, Fianna Fail)
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I thank the Deputy for raising this issue as it provides me with an opportunity to update the House on Government policy on the home help service and community services generally for older people.
The guiding principle of Government policy in this area is to support older people to live in dignity and independence in their own homes and communities for as long as possible. This policy is delivered through a range of community-based supports such as home help-home care packages, meals on wheels and day and respite care services. The importance attached to these services is highlighted by the fact that between 2006 and 2010 more than €200 million in additional funding was provided for the HSE to develop such supports for older people. Without these initiatives, many older people would spend longer than necessary in acute hospitals or be admitted to residential care earlier than might be required. Home care services are provided either directly by the HSE or in partnership with the community and voluntary sector, or by arrangement with private providers.
The home help service is one of our core community services, enabling vulnerable people to remain at home. It is a critical support for older people, in particular, and facilitates prompt discharge from acute hospitals or prevents inappropriate admissions to such hospitals or long-stay residential care. Significant progress has been made in developing the service since 2006, with a noticeable impact both on the number of people benefiting and in relieving pressures on the wider health system.
The provision has increased from 10.8 million hours in 2006 to 11.97 million in 2009. This corresponds to an increase from approximately 49,600 clients at the end of 2006 to 53,800 recipients at the end of 2009. The executive is committed to achieving its target of 11.98 million hours this year in respect of some 54,500 clients, as set out in its current service plan. The national target for 2010 for home help hours is unchanged from the 2009 figure of 11.98 million hours. Any change to this commitment would have to be notified to the Department of Health and Children.
Despite the serious economic constraints experienced in recent times, we have continued to prioritise improving community services for older people. This commitment is demonstrated by the €10 million additional funding provided in the last budget to expand home care packages nationally. These packages often contain a significant home-help component.
In addition to the mainstream home help provision, the current service plan is designed to deliver home care packages to approximately 9,600 people at any one time or some 13,000 clients over the course of the year. This represents an increase for this initiative on that provided for last year. The plan also provides for 21,300 day-care places which should facilitate up to an estimated 80,000 people. Other important initiatives in the area of home care supports are also being undertaken. Arising from an evaluation of home care packages, commissioned by the Department of Health and Children and published last December, the HSE has progressed this year with various improvements in home care provision for roll-out during 2011. These initiatives include revised national guidelines for standardised implementation of home care packages, new national quality guidelines for home care support services, national guidelines for the home help service, and a national procurement framework for home care services. The executive went to tender with the procurement framework on 22 October.
The HSE has operational responsibility for the delivery of health and social services, including the home help service at both regional and local health office levels. Reviews of service delivery are ongoing to ensure those who most need the service receive it, that the changing care needs of clients are taken into account, that people are treated equitably and that services are managed in a way that reflects seasonal changes in demand. The HSE has confirmed that services are being closely monitored to ensure the targets for service delivery in 2010 as set out in the service plan will be achieved. Notwithstanding the difficult financial environment, the Government is determined to do everything possible to protect the services referred to by the Deputy, respond to priority demographic and other needs and support ongoing reform of the public health services within available resources.