Tuesday, 14 May 2019
Saincheisteanna Tráthúla - Topical Issue Debate
Home Care Packages Provision
The House will be aware that serious challenges face the planning and provision of home care supports and services. The deficits have a serious impact on the quality of choices people make, if they are able to make any, about how they receive the care they need. The people who need the care are among the most vulnerable in society and it is the moral responsibility of the State to care for its most vulnerable citizens in their time of need.
Deficits and challenges facing the health system are complex. From my direct work with older people and their families in counties Sligo and Leitrim, south County Donegal and north County Roscommon, however, I know that older people do not receive the quality of home care support services they need to maintain their health and well-being, to allow them to continue to live independently within their homes and communities and to avoid or delay hospital residential care stays. Home supports are critical for older people but it is clear that families do not receive affordable home care supports of an adequate quality.
The Citizens' Assembly dealt with the issue and the findings were clear. A total of 99% of members wanted the Government to expedite the current commitment to place home care on a statutory footing. Life expectancy is rising and people aged above 65 can expect to live into their 80s, with two thirds of these years lived disability free.
The number of people aged over 85 is projected to double in the next 20 years. The number of people aged over 65 will increase by 59%. This will create capacity challenges and has been well signalled. The ESRI report on health care projections noted the demand for home care packages will increase by between 44% and 66% by 2030 and the demand for home help hours will increase between 38% and 54%. The health service capacity review also flagged this.
Older people can sustain an independent lifestyle at home if they receive appropriate and timely quality physical and psychological supports. The absence of available supports impacts fundamentally on the range of choices available to older people. Without access to home care supports some older people are forced to move to residential care settings, which are often not their first choice. This undermines their human right to live with dignity and independence. We know we need a large injection of funding in home supports to enable the service to meet its yearly growth in service users.
The HSE national service plan for 2019 provides for a target of almost 17.9 million home support hours to be provided to 53,000 people. Despite the significance level of service provision, demand continues and the waiting list will persist and rise. At the end of March, 519 elderly people were on waiting lists for home care in community healthcare organisation area 1. The average time spent on waiting lists for home care supports for non-priority cases is at least 3.3 months. The average home care package is now six hours a week and not, as we all thought previously, ten hours. Fewer hours are now being spread more thinly per client every week, with an increase in the provision of short 30 minute slots. There is not much one can achieve in 30 minutes.
There is an absence of legislative entitlement to home support and a lack of transparency and accountability. There is limited access to packages due to chronic underfunding and the eligibility criteria for supports remain unclear. The overall lack of the provision of supports is the key issue. My office is contacted by families and people needing to remain in hospital or who need to go to a nursing home because there are no supports at home, to where they want to return. This is a serious deficit. I know of one case where a man has been between hospitals for more than a year. His home, which was not appropriate for him, has since been converted and now has a downstairs en suite bedroom, for which the HSE provided a hospital bed and a wheelchair. The man cannot be sent home as there are no carer hours in the area. It is far more expensive to keep him in a nursing home or hospital rather than provide a few hours to the family so this 93 year old man can come home.
I thank Deputy Scanlon for raising this important issue. I am taking this matter on behalf of my colleague Deputy Jim Daly, the Minister of State with responsibility for mental health and older people. The Government's core objective is to promote care in the community so that people can continue to live with confidence, security and dignity in their own homes and communities for as long as possible. A wide range of services are provided, including home supports, day care and residential care, through direct service provision and through voluntary and private providers.
Improving access to home support is a priority for the Government. Over the past four years we have seen a considerable increase of nearly €140 million in the budget, which has grown from €306 million in 2015 to almost €446 million in 2019. More than 53,000 people will receive more than 18 million home support hours this year, including intensive home care packages to 235 people. Despite this significant level of service provision, the demand for home support continues to grow. The allocation of funding for home supports throughout the system, though significant, is finite and services must be delivered within the funding available.
Preliminary data indicates that during the first quarter of the year 4.2 million hours were delivered nationally, 4,411 new clients commenced the service and 6,238 people have been assessed and are waiting for either new or additional home support services. I acknowledge that in some cases access to the service may take longer than we would like. However, the HSE has assured the Department that people on a waiting list are reviewed as funding becomes available to ensure that individual cases continue to be dealt with on a priority basis within the available resources and as determined by the local front-line staff, who know and understand the clients' needs and who undertake regular reviews of those care needs to ensure the services being provided remain appropriate.
The allocated home support budget for community healthcare organisation area 1, which covers Cavan, Donegal, Leitrim, Monaghan and Sligo in 2019 is €44.3 million. This is an increase of approximately €4.5 million on last year’s allocated budget. While the overall aim is to be as responsive as possible to all applications, delays can occur. According to the HSE, currently the home support budget for the Sligo, Leitrim and west Cavan region is experiencing demand in excess of the funding available. Preliminary data shows 205 people are waiting for new or additional hours. In this context, those clients who are assessed and who are not provided immediately with a service are prioritised based on the clinical assessment and are placed on a waiting list for a resource as it becomes available. The number of people waiting for funding for home support services reflects a point in time. While the existing home support service is delivering crucial support to many people throughout the country, it is acknowledged that the service and access to the service need to be improved to better meet the changing needs of our citizens. This is why we intend to establish a statutory scheme for home support services that will improve access to the service on an affordable and sustainable basis while also introducing a system of regulation that will ensure public confidence.
There is a specific commitment in the programme for Government to introduce uniform home care services so all recipients can receive quality support seven days a week. The Minister of State is right that every year the funding has increased but it is still not sufficient to meet the demand that exists. The Minister of State spoke about 205 people waiting. That is actually 205 families waiting for some help and support so they can bring their loved ones home, where they want to keep them and where they want to be themselves, and where they can be looked after. We all know the cost of nursing home care. It is €1,000 or €1,200 a week. The sum of €100 a week would keep people in their homes with the support and help of their families. Quite honestly, it is economic madness not to provide the funding. I agree the funding has increased but not sufficiently to look after these people. It is small money when we compare it to the cost of the children's hospital, which I agree has to be built and is badly needed. When we consider we are over budget on the children's hospital by €450 million or €500 million, I believe €5 million would solve the home help problem nationally. It would allow people to have enough home help and home care to look after their loved ones at home. The Government owes it to these people who have worked all their lives, paid their taxes and reared their families. Now they are being left without support or help. It is wrong. Some people wait for three and a half months. It is disgraceful and the Government should do something. We are not speaking about millions or billions of euro. We are speaking about small money of €4 million or €5 million to sort out the problem for the people.
I thank Deputy Scanlon and I take his point on the economic argument. There are strong indicators that it is the sensible thing to do. We also have a situation where people now live longer than they have ever done in the history of the State. Success in improved health and extended life expectancy has been achieved in recent decades and every year there is an increase of 20,000 in the over-65 population. There is an obvious need to provide high quality and flexible services that not only best meet the needs of individual clients, but also reduce pressures elsewhere on the health system. This is another argument. Social care services, including home care, day care and respite, are an important component in enabling people to remain living at home and participating in their own communities. They also provide valuable supports to carers.
We are aiming to improve home support services so people can remain living with confidence, dignity and security in their own homes. While the existing service is delivering crucial support throughout the country, I recognise that home support services need to be augmented to better meet the changing needs of our citizens. The Department is engaged in a detailed process to develop a new stand-alone statutory scheme for the financing and regulation of home support services. This is a point on which the Deputy spoke strongly. This scheme is a key action under the Sláintecare implementation strategy, along with improving and developing supports in the community. I will raise the Deputy's valuable points with the Minister of State, Deputy Jim Daly.