James Browne (Wexford, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

Wexford is consistently ranked among the worst counties in terms of waiting lists for home supports. There are 753 people waiting for home support in County Wexford, the third worst waiting list in the country. This has been getting steadily worse. Up to 174 people were added in the past few months. A significant amount of money has been put into the provision of additional home care supports and packages in recent years. Wexford, however, does not seem to be the beneficiary of this. The waiting list there is steadily getting worse rather than better. This is having a seriously detrimental effect on some vulnerable people. They are allocated a few hours here and there but often the staff are not in place to help them. Other vulnerable people who need help and assistance have seen their hours cut.

Robert Troy (Longford-Westmeath, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I welcome the opportunity to raise the issue of the scandalous waiting lists for home help supports in counties Longford and Westmeath. Over 200 people are on these waiting lists. All new applications are put on a waiting list straight away, with the only exception being 3.5 hours per week provided to somebody at the end of his or her life. The qualifying criterion is that it can be specified within a number of weeks when that person is going to die. No home help hours are recycled. When someone passes away, those remaining hours do not even come back into the system. The decisions are being taken by non-clinicians. Accordingly, there is no reflection on the medical need of the applicants whatsoever.

I am dealing with the case of a lady who is 77 years of age and living on her own. She has been given medical approval for an additional five hours of home help. She has fallen twice and ended in hospital on both occasions as a result. Her nearest relative lives in Canada. She has no help or assistance. She is deemed medically in need but she is not getting help.

Fiona O'Loughlin (Kildare South, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

The mater I tabled for discussion specifically related to respite stays which, obviously, go hand in hand with the home care package issue. The situation in Kildare is appalling. There are families in crisis there. Numbers given for the CHO 7 area show they have gone down from 7,064 hours in 2015 to 5,808 hours in 2018. That is despite all of the different calls for this to be increased. I recently met representatives from the Muiríosa Foundation in Monasterevin and the KARE organisation in Newbridge. I was shocked, appalled, upset and emotional when I heard the stories of the families which the two organisations help. I met one mother at one of those meetings, a widow from my area. Her 19 year old daughter needs to have two people to collect her in a separate bus to bring her to her day care centre. She needs to be in an isolated room while there. She is then brought back home but her mother has no other help, support or means of respite. It is a shocking indictment of our system to not have supports for families the way we should.

Fianna Fáil fought really hard to get extra funding in the recent budget for respite services. Even with the funding put in, it will only bring it back to 2015 levels. Much more is needed.

Jim Daly (Cork South West, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I thank the Deputies for raising this issue. Home supports enable older people to remain in their own homes and communities, as well as facilitating timely discharge from hospital. As outlined in the HSE’s national service plan for 2019, the HSE maximises the utilisation of current resources prioritising those requiring discharge from acute hospitals. Significant resources and services in 2019 have been targeted to facilitate timely egress. Last winter the focus was on reducing delayed patient discharges through mobilising the additional resources made available, as well as ensuring social care measures were effectively deployed to enable older people to move to a more appropriate care setting, including to step-down or transitional care or their own home with the supports they need.

The national service plan for 2019 sets a target to deliver 18.26 million hours to over 53,000 people, including 360,000 hours as part of an intensive home care package. By the end of July, more than 10 million hours of home support had been delivered nationally with almost 52,000 people in receipt of the service. The most recent preliminary data available indicates this has increased to over 11.8 million hours by the end of August. Despite this significant level of provision, demand for home support continues to grow and nationally over 7,000 people have been assessed and are waiting for either new or additional services. Arrangements for home supports have developed over the years with a significant local focus. It is acknowledged by the HSE that there may be a considerable variation in access to services in different parts of the country. The recent report from the ESRI, published in July of this year, Geographic Profile of Healthcare Needs and Non-Acute Healthcare Supply in Ireland, highlighted this variation across counties and regions.

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 the waiting list are reviewed, as funding becomes available, to ensure individual cases continue to be dealt with on a priority basis within available resources. They are also 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.

In line with commitments in the programme for Government, we have made improved access to home support services a priority in budget 2020. An additional investment of €52 million is being made in 2020 which will provide over 19.2 million hours of home support. This is 1 million hours more than the 2019 target, representing a substantial increase in service provision. This investment is focused on enabling older people to remain at home. As appropriate, provision of hours will also be targeted at times of peak demand, at the beginning and end of the year, to ensure more timely egress from hospital for older people.

While the existing home support service is delivering crucial support to many people, it needs to be improved to better meet the changing needs of our citizens. The Department of Health is developing plans for a new statutory scheme and system of regulation for home support services for older people and adults with a disability. Included in this investment is dedicated funding for the testing of the new statutory home support scheme in 2020. The design of the new scheme will involve the establishment of a model of service with a streamlined central system of administration to improve and simplify how people access home-support services. While the administration of the scheme will be centralised, the delivery of services will be co-ordinated at local level in line with a person's assessed need. This scale of investment clearly demonstrates the Government's commitment to addressing the issue through the introduction of standardised assessments, as well as additional resourcing which will go a long way towards the elimination of waiting lists and piloting of the new statutory scheme.

James Browne (Wexford, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

The Minister of State used the words “priority” and “targeted”, yet Wexford, with the third worst waiting list for home care package provision, has the fastest growing list. It does not make any sense that, if packages are being prioritised and targeted, neighbouring counties have no waiting lists. It seems to be more a question of implementation, targeting and prioritising.

We know living at home with home care aids people’s dignity, quality of life and safety. It also saves the State a phenomenal amount of money. It is the cheapest place to keep people, as well as the healthiest. It allows people to be discharged and go home. In Wexford, there are people in step-down beds ready to go home but cannot get the home care package to do so. In turn, this prevents people in hospital from getting a step-down bed. Home care makes financial sense. More importantly, it makes moral and common sense to provide home care. Will the Minister of State examine why over 700 people are on waiting lists in Wexford while neighbouring counties have none?

Robert Troy (Longford-Westmeath, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

The Minister of State indicated that the new scheme will be centralised and that the delivery of services will be co-ordinated at local level in line with a person’s assessed needs. The 200 people in Longford and Westmeath have been assessed and deemed medically in need of this help but they are still not getting it. Does he agree with the decision in my region that people who are medically approved are put on a waiting list? Does he think it is morally right that the only people in my constituency who can get home help are terminally ill? The only help they are getting is 3.5 hours per week? That is half an hour a day to a family whose loved one is dying in their home. That is the only support the State is giving the family. Whatever happened to ensuring that people who wanted to live out their last years in their own homes could be enabled to do so with the support of the State? It is not happening now and it is wrong. People want to live out their last years in their own homes. It is the right thing to do and makes economic sense.

It is a shame the way the Government is treating senior citizens at present.

Will the Minister of State, in his reply, say when the additional 1 million home help hours achieved as part of the confidence and supply agreement will come into effect for those on the waiting lists?

Fiona O'Loughlin (Kildare South, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I share the indignation, anger and upset of my colleagues at the way that people who need home help hours are being treated. My colleagues have gone through the figures. Kildare is one of those counties that features highly in terms of waiting lists.

As I mentioned, I specifically asked about respite. Respite is not mentioned once in the Minister of State's response, and I have gone through it twice. Respite, while going hand in hand with the home packages, is a particular form of intervention, help and support to families in crisis.

I mentioned already the agencies that I met in Kildare. They have told me of the distress and the unsustainable situations that many families find themselves in. In some cases, these have led to emergency admissions to full-time residential care, which is difficult to get. I am disappointed the Minister of State did not address the area of respite. While money comes into it, it is about the outcomes. It is about the difference we can make to families who need it.

Jim Daly (Cork South West, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I could not agree with the Deputy's last line more. It is not about money alone. Money alone will not solve this problem. I have stated that on the record of this House. While I got an additional €52 million in this year's budget, if I got an additional €152 million, I could not wipe out the current waiting list.

While I do not intimately understand the Wexford situation and Deputy Browne will appreciate that I do not manage the services at a local level, the issues in Wexford that are making it particularly acute are the supply of labour in many areas and getting people to deliver the service. That is why we have the postcode lottery, which is less than satisfactory, and that is why we have committed funding. From a financial point of view, three or four years ago it was €300 million a year. Now it is €450 million a year. That is a 50% increase in funding. We could keep doing that, for instance, adding another €52 million onto it this year. We can keep putting €50 million on every year. That, in itself, will not do. What we need is a centralised system that makes sure that it is fair and equitable throughout the country. That is what the Deputies are saying loud and clear. It is irritating if one represents Wexford, as Deputy Browne does, where there is a waiting list of 700 and a neighbouring county has a waiting list that is not half or a quarter as severe.

There are 7,000 people waiting nationally. That is not acceptable. I am on the record as stating that I am embarrassed at that waiting list. That is why I have committed to developing a statutory scheme that will be underpinned in law, like the fair deal scheme, so that everybody who needs it will get it. We will have a single assessment tool so that everybody's level of need will be assessed in a fair way no matter whether one lives in Donegal, west Cork or anywhere in between. We will also have it fully funded and make sure that there is adequate funding there. I will test a pilot of that next year. This is not something we are talking about in the never-never.

Deputy Troy asked when the additional 1 million hours that are the result of this year's budget will come on stream. I acknowledge the contribution of the confidence and supply agreement to that budget and the input of the Fianna Fáil Party to ensuring that this area got funding. I thank the party's Deputies for that. That is appreciated. Certainly, it is helpful at my end. Those 1 million hours will come on stream on 1 January and will be allocated. As I stated, a part of that will be running a pilot of the new statutory scheme, which will be unveiled in January of next year - I will be telling people exactly how it will look - and it is to be hoped it will be brought in the following January.

I do not have figures for Deputy O'Loughlin on respite. That is a separate issue to home help. Respite is delivered through the community nursing units. It is managed locally by each individual community healthcare organisation, CHO. If Deputy O'Loughlin wants me to get particular figures on that for Kildare, she should by all means contact my office or send me an email.

Fiona O'Loughlin (Kildare South, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I accept that, but that was the question I submitted on respite.