Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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We now move to the final matter, which is tabled by Deputy Ó Murchú. He wishes to discuss the lack of home carers and the impact this is having on families.

Ruairi Ó Murchú (Louth, Sinn Fein)
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I thank the Minister of State for taking this question. I assume Members have, as I have, experienced multiple call-ins to our constituency offices by families struggling to get carers in order for them to put a home care programme in place so they can keep their loved one in their home. There were numerous reports in the last year, particularly during the pandemic, when many of us recognised the type of work done by carers, and how their work makes a huge impact in our State and society, in addition to saving the State a significant amount of money and resources.

The problem, and we have all dealt with this, concerns people being unable to get care packages or only being able to get insufficient hours. From time to time, there have been issues in this regard. For example, community healthcare organisation, CHO, 8 might not have had enough directly-employed HSE staff or contract staff available. We hear at times that such problems have been sorted out but we still have these cases. If we are going to deliver home care that is an alternative to nursing home care, if that is what these people and their families want, then we must ensure that we resource this option.

I go through the details of some cases. I will speak in generalities and not name names. These cases have come through our office in the last while. The first concerns a 61-year-old woman. She lives in north Louth and had a stroke several months ago. She was in the care of the RCSI Hospitals Group in Drogheda and later in Dundalk. She was due to return home recently and her family made many attempts to try to get the recommended home care package. It involves four visits by two carers seven days a week. The family, however, has not been able to secure that package. The family has also been absolutely clear from the outset that this woman will not go into a nursing home. She is a young woman of 61 years old and a nursing home is not the place for her. The family are very supportive and are willing to do whatever they can but they must be facilitated. We must find solutions to cases like this.

I have another case involving a 93-year-old lady who spent a few days in Our Lady of Lourdes Hospital. She was discharged but a care plan was not put in place and no advice was provided to her daughter, who attempted to try to put something together at that stage. She made contact with a district nurse who was very busy and it was not possible to get a meeting for about a week. We had contact with people in CHO 8. They have been in touch and are assisting her. Again, it was stated that there was a need to deal with such cases and that people should not be let out of care until the correct home care package is in place.

The next case I will raise has been brought up previously. It involves a 74-year-old woman. These are all cases involving women and in most cases, the carers are also women. We are failing miserably in this regard. The lady involved in this case has advanced dementia. She had secured home care but not sufficient care for the weekends. The situation is the same months later. We are dealing with a family whose members are exhausted and at their wits' end. They are doing everything they can to try to give the required care to this lady on the weekends and get her through to the weekdays, when a better care package is in place. That is it, however. We are again talking about people doing their absolute best. It is, though, keeping an engine going with baling twine. It is not good enough. If we are talking about home care as an alternative to nursing home care, then we must offer people what is necessary.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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I thank the Minister of State for being here to deal with this matter.

Mary Butler (Waterford, Fianna Fail)
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I thank Deputy Ó Murchú for raising this important issue. It is a timely one, as tomorrow we celebrate the UN International Day for Older People. It is a key priority for the Government and for me to enable more people to engage in services that allow them to remain independent and live in their own homes with dignity for as long as possible. To advance this, the Government is committed to establishing a new statutory scheme on home support. In July, I announced the selection of four sites to test a reformed model of service delivery, through the delivery of 230,000 hours of home support. The four CHOs selected were CHO 2, CHO 4, CHO 7 and CHO 8. This pilot will underpin the development of the statutory scheme for home support services and will be fully operational on 1 November.

A national home support office will also be established before the end of this year to support the testing of the reformed model of service delivery. In addition, approximately 130 posts have been funded for the national roll-out of the interRAI Ireland system, which the home support pilot will test as the standard assessment tool for care needs. Recruitment for these posts will commence shortly. In parallel, work is ongoing by the Department to make progress with other aspects of the scheme, including the development of a regulatory framework and the examination of options for the financing model. The Economic and Social Research Institute, ESRI, is examining that aspect for us.

To answer the Deputy's specific question, while this new home support scheme is under development, the Government is prioritising improving access to home support services for older people. An additional €150 million was allocated in budget 2021 to provide for 24 million hours of home support. This is an increase of 5 million hours, or more than 25% on 2020. Therefore, my budget for home support this year is €666 million, and that is a phenomenal amount of money. Provisional data indicate that at the end of August 2021, approximately 13.2 million home support hours had been provided to 53,905 people. This is about 2 million more hours compared to the same period last year. Approximately 478 people were waiting for funding approval, representing an 88% reduction compared to the same period in 2020. This has resulted in keeping 1,200 people out of nursing homes this year alone.

The difference now is that in other years, we did not have the funding. This year, I have the funding but we have a shortage of staff. That is the whole issue. Due to these issues with capacity and staff availability, there are sometimes delays between the approval of funding and the delivery of home support hours. There are ongoing difficulties with the recruitment and retention of staff, with particular local areas experiencing increased pressures. This is particularly the case at weekends and in rural areas. It is a problem in my constituency. This no doubt affects access to home support for approved clients, even where funding is available. At the end of August, some 4,449 people had been assessed, approved and were waiting for a carer to become available. The funding is there to support the package of exactly what those people need. The problem, though, is that we do not have the carers to deliver the packages. As a result, this week I met Joseph Musgrave, CEO of Home and Community Care Ireland, HCCI. I also met representatives of the HSE. I spoke to them this morning to see what we can do to resolve this issue. It is not an issue with funding. I have the required money. We have established a strategic workforce advisory group with the involvement of key stakeholders, including representatives from the sector, education and the Government. Someone delivering home support now has to have a level 5 qualification before entering the house. The group will provide a forum for practical actions. It will also look, however, at aspects such as recruitment and retention. Terms and conditions are important for private providers as well. There is a financial issue in respect of mileage if, for example, a carer is going out to a rural area three or four times a day.

Ruairi Ó Murchú (Louth, Sinn Fein)
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I welcome that answer from the Minister of State. She stated clearly and I accept that the issue now is not one of funding but involves a shortage of staff. I also welcome the establishment of the strategic workforce advisory group. To quote someone else, we must do the devil and all to ensure that we can deliver the staff required. It is as simple as that. The problem concerns added pieces to fill the gap. As this pilot is worked out, I would like to think that it will catch some of the mistakes made before. That could include communicating with people to tell them that it will be possible to offer them the enhanced package with weekend cover, even if not immediately, and that everything necessary is being done. Even if we know that is the situation, then we can be part of the messaging service. If that only served to give people hope in the form of letting them know that we are aware they are in a bad place now but that we will deliver for them, that would be welcome.

It is what is necessary, and we have had multiple reports in this regard. When it suits the family, the person involved and everybody wishes it, the whole idea is that it is necessary to offer the person concerned the ability to live in his or her own home. In situations where families are adding their help, support and capacity, they are doing a huge favour for the State. It is saving the State an absolute fortune. Therefore, we must add those bits of the picture which are missing now and which will make this option possible and doable. I welcome the work that the Minister of State is doing, specifically the meetings with the HCCI and the HSE. It looks like it is happening from the point of view of delivering this scheme. I would just like the Minister of State to add a wee bit more on the specifics. I know it is difficult for her to give me a timeline in this regard but it would be good to get some idea of a general scenario where we are on the correct road and that in two, three or four months' time, we should be in a situation where these types of issues are resolved. I may contact the Minister of State afterwards regarding these specific cases.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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One wonders, if the main problem is with personnel, whether it will be possible to magic them up out of somewhere. Will work permits be an issue in this area?

Mary Butler (Waterford, Fianna Fail)
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I thank the Deputy for the constructive approach. I sat where he was sitting for four years and I raised this issue on a weekly basis. You can attest to that, a Cheann Comhairle.

In May 2020, there were 7,250 people waiting for financing of a home care package and, currently, there are 1,440 waiting. That shows we have improved by 90%, which is fantastic. The challenge we face now is to try to get more home care workers into position. We are going to look at alternatives. For example, there might be parents who do not work and whose children are in school, and we are going to try to get a flexible approach so that they might be able to deliver perhaps three hours a day. We are looking at that.

There is also another option that is taken up by very few families. It is in place since 2018, but it has not been spoken about very much. People can receive funding from the HSE to provide home care support and they can hire the providers themselves, but that has never really taken off. There is an option for people to receive the funding allocation it would cost the HSE to provide the package and for them to hire the staff themselves.

We are also looking at weekends. For most people, home care is not an issue from Monday to Friday, but Saturdays and Sundays are an issue. We are looking at providing financial support to people at the weekend and they might be able to get help in themselves. We are looking at all the options. For once, I have the budget, but I am challenged currently with not being able to get the staff. There are staffing issues across a lot of sectors of society.

Permits are a bit difficult because 75% of home care workers are part time and if we bring in somebody from a non-EEA country we must pay the minimum wage. The rate we have to be able to pay is €27,000. Given that most home care workers are part-time workers, most of them do not work for the required number of hours.

I say to the Deputy and the Ceann Comhairle, as I know he is very interested in the sector and he often raises it with me, that we are trying to do everything we can. Coming into the winter we need to get as many home care workers as possible, and we will do our utmost to do that.