Thursday, 18 November 2021
Saincheisteanna Tráthúla - Topical Issue Debate
Home Care Packages
I have sought to discuss the crisis in staffing in the home care sector and Government proposals to address it. The reason I raise this matter is because I have been contacted by a number of constituents who are extremely anxious about the current difficulties with recruiting staff to care for people in their homes. In other words, home care workers. We know that we simply do not have enough home care workers and that hospital patients who are ready for discharge are occupying scarce hospital beds because of a shortage of home care workers. In September, the Committee of Public Accounts heard from the HSE's chief operations officer, Anne O'Connor, that there are not enough people applying for home care jobs in either the public or private sector. We hear that in some cases HSE community organisations are only able to deliver 60% of home care needed. This is impacting on patients who need home care in order to leave hospital, but it clearly is also impacting on many other people who require care in their own homes.
As we know, there is a policy, which I support, of decongregation or of moving on from congregated settings. As the Minister of State will be aware, that is the Government's policy. The concern is that the Government will simply not be able to move people on from congregated from settings or, indeed, to keep people from going into congregated settings without the recruitment of additional home care staff. There is a lack of any governmental response to this difficulty.
As I said earlier, I have been contacted by a number of individuals and organisations on this matter, including Home and Community Care Ireland, who told me that its providers is at close to full capacity. That organisation is on record that 8,000 carers are urgently needed in order to look after elderly persons in their own homes. I have called for a new a fair deal. We should be adjusting or amending the fair deal scheme to prioritise care for people in their own homes, rather than prioritising nursing home and congregated settings. This is a real concern.
I have also been contacted by people who are carers and individuals who require care, including one constituent who is upset in circumstances where a home care package has been compromised to the point where the person who requires care is expected to cover for home carers unpaid. I have also been contacted by a constituent who is a carer. She told me that as non-EU worker she does not have any security of status.
I am asking the Minister of State what the Government proposes to do about this? I understand that due to the exclusion of home caring from the critical skills occupational list prepared by the Department of Enterprise, Trade and Employment, many of those who are currently providing home care and who are from outside of the EU are leaving to work in nursing homes and hospitals. We need to ensure that there is an overall Government scheme put in place to ensure that we can recruit enough home care workers and that, if necessary, any issues around visas for those from outside of the EU who are carrying out home care are sorted out. The provision of employment permits is one issue. Staffing is an issue, but it is clear that conditions and pay in the sector are also issues. I have previously submitted a parliamentary question on this issue, to which I received a response on 9 November from the Tánaiste and Minister for Enterprise, Trade and Employment stating that a recent review of the critical skills exemption for the non-EEA employment permit system for home care workers did not recommend removal of the occupation of care worker or home carers from the ineligible occupations list. If we are not seeing a move towards resolving this issue at that level, I want to know what the Government is doing to ensure that we will have enough supply of home care workers to carry out the necessary care in the home that people like my constituent and his husband so badly require.
I thank Deputy Bacik for raising this very important matter. I know the issue of the home care sector is an important one for the Deputy.
The Minister of State, Deputy Butler, and the Government are committed to the development of improved community-based services, shifting care to the home and offering greater choice for older people. Last year, an additional €150 million was secured for home support to progress the development of a reformed model of service delivery to underpin the statutory scheme for the financing and regulation of home support services and to provide 5 million additional hours of home support. The HSE national service plan sets a target to provide 24 million hours of home support this year. It is estimated that at the end of September 15 million hours had been provided to more than 53,000 people. This is approximately 2.2 million more hours compared with the same period last year. The funding secured in budget 2021 to provide these additional 5 million hours has been maintained for 2022.
Significant inroads have been achieved in reducing waiting lists for funding approval for new or additional service, from over 7,800 in January 2020 to just under 400 in September 2021. This has been achieved through a combination of validation of the waiting list and availability of funding to address those waiting.
However, there can be delays between the approval of funding and the delivery of home support hours, and the numbers of people in this category have increased steadily this year. At the end of September 2021, there were 4,933 people assessed and waiting for a carer to become available. In January 2020, there were approximately 1,300 people in this category. Certain geographical areas that are experiencing increased pressures due to staff availability are particularly affected. Despite the increase, it is important to note that the total number of people waiting for home support across both categories has reduced from more than 9,000 at the start of 2020 to approximately 5,300 in September 2021.
The HSE is acutely aware that there are increasing capacity issues across both direct and indirect provision. It continues to advertise on an ongoing basis for healthcare assistants and to recruit as many suitable candidates as possible. It conducts its recruitment through a variety of channels, both at local level and through the shared service offices of the Health Business Services. Due to the nature of the role of healthcare support assistants, this recruitment is normally conducted at a very local level and is ongoing across the HSE. In addition, approved home support providers continue to recruit home support workers.
My colleague, the Minister of State, Deputy Butler, has committed to establishing a cross-departmental strategic workforce advisory group, the role of which will be to facilitate the views of stakeholders and examine workforce challenges in home support and nursing homes. Potential areas to be considered include recruitment, retention, training, career development and the sustainable employment of home care workers into the future.
Work is also ongoing within the Department to progress the development of the new statutory scheme to support people to live in their own homes within the broader context of the Sláintecare reforms. Recruitment of the 130 posts funded for the national roll-out of interRAI as the standard assessment tool for care needs is scheduled to commence in this quarter. A national home support office is in the process of being established. The testing of the reformed model of service delivery for home support commenced this month in one pilot site, with other pilot sites expected to be fully operational by January 2022. Overall, the testing will deliver up to 230,000 additional hours of home support in 2021 and 2022.
I thank the Minister of State for his response and for setting out the Government's aspirations, but it is shocking that nearly 5,000 people, according to his figures, have been assessed and are still waiting for a carer to become available. There is no indication, although he might be able to provide it, as to how long they have been waiting. The shortage of home care workers clearly indicates there is a recruitment crisis, which is causing immense hardship, distress and suffering to many of those who are awaiting the allocation of care hours and to the members of their family, who may be in their immediate household, who are currently taking on the role of carer. It is also causing immense uncertainty and hardship for carers. One individual told me she has sent emails to many Deputies, media outlets and others. She notes that the majority of clients are very vulnerable. People need care and there are people available to provide it but because of the difficulties with visas for non-EU workers, there is a recruitment crisis.
The response I received to a parliamentary question on this issue states that the difficulty is caused by contracts of employment and employment terms and conditions. These are the significant factors in the recruitment challenges faced by the sector, I am told, rather than a demonstrable labour market shortage. If that is the case, what is the Government doing to sort out the contracts of employment and the terms and conditions being offered? There is clearly an enormous need and demand for people to have access to home care assistants in their homes. It is extremely important for us all that we are moving towards a society where people are not required to be sent into congregated settings when they need care because the State is providing supports and care for such individuals in their own homes. I want to be of assistance in addressing this serious recruitment crisis. We need to see a freeing up of the logjam that is currently blocking access for people who need home care assistants.
Enabling people with care needs to continue living independently at home for as long as possible is a priority for the Government. That is why there have been significant inroads in some of the waiting lists. I acknowledge, however, that almost 5,000 people have been assessed and are waiting for home care hours to be delivered. It is a distressing situation for anybody to be in, but I assure the Deputy that the Minister of State, Deputy Butler, with the support of the Government, is making every effort to ensure those hours are delivered and to address the recruitment need. We want to get staff in place to address those needs. That is the only thing holding back the delivery of care. The assessments have been carried out and the funding is in place. The last piece in the jigsaw is dealing with the recruitment challenge. I again assure the Deputy that the Minister of State is making every effort in that respect.
Alongside the significant increase in the level of service provision, the demand for home support and its importance as an alternative service to long-stay care has grown considerably over the years. That demand is a positive development reflecting the fact that most people want to live independently in their home. There may have been an attitude in the past whereby people were put into nursing homes at a younger age. I am glad that does not happen to anything like the same extent as it did in the past. We need to support people to be able to live at home.
The number of home support hours in communities is increasing in line with enhanced investment. It is important to note that despite capacity challenges being experienced within home support services, it is estimated that the overall service delivery has increased by 17% based on the year-by-year activity levels. Efforts are ongoing to meet the continued increase in demand for the service. In addition, as I stated, the Minister of State has committed to establishing a cross-departmental strategic workforce advisory group to facilitate the views of stakeholders and examine the workforce challenges in supported nursing homes. The purpose of the group is to establish and assess why those challenges are presenting in terms of getting the additional staff in place.