Colette Kelleher (Independent) | Oireachtas source

I strongly support the Health (Amendment) (Professional Home Care) Bill 2016, as presented by my fellow Senators, Senators Hopkins, Richmond and Colm Burke, during Private Members' time.

Home care enables people who have a disability, people living with a chronic condition, people with dementia, people who are frail or elderly. Home care enables people to live well with their disability, condition or frailty. It enables people to live independently and continue to be active participants in their own homes, among their families - citizens in their own community and country. Home care enables people to live where they wish to be, and often supports people with the most intimate and most personal care in familiar surroundings - familiarity being so important, for example, for a person with dementia or those caring for him or her. Home care enables people to even die in the comfort of their own homes, supporting the person with end of life palliative care which is referenced in the Bill. Therefore, home care is a really important part of the web of support that we all wish to rely on for those we know - people we love and for ourselves, the web of support that we would all wish to rely on when we no longer can fully look after ourselves.

This Bill acknowledges that home care can be provided, though not exclusively, by "nurses, home care attendants, home helps", and includes various therapies and personal care, including, as Senator Swanick mentioned, companionship which is often forgotten. Loneliness often really affects people. The Bill covers all of the aspects, from eating food that is digestible to personal care, to palliative care and to companionship.

Access to the right kind of home care, and at the right time, can literally transform the lives of both the person needing some support and his or her family, and this view is not new. The excellent Law Reform Commission report, published in 2011, highlighted in unequivocal terms the case for home care dating as far back as 1968 with the Care of the Aged report, the 1970 Health Act, The Years Ahead report of 1988 and the 1997 impact of The Years Ahead report. In fact, home care has been official Government policy and strategy since the 1990s and one wonders why home care, such an important plank of modern, dignified living for citizens, can be so neglected and unregulated for so long.

More recently, the preference, benefit and cost effectiveness of home care was, once again, affirmed in the report of a joint study published in July this years by UCD, Age Action, the Alzheimer Society of Ireland and the Irish Association of Social Work, IASW, entitled, Meeting Older People's Preference for Care, where people's clear preference was for home care rather than residential care.

This preference for home care was, once again, reflected in the support for the Alzheimer Society of Ireland's petition for expanded home care in its submission for the 2017 budget which was signed by 25,000 people. I have the submission here. It runs to three volumes, and is from people in all parts of the country. That is something that we should be paying attention to and taking note of. One can see what can happen when the citizen is ignored in countries such as the USA. When people go to the bother of signing a petition, we should take note of what is in it and pay attention to it.

In spite of warm words, photo opportunities by Ministers and politicians eager to be seen at pre-budget events, this preference for home care and the petition for it was only very modestly responded to, with a most modest increase in the home care budget for 2017. It is a baby step in the right direction which, of course, I welcomed in place of the recent cuts we have all seen. I welcome the additional funding but sometimes it is hard to see. Official information about home care is hard to find and maybe the civil servants here can help us out with the language because sometimes one gets a letter in response and one is not sure whether the funding is more or less. That would be important.

It is also important that additional funding for home care, if it is allocated, actually gets through. The most recent information I have on the modest - that word again - investment in home care through the national dementia strategy, co-funded by Atlantic Philanthropies, is that funding for the 500 intensive home-care packages has only reached 72 of the estimated 55,000 people with dementia in Ireland - a drop in the ocean. Not only is the case and preference for home care proven, it is also cost effective and often cheaper than residential alternatives. The availability of home care enables the health care system to work effectively for patients' timely and appropriate discharges, freeing up much-needed acute hospital beds.

This is an important Bill as it addresses home care specifically. Although home care is provided in its different guises to an estimated 50,000 people in Ireland for charge and often for profit, and funded by the taxpayer, shockingly, home care is not regulated. Given its nature of home care workers working on their own providing the most intimate of care to vulnerable people, shockingly, home care remains an area that regulation does not reach. The work is difficult and is usually carried out by the kindest and most compassionate of people, but some people are just not cut out for this kind of work which is sometimes badly paid. From scandals of the past, we know that work like this can also attract the unscrupulous and the abusive - people in it for the wrong reasons with vulnerable people at their mercy. The unregulated home-care sector makes it easy for such people to be up close and personal with people who are vulnerable, people we know, people we love and care about, people like ourselves one day. The kind and decent home care worker will welcome regulation and oversight and will have nothing to worry about. The other kind might just be put off and be denied easy access to prey on vulnerable people.

This Bill provides for the extension of the powers of HIQA to regulate professional, not family-provided, home care, building on and avoiding duplication of HIQA's expertise in its regulation of nursing homes and residential care for people with disability. The Bill provides for HIQA to set out national standards. These are already in draft form by the HSE.The Bill provides for the setting of training requirements for those providing this most sensitive and intimate of care and manual handling. It also provides for the establishment of a registry of all professional home carers.

I urge the Minister to take on this Bill, or do we wish as politicians to abdicate our responsibilities to "Prime Time Investigates" as in the case of Leas Cross or Áras Attracta? Shall we just wait for the scandal, the abuse or even the death of a vulnerable person in receipt of home care? Must we wait for Joe Duffy or the hidden camera before we act? If that is the case, perhaps those who voted to abolish the Seanad might have been right. Today, we have an opportunity to prove the worth of the Seanad. I urge support for this Bill. It will improve the lives of people with disabilities, older people, people with chronic conditions and people such as ourselves in time. We have a duty as legislators to put people first and to put protections in place. There will be arguments about money, but money can be suddenly found to bail out banks or to fund pay deals. It is important that we find the money to provide this regulation and to act before we see something horrible on our screens. I urge the Minister of State to take up legislation on behalf of people with dementia or disabilities and older people who may not always be able to speak out for themselves.