Robbie Gallagher (Fianna Fail) | Oireachtas source

I welcome the Minister of State and thank him for taking the time to be here. It has been widely accepted for some time that older people are happier, and live longer, in their own homes. Home care packages are essential in supporting older people to continue to live within their communities. As we know, however, the home care sector is beset by a staffing crisis. Close to 5,000 people are waiting to be provided with a carer in their home. In the constituency where I live, Cavan-Monaghan, more than 250 people are waiting for home care packages, about 50 are waiting for first-time packages and more than 200 for additional hours, some of whom have been waiting for more than 12 months.

The demand is clear in the HSE's service plan, which states that the HSE expects to deliver 23.67 million home care hours this year, up by more than 2 million on the 2021 figure. Home care packages have improved but, unfortunately, there is no one to deliver them. Fears are increasing that older people may be forced into residential care sooner than they would like or left to languish in hospital because they cannot go home as there is no home care package in place for them. Age Action has called for a radical shift in how home care is managed because the delays are putting people at risk of harm. Older people may be forced to move into residential care sooner than they want or may be stuck in hospitals unable to be discharged. They may suffer consequences for their physical and mental health and their independence. Access to home care has, traditionally, been affected by funding issues but, thankfully, that is no longer the case. Just 286 people were waiting on funding for home care at the end of 2006, whereas just before the pandemic, that figure stood at 9,000, according to Department of Health data. The very significant increase in the budget is to be welcomed. Additional money had to be found for home care packages and I, along with my party in opposition, am delighted that is now the case.

The problem, however, has moved to being one of staffing. Low pay and erratic hours for carers are key issues. It can be difficult work and we as a nation owe these workers deep gratitude for the work they do. A Government workforce advisory group has been working on the recruitment crisis in home care and nursing homes and it is clear some radical thinking is required. In the past, home care was provided by the family, but family life has changed and it is now very difficult to do that. Nevertheless, families may be able to work with the HSE to find solutions. There may be a way for families to subcontract the work at local and family level, allowing, for example, a number of family members to work as a team to provide care and support to an older family member. Indeed, a similar scheme has been rolled out in Australia and the UK, where it is referred to as the consumer-directed home care scheme, which allocates a certain degree of funding to the families to spend on whatever care they deem fit. There is much merit in such a scheme because it would give families more freedom by providing carers with more financial support. With the appropriate training and oversight, the home care provided would be an added benefit to families and their connections with one another.

The advisory group may come up with other solutions and possibilities, but it needs to move quickly as the current circumstances will have knock-on effects not just for older people needing home care but also in the wider health service, in both the short and medium term.It is clear that something needs to be done sooner rather than later.