Tom Clonan (Independent) | Oireachtas source

I thank the Minister of State, Deputy Butler, for attending. Given the date that is in it, I hope it will not be a case of there being no love lost between us at the end of the proceedings. I hope to enter this interaction with a solutions-based focus. The reason I am raising this Commencement matter is the problem in recruiting and retaining personal assistants, which I am sure has been brought to the Minister of State's attention. Personal assistants help disabled citizens and the elderly, as part of a home care package, to get them out of bed and live independently and with dignity. Based on my family's experience, there seems to have been a kind of collapse in these services from around 2021. The traditional providers, such as RehabCare and Home Instead, which I mention in a general sense as providers under the existing model, are unable to recruit people. I am conscious that Minister of State, Deputy Rabbitte, the Minister of State, Deputy Butler, and the Minister for Health have made millions of extra hours available, but the problem is that we cannot get the carers and personal assistants where needed, in people's homes.

Let me outline one of the solutions. The big corporate agencies, including RehabCare, do a great job but there is a one-size-fits-all model predicated on funding going directly to them from the HSE. Ideologically and philosophically within the Department, there is an agreement that we should move towards personalised budgets for families and carers so we can manage our care needs ourselves and do so flexibly. There are several service providers – for example, Home Care Direct and Áiseanna Tacaíochta, the ÁT Newwork – that act as a kind of link between families and carers, and a selection of personal assistants are available to them. On average, the agencies receive between €30 and €35 per hour in funding from the HSE for the carers. Typically, the carers who work for the big traditional providers get paid about €11 or €12 per hour, and that is why it is hard to recruit and retain them.That amount is barely above the minimum wage. However, the brokerages can pay carers up to €21 or €22 per hour, making them a more attractive proposition. In our house, for example, Eoghan's personal assistance hours for going to college are provided through Home Care Direct. We have no problem getting personal assistants - they are the most amazing people from South Africa and Romania – whereas his home care package, for want of a better expression, is provided through the traditional route and is failing. We have people who have become part of our extended family from Somalia, Nigeria, the Philippines, Korea and China. Without exception, these carers are wonderful people. They are not the problem. The problem is the model of provision. The Minister of State can revert to me if she needs further detail on this matter.

What is missing is a service-level agreement, SLA, between the HSE and brokerages like the Áiseanna Tacaíochta, AT, Network and Home Care Direct. The HSE national change and innovation unit and its national compliance unit have been working on this matter, but they have been doing so for over a year. They could come up with an SLA within weeks that would go a long way towards solving this problem and would have an immediate impact on people like my son and on those who are forced to remain in hospital after surgical procedures instead of returning home to live with their packages. There would be no cost involved. It is just a question of trying to get the HSE to draw up an SLA.