Seanad debates

Tuesday, 20 June 2017

Commencement Matters

Home Care Packages Provision

2:30 pm

Photo of Maura HopkinsMaura Hopkins (Fine Gael)
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I thank the Minister of State for coming to the House today. I want to raise the need for increased supports for home care packages and home help supports in County Roscommon, which has one of the oldest populations in the country and one of the most rural. We need to target areas with the greatest need and ensure adequate home care services are being provided to individuals who need them. I am concerned. I have received several calls from families regarding the provision of adequate home care support for their relatives. I can point to several specific cases where, despite strong recommendations from health care professionals outlining a clear need for increased care at home, this has not been provided. It is not good enough that the specific needs of individuals in respect of personal care, domestic tasks and other daily activities are not being met. It is also particularly difficult to get weekend cover. I have raised these issues numerous times with the Health Service Executive, HSE.

I have also received calls from home helps and relatives about the length of visits. Some have told me that visits have been reduced from 45 to 30 minutes. It is impractical for many to help an individual get up, get dressed, have breakfast and be prepared for the day in 30 minutes. It is extremely important that we support people to remain in their homes, but that requires proper home care packages and an adequate number of home help hours.

Our focus needs to be on the individual receiving the care. It is a question of delivering good quality care for the client, of the client’s welfare and of supporting families and family carers to look after their loved ones at home. Home care services are critical to allowing people stay in their own homes and communities for the longest time possible and to preventing early admission to long-term residential care.I also want to point out concerns and difficulties that have been raised with me about not-for-profit home care providers. If someone is receiving home help form a non-profit provider which is funded by the HSE but it is not currently possibly to get an additional number of hours privately from the same provider.

The importance of the client-carer relationship cannot be underestimated. These people are some of the most vulnerable within our society. A new person coming into their home for the provision of home help or care can be a cause of unease and anxiety for many people. When that relationship is built up, the value of it should not be underestimated. It should be recognised and there should be a consistency in terms of care provision. The arrangement with the non-profit organisations is a business one, with payment being made following the provision of home help hours. There is a need to review the funding model with regard to the non-profit sector in order to allow for more flexibility in terms of care provision.

I understand that work is under way on the consultation period for the development of a statutory home care scheme which would very much be focused and tailored towards meeting the needs of the individual.

I have plenty of experience in this sector, having worked as an occupational therapist and having seen the value of home care being provided. I have also seen the challenges when not enough home care is provided. That is why I am raising it today. I have genuine, serious concerns about the adequacy of home care provision within County Roscommon.

Photo of Finian McGrathFinian McGrath (Dublin Bay North, Independent)
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I thank Senator Hopkins for raising this very important issue. I know that she has a long held interest in the issue of services for home help and home care packages.

The overarching policy of the Government is to support older people to live in dignity and independence in their own homes and communities for as long as possible. Home care is an increasingly important part of the supports that we offer to older people, and will continue to increase in importance in the future. The HSE has operational responsibility for planning, managing and delivering home and other community-based services for older people. Service is provided on the basis of assessed health care need and there is currently no means testing.

The overall funding for services for older people in 2017 is €765 million. This included approximately €373 million for the direct provision of home care and the HSE's national service plan provides for a target of 10.7 million home help hours, 16,750 home care packages and 190 intensive home care packages for clients with very complex needs.

All applicants for home care in the community health care organisation two, CHO 2, which includes Roscommon, Galway and Mayo, are assessed by a home care forum with clinical and social care professional representation. Home care is allocated to those determined to be of the highest priority, having regard to the available budget. With a budget of €39.5 million, the HSE is providing a significant level of services for the area, and the projected monthly target is 1,254 people to receive a home care package, and that approximately 1.3 million home help hours will be provided by the end of the year. By the end of April the HSE was providing 1,600 packages and 436,000 home help hours. I am pleased to say that all new applicants on the waiting list across CHO 2 as of 31 March 2017 have 2.25 hours of home care per week approved for implementation. The HSE has acknowledged that there are pockets - I accept Senator Hopkins's point - including the Monksland area of Roscommon, where a shortage of carers has impacted the implementation of approved care. The Senator will be aware that arrangements for home care have developed over the years with a significant local focus, and there is considerable variation in accessing services in different parts of the country. It is also accepted that there is a considerable demand for home support services over and above the existing service levels.The Department of Health is engaged in a detailed process to determine what type of home care scheme is best for Ireland. This process will consider the future design of both the funding and regulation systems for these crucial services. An important step in this process is public consultation which I will be launching shortly. The purpose of the consultation is to allow all those who have views on this topic to have their say, including older people themselves, their families, and health care workers. The Department wants to find out what people think about current home care services and would also like to hear the public's view on what the future scheme should look like. I strongly urge all Senators, especially those in the Seanad with an interest in home care services, to make a submission to the consultation.

Photo of Maura HopkinsMaura Hopkins (Fine Gael)
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I thank the Minister of State for his update on services within the community health care organisation, CHO, area 2, which covers Roscommon, Galway and Mayo. However, I am still concerned about situations where health care professionals made recommendations on assessed need for personal care, domestic tasks and activities of daily life. I can provide specific examples to the Minister of State in that regard. The Government has continued to emphasise the importance of home care support to ensure people with disabilities and older people who need a little bit of extra support can live in their own homes and communities for the longest time possible. The Minister of State outlined that access to services varies across the country. I am concerned about that because no matter where one lives, one's financial situation, age or level of disability one should receive the same service based on an assessment of need. I accept that the consultation process on the development of a statutory home care scheme is important in terms of trying to deal with those variations.

I have significant concerns about a number of cases where individuals have contacted me and I will provide details in regard to those cases to the Minister. I have been in contact with the HSE on numerous occasions about them.

Photo of Finian McGrathFinian McGrath (Dublin Bay North, Independent)
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I thank Senator Hopkins. I will respond to the points she raised. First, I will bring to the attention of the Minister, Deputy Harris, the point about non-profit providers to see if there is anything we can do about the hours. I accept the point the Senator made about the importance of the client and the care relationship. There must be stability and flow in such a relationship. That is my experience as well, particularly in the disability sector. If one chops and changes hours and carers that leads to instability, especially for older people and those with disabilities. That is a very important point.

I urge people to get involved in the consultation process which is currently taking place. Senator Hopkins also made points about other important issues such as the assessed need of people. We need to ensure that if people are assessed and certain hours are recommended that they get them. I am aware of problems with staffing in certain parts of the country but that is a management and human resources issue which we will have to deal with as well. If there is anything we can do in terms of supporting those who are affected in the cases to which the Senator referred then it will be done. If there are examples of significant stress experienced by families, especially involving senior citizens, we will do our best to see if we can plug the gaps. I agree that it is not acceptable for either an individual in need of care or a carer for a person to be allocated 30 minutes or one hour and 40 minutes. I will take the points that have been made and bring them to the attention of the Minister for Health, Deputy Harris.