Thursday, 3 October 2019
Nithe i dtosach suíonna - Commencement Matters
Home Care Packages Provision
I thank the Minister of State for her attendance as I have a serious issue to discuss. I seek a status report on the home care supports that are available in the Carlow-Kilkenny region. I also want to know if supports are available, whether they are accessible and how many people await the supports because I have seen and heard conflicting information on the issue. I want to know the actual position in order that I can inform the people who want to know as they are people in my area who have asked for my help.
New data furnished to my Fianna Fáil colleague, Deputy Mary Butler, in the Dáil state that the number of people awaiting home care supports has increased from 6,238 at the end of March to 7,346 in the four months leading up to July. This week, we learned that the HSE's figures revealed that last month almost 800 patients across the country had not been discharged despite being deemed medically fit. Yesterday, staff in hospitals assessed patients to see who they could send home to ensure safety in the event that Storm Lorenzo is worse than first thought. However, I have seen figures that were supplied to the Department of Health that show no one is awaiting home care supports in Carlow-Kilkenny. Officially I have not been given the number of people waiting for supports in Carlow-Kilkenny but I tried to acquire them. I assure the Minister of State present that people await the supports because at least seven families have contacted my office about the matter. I am only one local representative so one can imagine how many more people have made representations to their local politicians.
I am referring to people who cannot leave their hospital setting without important supports being put in place. These are people who may be unable to fight for themselves. In most cases I am contacted by family members inquiring about the provision of supports. I am aware that moneys were provided to the HSE for it to provide these services. Unfortunately, people have contacted my office stating that they have not received the services, despite needing them.
I have heard, anecdotally, of people with severe needs not having anyone to care for them at home and being told that they do not qualify for anything. Patients have been told there is no availability of home care supports in their areas but not to tell anyone, to stop asking for help and to find another solution. I cannot accept such a situation. I have been told by staff in the hospitals and HSE respite settings that they can do nothing for their patients other than hope they can go home because they are in much needed beds that are sought by many other patients. Often people waiting to be discharged suffer a significant deterioration in their health. These people are forced into lengthy stays in hospitals, despite being well enough to be discharged or moved into a nursing home or retirement home rather than being allowed to stay in their own home, which is where they want to be.
We pay for health services by paying taxes but we do not get value for money. We seem to be just putting an ever increasing amount into the children's hospital without fixing existing major problems. We should get more for our money and get value for money. Patients repeatedly lose out and staff are frustrated by these issues as they know here are ways to fix them but they are not being addressed.
Yesterday, we heard that the HSE has a deficit of €280 million and will now try to clawback overspending by cutting the spending on agency staff's overtime and staffing levels. Every year more money is poured into an inefficient system and life is not improved for patients. Not having the correct numbers frightens me. If people are not being counted, how can we help them? There is a genuine care need for these people and the Department wants to help. I am concerned that if the Department does not get the accurate figures, these patients will not be helped. As late as yesterday I had to deal with a family, which is one of many, as the father in the household was in hospital. He was told that there was no home care package for him and he was sent home. He was told that he would get a bed and the facility would try to sort out a bed for him. He was also told that the occupational therapist would pay him a visit when she had an opportunity. I cannot get him medical aids in the form of a seat and a Zimmer frame. I will contact the local authority to get him a bathroom adaptation grant. The service is not fit for purpose. I am more worried that the Department is saying that Carlow-Kilkenny does not have a waiting list for home care packages and patients are being sent home but told nothing is in pace and there are no home care packages.
I thank the Senator for raising this issue. I am taking this matter on behalf of my colleague, the Minister of State at the Department of Health, Deputy Jim Daly, who has responsibility for this area.
Home supports enable older people to remain in their homes and communities, as well as facilitates a timely discharge from hospital. The Government has made improved access to home support services a priority. Progress is reflected in the additional funding made available in recent years with the budget growing from €306 million in 2015 to almost €446 million in 2019.
As outlined in the HSE's service plan for 2019, the executive maximises current resources, prioritising those requiring discharge from acute hospitals, and significant resources and services in 2019 have been targeted to facilitate them leaving. In winter 2018-19, the immediate focus was on reducing delayed patient discharges through mobilising the additional resources made available and ensuring that social care measures were effectively deployed to enable older people to move to a more appropriate care setting, including to step-down or transitional care in their own homes with the supports they need. At the end of July, almost 52,000 people were in receipt of home support, including those in receipt of an intensive home support package, and more than 10.3 million hours have been provided during the first seven months of this year.
Community healthcare organisation, CHO 5, provides community healthcare services to the people of Carlow, Kilkenny, south Tipperary, Waterford and Wexford. CHO 5 continues to profile priority home support clients based on assessed needs and is working to provide services based on its priority profile. This year, €11.7 million was allocated to Carlow-Kilkenny for home supports. The target set was that the HSE would deliver in excess of 419,000 hours to approximately 1,460 people. As of 31 July, 1,469 clients receive home support and, on average, 43,515 home support hours are delivered in Carlow-Kilkenny on a monthly basis. Despite this considerable level of service, 152 clients are on a waiting list for new or additional services. As the numbers in the over 65 years age group are increasing, demand for new home supports increases, and as those in receipt of services are dependent, demand for additional supports for existing clients also increases. All those waiting are assessed and provided with a service, if appropriate, as soon as possible having regard to their assessed needs. In addition, people being discharged from acute hospitals, who can return home with supports, are prioritised.
The level of activity and associated cost of home supports in Wexford and the south east is monitored on an ongoing basis by the south east community healthcare head of social care and the general manager of services for older people. This is done to ensure that the people with the greatest needs are supported and that the overall expenditure on home support services by the HSE does not exceed the available funding.
The Minister of State, Deputy Daly, acknowledges that in some cases access to the service may take longer than we would like. However, the HSE has assured the Department that people on the waiting list are reviewed as funding becomes available to ensure that individual cases continue to be dealt with on a priority basis within the available resources. These cases are determined by the local front-line staff who know and understand the needs of clients. These staff undertake regular reviews of those cases to ensure that the services being provided remain appropriate.
I will come back to some of the questions.
I thank the Minister of State. I knew that the Minister of State, Deputy Daly, was not coming in. I requested his presence but I seem to always get Deputy Byrne instead. She is always courteous to me. I would have loved if the Minister for Health came along because my Commencement matter is so serious. I am concerned with the statement that "152 clients are on a waiting list" and ask for details to be supplied to me.
The lack of home care support packages is a significant issue in the sense that people are leaving Kilkenny hospital, and families are in dire straits, but these people are crying out for help having been told that there are no home supports or support care available. The families are all working and we are trying to sort them out. They cannot avail of respite care. They are, therefore, in a serious state. I ask the Minister of State to respond on these matters.I knew the Minister of State, Deputy Daly, was not coming in. I am disappointed again. I have only got him to come in once in all the time I have been calling for him to come in. That is all I can do. I ask the Minister of State, Deputy Catherine Byrne, to come back to me on this. I will give her the details of the seven families I am working with. I ask her to forward those details to Deputy Daly so that I can get supports in place for these families. This is very serious. I thank her again for coming in.
I understand the stress. I deal on a daily basis with many people who need to be taken out of hospital and put into care. They need services in their homes or in facilities. It is becoming challenging because people are getting older. I spent two days in an emergency department over the past couple of weeks. I was conscious that many of those there were older people with respiratory illnesses. As we get older, such illnesses become more prevalent. My daughter, who works in this area, told me that it is very hard to get staff to work in home care packages and home care services. She has said that difficulties arise when these services are loaded with more work and not enough staff are available to do it. It is a very dedicated service. I acknowledge that supports are needed for people. I attended a meeting in St. James's Hospital last week with the CEO. We spoke about people who are in addiction, homeless people and people who are in hospital. We discussed how we need to use the Housing First approach to get them to vacate the beds. It is an issue across the country.
I acknowledge that. I have plenty of friends and neighbours who work in St. James's Hospital. I will bring the Senator's concerns about the 152 beds to the attention of the office of the Minister of State, Deputy Jim Daly. I ask her to supply me with the names via email.