Seanad debates

Thursday, 30 September 2021

Nithe i dtosach suíonna - Commencement Matters

Home Care Packages

10:30 am

Photo of Aisling DolanAisling Dolan (Fine Gael)
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I welcome the Minister of State at the Department of Health with responsibility for mental health and older people, Deputy Butler, to the Seanad. Families are applying to the HSE's home care hours scheme and receiving approval, which is great, but no help or home care is forthcoming. There are delays and backlogs and the shortage of staff is having an impact. I request an update from the Department of Health on waiting times for people who have been approved for family home care hours by the HSE in the community healthcare west area, which comprises counties Galway, Roscommon and Mayo. Older people and those with disabilities in rural areas are urgently waiting for help.

The home support scheme is for people over the age of 65 and for anybody with a disability or early onset dementia. The Minister of State has done a great deal of work in this area. People usually avail of the scheme after a hip operation or any stay in a hospital. It helps them settle back into their homes. The challenge is that we have very few step-down facilities. In rural regions, particularly in Roscommon and east Galway, the wide geographic areas result in higher mileage costs for healthcare assistants. We see younger members of the family moving away from home, which makes it more difficult. There was also an increase of 20% in the number of people aged over 65 in the most recent census. Our area of Roscommon and east Galway is particularly affected as we have an older age cohort.

Frailty is also a serious issue, as the Minister of State will be aware. After their first fall, many older people suddenly lose the confidence to walk around by themselves with walking or mobility aids. Our older loved ones are unable to handle a bath, a shower, dressing or shaving and need home help.

Under the Programme for Government: Our Shared Future, there are commitments to enable older people to live in their own homes with dignity and independence. Staff within the community healthcare organisation, CHO, 2 area, or the community healthcare west area, are dealing with very significant backlogs and are doing their best to meet demand. I am aware of the challenges in recruiting to the HSE. We need to increase the use of ehealth assistive technologies.

Our social services in Ballinasloe are going to be opening up, but slowly. This has also had a great impact on home care services. The HSE has the option to engage approved third party providers of home care, that is, consumer directed home support, CDHS. How well is this working? Do private providers have the staff to take these referrals from the HSE? We need to look at training. The Minister of State brought up the level of the minimum wage and the comparisons between the HSE and the private sector.

I am aware of the four sites for the new home support pilot the Minister of State has announced and that she is planning to provide for an additional 230,000 hours in CHO 2, that is, Galway, Roscommon and Mayo. This is to look at Tuam, Athenry and Loughrea. In last year's budget, 5 million additional home care hours were provided for 2021. That followed on from the 19 million hours provided for 2020 to alleviate community waiting lists for home care and to support people in avoiding hospital. I have a number of questions for the Department of Health. When will more pilot schemes come on stream, particularly for Ballinasloe and the rest of the CHO 2 area?Ballinasloe has a catchment of nearly 14,000, taking into account both the rural zone and the urban area. What are the figures? What are the waiting lists? How many third-party providers are being used by the HSE to support the roll-out of the programme? What is the status of the new home support office, which I realise was to be opened only very recently, in August? There are 130 posts under the interRAI system. What are the numbers in this regard? Could I have a timeline for the new statutory home care scheme? I am aware of the Minister of State's commitment to home care support. She was a spokesperson on health previously and would have known this area extremely well.

We need access to resources in rural areas, wide geographical areas. There are challenges in this regard because there is a wider area to cover. For healthcare assistants, we are talking about mileage costs. We are talking about increased costs for private providers. Older people are living alone in isolated areas. When HSE home care hours are approved, they are urgently required. We need to make sure we are supporting people to live with dignity and independence in their own homes.

Photo of Mary ButlerMary Butler (Waterford, Fianna Fail)
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I thank Senator Dolan for raising this important issue. It is a key priority of the Government and of mine to enable more people to engage with services that allow them to remain independent and live in their own homes with dignity and independence for as long as possible. To advance this, the Government is committed to establishing a new statutory scheme on the financing and regulation of home support.

As the Senator quite rightly said, in July I announced the selection of four sites to test a reformed model of service delivery, through the delivery of 230,000 hours of home support. This pilot will underpin the development of the statutory scheme for home support services and will be fully operational by 1 November. As the Senator quite rightly said, Tuam, Athenry and Loughrea were selected for the pilot in the CHO 2 area.

A national home support office will be established before the end of this year to support the testing of the reformed model of service delivery. In addition, approximately 130 posts have been funded for the national roll-out of the interRAI Ireland system, which the home support pilot will test as the standard assessment tool for care needs. Recruitment of these posts will occur in quarter 4 of this year. In parallel, work is ongoing in the Department to make progress on other aspects of the scheme, including the development of a regulatory framework and the examination of options for the financing model. The ESRI is doing some work on that for us.

While this new home support scheme is under development, the Government is prioritising improving access to home support services for older people. The largest ever investment was made for home support hours for older people in budget 2021. My budget this year for home care supports is €666 million, a phenomenal amount. There has been an allocation of an additional €150 million this year. The national service plan sets a target to provide 24 million hours of home support. This is an ambitious target, the objective being to increase provision by 5 million hours in one year, or to exceed the 2020 target by more than 25%.

The Covid-19 pandemic has led to unprecedented challenges across our health services, the greatest being in older persons services. While there have been challenges in the delivery of home support hours, particularly during the third wave of the pandemic, significant progress has also been made.

Provisional information, which may be subject to change, indicates that at the end of August 2021, over 13.2 million home support hours had been provided to 53,905 people. This is about 2 million more hours than in the same period last year. Approximately 478 people were waiting for funding approval, representing an 88% reduction by comparison with the same period in 2020. As a result, the preliminary figures indicate to me that the extra hours have resulted in 1,200 people not having to enter nursing home care this year. That is a great achievement.

The consumer-directed home support approach facilitates funded clients to deal directly with the HSE approved providers of their choice and to arrange days and times of service delivery. This is available in all CHOs across the country. However, based on a recent evaluation undertaken by the office of the assistant national director responsible for older people, it has been found that the uptake of this approach nationally has been minimal since its launch in 2018.

To answer the Senator's questions, provisional data from the HSE indicate only one person was waiting for funding approval in CHO 2 at the end of August 2021. However, 651 are waiting on carers – 212 in Galway, 325 in Mayo and 114 in Roscommon. The challenges we have are not financial; they concern securing the staff. There are only 1,400 people waiting for funding. By the end of next month, there will be only 500, but the challenge is to recruit the staff. I will touch on that in addressing supplementary questions.

Photo of Aisling DolanAisling Dolan (Fine Gael)
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I thank the Minister of State for her response but I am shocked by it. I understand that funding has been provided and that the Government and programme for Government have indicated there is to be support for home care hours but there are still challenges that we have to rectify. No one else is going to rectify the recruitment problems within the HSE, or within the CHOs. We have to do this. We have to consider the number of third-party providers of consumer-directed home support. How many of them are being used to support the CHOs in delivering what is required? The staff within the CHOs are struggling and crying out for help trying to deal with this.

There are 651 people waiting on carers, including 212 in Galway, 325 in Mayo and 114 in Roscommon. These individuals all have families that are struggling and looking for help urgently. Our hospitals are not able to accommodate the individuals. We saw the waiting lists. We noted the issues in University Hospital Galway yesterday. In Portiuncula hospital, and probably in Roscommon town, the relevant figure is over 60. There is nowhere for the patients to go. Some are living longer, which is great. Life expectancy is increasing, which is wonderful, but we are still not able to support people living in their own homes. This is all part of Sláintecare. The affected people have suffered over the past 18 months.

I am aware that the Minister of State is doing her best but we have to do more. I would be interested in comparing my CHO area to others. Is it the same for other CHO areas? For other geographical areas, is it the same? I would be very interested in finding out. I thank the Minister of State very much.

Photo of Mary ButlerMary Butler (Waterford, Fianna Fail)
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I thank the Senator. To reiterate, there is only one person waiting for funding approval in the CHO 2 area. That is what makes it so frustrating. Previously, the challenges we had were related to the number of people waiting for funding. In March of last year, 7,250 people were waiting for funding in the country. There are now only 1,400. Therefore, we have made huge strides. Efforts are ongoing to meet the demand for home support services. The HSE continues to advertise on an ongoing basis for healthcare assistants and recruit as many suitable candidates as possible. The HSE conducts its recruitment through a variety of channels.

The split between public and private provision is 50:50, but it varies depending on the CHO. On Tuesday of this week, I met representatives of Home and Community Care Ireland, which advocates for all the various groups, including Home Instead Senior Care and Bluebird Care. I am to speak at a conference in this regard at 12.30 p.m. today. Home care groups face huge recruitment challenges, as does the HSE.

We have agreed to set up a task force to examine the challenges. The Senator asked me whether the position is the same everywhere. It is not but rural areas are proving very difficult. There are many challenges in respect of private providers that do not offer mileage supports. That is also an issue.