Joe Costello (Dublin Central, Labour)
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Question 185: To ask the Minister for Health and Children if her attention has been drawn to cases of elderly or disabled people being asked to give a monetary contribution for home help; if she will make it clear that this is a free service; and if she will make a statement on the matter. [32153/08]

Máire Hoctor (Tipperary North, Fianna Fail)
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The over-arching policy in relation to older people is to support them insofar as possible to live at home and in their own communities. The Home Help Service, delivered by or on behalf of the Health Service Executive (HSE), is therefore a core community service enabling people to remain at home, where appropriate, who otherwise might need to be cared for in long-term residential care. It is also a critical support to older people in facilitating their early discharge from and in preventing inappropriate admission to acute hospitals. Home-Help is one of a wide range of community based services being provided by the HSE including Primary Care Teams, Home Care Packages, Meals on Wheels, Day/Respite Care, or through similar services provided by voluntary agencies or private providers.

Significant progress has been made in developing home based and community services since 2006. This has had a considerable impact in terms of numbers of people benefiting from such services, as well as providing much needed support to the acute hospital sector. The development of this service over the period 2006 to 2008 shows, for example, the following:

€211 million revenue funding provision, including €55.6 million for new service developments.

in excess of 11 million Home-Help hours were provided by the HSE in 2007.

numbers benefiting increased from just over 41,000 in 2006 to around 54,000 clients at present.

total Home-Help hours increased from just over 9 million hours in 2006 to over 11 million hours expected this year, i.e. an increase of 22%.

The HSE provides a Home-Help Service under Section 61 of the 1970 Health Act which states that "a health board may make arrangements to assist in the maintenance at home of a sick or infirm person or a dependant of such a person." The Act specifies "may" and therefore the provision of a Home-Help Service is discretionary. To qualify for Home-Help service an assessment of need of the client concerned is undertaken in all instances. Section 61 also provides an option to charge for such services "either (as the chief executive officer of the board may determine in each case) without charge or at such charge as he considers appropriate".

Historically, varying financial eligibility practices were in operation in the former health board areas. Generally, however, medical card holders were deemed eligible. In addition , some voluntary agencies who provide Home-Help services on behalf of the HSE will accept a donation from clients towards the cost of the service. This does not apply in areas where Home-Help service is provided directly by the HSE.

Currently, where a financial assessment is applied, it ranges from applying the same financial guidescale which pertains to eligibility for a medical card in some areas, to a maximum income of €300 a week for a single person living on their own, in other areas. Where a financial assessment is applied, it is treated as a general guide line and applied in a flexible manner, to ensure that clients are appropriately supported to continue living in their own homes for as long as possible and in order to avoid inappropriate admissions to continuing care units. The operation of this service is at present being examined by the HSE, with a view to standardising nationally all aspects of its operation.

Levels of services provided by the Home-Help Service are reviewed regularly, and as a result, the service in individual cases may increase, decrease or may remain unchanged, based on the assessed need of the individual. Professional staff on the front line, who are aware of local circumstances, undertake the individual client assessments. Services are targeted at those with a high level of dependency and in accordance with their assessed need. The development of the Home-Help Service has also seen the professionalisation of the service in recent years with the implementation of the National Home Help Agreement. This has resulted in greater flexibility in service delivery and has improved consistency and service quality, through training, to the benefit of service users.