Home care packages need to play a central role in efficient use of hospital resources

13 June 2019

The crisis we are discussing was readily predictable. Ireland, like other countries across Europe, is experiencing a rapid demographic change as our population ages. This ageing is set to increase over the coming decades. Since 2006, there has been a 36% increase in our elderly population. The number of people with disabilities has increased by approximately 63%. Consequently, the old-age dependency ratio is increasing, particularly in rural Ireland, as the Minister of State knows. This is leading to a greater demand for home help hours. We can secure a huge return on the resources we expend in this important area. In 2017, an ESRI report highlighted that the anticipated demand for home help hours will increase by between 38% and 58% by 2030, which represents a massive upsurge. It is estimated that by then, one in five people will be a care provider in the home environment, which will represent an increase on the current figure of one in ten. How can we expect to meet the future demand for services when we cannot meet the current demand?

We are all acutely aware of the need to achieve value for money in public expenditure. That has to be done. The substantial cost-benefit return from money expended in this area is an absolute no-brainer. Given the significant growth in demand and the pressure of an ageing population, it is clear that we need to maximise the efficiency of current resources. The Labour Party believes that home care services are valuable in supporting older people to remain in their own homes and stay connected to their own communities. The availability of home help relieves the burden on acute hospitals and allows people who are hospitalised to return home. This was a central theme in a report prepared by the Joint Committee on Social and Family Affairs when I served as its Chairman in the early 2000s. I authored the report in question. It is ridiculous that people who require home help are taking up acute hospital beds while those who need emergency care are forced to sleep in corridors. It is a clear issue. I read about the case of a 92 year old man who spent 70 days in hospital, due to the non-availability of home care help, even though he had been fit for discharge after ten or 12 days. It must be a priority of the Government to take people who require home care out of the acute hospital service. As my colleague, Deputy Kelly, highlighted some time ago, if the Government is serious about the effective and efficient use of hospital resources, including expensive acute beds, home care packages need to play a central role in its plans.

Likewise, there is an imbalance in the provision of nursing home case instead of home care. The Government currently spends more than twice as much on nursing care than it does on home care. Approximately €408 is being spent on care, whereas the average contribution to the fair deal is €824, which is some imbalance. I salute the efforts that were made yesterday with regard to the fair deal. We pay just €219 in respect of carer’s allowance. I know everything about this because I wrote a report on it. The payment of €219 is €16 more than the basic rate of social welfare. The care provided within the home is costing us approximately €2.70 an hour. This is never factored into the equation.

Compared to the average contribution of €824, one can see the tremendous value the State gets for the meagre children’s care allowance that is given to people. It is critical to abolish the means test for the carers allowance. It would give huge relief as it would be €119 versus €824 and it is a no-brainer. It is one quarter of the cost. I do not blame the Minister because I know he has a heart but no Government thinks. Every Government has silos in Departments, there is no cross-referencing and one hand does not know what the other is doing. If the Government thought about the situation, it would abolish the means test for carers allowance. There are 81,000 people who get it but we have 350,000 people in the State providing care at home, some 25,000 of whom are young, and we have ignored this. Denmark has successfully moved from an over-reliance on nursing home care to more holistic home care and it has had sheltered housing models since the early 1990s. All Danish citizens are now eligible for home help and home care, including round-the-clock care. The critical thing is that this is on the basis of need, rather than means. We should give more consideration to this model by giving it to a committee to consider.

We need the right mixture of organising and providing home care but it is clear that keeping people in their own homes is among the most efficient models. The reality, however, is that the bulk of care that enables people to live at home is provided by informal carers, usually loved ones and friends. One in ten adults, equating to 350,000 people, provide this invaluable service to the State but we had 6,310 people on the nationwide waiting list for a home help service at the end of April. The HSE has all but closed the home help scheme for the short term as it does not have the staff to deal with the demand.

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