That Dáil Éireann:
— Home Care Packages (HCP) aim to help people who need medium to high caring support to continue to live at home independently;
— the HCP scheme is not established in law, as it is an administrative scheme, therefore there is not an automatic right to the scheme, or to avail of services under the scheme;
— the HCP scheme is not means tested, and there is no charge or contribution to be paid for the services provided;
— the HCP scheme is resource limited and the extent of the support available is subject to the limit of the resources allocated each year to the Health Service Executive (HSE);
— the level of service or support one receives may vary in different parts of the country depending on the local population, their individual needs, who is available to deliver services and the demand for the scheme, and there are major regional disparities
within these figures with 554 people waiting in Community Health Organisation (CHO) Area 9 at the end of December 2016, compared to nobody in CHO Area 7;
— vulnerable people are being denied essential services as individual applicants who have been approved for a HCP may be placed on a waiting list for the HCP scheme following a risk assessment of their needs and the numbers waiting for home help are
increasing as at the end of December 2016, there were 2,039 people assessed as needing home help but waiting for a service and by the end of April 2017, the number waiting had increased by more than 20 per cent to 2,456;
— if a caregiver becomes ill, it is difficult to source cover due to the limitations of the resources;
— Ireland has an ageing population and thirty per cent of the population will be aged 65 plus by 2030, which raises very significant challenges and opportunities for Irish society and in particular for the Irish health services;
— home help hours available are minimal and range from less than an hour to a maximum of five hours per week, usually Monday to Friday, between 9 a.m. and 5 p.m.; and
— increased privatisation of community care is a clear indication that the public system is not working for people; and
calls on the Government to:
— promote positive ageing and secure the right to comprehensive and high quality services;
— support older people to live independent fulfilled lives by enabling them to age with confidence, security and dignity in their own homes and communities for as long as possible;
— maximise the use of community and home based care and support the important role of family and informal carers’, in order to maintain older people at home for as long as possible;
— effectively reduce pressures on hospitals by reducing inappropriate admission of older people to acute care or residential care and facilitating timely discharge of older people from Accident and Emergency departments and acute hospitals;
— establish the HCP scheme into law, therefore allowing people to have an automatic right to the scheme and to avail of services under the scheme;
— introduce a HCP modelled on the principles of the Fair Deal Scheme with a statutory objective of relieving the burden of care families experience, and those that qualify for the scheme could use the money for home care instead of a nursing home;
— support caregivers so that they might be able to continue to provide care for older people; and
— increase home help hours so that an efficient service can be provided to additional older people.”
It is my pleasure to introduce this Private Members' motion on behalf of the Rural Independent Group on the issue of home care being placed on a statutory footing. This motion applies to people of all ages, be they children, persons with disabilities, or those who become dependent as they age. It concerns the provision of home care to everyone who needs it. The purpose of home care is to keep people living at home in their community and to maximise their potential to remain as independent as possible. It also seeks to avoid unnecessary institutional care and to defer the entry to institutional care for as long as possible; for a person's entire life, if possible. We want to put home care on a statutory footing to ensure that it is governed by legislation.
The Minister entered into a period of public consultation which has now concluded. There were over 2,000 submissions to that consultation. Those submissions are being published at the moment, and the delay in introducing a report is due to the number of submissions received. I believe the date was extended for a month or so, and I understand why the delay happened. However, we would expect that when a report is produced that legislation would be provided as speedily as possible.
Home care needs to be put on a statutory footing because its provision can be a postcode lottery. It is very patchy throughout the country, and some areas receive care while others do not. It is very uneven. We know there are limited resources, but when it is placed on a statutory footing we would expect that resources would meet demand. It should be primarily based on need, and also the depth of need. I believe that home care on a statutory basis should be provided through the public system. There are private providers, which provides competition for the provision of home care, but it does not necessarily drive down costs. The Minister should consider home care as a public-based system.
The debate on whether this should happen is now over. We need to have home care on a statutory basis. How is it going to be delivered, when will it happen, what form will it take and how will it be funded? I hope that the process of consultation and the drawing up of a report and legislation will be done in a speedy fashion. We had a hearing at the Committee on Health a number of weeks ago which suggested that there would be a two to three year process before legislation for statutory home care was finalised. I hope that can be speeded up and that statutory home care can be delivered in a shorter timeframe than that.
The scheme needs regulation, and we understand that. It must be transparent and there must be integration with other services. We do need to have a home care system, but it must be integrated with other systems. It must be complementary to family carers rather than replacing family carers. It must be flexible and adaptable to individual circumstances, and it must be person-centred. Funding mechanisms must be developed, and this is very important when one considers whether the scheme will be free or whether the recipient will make a contribution. That is a very important element of the statutory basis of home care.
We need to look at this from a different perspective. There may be room for a social insurance model rather than a model based entirely on taxation, and there may be a need for ring-fenced funding so that funding cannot be cut on the whim of a government or in circumstances which put pressure on State funds. It is a false economy to limit funding to home care because it only transfers services on to much more expensive nursing home care and hospital care.
We should look at home care in an anticipatory way. We should be providing home care to people who are becoming frail but have not had an emergency and have not had to enter hospital because of an illness or a fall. It should be provided so that we can predict and supply services to people before things escalate. One example I have come across recently is that of a man who, as they say in rural Ireland, "Took to the bed", and unfortunately, because he was not receiving home care services or physiotherapy services he became so incapacitated that he needed to access acute services. We should be providing home care to try and prevent those situations from happening.
Home care is very important in terms of the social determinants of health. It encompasses not just health but housing, social protection and transport as well. All of these things feed in to supporting our elderly people to stay within their communities. Many areas have developed supported housing for our elderly. When they become isolated, incapacitated and live alone with a lack of family support they can come into a community based housing setting where they get low support but are supported by the community. They can continue to live independently in the community with that level of community and low-level support. There are many examples of housing situations around the country like that, and it is another aspect of home care that we could look at.
There is much un-met need, and the changing demographics are against us. Our population is ageing, which will be a huge problem in the future. We need to anticipate its development. It makes economic and social sense to do this, and it makes no sense to ration home care services. That is a false economy. Home care keeps pressure from our accident and emergency departments, from our lengthening trolley queues, and it reduces hospital admissions and hospital referrals if we can support our elderly people or those with disabilities within the community and prevent them from having to go through our secondary services. The answer to our home care problem is in the Sláintecare report, which was produced last May. That includes many hospital avoidance measures which could keep people living within our community. The Taoiseach mentioned this morning that if each GP referred two fewer patients each week and kept them at home instead the multiples of patients going on our waiting lists would be reduced by thousands. This can only happen if there are GP services, public health nursing services, properly staffed primary care teams and community intervention teams. These would all be very important in providing support for our community of dependent people. That aspect of home care should also be included in the Minister's deliberations.
It is important to provide respite care for carers. Many carers are working 24-7, 365 days of the year.
There is a huge deficiency in respect of providing respite care so that they too can get a break and do not burn out. We have problems in the transition from childhood to adolescence. Respite falls away and must be fought for again. Carers are very concerned about what will happen to their dependant children and the dependant adults they look after when they pass away or become incapacitated. That must also be looked at in respect of home care packages.
We have to look at the recruitment and retention of those who supply care. There is an issue here. Many people who would supply home care services in their communities are disincentivised from doing so because the social welfare system is against them. If they worked for a few hours each day for five days of the week they would lose their entire social welfare entitlements. If it was based on hours per week rather than hours per day, there would be many people within communities who could provide caring services to their neighbours, friends and families. They cannot do so currently because they are disincentivised by the social welfare system. That is something which should be looked at. If an exception is necessary to allow people work for one or two hours a day without losing their social welfare payments, one should be arranged between the Department of Employment Affairs and Social Protection and the Department of Health. I mentioned this to the previous Minister for Social Protection. He had issues with it, but it needs to be looked at again because in many instances patients who need care have been given home care packages and have been allocated hours but cannot get a service because there are no carers to provide it.
We also need to look at the UN Convention on the Rights of Persons with Disabilities. We need to ratify it as quickly as possible and get over the road blocks in respect of the deprivation of liberty and assisted decision making. It makes no sense not to provide home care. The Minister of State knows that as well as I do. It is a false economy.