Home Care and Support Services: Motion [Private Members]

Deputy Noel Grealish

I move:

That Dáil Éireann:

acknowledges that:

— the Programme for Government: Our Shared Future includes a commitment to introduce a statutory scheme to support people to live in their own homes by providing them with access to high-quality regulated home care, but this is not happening;

— the Health Service Executive (HSE) Home Support Service (formerly called the Home Help Service or Home Care Package Scheme) aims to support older people to remain in their own homes for as long as possible, and to support informal carers;

— the HSE Home Support Service aims to also support people with a disability who need home help;

— the Home Support Service is available to people aged 65 or over who may need support to continue living at home or to return home following a hospital stay;

— according to the Central Statistics Office (CSO) estimates, the current population of people aged 65 years and older will have increased by more than 30 per cent by the year 2031, and will have doubled by the year 2051;

— according to the CSO forecasts, the Old Age Dependency Ratio, the population aged 65 years and over as a percentage of the population aged 15-64 years, will continue to rise steadily in the coming years, from 23 per cent now to 41 per cent in 2051;

— more than a quarter of all people aged 65 years and older live alone;

— "Tender 2023" needs to be finalised as quickly as possible to help improve care for older people who want to remain living in their own homes; and

— reforms to social welfare means assessment could facilitate an older person having company in their home by renting out a room with a maximum income disregard of €269.23 a week (€14,000 per year) if the medical card means assessment reflected this change;

recognises that:

— the chronic shortage of home help hours means that there is a delay in discharging people from hospital, especially vulnerable older people, with the lack of home help support adding to the chaos in some hospitals in provincial locations;

— a shortage of people to work in the sector is at least in part due to poorer pay and conditions in the private sector, coupled with the fact that they do not have access to a supplementary pension; and the number of staff moving to jobs within the HSE is exacerbating the situation;

— almost 300,000 people currently provide unpaid care to others, 86,000 of whom provide such care for 43 hours or more each week according to Census statistics;

— there were 6,432 people on the waiting list for home support care at the end of March 2023, including new clients approved to receive home support care and existing clients for whom additional home support hours have been sanctioned;

— carers need regular breaks from their duties through respite care to protect their own physical and mental health; and

— the Government, through the Minister of State at the Department of Health, has endorsed the 16 recommendations contained in the cross-departmental Report of the Strategic Workforce Advisory Group to address the challenges in front-line carer roles in the home support and long-term residential care sectors; however, only one of these recommendations has been implemented to date; and

calls on the Government to:

— place home support on a statutory footing so that it is enshrined in legislation as a sector;

— provide an update on the recent tender process for home care providers;

— develop a nationwide cluster housing model for older people, with security of tenure and rent fixed to increases in the State pension;

— support not-for-profit home share initiatives that assist with the pairing of older people to suitable younger tenants;

— establish the delivery of "meals on wheels" on a national basis to enhance the health of older people, especially those living alone;

— take steps to increase the use of new technologies to assist with the care of older people, such as voice recognition software, remote health monitoring etc;

— amend the rules governing eligibility for Jobseeker's Allowance so that the total amount of paid work in hours is taken into account, rather than days, as the current system disincentivises engagement in part-time employment;

— increase the means test limits for the Carer's Allowance and establish a high-level group to scope out and develop a roadmap for the delivery of a non-means tested participation income for family carers;

— increase the financial threshold for people on State benefits so that they can work and earn more money working in the homecare sector, and this helps with staff shortages, while at the same time helping people earn more and have a better standard of living without being penalised by the State;

— allow families access to direct funding to source help/care outside regular hours rather than being restricted to private providers;

— ensure that all training for people engaging in the care industry is paid for by the Department of Further and Higher Education, Research, Innovation and Science to assist private providers in replacing staff who have moved to jobs within the HSE;

— establish on a statutory footing the principle of every family carer being entitled to a minimum number of days respite care in the year;

— ensure that remuneration for time spent travelling, motor travel expenses and pay when clients are in hospital is standardised for all healthcare employees; and

— ensure that industry and public sector travel expenses be made available for home care providers who provide home care for older and vulnerable people in rural areas, to help create a balance between rural and urban travel services.

There is a growing crisis in Ireland today that is affecting families the length and breadth of the country.

The difficulty in accessing home support for older people is, after housing, one of the biggest issues coming into my constituency office every week. It is a problem that is causing enormous stress for families. This is the basis for the motion that I and my colleagues in the Regional Group have put before the House.

There are huge waiting lists for home care packages. The most recent information available from the HSE shows that at the end of March 2023, more than 6,400 people were on the waiting list for new or additional home support care. These are often extremely vulnerable people whose need for home care has been proven, and accepted by the HSE. All Members have come across cases where older people have had a spell in hospital and are ready for discharge but cannot leave because supports are not in place for their subsequent care. Late last month, 84 people on the HSE national delayed transfer of care list had their home as their discharge destination. A further 240 people were being kept in hospital while waiting for residential care to be put in place. That is 240 people in hospital, taking up beds.

Unless matters change, the whole situation regarding care of older people will continue to worsen. The census last year found there were 776,000 people aged 65 or older, an increase of more than one fifth on the position in 2016. The number of elderly people aged 80 or older will quadruple in the next three decades, to more than 500,000.

Today, there is a challenge facing thousands of families across the country which needs to be addressed with urgency. The number of officially recorded unpaid carers increased by 53% between the two most recent censuses, rising to almost 300,000 last year. Almost 87,000 of them were providing at least 43 hours of care a week, more than double the figure in 2016.

Last year, a cross-party advisory group was established to figure out how to tackle the shortage of care workers for home support services in the nursing home sector. The group came up with 16 key recommendations it believed could at least alleviate some of the problems but, so far, only one of those recommendations has been implemented. It involved allowing non-EU home support workers to be employed in home support services. Of the 1,000 work permits permitted, however, only 84 have taken up the opportunity. The reason there is so little interest needs to be further examined.

Many of the other recommendations of that strategic workforce advisory group are included in the motion which I and my colleagues in the Regional Group have put before the House. We strongly believe several steps need to be urgently taken to tackle the problem of a shortage of staff to provide the home care that thousands of people on the waiting list need if they are to continue to live in their homes and communities. Among the actions we are proposing is that home support workers be paid for time travelling between clients and that other expenses be refunded.

The motion also calls for an increase in the means-test limits for carer's allowance and a review of the rules governing the payment of jobseeker's benefit for people caring for loved ones in their family. Currently, any number of hours worked outside the home while not on caring duties is counted as a full day worked. The rules as they stand state that a person is paid jobseeker's benefit for the days not worked but if the person works more than three days, he or she gets nothing. If the rules were changed, at least for those in caring roles, to allow a certain number of hours' work per week, it would facilitate carers supplementing their incomes.

Too many people caring for members of their families rarely get a break. The motion provides for the laying down in law of the principle that every carer is entitled to a minimum number of weeks of respite care each year.

I call on the Government to support the motion. I thank Maria Burke, Teresa Delaney and Brendan Carroll in my office for their research on this issue and Cáit Nic Amhlaoibh, our party administrator, for putting the motion together.

Deputy Michael Lowry

Old age is something that we hope lies ahead for us all. While many are denied the privilege of growing old, sadly, there are also many who are in fear of becoming old and view it with worry and unease. One of the most common reasons for this is that they do not wish to lose their independence. They do not want to become a nuisance or a burden on their families. They may worry about being able to cope if they live alone or with an elderly spouse. Old age can create an increase in needs and an unfamiliar level of dependency on others to help with even the most basic tasks. None are more aware of the issues and fears associated with old age than those who are facing it.

In today’s world, elderly people are encouraged to remain in their homes for as long as possible. This is often their wish but they know they may not be able to do so without help. This can leave elderly people plagued by fears and worries. Those who feel their independence slipping away may fret over what the future holds for them. As the years pass by, their worries become more intense and they can no longer dispel their need for help and support.

On the other side of the coin, caring for an elderly parent or relative in the person’s home can be challenging for adult children. They can be torn between the needs of their own families or holding down a job or may be unable to travel daily to the older person’s home. There may also be fears of inadequacy in their ability to meet the older person's growing needs. They have not been trained to do so. Some people simply cannot take on such a role.

These are just some of the many reasons a complete and fully functioning home help and home care system for elderly people in Tipperary and across the country should be a fundamental part of the overall healthcare provision. At present, more than 25% of people over the age of 65 live alone. Life expectancy has increased. As the motion states, the number of elderly people will increase exponentially in the coming years. The need for the provision of a properly funded and fully functioning home care and home help service across the county is growing more urgent with every passing year. The urgency of this cannot be ignored. The issue has spent far too much time on the long finger.

I recently spoke to a community nurse and home care manager. This lady works for a private company contracted to provide home care for elderly and ill HSE patients. She co-ordinates a large team of home carers and nurses in County Tipperary. The professional services they provide make it possible for elderly and sometimes even terminally ill people to remain in their homes rather than becoming hospital or nursing home patients. These community-based healthcare workers carry out their work alone. Not only do they care for the needs of the patient, but they also provide support and guidance to family members. Their work is invaluable. The lady to whom I spoke stated that it is impossible to retain staff. Despite their dedication to their work and the importance of what they do, they are paid a pittance. They cannot survive on the money they earn.

I also spoke to the family of a recently deceased 95-year-old lady. This woman had a number of serious health conditions and was totally immobile. Her four adult children have jobs. Nevertheless, they took turns staying with her every night. If they had not done so, her one and only wish, namely, to stay in her home, could not have been realised. During the day, this lady was entitled to a so-called home care package. The time allocated to her was just one hour a day. A 95-year-old woman living alone was entitled to just seven hours a week of home care. In the course of the time she had this home care package, the family lost count of the number of different carers who came into their mother’s home. The staff turnover was huge.

The present system is letting down both the patient and the carer. The points raised in this Regional Group motion may not provide all the answers but the motion provides a valuable insight into how to improve the system. The home care system for the elderly is in crisis and that means, to our shame, that elderly people are suffering. Addressing this should be a priority.

Deputy Seán Canney

I commend my colleagues in the Regional Group on tabling this important motion. I compliment and thank Cáit Nic Amhlaoibh, who prepared the content of it for us. The most important thing is that we are throwing a light on something that all present know is wrong.

The system of home care is not working. Home care hours are being allocated to people who have been medically assessed and deemed to be in need of home care but unfortunately, the hours are not being fulfilled. As a result, there is greater pressure on families who are trying to care for their loved ones at home. Sláintecare suggests that we should be keeping people at home for longer and that people should only go into long-term care as a last resort. However, the system we have at the moment is not just at breaking point but has moved way beyond that. The situation is very serious.

More than 300,000 people are currently providing unpaid care in homes across this country. There is no recognition for them. They are doing it by juggling their lives around their loved ones. It is important that we acknowledge the fact that we have so many people who are providing this care. Over 86,000 individuals are dedicating 43 hours or more per week to caregiving. Regular breaks are essential but carers are not getting them. As respite services are not available, people are denied the opportunity to have a decent quality of life. We are at risk of putting a further burden on this State by creating health issues for the carers themselves who are striving to care for their elderly relatives. They are trying to juggle their lives, rear their own families and do many things, including trying to work as well. At a time when we have cost inflation and many other pressures, we have a silent group of people who are weighed down by the burden being placed on them.

While it is important that we debate this motion today, we cannot just talk about it; we must see a plan coming into place. We have made many recommendations here and as Deputy Lowry said, not all of them will solve the problem. There might be other things that need to be done but at the end of the day, what we need to have is a coherent and effective home care service. I want to speak briefly about the private home carers who are also providing care. We have a ridiculous situation whereby there is a tiered rating for people providing home care services. Some of them are getting paid less per hour than what the HSE is paying. It is important that this new tender process, which has been ongoing forever, actually addresses this issue so that every care provider gets the same rate. We cannot have differential rates depending on where staff are located or on whether they are working for a small organisation or a major multinational company. We have created tiers of providers and given them different rates. This must be changed. There must be a flat rate and that rate must be such that people can live on it in order that we can attract more people into the industry.

It is very important that we do not just talk about all of this. There is a lot of engagement going on but at the end of the day, our elderly people and people with disabilities need care at home. If we cannot support the families who are doing all of this work for nothing, we are doing a disservice to the State as well because in the long term, it will mean that there are more people being kept in hospital, blocking beds. This will have a negative impact across the board. The people who deserve home care should be getting it and the people who are providing that care should be recognised and get respite care as well.

I do not know if the Minister of State intends to accept the motion but even if she does accept it, that is not really what we want. What we want is for action to be taken now, so that by the time the next budget comes around we will have a care plan for everybody who needs home care. I rest my case at that.

Deputy Peadar Tóibín

Gabhaim míle buíochas leis an Leas-Cheann Comhairle. Ba mhaith liom buíochas a ghabháil freisin leis an nGrúpa Réigiúnach agus le Cáit Nic Amhlaoibh as an rún seo a atheagrú inniu. I want to briefly discuss a related issue, namely, the nursing homes cases of which the Minister of State will be very aware. I welcome to the Public Gallery some of the families who have travelled from Cork today to protest the inaction by the Government in relation to the cost of nursing home care in the Cork area and the massive danger that their loved ones will be evicted from their homes. This is a shocking emergency within the nursing home care sector.

The sector has experienced a 36% increase in costs since 2013. One third of nursing homes are losing money at the moment and approximately 900 nursing home beds have been lost in the system in the last three years. The Economic and Social Research Institute, ESRI, has stated that we will need 40,000 nursing home beds by 2030, which is double what we have now. It is incredible that we are in reverse in terms of capacity when we need to be putting more capacity in at a serious rate.

A report published in recent weeks by Nursing Homes Ireland, NHI, found that 33% of nursing homes that were surveyed in 2022 had an operating loss, up from 19% in 2021. On average, HSE homes are paid €730 more per resident per week than private nursing homes. We all remember how appallingly people in nursing homes were treated during the Covid crisis and it is astounding that we have a situation where the State is again letting down people in nursing homes. All private nursing homes, including Beaumont Residential Care in Cork, need €183 per resident per week to match the increase that public nursing homes received just to remain viable. Why are nursing homes in Cork getting €200 less per resident than nursing homes in Dublin under the fair deal scheme? That seems absolutely ludicrous given that the cost base is the same.

Aperee, which is currently operating in receivership, supplies 200 nursing home beds in Cork while Care Choice provides over 300 beds in Cork, including 56 beds at Beaumont Residential Care which operate under the fair deal scheme. Cork could be an absolute disaster zone in the next few months in terms of nursing home beds. If Aperee closes its 200 beds and Care Choice shuts down its 500 beds, we would have a total of 700 beds at risk. Where are the residents going to go? This is a really important question. How are families going to be able to afford the alternatives for their loved ones? I heard the Minister say on radio that the Government will put in place State nursing home spaces but that will cost far more than the cost of the care that these nursing homes are already providing which does not make sense.

It has also been reported that eight nursing homes in Cork have a full-time fire warden now which is not normal within the nursing home sector. Two of these homes are so unsafe that they are no longer allowed to admit residents. There is no registered provider representative for any of the Aperee nursing homes at the moment. These are the people who built this country, the people who through their blood, sweat and tears raised a generation, paid their taxes and invested their lives in this country and here we are, so soon after the Covid crisis, and this is how we are treating them. It is absolutely disgraceful.

I do not think the Minister of State understands how serious the situation is. I received an email recently, as I am sure did the Minister of State, the subject line of which reads: "My 90 year old mother will be made homeless in three weeks". The Government's inaction is leading to the eviction of people in the last years of their lives. We had massive debates in here about the eviction ban in recent times and here we are potentially seeing people in their 90s being evicted from the homes in which they live. This is potentially a humanitarian crisis of epic proportions. The Government needs to immediately and urgently engage with the group protesting outside the Dáil today, many of whom are older people who got up early this morning to travel to be here. The Government also needs to provide €183 per resident per week to avert this disaster.

A total of 31 nursing homes have closed in the last 28 months with a loss of 980 beds. Approximately 80% of those beds were in privately owned care homes. The fair deal rate that the six Care Choice homes in Cork, including Beaumont Residential Care, require to be sustainable is €1,270 per resident per week but they are currently receiving €1,085 from the National Treatment Purchase Fund, NTPF. Just to add to the confusion, the NTPF is unwilling to agree that sustainable rate with those homes, while at the same time it is paying a rate of €1,365 for another private nursing home in Cork, St. Luke's Home. The NTPF is talking about budgetary constraints but we are hearing from the Government that there is plenty of money available, to the tune of billions of euro.

I have raised this issue before. I have raised the issue of people with dementia being thrown out of nursing homes, people who are 99 years old being put out of nursing homes, all for a small amount of funding. I urge the Ministers of State to engage with the families who are under such pressure.

Minister of State at the Department of Health (Deputy Anne Rabbitte)

I welcome the opportunity to discuss home support services and I thank the Deputies for tabling this Private Members’ motion. As Minister of State with responsibility for disability, the issue of home care is very relevant to my brief.

We know that most people prefer being cared for at home. The home support service is therefore essential for thousands of people across the country. As I stand here today, 56,000 individuals are receiving that home care support. It is highly valued by service users and their families because it enables older people to live independently and with dignity in their own homes for longer. It also enables many older people to return home following acute hospital admission. Otherwise, they may remain there or would be admitted to long-term residential care. For these reasons, improving access to this service is a Government priority.

Home support hours in communities are increasing in line with enhanced investment. We currently provide more hours of home support to more people than ever before. There are over 56,000 people receiving home support services, with almost 75,000 benefiting from the service over the course of 2022. We, as a nation, are investing €723 million into home care in 2023, representing a €228 million increase from 2020. In 2022, we provided 20.78 million hours, an increase of 3.29 million hours on 2020. As of 30 April 2023, preliminary data show that almost 7 million hours have been provided this year to date. This represents an increase of about 300,000 hours compared with the same period in 2022.

In terms of waiting lists the latest figures show there are a total of 3,310 new applicants who were approved for funding and waiting for supports. These are people who currently do not have a home support service and are awaiting a carer to be assigned. In addition, there are 2,884 people who are already receiving supports but are not yet receiving the maximum hours advised. That figure is down from a high of 9,000 on a waiting list. I wish to take this opportunity to recognise the hard work of carers up and down the country in delivering this unprecedented amount of care, and thank them for their commitment and for the care that they deliver in the homes of older people every single day.

In the programme for Government, we committed to introducing a statutory scheme for home care. A key step in this process is to regulate home support services in order that no matter where or how care is provided, service users can be assured that their provider meets minimum standards of quality, safeguarding and governance. I am pleased to say that significant progress has been made on this front. A new regulatory framework is being developed to provide for the licensing of home support service providers with the aim of safeguarding individuals. The new system of regulation for home support will ensure that the public can be confident that the services provided are of a high standard and will bring Ireland in line with best international practice. In addition, the Department of Health is preparing primary legislation to accompany the regulations. The Bill will be brought to the Oireachtas in quarter 4 of this year by the Minister of State, Deputy Butler.

There are still challenges in the sector, and in particular on the workforce side, and the Government is committed to improving recruitment and retention in the sector. In March 2022, the Minister of State, Deputy Butler, established the cross-departmental strategic workforce advisory group on home carers and nursing home healthcare assistants. It set out to examine and, most importantly, propose solutions to the challenges in front-line carer roles in the home support and long-term residential care sectors. The group is chaired by the Department of Health and comprised of representatives from seven Departments, the HSE, HIQA and SOLAS.

The report of the strategic workforce advisory group on home carers and nursing home healthcare assistants was published on 15 October 2022. It presents 16 recommendations spanning the areas of recruitment, pay and conditions of employment, barriers to employment, training and professional development, sectoral reform and monitoring and implementation. The Minister of State, Deputy Butler, endorsed the recommendations and full implementation. The statutory instrument authorising the issuance of 1,000 employment permits for home care workers was signed in December 2022. These permits will be for full-time positions with a minimum salary of €27,000 per year. Some 129 permits have been availed of to date, not 79 as set out by colleagues opposite. A group has been established to drive the timely implementation of the remaining recommendations. The first meeting of the implementation group is scheduled for 29 June 2023. Regular updates will be published. When I talk about the living wage, it is important also to state that the Minister of State, Deputy Butler, awards the HSE €28.50 per hour. That is what the HSE paid to the private providers.

Deputy Noel Grealish

What do the workers get?

Deputy Anne Rabbitte

I am just putting this information on the floor of the Dáil. I am not the operational manager nor am I the head of any of those private companies.

Deputy Peadar Tóibín

The Minister of State is responsible for the process, surely.

Deputy Anne Rabbitte

It is possible to say that €28.50 is what is provided to the private providers. It is anticipated that the implementation of the 16 recommendations will have a lasting, positive impact on the waiting lists and recruitment and retention in the sector.

I am pleased to say the HSE has progressed the tender for home support services with the new authorisation scheme anticipated to commence this summer. The authorisation model is open-ended; therefore new entrants to the market may apply to join at any stage, periodically. The authorisation scheme will ensure that home support workers are paid appropriately and will help address some of the key issues impacting the waiting lists and the recruitment and retention issues identified by the strategic workforce advisory group. The scheme will advance sectoral reform and incorporate travel time for home support workers and will address the living wage and reform legacy rates, as recommended by the strategic workforce advisory group. The Government’s policy goal is to deliver a new model of integrated, older persons' health and social care services across the care continuum, supporting older people to remain living independently in their homes and communities for longer.

The Government is committed to supporting healthy and positive ageing throughout the life course. Acknowledging the disproportionately negative impact of the Covid-19 pandemic on older people, the programme for Government commits to the establishment of a commission on care that will assess how we care for older people and will examine alternatives to meet the diverse needs of our older citizens, learning the lessons from Covid-19. An initial scoping exercise for the commission on care has been undertaken. It is envisaged that the commission on care will support a whole-of-government and whole-of-society approach to examining existing policies and strategies that support positive ageing. It will effectively address the gaps which currently exist in the policy landscape. The Minister of State, Deputy Butler, announced in budget 2023 that funding of €5.2 million has been allocated to roll out the initiative nationally. This programme is delivering meaningful outcomes for older people, including hospital avoidance. In addition, under Housing for All: A new Housing Plan for Ireland, a review of the housing adaptation grants for older people and people with a disability scheme is under way. Grant limits and income thresholds are being considered as part of this process.

I would like to also mention some of the developments taking place in the disability sector that relate to this motion and more widely to home support. Specialist disability home support services are provided to both children and adults with a wide range of disabilities from physical and sensory disabilities to intellectual disabilities and autism. Over 3 million home support hours are delivered to almost 7,200 people annually. Home support is entirely different from personal assistance support. In this context, services are discretionary, and the number of hours granted is determined in the context of other support services already provided to the person or family.

The programme for Government commits to the introduction of personalised budgets, improving the provision of services for people with disabilities through a range of options including service brokers, and empowering people to choose the supports that most meet their needs. A personalised budget is an amount of funding allocated by the HSE to an eligible person with a disability to enable the individual to make his or her own arrangements to meet specified support needs. The funding qualifies individuals to access a wide range of HSE-funded services, including residential, rehabilitative training, personal assistance and day services.

The personalised budget pilot is open to adults with a disability who are currently in receipt of HSE services, including appropriate school leavers. The 2023 HSE service plan aims to deliver the national personalised budgets demonstrator project to 180 participants. I have granted an extension to the personalised budget pilot until the third quarter of 2023 with the accompanying evaluation process to be completed in the second quarter of 2024. I am aware that officials in the Department of Children, Equality, Disability, Integration and Youth are eager to learn from this pilot in the disability sector to see if it would be appropriate to have a similar initiative in general home support services.

I thank the Deputies for raising this important issue. I propose that the motion not be opposed. We are accepting it.

Deputy Peter Fitzpatrick

I welcome the opportunity to speak on this important topic and thank my colleagues in the Regional Group for raising this motion. We have learned many lessons during the pandemic. One is that concentrated care of our older people is far from ideal. These issues are predominant and are only going to get worse. Ireland has an ageing population. The number of people over 65 years of age increased in both urban and rural areas between 2011 and 2016 and such people now account for 15% of the population in rural areas. The Health Information and Quality Authority has called for an overhaul of the unregulated sector, including the introduction of oversight and standards for home care services, as most older people would prefer to age and receive care at home but require more complex care.

To be fair to the Minister of State, she has increased the funding and cut the waiting list for new home care packages. However, the 2023 tender urgently needs to be finalised to improve care for older people who want to remain living in their own homes. At present, the HSE home support service supports people with a disability who need home help, as well as supporting people aged 65 or over to continue living at home or to return home following a hospital stay. More than 40,000 people receive care through these organisations, care that was charged to the HSE at an hourly rate of €26.50. However, while demand increases and with 6,432 people on the waiting list for home support care at the end of March 2023, an acute labour shortage of home care workers in the State is evident.

Home care is often seen as an unattractive career path due to the failure to provide guaranteed hours of work and the lack of travel and subsistence payments. Reform within the 2023 tender is essential to provide a predictable income for carers. Despite this, while the pay increase agreed last week was a long-awaited step in the right direction, several issues, including paid travel time for care providers, remain unresolved in the agreement and reform to provide a predictable income for carers has been taken off the table by the HSE. According to the chief executive of Home and Community Care Ireland, Joseph Musgrave, the HSE has refused to state what it means by a "living wage" and has refused to engage with the sector to calculate travel time. All of us here today can agree that home care workers need a predictable income, to be paid the living wage and to receive payment for travel time and mileage, as well as access to career development opportunities. Essentially, they should be respected and valued for the crucial work they do day in, day out. We need to step in and ensure that compensation for time spent travelling, motor travel expenses and pay when clients are in hospital is standardised for all healthcare and home care providers, especially those providing care in rural Ireland.

Carers do a fantastic job and, in fairness, they save the State a fortune. Almost 300,000 people currently provide unpaid care to others and 86,000 of these provide such care for 43 hours or more each week, according to census statistics. We need to increase the means test limits for the carer's allowance for family carers while also reviewing the financial threshold for people in receipt of State benefits in order that they can work and earn more money working in the home care sector. This would help with staff shortages while at the same time helping people to earn more and to have a better standard of living without being penalised by the State. It is a win-win.

The current system is not sustainable and is not meeting our needs. Our failure to provide improved pathways of home care is pushing older people into already overcrowded hospitals and nursing homes. Some 1,000 patients approved for home support had their discharge from hospital delayed last year due to a shortage of carers and the lack of community care alternatives, while the lack of regulation meant that quality and safety were not ensured.

The Government must advance vital regulation for the home care sector and should make this legislation a priority. The acute shortage of care workers against a background of rising demand is the most urgent problem in home care. The Government must liaise with carers and the HSE and take measures that will make the home care sector more attractive and a more viable career option, with the national living wage, travel time and legacy rates all being addressed, while also considering the aforementioned reforms.

Delivering proper home care would reduce the length of hospital stays, reduce the risk of hospitalisation, reduce pressures on our emergency departments and reduce the number of delayed discharges. We must deliver a high-standard and fully public model of care for older people, incorporating the use of digital technologies, especially in rural areas, for the provision of digital services such as healthcare. We need to place home support on a statutory footing in order that it is enshrined in legislation as a sector.

Deputy Matt Shanahan

I welcome the presence of the two Ministers of State at the Department of Health here this morning to debate this motion. I thank Deputy Grealish for proposing the motion, which is very important. I also thank Cáit Nic Amhlaoibh in our office. The Ministers of State will be well aware that, in the Programme for Government: Our Shared Future, there is a plan to introduce a statutory scheme to support people to live in their own homes by providing them with access to high-quality and regulated home care. Unfortunately, this has not happened to date. The home support service, formerly called the home help service or home care package scheme, aims to support people to remain in their own homes for as long as possible and, most importantly, to support informal carers. It also aims to support people with a disability who need home help. The Ministers of State will be well aware that we have a significant demographic bulge coming through in our population. We can be thankful that more people are going to live longer although this means that more people are going to need home help. At present, more than a quarter of all people aged 65 years or older in our country live alone.

As other Members have outlined, and as the Ministers of State are well aware, we have a chronic shortage of home help capacity and home help hours. This is leading to two very significant pressures. It is resulting in delayed discharges from hospital and putting pressure on our residential care homes, thereby reducing the ability of our people to live at home, which is what we want to achieve. We also have a second problem, the shortage of people who are available to work in the sector. Our economy is now at full employment and, unfortunately, this sector is not seen as attractive for many, particularly in the private sector. As has been highlighted, there is also no access to a supplementary pension. That is very important to people who are working. We also have to acknowledge that the HSE has been very quick to target those in the private sector. This is a big problem for private companies that are trying to hang onto their staff. This also applies to section 39 organisations.

There were 6,432 people on the waiting list for home support at the end of March. Notwithstanding the significant additional funding the Minister of State, Deputy Butler, has outlined, we still have a tremendous waiting list. In our motion, we propose 14 recommendations but I will concentrate on five, if I may. One relates to the idea of developing a nationwide cluster model for older people with security of tenure and rent fixed to increases in the State pension. This is very important, particularly as we now have a larger number of people who, unfortunately, will not own their own homes and who will be in rented accommodation for all of their lives. We need to put something on a statutory footing in that regard.

A second recommendation is that steps be taken to increase the use of new technologies to assist in the care of older people, such as voice recognition software, remote health monitoring and so on. The age bracket for this needs to be reduced. There are a lot of people who could avail of monitoring technologies in their homes and who need assistance but who are younger than 65 years of age. I know of a number of people who cannot access that funding because they are under 65. It is a significant impediment to them staying at home. These are people with mobility issues and so on. They should be given wearable dongles and all of that without having to pay for it. I ask the Ministers of State to look seriously at that.

Another recommendation is to increase the means test limit for the carer's allowance and establish a high-level group to scope out and develop a roadmap for the delivery of a non-means-tested participation income for family carers. This is very important. I know the Ministers of State have acknowledged this but we need to see further action. I hope the commission can look at the matter.

The financial threshold for people on State benefits should be increased in order that they can work and earn more money working in the home care sector. This is the quickest remedy that could be applied to get staff into the home care sector. We have a lot of informal carers who are available and potentially are in receipt of State benefits at present. We need to find a way to activate them. They would increase the working population.

They will also take pressure off the system. I ask the Ministers of State to speak to the Minister for Finance about it.

Finally, we must ensure that industry and public sector travel expenses are made available to home care providers who provide home care for older and vulnerable people in rural areas to help to create a balance between rural and urban travel services. Travel expenditure is one of the significant problems in rural home care, as the Ministers of State are well aware. The allotment of time between when a carer arrives into a house and when they have to leave to go to the next house is also an issue. Even though people are being told that they have an hour or an hour and a half of care, they do not, because the travel time is eating into that. Certainly, remuneration and adequate travel expenses would do a lot to support people, particularly in our rural communities. I know people who are working in the sector, as I am sure the Ministers of State do too, and travel expenditure is the issue that comes up the most. I am glad that the Government has accepted our motion. I hope we will see the main recommendations that we have made in it being accepted and enacted by the Government.

Deputy Pauline Tully

Home care support plays a very important role in supporting older people, as well as disabled people, to live as independently as possible. While not all disabled people need or want home care support, many do require the service, including many children as well as older people. There has been a growing crisis in home care support over the past number of years. The demand for home care has grown considerably. We see an increase, year on year, in the number of people being approved for hours and being allocated home care. I suppose that is down to the growing population. The disability capacity review shows that the growth and ageing of the disability population is likely to drive increased demand for home care services much further. The failure in home care provision is compounding further the pressure on our hospitals, because the lack of alternatives in community care has left thousands of people in hospital longer than they should be. Many people cannot return home because there is not a carer in place to provide the care that they need once they return home from hospital.

The issues confronting home care services come down to a failure of planning by the Government. Home support workers will not simply appear out of thin air. We need a proactive strategic approach to workforce planning across health and social care services. We need to see a pay agreement for the sector. We need to see public investment in the future regarding home care. We need a proper career pathway for carers with advanced skill sets, and perhaps a greater role for nurses and other health and social care professionals in delivering care in the home. What I am seeing is that there is an over-reliance on the part of the HSE on private companies or agencies to provide care. While it is paying them a substantial amount of money, the money is not being passed on to the carer. It is very difficult to get carers to work for that amount of money. When they do, they go into a house to provide care to a client and they are constantly clock-watching because they need to be at the next house. This is putting immense pressure on them and it is also unfair on the person who is receiving the care, because they are not getting the care that they desire and require.

There are several examples of this. I have come across a 101-year-old man who has been allocated hours, but cannot get anyone to fill the middle part of the day when he requires care. His own children are in their 70s and they are not able to provide the care he requires anymore. The man is living in his own home and is relatively healthy. He just requires a little bit of extra support. I have come across two families who have children with autism who have been granted home care supports but cannot get anyone to work for the money that is being offered. The HSE has said that they can have home care support, but the families must act as the employer. They have been told that they must register as the employer, must pay the PRSI and the PAYE, and must change their home insurance policies as well. I do not know whether this is just peculiar to CHO 1, but I have come across it on many occasions. The pressure and strain of that on either a parent or a spouse is too much and they do not want to take it on. It is a lot of responsibility and it is just not something they want to do. While they appreciate the money that has been granted to them to provide the support, it is not something they actually can do.

Deputy Patricia Ryan

As Sinn Féin spokesperson for older people, I see at first hand the effects of the failure of this Government and previous governments to properly plan for home care and home help for the elderly. There are people in hospital now who could be at home, but because there are no staff for their fully approved home care packages they remain in hospital, putting further pressure on already-stretched hospital resources. We have heard the phrase "bed blocker" on many occasions. I hate anybody who uses that term.

Deputy Mary Butler

So do I.

Deputy Patricia Ryan

It is an absolute disgrace. These are people who need to be in hospital and need to be brought home to get proper care. We cannot, and should never, use the term, but that is what is happening. These people need dignity and need to be approved further care. When will we see the implementation plan to enact the cross-departmental strategic workforce report? Can we see some urgency on this, given the chronic recruitment crisis? When can we expect delivery of the enhanced community care programme? I heard the Minister of State say that there will be a meeting around 29 June. I very much appreciate that, but I am not asking when the meeting will take place; I am asking when we are going to have the delivery of the implementation of the programme.

Waiting lists for carers are 25% longer in rural areas, so I am delighted both Ministers of State are here. In my constituency, there is an 89-year-old lady who is caring for her 59-year-old son who has profound special needs. She cannot get home care. She depends on her daughter to drive 35 km to help her with him when the daughter comes home from work in the evenings. How can we ever justify leaving an 89-year-old woman with her 52-year-old son with intellectual difficulties who needs specialist care? She cannot get the care. I think it is an absolute disgrace. It is a pure failure of this system.

The Minister of State, Deputy Rabbitte, spoke about a personalised budget. A personalised budget is not going to help here. Home carers deserve a living wage and mileage allowances in rural areas, given weekly incomes, especially if they are losing income when a client is hospitalised and funding is stopped. We need reforms to social welfare rules to calculate hours worked, not days worked, to protect social welfare entitlements. It is vital that this happens.

It is past time the Government acted to resolve the crisis in home care. We are asking it to prevent our elderly from suffering now. It is vital that it is done to prevent the crisis from escalating. I have met the Minister of State on several occasions. She has always been very approachable and has answered anything I asked, but I am absolutely asking that something is done around this. We cannot have people without care.

Deputy Claire Kerrane

I welcome this motion and commend the Regional Group on bringing it forward. There is an awful lot in it, and a lot that needs to be done in relation to home care and the care of our most vulnerable citizens overall. I want to speak first on those who remain on waiting lists in Roscommon and Galway and across the board, both for home care in the first instance and for additional home care where the need is there. It has been said - I think it is something we all agree on - that people want to be cared for at home and want to remain at home. It is the job of government to ensure that everything possible that can be done is done to ensure we facilitate this. Of course, being on a waiting list causes worry and anxiety both for the person in need of care or additional care and for their families. It is huge pressure.

In fairness to the Minister, the budget is there and the hours are there. That is all in order. The issue is home care workers and their pay, terms and conditions. The report from the advisory group is really important and we need to see those recommendations implemented as quickly as possible.

I have raised the issue of home care services in Roscommon in this House many times. I think they really are the blueprint in relation to the living wage, and how they calculate and allow for mileage. I ask the Minister of State to look at that in relation to the new package, which we hope will be put on the table right across the board. Qualifications in home care, including the training and the course, need to be looked at as well. We should also look at the possibility of intertwining that with some of the schemes, such as the community employment scheme, as a way to get people through, train them properly to a high standard and ensure they are in place and able to do the job.

The HIQA report published in December 2021 is one that I have raised in this House. It said that home care services were in dire need of regulation. I welcome the fact that legislation is coming. It is a long time awaited and it is really needed.

To close, I want to reference two points in relation to the motion and what it calls for. The nationwide housing model for older people is something that we really need to look at. The housing with supports project that is ongoing in Inchicore at the moment needs to be rolled out. We need to have a safe space and a community for older people where they can live together but retain their independence.

I understand that the meals on wheels delivery service is under review at the moment. Ballinasloe social services provide a meals on wheels service, like many others. They are under significant financial pressure to keep this service going.

If we all acknowledge that a service such as meals on wheels is important and does good work, we need to make sure we fund it adequately to make sure it can continue. This is so important.

I hope there has been engagement on jobseekers with the Department of Social Protection and the Minister. Work is ongoing on jobseeker's benefit and it is a perfect opportunity to look at jobseeker's payments in terms of working and moving to the model of hours rather than days. I hope this is being looked at.

Deputy Rose Conway-Walsh

I thank the Regional Group for tabling the motion. We are here week after week discussing the very same issue and we need to see more progress in this area. This is why the Government must advance the vital regulation for the home care sector and make the legislation a priority. It has to be a priority. We know what is happening in the constituencies. It must establish the promised commission on care to modernise social care arrangements. Too many people are unable to access the funded home care packages they desperately require. The waiting lists for home care at the end of March reached an alarming 6,432 individuals.

Will the Minister of State look at home care? People tell me how restrictive it is. I completely understand risk assessments but home help workers are restricted in what they can do. I know of a recent case where a woman asked for a piece of toast, but was told the home help could not make the toast because she might choke on it. I can understand this in certain cases but we need to be careful not to get to a situation where the risks narrow down what home help workers are able to do to very little. Perhaps we need to review the risk assessments on an ongoing basis with regard to what can be done to ensure people are comfortable in their own homes. Otherwise it defeats the purpose.

One of the biggest problems we have in Mayo is with regard to people who are kept in hospital longer than they need to be. We have great pressures on Mayo University Hospital and other hospitals. We do not have home care support packages in place. Has there been a proper audit on the cost of not having home care at the right time? I am not sure whether a financial figure has been put on it but that should be done. Sometimes all that is listened to is information on the money lost. We have wasted so much money and put people's lives at risk. Hospitals are backed up. People desperately need an acute bed but cannot get one because the home help is not there. Mayo University Hospital is overcrowded because of delayed discharges. Every month patients who do not have to be there are in acute beds. This means hundreds of bed days are lost each month.

Other people live at home in real hardship. We are dealing with an elderly lady in Mayo who has a disability. She had an agency doing her visits but she was being put to bed at 5.30 p.m. Being put to bed at 5.30 p.m. on a nice summer day is not acceptable. It was done because staff were not available to call on her in the evenings. None of us would like to be told we have to go to bed at 5.30 p.m. and wait there until the next morning in this heat. It is not the quality of living we should be giving to older people in their own homes.

I want to speak about respite, not only for elderly people but also for families who are in desperate situations. Family carers do a wonderful job in the home but they need a break. Siblings also need a break where there are children with disabilities. There was a story in the Mayo News last week about a severely autistic eight-year-old boy in Westport. His parents are at the end of their tether. They have had no break whatsoever. They love their children and care deeply for them. They do everything for their children at home but they cannot get respite. Will the Minister of State ensure that all respite services for the families of people with disabilities and young people with disabilities are reopened so they can get the respite they desperately need to be able to have some quality of life themselves?

Deputy Ruairí Ó Murchú

It is not the first time we have dealt with home support and home care packages. I thank the Regional Group for putting this vital issue front and centre. It is a pity we are still talking about this. We all speak about how we want to facilitate people to be able to live in their own homes. The problem is that we are not very good at putting in place those pieces that allow this to happen.

I will throw out, and not for the first time, that housing adaptation grants could facilitate people to leave step-down hospitals or hospital beds. I do not like the term "bed blocking" but these people are being forced into these circumstances. Louth County Council has made a request to the Government for €570,000. At present it is not taking applications for housing adaptation grants. I have spoken to the Ministers of State, Deputies Rabbitte and O'Donnell, and others about the fact that we need a review of the entire system. Even where people get the money and are able to wait a long time for very necessary adaptations that relate to severe mobility issues for older people and disabled people, in some cases the grants are not sufficient to deal with the need. I have been dealing with the Minister of State, Deputy Rabbitte, on the issue of a child coming of age with severe disabilities. We are speaking about hoists. Louth County Council has done what it can but it is insufficient. The Minister has managed a workaround but we need to be able to deliver it. The longer this goes on, the more difficulties it creates for individual families.

To come back to home care, the problem in north Louth is that there are significant difficulties getting full home care packages for those who need them. They may get partial packages. There are families who will get part-time packages when full-time packages are required. CHO 8 states it is difficult to get home care assistants to travel to north Louth. At times the RCSI Hospital Group, in order to free up its beds, has put on its own services. This is a lot easier to do for people who live in the vicinity of Beaumont than for those who live in north County Louth. Communication is never particularly great with CHO 8. I do not know how many times I have raised the added issue of these adaptation grants. We really need to get real about all of this.

I will raise the issue of a 15-year-old girl who was diagnosed with autism at the age of seven and has also been diagnosed with neurofibromatosis type 1. This is a terrible genetic condition that causes tumours to grow on the nerve endings. People can imagine the difficulties it causes. She is regularly hospitalised for high blood pressure. She is awaiting a home care package to assist her mother who has three other children with disabilities. They are also waiting for a profiling bed and other additional equipment. We have been in communication with the HSE on this. It is an issue that needs to be escalated. I will speak to the Minister of State and whoever else I need to on this. It is a real pity we have people in these circumstances. The problem is that it is never just one but many. We cannot even put ourselves in their shoes with regard to the life they need to lead. We are constantly speaking about facilitating families and making sure people can live in their own homes. Unless we put these parts into play, it will not happen.

We know about the tender of €31 per hour of care and that there are still some issues that need to be ironed out. There is still instability in the sector.

There is a request to look at all the terms and conditions of the sector. How long have we been talking about this cross-departmental strategic workforce advisory group, or CDSWAG, which is a hell of a lot easier to say? We really need these recommendations to be put in play. We have all talked about the issues, particularly with regard to travel expenses. We just need to make sure we can bring it to a place where people have a liveable wage, we have something that is attractive, and the people who want to do it are in a position to do so.

Some of my colleagues have already spoken on the necessity of social welfare reform. We know we need to make sure we have workforce planning and throughput coming through. Beyond that, we will have to incentivise people. The Minister of State, Deputy Butler, spoke about how we need to look at tax implications and whatever else for people who work in the health sector who may be willing to provide home care for the weekend if it is financially worth their while. We know we need to look at the hours for those on social welfare payments. We have many other things that need to be dealt with. At this point in time, we have a system that is not fit for purpose and we are failing people.

Deputy Sean Sherlock

I want to start with the report on "Morning Ireland" this morning about the Emily case. I refer to Ailbhe Conneely's reporting on RTÉ. The report was clear that the national independent review panel stated that none of the very distressing incidents in that case were followed up in accordance with HSE safeguarding policy. I do not want to go too much into the detail of it, for obvious reasons, because it is so distressing. It speaks to the lack of legislation for safeguarding policy for older people. In her reply, could the Minister refer specifically to that case if she is able to? We acknowledge the fact that Bernard Gloster has been front and centre on this. I imagine that Bernard Gloster has spoken with the Minister in respect of this case. It points to the overdue, dire need for safeguarding legislation to protect older people. This motion is effectively about older people. Could the Minister give us some reassurance that there would be legislation underpinning the safeguarding of older people in the way that we have robust legislation that underpins the safeguarding of children? That would be a good day's work.

There is a report on this from 2019 by the Law Reform Commission. Our own party proposed legislation on this in the Seanad in 2017. I welcome this motion. It is a good motion because it captures the issue of care for older people in Ireland today, what their needs are, and some solutions.

Looking at the census figures, we see that the population aged 65 and older will continue to rise steadily and will increase by more than 50% by 2051. That presents all of us with a clear challenge with regard to what care for older people will look like today and in the future. We have to continue to engage with organisations like, for instance, Family Carers Ireland. We have to engage with reports that they issue because they are at the coalface now and are in tune with the challenges that face older people.

I refer to the State of Caring report and its detail on participation income. There are some stark findings based on interactions with people who avail of State services relating to care. They speak to the issue of those people who are carers. I want to speak for carers today. They want home support to be put on a statutory footing. That argument has been going around for a long time now. We wait to hear the timeline for that from the Minister. The report states that 24% of carers experienced a delay or a reduction in the delivery of home care support hours or packages due to the shortage of home care workers. I know the Minister of State, Deputy Rabbitte, has already quoted to us the number of home care hours that are delivered in a given year. The hours are significant and are increasing.

We have still not solved the problem. It is a question of how we solve that problem in a society where we want people to be cared for in their home. How do we fast forward to a point where, when somebody is given an allocation, that allocation is made immediately, with the package being tailored in accordance with the particulars of a household or a person's needs? The Minister of State has heard chapter and verse on individual cases from all of us today. There are particular circumstances and restrictions on how the package is tailored for the individuals' needs. That is needed.

We also have to tackle some shibboleths relating to the means test for the carer's allowance. I know it is not necessarily the line Department of the Minister of State, Deputy Butler. Family Carers Ireland does surveys and research. Some 47% of carers who participated in the 2022 State of Caring survey live in households with a gross income of less than €30,000 per year. Almost one in four live in households with a total income of less than €20,000. By comparison, 18% of the general population live in households with a gross income of less than €20,000. When asked about their ability to cope financially, more than two in three, or 68%, of carers said they find it hard to make ends meet. More than one in ten carers, or 13%, are in arrears with their rent or mortgage. Some 16% are in arrears with utility bills. By comparison, 7% of the general population in Ireland were in arrears with their rent or mortgage payments and 8% were in arrears with utility bills in 2020.

I know the carer's allowance is a matter for the Minister, Deputy Humphreys, but the Minister of State, Deputy Butler, will have an interest in it. Carer's allowance was introduced in 1990. It is outmoded, outdated and anachronistic. When we look at the Central Statistics Office figures for the projections arising from the census in respect of where the population or demographic growth is now, particularly the number of over-65s who will be living in Irish society in 2051, and at the number of people who will require care in the home, we see that thee needs to be a fundamental overhaul of payments like the carer's allowance to reflect the realities of Irish society today. We need to dispense with these anachronistic payments. Not everybody can benefit from them.

In my experience as a typical constituency Deputy who does the ground-turning and hard cases for people, I see that more often than not, people are kicked out of a system if there is an increase in income in the household. The means test, income regards and all of that need to be overhauled. If we truly value care and caring for people in their home, and if we value a system of payment like the carer's allowance, it needs to be overhauled. If the Minister could respond to that, I would be grateful.

Deputy Róisín Shortall

I thank the Regional Group for tabling this motion. The Social Democrats will support it. In 2018, a statutory right to home care was first promised, with 2021 being the target date for its introduction. Now, five years on, this Government still has not delivered it despite numerous promises from the Minister of State, Deputy Butler, and other Ministers. What is the problem? Why is the Minister of State not delivering on what she said she would do and what is so desperately needed?

The Covid pandemic is usually blamed for any delays in progressing Sláintecare reforms. In some instances, that is a reasonable defence. However, when it comes to home care, the pandemic should have acted as a catalyst for reform and not a barrier. Lessons have to be learned from the experience of the pandemic as regards elder care. One only has to look at what happened in the nursing home sector to understand why that is the case. Instead, this Government has dragged its heels rather than accelerate reform of a sector marked by increasing privatisation, poor pay and the continued dominance of institutional care. Even the new home support tender, which was supposed to herald improved pay and conditions for home care workers, falls entirely short. Not only was the process mishandled by the Minister, it has not even delivered on the recommendations of the strategic workforce advisory group. For a start, workers will not receive the living wage, currently set at €13.85 per hour. Instead, the Government is doubling down on its own version of the living wage, which, of course, is not a living wage at all. This shows a complete disregard for home care workers.

Care work should be valued and regarded as a viable career. We cannot continue to expect this workforce, 87% of whom are female, to deliver high-quality, person-centred care in the absence of adequate pay, terms and conditions, and opportunities for career development. While significant progress has been made on pay and conditions for carers working directly for the HSE, staff within the private sector, who provide more than 60% of HSE-funded home care, still face serious challenges and disincentives. These workers are not covered by any collective negotiating agreements and face resistance to trade union membership and attempts to organise. This is just another reason the State must expand direct provision of home care and reduce our overreliance on outside providers.

On travel, the new tender also disappoints. Home care workers should receive mileage but instead only travel time at a rate of €2.99 per hour will be covered. This is another broken promise. This is a completely inadequate response to the costs incurred by these workers, given the distances travelled by many of them, particularly in rural areas, and the considerable expense of running and fuelling a car.

Another recommendation of the advisory group that remains unaddressed is the review of social welfare eligibility rules. The current three-day rule is extremely restrictive and in need of reform. A new system, based on cumulative hours worked, would free up capacity in the sector and help reduce our stubbornly high waiting lists. I raised this with the Minister for Social Protection last February, but she showed no sense of urgency. The Minister for Health and the Minister of State with responsibility for older people need to urgently engage with her to move forward on this important issue. The point is the manner in which there is a demand for home care means it is spread over the whole week, sometimes six days in the week, and the three-day requirement is just not relevant to people working in the sector, which is why we need it to be addressed urgently. We simply cannot allow this situation to continue deteriorating.

At the end of March, more than 6,000 people were on a home care waiting list. They had been approved but the staff were not there. In addition, from the acute hospital perspective, there are regularly 600 delayed discharges. In the short term, these unacceptably long waiting lists could be addressed by better pay and conditions. While in the medium term we need to seriously examine the model of home care provision in this country, this must be part of the commission on care.

We know what is happening, driven by the Government in particular, is a drive towards incentivising nursing home care, and the use of a large tax-based model that is entirely inappropriate. The Government is driving outsourcing and privatisation and losing all sight of what is in older people's best interests. We have to change approach on this. We cannot continue with this. We cannot have older people being warehoused and this kind of creeping privatisation we have seen right across elder care. It is simply not good enough. The starting point has to be an immediate statutory right to home care.

Deputy Violet-Anne Wynne

I thank the Regional Group for bringing forward this very important motion and the Social Democrats for lending me time to speak on this issue on behalf of the people of County Clare.

Bluebird Care provides approximately 91,000 hours of home care support to 173 clients in Clare every year. Its representative body, Home and Community Care Ireland, has made several representations to the HSE, the Minister of State and even to her Government colleagues regarding the delays with the 2023 tender. Not only does Bluebird feel devalued by being messed around so much, it also feels its hardworking care staff are not being treated fairly. It has been unable to update staff on a potentially increased package that offers a pay rise and properly remunerates them for travel time and mileage, which is very helpful at a time of high inflation, especially for those living in rural areas.

Between the 2023 tender and the proposed statutory right to home care, there is a unique opportunity to redefine services and invest in a flourishing sector, but the opposite is happening with a race to the bottom unfolding. Clare public participation network, PPN, reported that only 4.4% of home care hours in Clare are delivered directly by the HSE. That is compared with 49.6% in Limerick and 56% in north Tipperary-east Limerick. Clare has the highest number of people on waiting lists in CHO 3 due to staff shortages.

I recently spoke to Martin from Inagh. His brother, Michael, is due to be discharged from hospital but this is not possible as his home care hours have been slashed from 28 hours a week to just 14. The nature of Michael's condition means it will not be possible for him to return home, with half the home care support he was previously getting. Unless the Minister of State takes action, Michael will join the thousands of people throughout the country who are forced to live in nursing homes against their wishes because the State cannot provide the adequate care he deserves. For Michael and everyone in this situation, I urge the Government to support this motion.

Deputy Gino Kenny

I, too, welcome the motion. We have discussed the issue of home care many times over the past number of years. It is an extremely important part of the healthcare system. It is vital that somebody in his or her own home is given the proper intervention and vital care at that time. We have moved towards the model where people want to stay in their homes, if it is medically feasible, because that is obviously where they feel more relaxed and more at home - excuse the pun. It is a better environment, both physically and mentally. All the evidence indicates that where a person gets a proper intervention, the outcomes are very good. The State has funded home care but it still lags behind the need, especially for people in a hospital setting who cannot leave that setting to come home. The home care approach and model is better. As I said, the evidence indicates people are happier and so forth.

We are not only talking about those people who need home care but also the workers. Speaking as a former home care worker, it is a brilliant, rewarding job in more ways than one. You do not do it for the money. Nobody does it to get rich. You do it for the passion, the altruistic need, and wanting to give back to your fellow human beings. However, there is a major issue around pay. There is no doubt about that. The proliferation of privatisation of home care is a huge worry. A tendering process is under way. These companies are doing very well but their workers are struggling. It is to be hoped some of this can be addressed through the tendering process, including travel expenses. A home care worker who has ten clients will sometimes have to travel wide distances to get from one client to another.

That takes up a lot of time. It has to be addressed because if we do not keep workers, we will have this situation all the time. A huge number of people want to give but cannot do so if they are not paid properly or recognised. That is important.

The proliferation of privatisation has been a huge worry and has denigrated the service the State is obliged to provide. It is important to address that imbalance in home care work and to recognise home care. We live in a society possessed by financial rewards but we need to become a society that cares about its individual members. We are a caring society but there are things in place which do not help people who want to give. The main issues are more home care hours for people who need home care and proper pay and conditions. There are people in our society who earn hundreds of thousands of euro and sometimes you have to ask yourself what social good they do. The social good of a carer who is meeting the most basic needs of a fellow human being is vital. Sometimes we do not recognise that in a capitalist society. I hope the tendering process will give a living wage to those who want to give back and make people’s lives better. That is vital.

Deputy Danny Healy-Rae

I thank the Regional Group for this timely motion. Home help is something every public representative is dealing with. On an hourly basis, there is someone ringing about home help. When people get elderly and have little problems, they want to stay in their own homes for as long as possible. We should be doing a lot more to help these people stay in their homes and give them the home help they need.

There are desperate anomalies. In Kerry, there are people granted home help and being notified they will get it, yet the home help does not arrive because there are no home helps available to do the physical work. We must address that issue.

When we debated this issue previously, I ask about Ukrainian refugees, women and men, who should be trained up, especially those who speak English and have a car. I am sure they would want to work and could help.

We should be doing more to recruit people. Sadly, last year, people were recruited and trained but were not being called. People will not stay hanging around like that when they are looking for work after training and everything. It takes too long. I do not know where the knots are.

We have a situation where people are in hospitals and the hospital wants to get them out and get the bed free but there is no one to come at that moment to do the home help. It is a fierce worry for elderly people. The one thing they want is to stay in their homes for as long as they can. We are not doing enough to help them.

Deputy Michael Healy-Rae

I thank the people of Kerry who already provide home help and keep people in their homes by their work and efforts. I want to remember the time they worked during Covid. I know many of them personally. Many of them walked the byroads and high roads with me during election campaigns. The message I want to send to them is to thank them from the bottom of my heart. I know the Minister of State also does so and will, during her address at the end of this debate, thank them.

I thank the Regional Group for bringing this important motion before the Dáil. It is important to acknowledge where we are, what we have been doing and the fallings and failings in that. I will give an example. Everybody knows the ever-increasing cost of running a motor car but the unusual thing about home helps is that when they leave their house in the morning and go to take care of their first and second people, they have to move all the time. They are burning petrol, breaking their cars on bad roads and wearing and tearing tyres. Cars deteriorate with use and they use them a lot. Predominantly they are in rural areas. It is important we recognise the need to increase the money home helps are being given. What it costs to keep a person at home is minuscule in comparison with not having a home help call to a person. If the person at home fell and broke a hip, can the Minister of State imagine what it would cost to keep him or her in an acute bed? It would cost €2,000, €3,000 or €4,000 per week. Even if the person were to go into a district hospital, it would cost multiple thousands every week. The amount of money the Minister of State is giving to home helps is small in comparison with what we would pay if we were keeping people in State care. Let us look after the home helps we have, try to encourage more people into the service and make sure people are allocated hours.

I thank the management and home help organisers. We often have debates on services but I thank them for their work in County Kerry. I am talking about the Kerry people and I thank them.

Deputy Mattie McGrath

I, too, support the motion. It is important we have a debate on this issue because this is an important service involving important people, as Deputy Healy-Rae and many others said, who deliver these services to our elderly and vulnerable and those who need supports.

We have been on about this so many times. There is a dichotomy in many areas. A couple of years ago, people were all the time trying to get supports and could not get them. Now we talk to the Departments and the Ministers and are told there are heaps of money and we can get approval but we cannot get personnel to do the job. That is an issue and will be an issue going forward. We have to value, respect and support home helps. Many of them travel long distances to spend a short time, maybe half an hour, here or there. That is onerous on them and it is expensive for them to travel.

I also support the management and people in charge but common sense does not always prevail. I raised a case recently with the Minister of State in her constituency. An elderly gentleman - he is 92 years old - had home help from a private service contracted through the HSE. He decided, and rightly so, he wanted to join the HSE and then he was taken away from the family when he qualified.

Deputy Mary Butler

He is back now.

Deputy Mattie McGrath

Why are these things made so cumbersome? That family was put through enormous stress, as are many other families, waiting for a week or ten days with nobody. Thankfully, the case is somewhat resolved. There are many issues that need to be addressed but do not seem to be getting addressed.

We have seen cases where home helps have been moved from the families they had or the people they were caring for. I also have cases where if the home helps say a word or make any complaint, they are punished, not directly but indirectly, by being moved, given more awkward hours or whatever. That kind of pettiness should not be allowed. We must value the people who provide the service, the role they play and the fact they give their time, their service and much more.

Deputy Catherine Connolly

I thank the Regional Group and welcome the opportunity to focus on this. The only thing absent in the motion, perhaps, is what led us to this point, which is the ideology promulgated by many parties to the effect that private was best. We privatised the system. It was the ideology of a particular party but I will not go into party politics. It is important to say, however, that it is neoliberal ideology that has left us with this mess on our hands. If we are getting sense at this late stage, or mar a deir said i nGaeilge, "ciall cheannaithe", meaning "bought sense", that is good.

This is a theme we return to all the time, like climate change, housing and domestic violence. We have statements ad nauseam about it but what we really want is action. I welcome the fact that the Minister of State has taken action. She did so back in 2021 when she listened to the various debates and set up in March 2022 the workforce advisory group on home carers. I have read its report. The Minister of State received it in September of last year and it was published in October. I give her full marks for that and the work that was done. It is a very interesting read and it really encapsulates how we got to here. We have a mess on our hands. I pay tribute, as always, to the carers, without whom this economy could not function, not to mention thrive.

I always say when speaking here that I wish economists would examine the value to our economy of care and carers' work, without which it could not function. Of course, the profession is 90-something percent female, which is another indicator of why the pay is so low and no value has been put on it.

What is the mess we have? We have a health service executive providing good money per hour. That same executive is providing good money to the private and not-for-profit sectors but it is not being passed on. The Minister of State said the rate was €28.50 per hour. I can tell her that there are many carers in Galway who would love €28.50 per hour. What has happened under the neoliberal ideology is that we are now helping private companies, however big or small, to make a profit. That is exactly what Government policy is. The Minister of State has inherited that. I realise she is on record as saying she would like change so as to have more direct provision. I welcome that.

The findings of the review are absolutely stark. I have only a minute and a half left, so I will not be able to go through them. Pay and conditions are referred to. The pay is way too low. We should ensure a national living wage. Currently, there is no mechanism for care workers employed by for-profit or non-profit organisations to engage in collective bargaining. The hourly rate paid by the HSE to providers from which it commissions home support and that provide care at a profit is significantly higher than the rate paid by those providers to their care workers. There is something seriously wrong with this.

The report makes 16 recommendations. They are good and include putting measures on a statutory footing. Of the 16 recommendations, only one, on overseas workers, has been implemented. I welcome its implementation. Although all the recommendations caught my eye, No. 11 did so in particular. There should be a significant increase in the proportion of home support hours directly provided by the HSE. We are talking around in a circle in that we were providing direct home support through whatever entity is now the HSE but then changed things to ensure the companies would make a profit and not provide a proper service. The care was commodified. Professor Kathleen Lynch has clearly outlined the commodification of care services. That is what we are doing. If the Minister of State is going to lead us back to where we were, I will fully support her.

On the ideology, it is often important to identify that we did modify care services. It used to be a matter of getting somebody assessed for home care but it is now a matter of getting the carer. There are geographical differences in that carers cannot be got in rural Connemara, for example. On top of that, there is terrible language, such as "a person entitled to care". Such a person is not entitled to continue with the same carer, so he or she could have up to three or four different carers in the day, provided by different institutions or entities. All this is based on a neoliberal philosophy or ideology that has made a product out of care rather than an essential service. My colleague from Galway, Deputy Grealish, is nodding his head in agreement. I would welcome a change to the ideology on what are the essential ingredients of a democracy. The most basic one is to provide carers directly through the HSE and give them a living wage.

Deputy Michael McNamara

I very much endorse much of what the previous speaker has said. I thank the Regional Group for tabling the motion and giving us the opportunity to discuss this very important issue.

I acknowledge the Minister of State's bona fides on this issue in that she has very much sought to introduce reforms. I look forward to hearing in her closing remarks how those reforms are advancing, because the reality, notwithstanding the Minister of State's efforts, which I acknowledge, is that difficulties remain. Deputy Connolly pointed out that the difficulty before now was getting people assessed. Now it is quite easy to get people assessed. I know many families across Clare who have been assessed and told they are entitled to hours, but there is simply nobody available to offer them. That raises many questions. Obviously, we have full employment, which is part of the issue, but the fact that a fundamental service for a person, family and community is regarded as unattractive or that other fields of employment are regarded as more attractive raises questions. We must acknowledge that most people look for care early in the morning and late in the evening and that this poses difficulties in terms of the attractiveness of employment because many carers deal with their own families, including children, parents and dependent relatives, at these times. People like to work an eight-hour shift. It makes it difficult to provide a service on two occasions per day, 12 hours apart, if people are being sought to do eight-hour shifts.

As Deputy Connolly and other speakers have pointed out, there are issues with the margins being taken by some of the service providers, including not only the for-profit ones but also the not-for-profit ones. The latter also take a fairly handsome margin, and that needs to be looked into. Admittedly, there are administrative and insurance costs and the care has to be provided, but we must ensure the carers providing the service are paid an amount of money commensurate with the great service they provide.

We must examine what occurs if somebody goes to hospital or does not require care for a week or two, meaning that the person's carer is not paid for that period. What is happening in that regard? What is the position on payment for travelling time? Cities are one thing but in rural areas such as Clare or the area the Minister of State represents, carers inevitably spend much time travelling. For the job to be in any way attractive, carers need to be paid for their travel time, and also for fuel because they are driving around in their own cars.

Minister of State at the Department of Health (Deputy Mary Butler)

I thank Deputy Grealish and the other members of the Regional Group for the opportunity to discuss home care. When I was informed last Thursday or Friday morning that there would be a Private Members' motion on home care, I was absolutely delighted because we do not often get two hours to discuss what is a really important feature for so many older people living in the country. I thank the Deputies for tabling the motion and for the work they have done.

I read over the weekend what the Deputies have in their motion and believed it was very fair and balanced. Much of what is in it, especially what Deputy Shanahan referred to, is already in train. I will go through some of the things we are doing and also speak about where the challenges lie. I will speak about what we are doing more generally regarding the extensive reforms occurring in home support.

It is crucial to acknowledge the outstanding efforts of front-line carers and all those who work right across our health and social services. They have stepped up and demonstrated their outstanding commitment to meeting the needs of service users in communities right across the country.

I was struck by the comments of the last speaker, Deputy McNamara, who said home care is a difficult job. It is predominantly female led. A home carer does a split shift in many cases, working early in the morning and late in the evening. It is a seven-days-per-week job. It is very difficult at weekends in rural areas, especially if somebody needs two carers or if the person being cared for has to be hoisted or has special care needs.

If they are looking for a male carer, that is challenging as well. There are a lot of challenges there, but it is a priority for the Government. Our population is growing and it is also ageing and this means that demand for home support services is projected to increase substantially.

Older people want to age well at home and it is important that the supports are in place. I call this the triangle of supports that I deal with every day as Minister of State with responsibility for older people: home care, day care and meals on wheels. We have 330 day care services back up and running. We have 46 specific dementia day care services up and running. That is nearly 380 in total. Meals on wheels provides meals to 250,000 people every month and is hugely important. It is so much more than just a knock on the door with the meal; there is a social connection. Then we have home care. I am pleased to say that regarding home care, funding has kept pace with demand. The Government delivered unprecedented funding amounting to an additional €228 million over the last three budgets. My budget this year is €723 million specifically for home care to support older people to age in place.

There should be no doubt that this investment in social care and home support is a priority for me. It is a priority for the Government and for the Minister for Health, Deputy Donnelly. When I listened to all of the contributions, some really good contributions that I will take on board, there was one person who said the system is not fit for purpose. I do not agree. As we all sit here this morning and debate, 56,865 people will get a knock on the door and somebody will come in and help them to get up and get dressed and deliver the care they need, more from a medical model now. We have moved away a little bit from the fact that originally, home carers, or home helps as we used to call them, helped with cleaning out the fire and maybe going for the shopping or helping with it. We have moved to a different type of model. We had no choice, because the demand was there. Almost 7 million hours have been provided so far this year. This represents an increase of about 300,000 hours on the same period last year, notwithstanding the challenges we have. We have witnessed a significant increase in the number of home support hours being delivered, but also a significant increase in the demand. That has not been spoken about at all today. There is much more of a demand, especially post-Covid-19.

Last year, around 75,000 people in total benefited from home support services. The service is highly valued by service users and by their families, because it enables older people to age in place and live with dignity in their own houses without compromising on standards. Somebody spoke earlier about standards. I will not compromise on the level 5 HIQA standard that is needed to deliver home care. One cannot do so. People have to be Garda vetted. People have to have the correct verification to go into somebody's house and offer them personal care. I will not ever apologise with regard to standards.

I also want to say something which has not been said. Ireland has the highest life expectancy in the whole of the EU, as deemed by the World Health Organization, which is almost 83 years for women, and 82 years for men. That is something that we have to acknowledge as well. We are doing a lot of work to support older people to remain at home.

On the waiting lists we have currently, and this is something that I follow on a weekly basis, there are 3,310 new applicants. They are approved for funding and they are waiting for supports. There are a further 2,884 people who are already receiving supports. I know people cobble it together and say that there are 6,000 waiting. Technically there are not. There are 3,310 waiting, which is 3,310 too many, I will add. There are 2,884 people who are receiving a package, more than likely Monday to Friday, and challenged at the weekend. We are challenged at the weekend in rural areas and where we need two providers and one cannot ask any home carer to work seven days a week. It is as simple as that, so we are challenged there.

Work is ongoing to address the waiting lists and the HSE is endeavouring to prioritise service for clients with the highest care needs. That is what we have to do when we have a waiting list. The waiting list is predominantly made up of people who have been approved for support. I have to be crystal clear here: this is not a funding issue. There are not too many Ministers who can stand up and say that. It is not a funding issue, it is a workforce one at the moment.

I will move to the strategic workforce advisory group, SWAG, and the recommendations. We put that in place last year. I compliment my Department, which did phenomenal work on it. What I want to say is that while only one of the recommendations has been put in train, there are another four in train at the moment as well. The first recommendation involved working with the former Minister of State, Deputy Damien English, in pushing it through to get 1,000 permits outside the EU, and 129 have come in so far. I think it will work, because 2,600 people have come in on permits to the nursing home sector under the same pay and conditions. It is early days yet and I think the permit will work as the year rolls on.

On legacy rates, which were a huge issue for the private providers, travel time and the living wage, that is all being worked out in the tender at the moment. I do not want to say too much about the tender, because it is at a delicate stage and negotiations are ongoing. However, those three issues are being dealt with.

Another of the recommendations is rolling recruitment within the HSE. The HSE is paying €16.50 per hour plus mileage to home carers and it is still struggling to get them. As it recruits, what is happening is that we have a lot of home carers who are retiring. They stay on even until they are over 65 or 66 and they are retiring because it is a tough job which involves lifting people. If one is doing it all of one's life, it is time to be taking it a little bit easier. There is a rolling recruitment campaign across the country. That is another one of the recommendations and I look forward to the meeting on 29 June which will set out very clearly how many of the recommendations are under way.

I really want to make progress in working with the Minister for Social Protection, Deputy Heather Humphreys. I take on board 100% that there are lots of people who would do home care if they did not have the challenges with their medical card, or if the amounts they receive in social welfare were not affected. There are a lot of people who have told me that when their child goes to school in the morning, they would be able to give three or four hours. They might be able to give 20 hours a week. That is an area that we really have to progress, and we will, but these things take a little bit of time.

On reform of home care, the programme for Government commits to introducing a statutory scheme. I will have that in before the Dáil before Christmas and I look forward to the support of Members on that. I thank Members for the pragmatic approach they have taken on this. That was one of the main reasons why I wanted to accept what Members have set out. We all want the same thing. We all want older people to age in place.

I do not have much time left, so I want to turn another area. Deputy Shanahan will be aware of this, because he was with us last Friday when we had the Minister for Housing, Local Government and Heritage, Deputy Darragh O'Brien, in Waterford. A new age-friendly premises was opened in the heart of Waterford city. It was formerly St. Joseph's nursing home. There are 71 homes there for older people under repair and lease and the local authority is going to provide a dedicated person there to support people when they move in and help them with social care, for example, meals on wheels, whether they need help filling out forms, or need help in getting home care. Age Friendly Ireland will also work with them in delivering supports. We need to see one of these in every community, giving older people the options to age in place with the correct wraparound supports. I thank Members for bringing forward this motion and I am happy to support it.

An Cathaoirleach Gníomhach (Deputy Pauline Tully)

I thank the Minister of State. We will now go to the Regional Group to conclude, with Deputies Cathal Berry and Denis Naughten sharing five minutes each.

Deputy Cathal Berry

I am very grateful to be in the Chamber this morning to speak on this very important motion and I acknowledge Deputy Noel Grealish and Maria in his constituency office and her team who did all the heavy lifting to put this together.

To start, I want to double on what the Minister of State said about demographics. People talk about this demographic bulge as though it is a time bomb. I think it is a good thing. It means that about 40 years ago there was a baby boom, because people had great confidence in the future of this country. There are also the high life expectancy rates at the moment, which are top of the class from an EU point of view. That has not happened by chance. Our healthcare system, for all of its imperfections, is doing great work. Outcomes are improving, people are living longer with chronic diseases and we should acknowledge that from a healthcare perspective, and our wonderful doctors, nurses and healthcare professionals.

There has been a lot of talk about childcare and with good reason. It has been said that the State should provide childcare, and that is absolutely true, but to me elderly care is just as important. It is an integral part of the social contract and societal covenant and we have to make sure that elderly care is looked after as well. With regard to other recipients of home care, I would mention the disability sector. I contend that people with disabilities are even more deserving of State support than the able-bodied, because of the particular hand that the lottery of life has dealt them.

The next point I would like to raise is on what I would call the unseen health service, which is so important. We are all familiar with the seen health service.

We have hospitals and lovely primary care centres now, which I welcome. We also have ambulances flying around with blue lights but the unseen health service is just as important, if not more so. That is what goes on in people's homes every single day of the week, and that is why carers are so important. The unseen health service takes huge pressure off the actual health service, at both ends, as Deputy Shanahan has mentioned. It reduces the risk of unnecessary admissions to accident and emergency units but it also facilitates the other end as well, in that it reduces the risk and the likelihood of delayed discharges, because there is a step-down option thereafter. Therefore, it is really important.

I think most people here would agree that the most efficient healthcare bed in this country is the patient's own bedroom, and the most efficient healthcare worker is the one who facilitates the patient to stay in his or her own bedroom. That is really important. Even the most heartless and cruellest bean counter accountant can see the economic benefit and advantage of that. That is before we include the autonomy, independence and dignity of the patient as well.

We have 14 recommendations and I endorse every single one of them, but I will focus on three in particular. The Minister of State rightly mentioned the remuneration package. I thank her for sharing the information on the €28.50 per hour rate. I was not aware of that figure and I think it is intriguing. There is a lot of work we can do there.

The obvious question is whether there is any caveat or conditionality associated with that money before it is handed over. That money is really needed on the front line. It is needed in the bearna bhaoil. I do not want to be pejorative. We do not engage in that kind of emotive language but we do not want it siphoned off by various layers of management. We do not want the CEO of a company to get a brand new company car. We need the money to be spent where it is needed most. That is what the taxpayer wants as well. We could do a bit of work on that, because it will not cost the taxpayer any more money, but we would make sure that the cash gets where it is needed most.

A further point relates to permits for non-EU staff. I presume the Minister of State will agree that there is a wonderful community out there. I know most of my colleagues certainly will. I refer to the Filipino community. They are running our health service. They are in every ward and in every nursing home. They are also disproportionately positively represented among carers. They remind me a lot of Irish immigrants in the past. We went to the US and Australia and we sent remittances home, which is precisely what the Filipino community is doing as well. Not only are they caring for Irish people; they are caring for their own people back in their country of origin as well. I want to put that on the record.

My final point is on carer burnout, which is a huge issue. The Dáil is going into recess next month and while it is not an analogous comparison, there is no recess for carers. We can call it what we like, but it is a 24-7 or a 25-8 situation and they need to get respite. I would be very grateful if the Minister of State could look at increasing the number of facilities providing two weeks or three weeks a year that are so crucially important, both for the patient and for the carer at home.

In summary, before I hand over to Deputy Naughten, I will wrap up by saying that I am grateful for the opportunity to speak. I thank the Minister of State for accepting this motion. The one takeaway for me is the €28.50. We need to get that money where it is needed most, which is on the front line.

Deputy Denis Naughten

At the outset, I thank my colleagues for bringing forward this motion. I thank Deputy Grealish, Maria Burke and Teresa Delaney in particular for drafting the motion. I thank the Minister of State for taking this motion on board wholeheartedly. We all know her commitment in relation to this. That is clearly reflected in the significant increase that we have seen in the home help and home care budget, which has gone up by 58% since 2019, up to €700 million this year. There is no doubt but that the money is there; the difficulty is that the hours that are being committed to are not being allocated. In fact, in 2023 there are just 59 additional hours a day being delivered across this country. That is 37 minutes of additional home help support per day in each primary care network for a population of 50,000. It is a case of the loaves and fishes. That is why we are in a situation where we have 6,500 individuals on waiting lists, trying to access support, including some people that are in hospital at the moment. The reality is that the number of people in the population aged over 65 is increasing and it will continue to increase over the years. In fact, the Central Statistics Office census statistics have shown us that today, there are more than 1 million people over the age of 60, and close to one in four of those are living on their own. We have a severe shortage of carers, leaving vulnerable individuals without the necessary support. This is support that the HSE has independently assessed as being required for these people to continue to live with dignity in their own homes. I refer to people with disabilities and older people. This is down to a chronic shortage of home help hours, which is causing delays in discharging patients from hospital, particularly vulnerable older individuals and that is exacerbating the chaos we have within those health facilities.

I accept that this is a complex challenge and that it is not easy to solve. However, in the interim, at least where we have allocated those hours and where the money is available, could we not provide it to the families to use it to buy in those services, where they themselves can support carers? This has been done in the past for children with profound disabilities. Why are we denying it now to older people with disabilities? Why are we denying it to families with older people? I will give the Minister of State one example. It is a case that I have spoken about to her previously regarding John and Mary. They are a vulnerable older couple living on their own. John's wife requires full-time care. While they have been allocated hours in the evenings and on weekends, they cannot get access to it whatsoever, and they are being denied those supports even though the money is there.

We could also take the case of Brigid, which the other Aire Stáit, Deputy Rabbitte, knows very well. She is a middle-aged woman confined to a wheelchair after spinal trauma. She has been told that she has to go into a public nursing home during the day, seven days a week, because home help is not available. Her husband will have to bring her in the morning and collect her from the public nursing home in the evening, which is going against stated Government policy. It is also going against the Ombudsman's report and the commitments that have been given by the Minister of State, Deputy Rabbitte, not to put people with a disability into nursing homes, yet that is the solution that has been proposed to that family this week.

In addition, we need to give family carers a break. We have 86,000 individuals across this country providing at least 43 hours of caregiving every single week. These people are effectively trapped in their own homes. They need respite. They need a break. We are asking that the respite would be put on a legal footing, in order that every single full-time family carer in this country has a minimum number of days of respite available to them. That is vitally important.

I welcome the fact that this tender process is going on. I also welcome the reassurances the Minister of State has given us on what will be covered in that process. Could she provide assurances to us that in the tender process the whole issue of travel, in particular in rural areas, will be addressed? As we all know, the cost of living has gone up dramatically, as has the cost of transport, in recent years, yet these people are being denied the basic level of cost to cover their transport to and from the work they are carrying out. I want an assurance from the Minister of State that this matter will be addressed.

The Minister of State is correct that quite a number of people have retired out of the system. Some of those people are prepared to go back and to do work, but they have been told by the HSE that their pension will be deducted if they do so under the pension abatement rules. Recently, Bernard Gloster reiterated that before the committee. The reality is that the pension abatement rules were brought in for super well-paid, high-level civil servants; they were not brought in to control the income of home helps. I want the Minister of State to take a leaf out of the book of the Minister for Education, Deputy Foley. As an exceptional measure, she got pension abatement introduced for teachers where there is a recruitment crisis in relation to teaching. Surely to God, if there is a recruitment crisis in relation to teaching, there is a recruitment crisis in relation to home help.

An Leas-Cheann Comhairle

I thank Deputy Naughten.

Deputy Denis Naughten

I think I have one minute remaining.

An Leas-Cheann Comhairle

No, Deputy Naughten is one minute over time.

Deputy Denis Naughten

No. The standing order is for two hours until 12 noon.

An Leas-Cheann Comhairle

I am not going to argue with Deputy Naughten but he is over time. I have been lenient with him. He should draw to a close.

Deputy Denis Naughten

With all due respect, a Leas-Cheann Comhairle, the Minister is not here yet. Could I not finish my point?

An Leas-Cheann Comhairle

I am only asking Deputy Naughten to draw to a close.

Deputy Denis Naughten

So we are going to suspend the House.

An Leas-Cheann Comhairle

No, I am asking Deputy Naughten to draw to a close.

That is what I asked the Deputy.

Deputy Denis Naughten

Pardon?

An Leas-Cheann Comhairle

I asked the Deputy to draw the matter to a close.

Deputy Denis Naughten

I am bringing it to a close.

An Leas-Cheann Comhairle

I thank the Deputy for his co-operation.

Deputy Denis Naughten

My point is that pension abatement rules exist in this respect and I ask the Minister to examine flexibility with regard to it.

The final point I wish to make is that Family Carers Ireland has come forward with an innovative proposal to introduce a non-means-tested participation income for family carers, to move away from the carer's allowance altogether. It has put a very detailed proposal together. I ask the Minister to engage with it on that matter and get a commitment from the Government to establish a high-level interdepartmental group of senior civil servants to investigate how this could be implemented on a phased basis. I commend the motion to the House.

Question put and agreed to.

Dáil Éireann debate - Wednesday, 21 Jun 2023

Home Care and Support Services: Motion [Private Members]

Dáil Éireann debate -
Wednesday, 21 Jun 2023