I thank Senator Wall for raising this important issue. As he is aware, for many years the main focus on care of the elderly has been to enable older people to continue living in their own homes for as long as they wish and are able to do so. It is recognised that the home help service contributes enormously to the maintenance and dignity of frail and dependent older people at home.
In December 1994, the National Council for the Elderly published a report entitled Home Help Services for Elderly People in Ireland. I welcome this report and the fact that the research undertaken points to the strength and value of the home help services. For example, the report finds that the number of home helps has increased from just over 5,000 in 1978 to more than 10,500 in 1993. The report also records that the satisfaction of clients with the home help service is overwhelming, while a further strength of the service is the speed and flexibility with which a person in need can be supplied with a home help. While it is acknowledged that the report draws attention to the problems with the home help service, we should not underplay the real strengths and benefits of the service.
Under section 61 of the Health Act, 1970, health boards may make arrangements to assist in the maintenance at home of persons who, but for the provision of such a service would require to be maintained otherwise than at home. This section empowers, without obliging, health boards to provide or support services such as home help, laundry and meals.
Health boards are not limited in the categories of persons they can assist at home and may charge for the service. The services are, however, usually provided free or at a nominal charge. The health boards consider individual cases on the basis of need and in the light of resources available to the scheme. In practice, about half of the home helps and the vast majority of meals are provided by voluntary organisations with funding from health boards. The remaining home helps are employed directly by health boards.
The balance between voluntary and health board input to the home help service varies from health board to health board. Home helps are predominantly part-time, though a number of full-time home helps and home help co-ordinators are employed by some boards. Voluntary involvement also strengthens the sense of neighbourly obligation towards the elderly and encourages the self-development of the home help.
The home help scheme originated as a "good neighbour scheme". Volunteers who work as part-time home helps are paid a stipend or gratuity for the service they provide. As operated in many areas, this is meant only as a contribution and is not intended to compensate fully for the task undertaken. The service is essentially a local client based service.
As mentioned earlier, the underlying philosophy governing the operation of the home help scheme is that it is a community based good neighbour scheme which would attract people primarily motivated by the desire to engage in community services. The remuneration of volunteers does not come within the real meaning of conventional employment. Income in respect of services provided does not come within the scope of the PAYE code. It must also be noted that income earned by the home help is not taken into account for the purposes of a means test where a home help, or the spouse of a home help, is in receipt of a means tested social welfare payment.
The rate paid to part-time home helps employed throughout the country varies from place to place and is related to the particular requirements and type of task undertaken in each case. The current rates vary from £1 per hour up to £2.61 per hour.
The issue of payment for part-time home helps has been raised on a number of occasions in the recent past. My Department, in consultation with the chief executive officers of the health boards, is considering a number of aspects of the home help scheme, including the overall organisation of the service and the variations from board to board. I hope to be in a position to announce details of an in-depth review of this service in the near future.
As regards Senator Wall's points, which were well made, I would like to assure him that this sort of situation has come to my notice as a constituency Deputy. It will certainly be discussed in that context and I will come back to him in that regard.
In the recently published health strategy, Shaping a Healthier Future, the role and potential of the home help service in adding to social gain is acknowledged. Indeed, the strategy states that over the next four years priority will be given to strengthening the role of the general practitioner, the public health nurse, the home help and other primary care professionals in supporting older people and their carers who live at home. I would like to assure the Senator that I am committed to this aim.
The Seanad adjourned at 4.35 p.m. until 2.30 p.m. on Wednesday, 22 March 1995.
