Dáil Éireann Debate, Thursday - 7 March 2024
367. Deputy Colm Burke asked the Minister for Health to confirm what action his Department is taking in conjunction with local authorities and community organizations to strengthen the overall support system for individuals receiving home and community care; and if he will make a statement on the matter. [11304/24]
View answerAs Minister of State for Mental Health and Older People, I am committed to supporting healthy and positive ageing throughout the life course, to ensuring that the Sláintecare vision of ‘the right care, in the right place, at the right time’ is realised for all people living in Ireland as they age and to support older people to remain in their own home for as long as possible. This commitment is reflected in a wealth of recent policies, strategies and initiatives that the Department of Health is part of.
Age Friendly Ireland
Since 2009, an Age Friendly programme has been developed in each of the 31 Local Authority areas following application of a consistent methodology and governance structure which supports cities and counties to be more inclusive of older people by addressing their expressed concerns and interests under the eight defined World Health Organization (WHO) programme headings. This WHO informed programme involves a multi-agency, multi-sectoral approach to age-related planning and service provision. Established in 2018 as a shared service function of the Local Government sector, Age Friendly Ireland coordinates the national Age Friendly Cities and Counties programme. The national Age Friendly Ireland Office is hosted by Meath County Council on behalf of the Local Government sector.
The Healthy Age Friendly Homes Programme
The Healthy Age Friendly Homes Programme is a cross-government collaboration between the Department of Health, HSE, and Local Government. It provides a model of care which supports older people to remain in their own homes where possible, to avoid hospital admission through the provision of care in the community, and to ultimately avoid early or unnecessary admission to residential care. Participants can be referred into the programme by family members, friends, healthcare providers, social prescribers, members of the community (for example, Gardaí), or self-refer themselves. On referral into the programme, a Local Coordinator carries out a home visit and conducts a holistic needs assessment for the older person in the areas of health, housing, community and social supports, and assistive technologies. The Coordinator agrees a personal plan with each individual and supports them to access the appropriate services and supports in their local communities.
During the course of the programme’s pilot across nine sites between 2021 and 2023, local coordinators have carried out 4,845 home visits and provided 9,030 supports to older people. An evaluation conducted by Maynooth University has demonstrated improvements in measurements of older peoples’ self-reported health status, quality of life, loneliness, social supports, self-efficacy, and functional ability. A final evaluation report is due to be published in spring 2024.
The cross-sectoral nature of this programme is the first of its kind, with key partners including the HSE, Department of Housing, Local Government and Heritage, Age Friendly Ireland, and SEAI. The approach taken by the programme has been cited by the World Health Organisation as a best practice example for the provision of person-centred integrated care for older people. Most recently, it has also been highlighted as a case study in the first progress report of the UN Decade of Ageing published in November 2023.
I allocated €5.2m in funding in Budget 2023 to expand from nine pilot sites to roll out nationally. This funding provides for at least one Healthy Age Friendly Homes coordinator in each Local Authority to deliver supports and advice to older people nationwide. Following completion of a recruitment campaign, the programme will launch nationally in Spring 2024.
Enhanced Community Care Programme
The Enhanced Community Care Programme, part of overall Sláintecare reforms, aims to increase levels of healthcare provision in the community setting, thereby re-orienting the focus of care delivery away from the acute hospital system, towards general practice, primary care, and community-based services. The focus is on implementing an end-to-end care pathway that cares for people at home and over time prevent referrals and admissions to acute hospitals where it is safe and appropriate to do so and enable a “home first” approach.
Support Coordination Services in the Community
The HSE, in conjunction with ALONE, is continuing the roll out of a Support Coordination Service across the country. The Support Coordination Service will support older people to live independently at home for as long as possible, through support coordination and access to services such as practical supports, befriending, social prescribing, assistive technology, and also the coordination of linkages to local community groups. This service is being led out under the Enhanced Community Care (ECC) Programme.
These services will support the Enhanced Community Care model and facilitate all Community Health Networks (CHN’s) to deliver a coordinated system of care, integrated around older people’s needs, by collaborating with the Integrated Care Programme for Older Persons (ICPOP) teams, and further expand the ALONE Community and Partnerships to co-ordinate and deliver services in each Community Healthcare Organisations (CHO).
The end goal of the Support Coordination Service is to improve the quality of life for older people by improving access to integrated care through working with provider partners, statutory bodies, volunteers, and to provide the right level of care, in a timely manner, in an appropriate location, ideally in a setting of older people’s choice.
Community Specialist Teams (Hubs)
The work that has been undertaken by the Integrated Care Programme for Older People (ICPOP) over recent years, has shown that improved outcomes can and are being achieved particularly for older people who are frail, through a model of care that allows the specialist multidisciplinary team engage and interact with services at a local level, in their diagnosis and on-going care.
This model is now being implemented at scale, with the rollout of Community Specialist Teams (CST) for Older People (ICPOP) to support local services and GPs to respond to the specialist needs of older people, bridging and linking the care pathways between acute and community services to improve access to and egress from acute hospital services.
These CSTs service a population on average of 150,000 and are being co-located together in ‘hubs’ located in or adjacent to Primary Care Centres reflecting a shift in focus away from the acute hospital towards general practice and a primary care and community-based service model. The services are fully aligned with the acute system with clinical governance being provided through the relevant model 4 or 3 hospitals, but with the services being delivered in the community setting.
Home Support
Improving access to home support is a priority for the Government. The Programme for Government commits to "Introduce a statutory scheme to support people to live in their own homes, which will provide equitable access to high quality, regulated home care". The Department of Health is working on four elements that are essential for meeting this commitment: regulation, funding, reformed service delivery including standardised care needs assessment, and recruitment and retention.
The Department of Health is focused on developing the regulatory framework for providers of home support services before year end. It aims to ensure that all service users are provided with high quality, regulated care. It will consist of primary legislation, regulations and HIQA national standards. This work is at an advanced stage. The Department has ongoing engagement with key stakeholders from the home support sector every quarter.
Improving access to home support is a priority for the Government. Since Budget 2021 we have provided approximately €230 million in additional funding. Preliminary data indicates that over 22 million hours of home support were provided in 2023, exceeding the HSE’s target. The HSE is expected to meet its targets again in 2024. In addition, the minimum proportion of new home support hours ringfenced for people with dementia will increase from 5% in 2021 to 18% in 2024.
Commission on Care
The independent Commission on Care for Older People will examine the health and social care services and supports for older people across the continuum of care and make recommendations for their strategic developments. The Commission members, which includes representatives from the community and voluntary sector, provide expertise across the areas of geriatrics, gerontology, health economics, health policy and management, primary care, health ethics, health technologies, and ageing and disability. The members of the Commission are now in place and work has commenced.
