EDITORIAL: Home-care service to aspire to

THE most significant thing that emerged last week from the report on the findings of the public consultation on home-care services, which was opened this weekend last year by Minister of State for Mental Health and Older People, Jim Daly, TD, was the obvious need for a statutory home-care scheme which will provide equity of access to standardised services and for a clear definition of home-care services.

This of course is the ideal scenario – and that which should be aimed for – but realising in practice will be a huge ask of a public health service that is all over the place in the way that it operates. Currently, home-care is provided by home helps, who are rushed off their feet trying to get from house to house and with barely enough time to provide the most basic attention for elderly people availing of the service.

Only for the dedication of some of them, working above and beyond the call of duty, the service would not be fit for purpose, as it seems to operate on a wing and prayer. The commendable public consultation served to confirm a lot of what was already known and the report of it highlighted the big journey that has to be taken to achieve the level of service that is needed to adequately care for older people in their own homes, which is what most of them want where practical.

Older people tend to be most comfortable and at ease in their own homes, which they have worked hard during their lifetime to provide and maintain. When their health starts to fail and they are no longer able to look after themselves properly, especially if they have no relatives in the general vicinity available to help, then the question of going into a nursing home inevitably arises.

While the care in the majority of them is top-class, many elderly people find the loss of their own home environment difficult to cope with and fear becoming institutionalised. Then, there is the navigation of the Fair Deal scheme – which is a good one – but always seems to be trying to play catch-up, which can be frustrating for the elderly people and their families seeking to avail of it. 

People are living longer now and may need to be looked after for a greater period of time; many are going into nursing homes nowadays to live rather than to die. However, home-care packages make more economic sense for the health service when compared with the cost of caring for people in nursing homes, but as the report states, the level of care and the quality of it expected needs to be put on a statutory footing in order to ensure that every citizen has the right to equal access to it. 

Some of the statistics pertaining to the 2,629 submissions received from individuals and stakeholder organisations are interesting, especially that over 80% of them were from females. They were evenly divided about whether home-care services work well alongside primary and community services with 43.8% saying they work well and 43.2% feeling that they do not. 

Almost 55% of respondents indicated that they do not think that home-care services work well alongside hospital services, which is food for thought. The vast majority (93.6%) believe that people in receipt of home-care should have a greater say in the range of services provided to them and a choice in relation to who provides their care.

A similar majority wants a standardised approach to be adopted across the country in relation to access to services, service-provision, application, assessment and appeals processes, and the monitoring of services and – most importantly – that the same national quality standards should apply to all (public, private and not-for-profit) providers of home-care services. To provide such services efficiently, not only will be there be a need for more specialised training for care workers, but the service will need a lot more of them.

As Seán Moynihan, CEO of ALONE, the charity that supports older people to age at home, stated when welcoming the report of the consultation, ‘We hope that, moving forward, home care will be available to older people for the hours they require it – not just for the hours that there is a budget for.’

That is the nub of the matter and begets the need for greater investment in, and for the development of a sustainable funding model for, home-care services. Minister of State Daly will obviously do all in his power to have this funding provided, but it will inevitably take a few years, at least, to have these commendable aspirations on home-care put in place.

In the meantime, the need for home-care packages continues to grow and also for more carers to provide them, so interim measures need to be put in place for those who need them.