Absence of carer checks ‘a risk to elderly’

The HSE is paying millions to homecare providers but the sector remains unregulated, leaving thousands of elderly people at risk of poor quality care, abuse and medication errors, an expert in quality healthcare compliance has warned.

Despite a public outcry five years ago after a Prime Time programme revealed appalling standards of care by a number of private home care providers (caring for people in their own homes), the health watchdog, Hiqa, still has no remit to inspect the sector.

This is despite a commitment in the 2011 Programme for Government “to develop and implement national standards for home support services which are subject to inspection by the Health Information and Quality Authority” and a recommendation by the Law Reform Commission in 2012 that the Health Act 2007 be extended to allow Hiqa regulate professional home carers.

The Department of Health said “primary legislation and resources will be required for the introduction of a statutory regulation system for home care services” and that this “will be considered by Government on a prioritised and phased basis as resources, legislative and planning processes allow”.

John Sweeney, CEO of Healthcare Informed, a company with expertise in international regulatory compliance, patient safety and quality improvement, said anyone could set up a homecare organisation “from their bedroom, tomorrow, if they wished” — even though elderly people availing of the service often had highly complex needs.

This was against a backdrop of the majority of the 50-plus private providers in Ireland not having relevant external quality assurance, Mr Sweeney said.

“We hear advertisements on the radio that various homecare organisations are quality-certified, but in reality, the certification relates to their business processes and systems rather than the actual quality of care,” Mr Sweeney said.

Bláthnait Ní Mhurchú, national service manager with Myhomecare.ie, who are contracted by the HSE to provide services, said vulnerable adults and older persons were “being ignored by the Government by failing to implement minimum standards without delay”.

“When someone is crossing the threshold of your home, you need to be confident that they are going to adhere to quality care standards,” Ms Ní Mhurchú said.

Research shows that those availing of homecare were far more likely to suffer an “adverse event” compared to hospital inpatients – 17% of hospital inpatients versus 66.5% of homecare clients, according to research carried out in 2013 by the Canadian International Journal for Quality in Health Care, Mr Sweeney said.

Mr Sweeney – who will deliver a speech entitled When is Homecare High Risk Care? at the National Healthcare Conference in Dublin’s Convention Centre today – said while media investigations and Hiqa had unearthed recent scandals in a number of residential care homes, “nobody knows what’s happening in homecare”.

The HSE said its approved providers were selected through a tender process in 2011/12 and a new tendering process was “nearing completion”.

It said the 2014 tender requires providers to meet “quality standards” building on the 2012 tender and covering areas such as a client- focused service, appropriate complaints process and training and supervision of staff: “The purpose of these measures is to promote quality and safety.”

It said arrangements for provision of homecare packages (HCPs) by approved providers are “monitored at local level” and that it is “in the process of implementing the Safer Better Healthcare Standards across all health services, including a range of measures to standardise home care services across the country”.

The HSE estimates that in excess of 13,000 people are in receipt of a HCP from approved providers. Among homecare providers in receipt of HSE funding in 2013, were Home Instead Senior Care (€10m); Bluebird Care (€4.6m); Comfort Keepers Ltd (€11m); and Irish Homecare Services (€6.5m).

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