'Bureaucratic nightmare' undermining plans to increase homecare support

With over 57,000 older people receiving homecare supports, this funding is expected to make it easier for more families to take up this option — similar to how the Fair Deal supports nursing home residents. File picture

Plans for statutory funding of homecare to increase access to this service are “mired in a bureaucratic nightmare”, according to a body representing private homecare bodies.

With over 57,000 older people receiving homecare supports, this funding is expected to make it easier for more families to take up this option — similar to how the Fair Deal supports nursing home residents.

Long waiting lists of almost 6,000 people, including people waiting longer than nine months across Cork and Kerry, indicate the urgency of these changes. However, Joseph Musgrave, CEO of Home & Community Care Ireland (HCCI), expressed frustration at the pace of reform.

“Discussion from 2017 to 2019 focussed on ways to fund homecare and give people a legal right to homecare but somehow, in recent years, these big ideas have been forgotten and we are mired in a bureaucratic nightmare of technicalities and regulations development,” he said.

“The current system is unfair; where a person lives is more a predicator of how much homecare support they receive instead of their actual homecare support needs.” 

He said an internal HSE review of four pilot schemes shows the plans are receiving “limited engagement” from key divisions within the health body. The review also shares frustrated comments from people using the service.

One person said even though her parent should get 60 minutes of care, it is usually 40 to 50 minutes only and another said the home support worker is “looking at their watch all the time”.

Another person said they are very aware the workers are under time pressure to get to their next client, and said: “You feel that too, ‘God, I can't keep them any longer, off you go’. I feel guilty.” 

This review, released to HCCI under the Freedom of Information Act and seen by the Irish Examiner, indicates a digital assessment tool, the interRAI, is causing some disquiet.

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HCCI are now concerned there is a lack of political will behind this scheme and Mr Musgrave described what they see as “a lackadaisical approach” to implementing the various steps required. He was critical of “a failure” in leadership to “deliver the cultural change necessary for the statutory scheme to happen”.

However, the HSE insisted the plans are a priority for them and the Government. A draft General Scheme for the legislation on licensing of homecare or home support providers was published last month, a spokesman said.

“The Department of Health expects the legislation to be enacted this year, with a proposed commencement period of up to two years before the regulations come into full effect for all providers,” he said.

These regulations have been drafted and will be finalised for approval after the legislation is enacted, he added. The regulator Hiqa (Health Information and Quality Authority) will send out draft national standards for home support for public consultation later this year.

In relation to the digital interRAI tool, he said this is used internationally. It is accepted while it is time-consuming the standard of assessment provided is high, he said. 

Procurement has begun for a digital case management platform and e-rostering system for the home support and Fair Deal schemes, he also said.