Struggling to care: New scheme must bring improvements to homecare system

Unattractive, badly paid and undervalued were some of the words used by a working group analysing the homecare system

Sinn Féin's Louise O'Reilly said the elderly and carers are being let down. Photo: Leah Farrell/RollingNews.ie

Frustrations are growing among the thousands of older people waiting on homecare, as the system struggles to prepare for a new funding scheme which could make homecare as accessible as nursing homes. 

Homecare should be the shining centre piece of plans to refocus care out of institutions and into people’s homes. Yet a working group has claimed a carer shortage “militates against the reorientation of care into the community to which the Government is committed under Sláintecare". 

It called for a greater proportion of homecare hours to be delivered directly by the HSE instead of through outsourcing as part of the solution. 

Before the pandemic there were waiting lists too, but it was always blamed on a lack of funding. Now money is washing around the sector but the working group’s report indicates this may have come too late.

Unattractive, badly paid and undervalued were some of the words used by the Workforce Advisory Group on Home Carers and Nursing Home Healthcare Assistants earlier this month. This is not what you expect in such a vital sector for older people. But they echo what carers have told the Irish Examiner.

The challenge now is how to solve this before statutory homecare funding comes in. This scheme is being worked on and will allow families to apply for homecare funding in the way they currently can for nursing homes. 

However, people in the sector argue that without enough carers to deliver the hours, the change may have little impact. 

Sinn Féin TD Louise O‘Reilly previously worked with carers in her role with SIPTU. She said the elderly and carers are being let down.

“You don’t get homecare unless you really need it,” she said. “The waiting lists are people who are waiting for any kind of homecare at all, then others get some but they don’t get enough. If you have half an hour to get an elderly person up, washed and dressed, you can’t do that.” 

The report found staff in private and voluntary companies rarely if ever get paid for travel.

Ms O’ Reilly said:

As a carer, you’ve got to leave one home to get to the next. You’re doing two half-hours but to get an hour’s wages you’ve probably been working for an hour-and-a-half or in some instances even longer because of the travel time.

She is critical of what she described bluntly as “a bad model” of increasingly outsourcing homecare to large private companies. This is a big change from how care used to be offered.

“I worked with carers for years. You couldn’t meet a better bunch of people, mostly women, committed and rooted in their community, always going above and beyond,” she said.

“You’d see them in the supermarkets with three separate piles in the trolley, doing shopping for people even though they didn’t get paid for that.” The Working Group recommended this community attitude be supported by better pay and conditions, with better access to specific kinds of training.

Most care-hours are needed in the morning or night, meaning many home support workers are part-timers. The working group said eligibility criteria for some social welfare benefits acts as a disincentive for them.

Outside of homecare for the elderly, shortages are also emerging in specialised disability provision meaning people, including wheelchair users, cannot get personal assistants at home.

Salaries

Minister of State for Older People, Mary Butler, has highlighted this crisis. She said recently: “We will also continue to invest in home care provision under new tender arrangements, so that we can deliver on our target of 24 million home care hours.” 

Siptu organiser Pat Flannery pointed out while the recommended €12.90 an hour is a welcome step up, it is still less than what the HSE pays its carers; starting at €14.95 and including travel.

Home Community Care Ireland chief executive Joseph Musgrave described the salary recommendation as “challenging” for its members. They want to put the ball back to the HSE to increase funding.

The Home Care Providers Alliance, which estimates it provides over 60% of home care, said the tender for services from January has not yet been published and called for new terms to allow providers to offer the same conditions as the HSE does.

Action is urgently needed, with 970 people waiting for homecare just in Cork and Kerry last month. Carers wash and feed elderly people, helping many hold onto a dignity they would otherwise lose. They offer a kind word in a day which may be lacking in chats.

Carers who have spoken to the Irish Examiner say they love their job and feel hugely valued by clients, but do not see this from employers. Some have moved to Homecare Direct which allows families book a carer through an online platform, but many others are simply fleeing the industry.

This report needs to usher in a fundamental change in how homecare is viewed, and that needs to start happening this winter.