THE HCCI FUTURE of Home Care Study paints a stark picture of how unprepared we are to face Ireland’s ageing population and the significant increasing demand for home care support this will create.
Our new nationally representative research shows that 59% of Irish people think they will need care in older age but just 46% save for future care needs. It also shows that, of those who believe they will need care in older age, 66% are worried about not being able to pay for future care and 74% cannot afford to save for their future care due to cost-of-living pressures. Almost one quarter (23%) of those who say they will need care said they will save when they are older.
The 2022 census figures show that the highest increase in our population – 26% – has been in the over 70s age bracket. Ireland is entering a demographic sea change. Longevity is to be celebrated and can deliver so many positives for families and communities, but it also means that we must shift our political and social priorities to reflect this new reality. Failure to grasp this issue will lead to a generation of our older and more vulnerable being left to fend for themselves in providing for their care.
Budget 2024 for home care is very disappointing and does not give much hope for the near future. It is a step backwards for home care in Ireland. There is no increase in funding to boost home care hours. This means an almost inevitable increase in waiting lists, which already stands at 6,200, no mileage for carers, no indexation of the living wage and no funding to implement Cross-Departmental Strategic Workforce Advisory Group recommendations such as training, career structures and social welfare reform.
When asked how they would access care in older age, 37% said they would live at home with home care support, 24% said they would live with family, 22% thought they would live close to family with their support and just 17% agree that they will need nursing home care.
Only 34% have confidence in the HSE to deliver care in their older years.
This is both unsurprising and an inditement of the HSE itself considering more than one-third of those on home care waiting list are waiting over two years.
People are not saving enough to provide for their future care, nor do they trust the HSE to deliver it when they need it. We need a new way, a new partnership between all sectors providing care in Ireland, to forge a new path for our home care service. We need to plan and be imaginative and we need to put finances and resources behind our home care service. It is simply immoral to do otherwise – short-term or even medium-term measures will just not cut it anymore.
When asked how much they would need to save to have good quality care in older age 21% believed between €0 – €4,999 per year, 26% agreed between €5,000 – €9,999 annually while 53% believed they would need to save more than €10,000 per year – which is closest to what it would cost in reality in today’s terms for a basic level of home care support.
A key part of reimagining home care support will involve making home care a viable career while also addressing continued issues with the basic remuneration package for carers. We need to value our carers, not just say that we do. Working in home care is extremely rewarding, meaningful and important. But it is also a difficult, demanding job.
Thanks to the advocacy of Home & Community Care Ireland (HCCI), carers are now being paid the Living Wage and travel time under the new Home Care Authorisation Scheme agreed between the HSE and home care providers. But more needs to be done. We need to index the Scheme’s rates so that they match inflation in the Living Wage and pay mileage to all carers. Critically, we need to develop a career path for home care workers with different pay rates reflective of skill and experience.
Private home care providers are not the enemy but a key part of the solution. Private home care companies have delivered approximately 75% of the increased home care hours over the last five years. We need to capitalise on the ability of the private sector to increase home care capacity.
The HSE’s own service has a key role to play. However, instead of competing against the private sector, we should reorientate it to be a true public service. We should introduce a maximum waiting list target: no one should wait more than 14 days to be discharged from the hospital back to their own home when they are deemed fit to do so. Where the private sector cannot meet this target, and in rural or hard-to-reach areas, the HSE’s service should provide care.
The public sector model is different to the private one – we should recognise the strengths of each and deploy them to the best effect. We need a new partnership between all parts of our economy – the State, the private and non-profit providers – to meet the challenge ahead of us. This will mean expanding and rationalising the outsourcing of care, underpinned by a strong regulatory regime to assure the Government and clients of the quality of their care.
The Government needs to stop prevaricating and – finally – legislate for a right to home care. This has been promised for more than five years now. Giving everyone a legal right to home care will mean that we will have to reimagine our home care service so that it is capable of delivering for all those who want it – and all of us who will want it in the future.
We need to have a national conversation about this. There is an opportunity to have just such a national conversation through the recently announced Commission on Care. We need a coordination function which would draw different Government agencies, the HSE and non-state actors like HCCI, together.
It is wrong that the choice for many older people is to either enter the Fair Deal scheme or stay stuck in a hospital. We need to think big, we need to think creatively and we need to plan for a future where demand is at an all-time high. Sticking plaster solutions – which is what we have to date – cannot solve the enormous home care challenges we face. But together, we can achieve a better tomorrow for home care in Ireland – one that is more responsive, of higher quality and that is set up for success.
Joseph Musgrave is CEO of Home & Community Care Ireland (HCCI). HCCI is the representative body for the home care sector. The HCCI Future of Home Care Study is a nationally representative research sample carried out by iReach research. Fieldwork was undertaken from the 21 to the 28 September 2023.
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