WE ARE ALL aware of the increasing number of people aged over 65 forecast in our demographics over the coming years and the challenges this will present to our health service. One key challenge is the delivery of home care.

Many of us have had a parent, relative or neighbour who has struggled to get the home support they need. While this presents challenges for our society, there is an opportunity presently to secure a better scenario for those entering this age bracket.

In recent times, both politicians and advocacy groups have called for increased funding for supporting older people in the community, to increase home help hours, and to increase home care packages. There is also a proposal to either open up the existing Fair Deal Scheme to home care or to set up a new contributory funding mechanism for home care.

Not just for our older population

Let’s not forget that home care is not just for our older population but is also for the disabled community, where similarly, the preference is to stay at home, living as independently as possible. Within the disabilities sector there is a push to move people from congregated and residential settings out to the community.

A key enabling factor is the provision of personalised budgets. This is currently being addressed by Minister Finian McGrath’s task force. Such a move would enable this transition of care to the community and also give people more control over the care they receive.

These initiatives are positive and show the recognition that care in the community and home care in particular must play a more important role in our health care continuum going forward.

Already struggling to meet demand

However, they do ignore one very salient fact: that the home care sector is already struggling to meet the existing demand, let alone increased demand created from significantly increased funding.

As noted recently in media, the number of people waiting for HSE free home care supports has climbed to 4,600 as demand for the service continues to grow. The figures – up from 4,381 at the end of last year – show the human cost of the current scheme of home care which, according to the Department of Health, has led to a patchwork system of delivery across the country.

We have various “home care black spots” in the country where it is not economically viable for existing providers to provide care because of the remote locations of the people needing care.

Before we increase funding for home care we must make sure that all providers will be able to increase the services they are providing in line with increased funding. Presently, the home care sector is losing existing carers to other sectors of the economy who pay better wages, offer contracted hours and offer easier work.

So what are the reasons for this lack of suitable carers?

The principle one is that caring is not an attractive career. Carers receive wages barely above the minimum wage, little guarantee of hours and have precious little career advancement prospects. This is due to how care is commissioned by the State and also how the sector is structured.

Secondly, we use our existing stock of carers very inefficiently. It is not unusual for several different care providers to be providing care on the same road with several sets of carers when it should be one care provider covering that road. In addition, carers often spend a lot of time travelling so you can have a situation where a carer is available for 40 hours work but ends up travelling for 15 hours of this.

Thirdly, the sector is not attracting a lot of part-time carers such as mothers and fathers who are free in the mornings before picking up kids from schools who would be available for work if the rewards were better.

Finally we are also losing a lot of care capacity because of the rigid way our social welfare system works and the implications for welfare payments if recipients exceed a certain number of hours of work in a week.

Need for long-term reform

In order to overcome these constraints we need to start to think outside the box.  We need to keep the focus on the need for long-term reform and broaden the thinking beyond money. We need bold solutions that go beyond just plugging the gaps in the system. We need to move beyond conversations about how we fix the current challenges in home care and set out an ambitious new vision for funding and delivering care that is truly fit for the 21st century.

In these situations it is always useful to look at what is happening elsewhere as there is no need to reinvent the wheel if it can be avoided.  A new, successful, approach being seen in the UK and in other countries such as Australia, where there is a movement towards personalised budgets, is the emergence of online platforms that are empowering local carers to deliver care directly to clients where appropriate.

By removing expensive agencies from the equation, these platforms are delivering more competitive prices for families while at the same time better rewards for carers. They are also driving quality by incentivising carers to take ownership of their work.

Michael Harty is founder of Home Care Direct.

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