A 90-YEAR-OLD woman living in rural Donegal, approved for a home care package three months ago, but is still waiting.
A 50-year-old man in Louth with muscular dystrophy who suffered a stroke and was told by the HSE that a home care package would be arranged to enable him to go home but nine weeks later, he’s still waiting.
These are just two cases raised in the Dáil recently in relation to the so-called “freeze” in home help hours.
The Home Support Service provides help to those who need assistance with everyday tasks, such as getting in and out of bed, dressing and undressing and personal care like showering and shaving.
People aged over 65 are eligible, but sometimes exceptions are made for younger people who may need support.
Often times, patients who are in hospital – or their families – apply for home help hours in a bid to get discharged from hospital, and to ensure there are sufficient supports at home to help with their recovery.
Whether someone gets home help hours is assessed on medical needs, rather than on their means.
Fianna Fáil and Sinn Féin have repeatedly raised the issue of home-help hours in the Dáil in recent weeks following complaints by constituents.
Effort to cut costs
Imelda Munster has accused the HSE of having a “penny-wise and pound-foolish policy” which is “targeting Home Care Packages in an effort to cut costs”.
Speaking about the 50-year-old Louth man, who has been left “languishing in a completely inappropriate setting”, Munster said she received a response from the HSE in relation to his application for home help hours.
The HSE told her the “business case totalling 26 care hours per week was submitted for approval” but “regrettably the HSE is not in a position to fund the business case at this time”.
“Here is a perfect example of the human cost of the cost-cutting measures imposed by Fine Gael. It is an awful indictment on the government and the so-called service providers and it certainly doesn’t follow best practice,” she said.
As the weeks have dragged on, the man has become more and more depressed, she said, adding that he has begun seeing a psychiatrist because “he is feeling hopeless at this stage”.
“Despite the fact that his house has already been fitted out with all the necessary equipment by the HSE, they will not now give him the 26 hour per week home care that he needs so that he can recover in the peace of his own home, because they cannot fund it,” said Munster.
“It costs €5,964 per week to care for someone in a hospital bed whereas to grant this man the 26 hours home care package that he needs would come in at approximately €546 per week,” she added.
HSE denies cut to hours
Despite the calls from Opposition TDs ,the government maintains there has been no “cut” to hours, saying it is merely living within its budget for home help support, which amounts to €450 million.
Health Minister Simon Harris has said that “when it comes to home-care, not only with there be no cuts, there will be additional hours provided this year”.
A statement from the HSE to TheJournal.ie said “there are no cuts to the home support service”.
However, the statement added that it has a “finite” budget that it must operate within, despite demands on the service.
Despite this significant level of service provision, the demand for home support continues to grow. The allocation of funding for home supports across the system, though significant, is finite and services must be delivered within the funding available.
The HSE is required to deliver the service within the available budget, and this means ensuring the hours allocated to the service are affordable. This requires the HSE to manage the budget and service provision throughout the year to ensure a balanced budget for 2019.
The HSE it is “prioritising those requiring discharge from acute hospitals”.
It added that the management of the home support service and budget aims to “improve responses to frail older people in the context of the most demanding times of the year, particularly winter”.
So, what is going on and how many people are waiting for home help?
Figures released to Sinn Féin’s Louise O’Reilly break down the number of patients waiting around the country.
As of 31 May 2019, 6,819 people were waiting for funding for a home support service.
The list comprises patients who have been assessed and approved for home support, but cannot be facilitated as funding is not immediately available.
Figures released in April by the HSE show that, as of March, 6,238 were waiting for home support packages to be funded.
In three months, there has been a jump of 581 people, which O’Reilly argues is evidence of a severe freeze of hours.
The number of people waiting in each county varies dramatically, leading Sinn Féin to describe the system as a “post-code lottery” with who is left waiting depending on where they live, the population in that area and the resources allocated in each community.
For example, the data shows that no one was waiting on home help hours in Louth, which has a population of approximately 128,000 people. Clare, which has a population of around 120,000 has a waiting list of 398 people.
The areas with the highest waiting list includes Dublin North, Dublin North Central, and Dublin North West, which collectively have 1,910 people waiting for their hours to be funded. This figure has increased by just over 100 people in a three-month period, with March data showing there were 1,805 people on the wait list for the area.
Areas such as Dublin South East, Dun Laoghaire and Wicklow have the lowest numbers on the list, with just 208 people waiting for packages as of May 2019. This is a slight increase from March when there were 196 waiting .
So, has there been a freeze to hours?
TDs have been telling the government that the HSE has effectively closed the home help scheme for all new entrants for the next five months. They state they are hearing it day in, day out from their constituents at their clinics.
The HSE has denied this but said local managers had been told to stay in line with their budgets.
O’Reilly said care delivered in the home is the preferred form of care for most older people and their families as it allows them to live with dignity and respect in their own home. It is known that this has significant mental and physical health benefits to being unnecessarily stuck in a hospital or a nursing home.
“The home help service is one of the best value-for-money services in the health service, anyone will tell you that – just look at the figures - the average weekly cost to the health service for an older person to be looked after under the home help scheme is around €165.
“Whereas, if someone is stuck in the hospital and cannot be discharged home because of a lack of home help services it costs the health service around €5,992 per week, and if they are in a nursing home it costs around €1,048 a week.”
Fianna Fáil’s Dara Calleary raised the issue with the Tánaiste on the last day of the Dáil session before the summer recess.
He said families have been advised that home help hours will not be made available to any family unless their loved one has a terminal condition and that must be proved by a letter from a consultant.
He said figures show that in June 18,600 bed days were lost because of delayed discharges from hospitals.
“At the same time one in every 10 applicants for home help support is waiting for some hours. The two matters are connected,” he said, adding “all the figures show that families and loved ones all over the country are not getting those hours”.
Calleary said patients are being left in hospital but would be far better off at home.
Coveney said the government is trying to increase hours and supports for families, but added:
However, we also must keep pace with the significant increase in demand in this area from a funding perspective.
Health budget overruns
Finance Minister Paschal Donohoe also pointed to the health budget’s finances, which already has an overrun.
He said he is “aware of waiting lists, and of families and citizens awaiting services after assessment” but also said there are “budgetary parameters” that must be kept.
Sinn Féin’s Pearse Doherty said he met with the HSE and was told that 250 people in Donegal have been approved for home help packages but are not getting them because the HSE cannot meet the needs of the public “because of the Minister’s demand that it stays within the allocated resources”.
Doherty said other issues are adding to the resource issue, such as transport cost of home helps (home help providers are now being paid for the time it takes to travel between clients).
He said the implementation of that change represents a cut of 1,000 hours per week.
Sinn Fein’s Martin Kenny summed it up recently, stating:
While it may not be officially stated that funding is frozen, it is effectively frozen. People cannot get access to new home care packages because there is not the money there to provide them.
Hours provided
The HSE states that 7,157,942 home support hours were delivered nationally to 52,382 people at a cost of €176.5 million.
Although, the HSE also admits that the “demand for home support continues to grow as the population aged over 65 years’ increases”.
New HSE boss Paul Reid as well as Stephen Mulvany, chief financial officer (CFO) and deputy director general for the HSE have faced robust questioning about the issue.
Mulvany told a recent Oireachtas committee that €150 million extra has been invested in home help over the last three or four years, but added that the HSE is now “requiring our services to live within their budgets for home help. There is more demand for home help services on which, if we had the money, we would want to spend it”.
“Home help is a valuable service and it is excellent for patients. However, if we do not have the money, are we going to spend it on something we do not have rather than simply making best use of what we have? We are not. Our intention is to live within the home help budget and home support budget on the basis that doing so should assist us to secure greater investment in future years.”
People Before Profit Richard Boyd Barrett said that explanation sounds like the HSE is cutting its cloth according to its means, arguing that it is a cut to hours.
Mulvany replied: “That depends on one’s perspective.”
Boyd Barrett said if someone is not getting something, even though they are entitled to it, then it is essentially a cut or freeze which is allowing that to happen.
“It is not that we are not giving it. It is not that we are taking it away. We are just not able to respond to demand that we do not have money for,” said Mulvany.
Because of budget restraints “people who need and have been approved for home care packages will not get them? Is that not the truth of it? The allocation of home care packages will not be driven by medical need?” asked Boyd Barrett.
“I assume that it is not seen as a negative to try to live within the resource. It is a question of making the best use of the resource we have and, given the demands facing us, determining whether we are prioritising and giving that resource to patients, families and service users as best we can. That is what we seek to do.
“We would like to, and could usefully, spend more on home support than we have this year, but there has also been a substantial extra investment of €150 million in home support in the past three or four years. More would be appropriate and of good value to the economy. The fundamental issue is that we have a budget of approximately €450 million for home support, which supports approximately 53,000 people across nearly 18 million hours,” said the HSE CFO.
HSE boss on keeping within the budget
Chief executive of the HSE, Paul Reid, accepted additional requests for services for home help are putting significant pressures on the system.
However, one of his main tasks is getting the overall health budget under control.
“We cannot sustain the level of overrun which happened last year,” he said.
Reid said a certain budget was allocated to home help hours for this year, and the HSE would not be breaching it.
If there are certain service demands or pressures above and beyond that – such as current home care packages where we have demands that are above and beyond even the extra budget we received last year – we are holding to our budget and our commitment that there be almost 17.5 million hours committed – to over 53,000 people for home care packages and to aim to live in that budget.
There are another 6,500 people who are currently looking for enhanced packages, that is extra hours, or new home care packages but we are aiming to hold it within the budget we have. It is meeting those difficult service pressures.
The HSE boss argued that if supplementary budgets are issued to meet demands, the overruns will continue.
“The HSE has had continuous extra allocations of budget and we are still under the service pressures that we have been under for several years. If we stand back from that, if we keep putting more money into the current way we deliver the services we will keep getting the same answer.”
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