The right to home care for everyone

By Joseph Musgrave, Chief Executive, Home and Community Care Ireland

Communities across Ireland have long recognised the value of home care. For centuries, this care was provided by families and there are still around 500,000 family carers who assist their loved ones every day. Some would have it no other way.

For an increasing number of people, though, there is a need for a formal service and home care has started to take a central place at the heart of our healthcare model.

Home and Community Care Ireland (HCCI) is the representative body for providers who offer a managed home care service. Our members, and the wonderful 10,000 carers they employ, enable elderly and vulnerable people right across the country to remain in the safety of their own homes and communities.

Our research shows how highly this is valued. 70 per cent percent of older people (aged 65+) believe that the ability to stay in their own home in later life would give them independence; 71 per cent agree it would mean they would be comfortable; and 70 per cent feel that it would safeguard their freedom.

During this pandemic, we have not seen Covid-19 cases spike beyond one per cent of our members’ client base of 20,000 older and vulnerable people. This is a testament to the hard work of HCCI members, their staff and families taking measures to protect their loved ones.

These facts show the resilience of home care, and the need to finally place it on a statutory footing. HCCI welcomes the efforts by deputies Colm Burke and Emer Higgins to bring coherent regulation to the sector. They are notable for the dedication and understanding they bring to the issue – home care is lucky to have deputies like them willing to put so much time into improving access to the service for us all.

HCCI has also been calling for regulation for years, and since I became CEO in September 2018 it has been a core aim of the organisation.

To understand what regulation means, it is important to know where we are.

Contrary to Deputy Burke’s belief outlined in his recent article in the Cork Independent titled Home Care Bill seeks to regulate sector on 25 February, that “an unregulated home care system means it is without insurance, garda vetting, employment standards, or any oversight, raising issues around the quality of care”, all home care providers who are awarded work by the HSE must comply with a set of standards laid out by the HSE.

Providers can be audited against these standards by the HSE’s in-house audit teams, although the HSE themselves are not subject to this level of oversight. Providers must ensure they have insurance, that their staff are garda vetted and that they have robust procedures in place to handle client complaints, should any arise.

Regulation should equalise the obligations – that is, both the HSE and non-HSE contracted providers should have to meet standards and be subject to independent oversight to ensure they comply. Regulation should enhance the existing patchwork of regulation to make sure our loved ones receive the very best care.

Regulation should rate providers, much like hotels, so that people can make informed choices about which provider they want to give them care. It should also deal with the informal care sector – that is, hiring a carer directly – as they are not subject to the same high standards as managed home care providers.

We know that home care is less expensive than alternatives, such as keeping people in hospital, and it is the stated preference of people to receive care in their own home; 71 per cent say this, according to a poll by HCCI. Regulation needs to improve access to this fundamental right, laying out in law how any person in the State can access high-quality, affordable, home care.

However, regulation needs to be careful not to extinguish the humanity that lies at the heart of the service. It needs to recognise the individuality of every home care client and be flexible and adaptable to a person’s unique needs. It cannot become so complicated with red tape that carers, clients, and providers fear every action they take could fall afoul of a regulation.

I am privileged to hear inspiring stories every day. There was a carer who walked over a hundred kilometres a week during the first wave of the pandemic instead of taking public transport so that she avoided any unnecessary contacts.

There’s an 80+ year old client who, thanks to quality care from their carer, can continue recording podcasts. The family devastated at a surgery gone wrong when a husband went from being healthy to needing 24/7 care – but who drew some solace from excellent home care staff stepping in to help.

HCCI recognises that more needs to be done to support our carers. To that end, I have established a Workforce Review Group, chaired by our board member and former minister for older people, Jim Daly. We are committed to enhancing caring as a career and supporting our carers to continue to do their vital work, although we will need the support of Government and the HSE to achieve this.

A right to home care, properly regulated and building on what works right now, is vital. The Government is currently promising this by the end of 2022 – we appreciate the support of deputies Burke and Higgins to hold it to that timeline.

We also need our representatives to understand that home care exists to enhance human dignity, and that any regulated right to home care needs to keep that principle central.