7th February 2009
A report into Ireland’s home care market, commissioned by the Irish Private Home Care Association, claims that the current service provided by the HSE for the care of Ireland's elderly population, suffers from large scale inefficiencies and a complete absence of regulation. This report, undertaken on behalf of private care providers, also claims that an additional 16,500 seniors could be cared for and up to €80 million saved if the findings of the report were implemented.
These claims are based on a calculation of the cost of HSE provided home help services at €29.44 per hour compared to €21.00 per hour charged by private home care providers. The calculation of the HSE hourly rate set out in the report is inaccurate as the HSE currently provides 11.98 million home help hours each year from its annual budget of €211 million i.e. an average hourly rate of €17.61 per home help hour including travel allowances and other non-pay expenditure. The average hourly rate relating to Home Care Packages (enhanced service levels) would be higher as these packages can include weekend and night services together with therapy and nursing care which attract higher salaries.
Of the entire HSE spend on home care, the report revealed that private home care companies provide just 4% of home care services. It claims that by switching from public to private home care providers the HSE could save €79.83million, however, as pointed out above this is based on an inaccurate calculation of the HSE hourly cost of care. Given that the claim that the private sector is cheaper than the public sector is inaccurate, the conclusion that potential savings would mean that the “HSE could offer home care services to an additional 16,500 seniors” is also inaccurate. Furthermore it is important to note that until recent years there was very limited number of private providers in the Irish market.
The involvement of private providers in the market only really began to develop as funding became available for Home Care Packages from 2006 in line with Government policy to support older people at home. Prior to 2006 the HSE relied almost exclusively on its own services, and those provided in some regions by voluntary service providers. Accordingly it was the HSE run and not-for-profit providers, and their staff, that were in place to enable the rapid expansion of home support services when additional funding became available.
The report further outlined how Ireland's home care market is completely unregulated and that despite the development of draft National Quality Guidelines for Home Care Support Services, they have never been implemented. The report’s claim that “This means a total of 57,581 seniors are availing of home care that is not monitored to ensure they receive quality home care services” is inaccurate. While it is acknowledged that there is currently no statutory basis for regulation and inspection of home care services, the HSE does supervise its home help staff. The HSE also provides training and induction for its home help staff, it undertakes Garda clearance for all new home help employees and home help staff are supervised by Home Help Organisers and local PHN staff on an on-going basis.
The National Quality Guidelines for Home Care Support are in the process of being signed off and once this is completed will be rolled out on a phased basis throughout the system. In the interim, commencing in 2010 as part of a national tender system for enhanced home care services as part of the Home Care Packages Scheme, the tender documents incorporate mandatory quality standards.
In addition national guidelines for the standardised allocation of home help hours to individual clients have been drawn up and will be implemented during 2010. This will ensure that clients with similar assessed needs will be allocated a similar level of service, within the available resources, regardless of where they live. Furthermore National Guidelines for the Standardised Implementation of Home Care Packages are due to be finalised in the first quarter of 2010 following publication of the Evaluation Report on Home Care Packages undertaken by PA Consulting on behalf of the Department of Health & Children. These Guidelines, when approved by the Department, will be implemented across the HSE during the second half of 2010.
The IPNCA report further claims that there is no complaints procedure in place for home help clients. However, all clients availing of HSE services, including home help services, have access to a standard process in place for dealing with complaints, comments and suggestions known as “Your Service Your Say” which is managed by HSE Consumer Affairs. There are over 800 complaints officers in the HSE. Literature on this service is widely available from all health service facilities and on www.hse.ie.
- ENDS –
Additional Information
2006 - 2009 Home Help Service Development
The development of this service over the period 2006 to 2009 shows the following:
- €211 million revenue funding (including €55.6 million development funding 2006 / 2008)
- On average, 54,500 people in receipt of home help service at the end of each month in 2008; 10.8 million hours were provided in 2006, 11.78 million hours in 2007, 11.96 million home help hours were provided in 2008 and 11.97 million hours in 2009.
- In the period 2006 / 2008 the number of people in receipt of home help services at the end of each month increased from 41,400 (at 01/01/06) to 55,366 (at 31/12/2008), an increase of almost 14,000 people.
- Total home help hours increased from 10.8 million hours in 2006 to 11.97 million hours in 2009, i.e. an additional 1.17 million hours representing an increase of almost 11%.
2006 - 2009 Home Care Package Service Development
- 2006 - €55m development funding to commence the nationwide rollout of Home Care Packages scheme
- 2007 - €55m funding was again allocated in 2007 plus a further €55m development funding to expand the scheme – total funding available in 2007 was €110m
- 2008 - €110m funding was again allocated in 2008 plus a further €10m development funding to further expand the scheme – total funding available in 2008 was €120m
- 2009 – The HSE Service Plan 2009 provides for €120 million for Home Care Packages in 2009 – i.e. the same level of funding as provided in 2008.
ends