Colm Fitzpatrick explores the power of home care
The benefits of getting older are manifold and range from having more space for leisure to spending more time with family, but like any process, ageing is often accompanied with some crucial and difficult problems.
One of the most common complications about getting older is an increased lack of mobility which may be the result of injury, fatigue or general muscle and bone breakdown from overuse. This problem affects everyone in variable ways, and in more serious circumstances, requires the intervention of a helping hand.
Given that the group aged 65 and over grew by almost one fifth – 19.1% – between 2011 and 2016, the demand for physical and mental support for the older generation in only going to increase.
Often, those suffering with mobility issues are placed in a hospital, confined to a bed, or reside in a nursing home under the purview of multiple medical helpers and assistants. While there are certainly benefits to both of these options, another much more desired possibility is Home Care.
The Home Care Package (HCP) scheme is operated by the HSE and aims to help people who need medium to high caring support to continue living at home independently. The scheme is not established in law as it is administrative and so there is no automatic right to it, but there are guidelines and how to qualify for it.
More recently, the Minister of State for Mental Health and Older People, Jim Daly ,TD, launched a report on Home Care to inform the development of a statutory scheme and system of regulation for home-care services. Notably, the Minister said: “Home care is a crucial support for the many people across the country who need extra help to live in their own homes and communities.
However, these services can and must be improved to better meet the changing needs of our citizens, and they must be put on statute to ensure every citizen has equal access to the services.
“For that reason, the development of a new statutory Home Care scheme and associated system of regulation is a key priority for me as Minister for Older People and for the Government. This proposed scheme will allow older people to live longer happier lives in their own homes. We have become very successful as a nation at adding years to life, however we must now work on adding life to those years.”
One of the primary benefits of the Home Care Package is that it’s tailored to the individual’s needs, and may include the services of nurses, home helps and various therapies including physiotherapy and occupational therapy. The individual package varies according to your medical condition, as well as the level of care required and the supports you have already had available to you. The HSE may provide a Home Care Package as a short-term arrangement, for example, when you are recovering following a stay in hospital, during an illness or while you are recuperating. A HCP may also be provided to help you with the activities of daily living over a longer term.
These types of services are highly desirable among older people, despite the fact that many are being placed in hospitals or nursing homes devoid of their wishes.
“The vast majority of older people prefer to be at home. A standard HCP is two to three calls per day (30-45 minutes per call) to help with getting out of bed in morning, dressing, personal activities of living, supervising medications and so on,” says Dr Kevin McCarroll, Consultant Physician in Geriatric Medicine at St James’ Hospital in Dublin.
“An important issue that arises too is when HCP beyond the standard call allocation are not provided and can mean some older people go to a nursing home instead, to essentially bridge the gap in care. However, the average cost of a nursing home is about €45,000 -50,000 per year which would fund in itself significantly more Home Care hours for a significant group of these older adults.”
Dr McCarroll also points out that there are a significant group of patients in hospital who are waiting for Home Care packages that ultimately results in “delayed discharges” and inappropriate longer inpatient stays.
“This becomes particularly problematic at certain times of the year. For example, in the last two months there has been a significant reduction in the availability of Home Care Packages for inpatients in hospital. This is simply because the community division of HSE has ran out of funding – not uncommon after the winter period – and indeed some packages are being recycled, for example, when a person dies or goes to a nursing home from home,” he explains.
He adds that some large hospitals in Dublin have less than 30 hours per week allocated for Home Care packages which is “well below” what is required. This effectively means that some older adults can wait for weeks for discharge until HCP become available.
“Furthermore, when patients stay in hospital for longer than necessary some can become institutionalised which can impact upon subsequent discharge. The hospital division of the HSE has its own budget which does not fund Home Care packages. However, the average cost of a hospital bed day is about €850 adding significant unnecessary expense to the acute hospital system for patients awaiting HCPs,” he says.
But living at home rather than being in a hospital or nursing home isn’t just generally desired by those directly affected, but also family and friends. According to Dr McCarroll, “families prefer their relatives to be at home” where they are familiar with the environment and know that they’re safe and comfortable. He notes that the family size and social situation obviously impacts usually on how much support they can provide in addition to HSE funded HCP’s and adds that “some families also pay privately for their own carers either alone or to supplement that provided by the HSE”.
As the demand for Home Care continues to increase, legislators and representatives of Home Care are trying to meet the desires of those desperately in need and hope to provide a much stronger and transparent system through better funding.
Last month Catherine Cox from Family Carers Ireland said this funding also has to cover related services.
“If somebody – a family carer- is providing care in the home, [there needs to be] a respite provision for the carer to have a break and for the cared for person to either avail of respite in a residential centre or in their home. We also would like to see therapy – vital therapies like speech and language, physiotherapy – included also in Home Care, as well as housing needs.
“So really what we’re saying is we need a holistic definition of Home Care.”
According to Dr McCarroll, there are many ways to improve the Home Care system, but there is still plenty more work to be done.
“I note in recent times Home Care agencies advertising more in the media and the issue of delayed discharges in hospital getting publicity (particularly when there is a hospital bed crisis). The Government has suggested the introduction at some stage of a statuary provision for home care packages that could be accessed by all. At present, the HSE has the discretion to withhold approval for HCP’s. Any statuary provision for HCP’s would probably be a good thing though the devil will be in the detail regarding criteria that would be used to determine eligibility. “It also seems very likely that such HCP’s would be means tested with a financial contribution being made by some older adults.”
For more information about Home Care, see: http://www.citizensinformation.ie/en/