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Changes to Employment Permits ignores care needs of older people in the community
18th December 2019: Nursing Homes Ireland (NHI) and Home and Community Care Ireland (HCCI) today accused the Government of turning their back on the care needs of older people in the community. Both organisations have, on a long-standing basis, advanced to the Department of Health a requirement for the role of healthcare assistant to be removed from the Ineligible Categories of Employment for Employment Permits List on a controlled basis. Both expressed strong disappointment at the exclusion of healthcare assistants from today’s announcement of changes to the employment permits system.
Within its Budget 2020 submission, NHI estimated over 800 healthcare assistant roles are vacant across the private and voluntary nursing home sector. HCCI has moderately projected over the next ten years the home care sector will need to recruit and retain around 18,000 carers to keep pace with projected demand.
Joseph Musgrave, HCCI CEO states:
HCCI and NHI members are feeling the effects of a staffing crisis day after day. As we are now deep in the Winter period, it’s a bit galling to see the HSE 2020 National Service Plan trumpeted to great fanfare but the tools to deliver it once again being denied to providers.
As Tadhg Daly rightly points out, we need to get serious about our commitment to community services. That means this Government putting in place policies to support those services. Instead, we have this decision to not change the employment permits system – despite the evidence – and it’s deeply regrettable.
Tadhg Daly, NHI CEO states:
This Government speaks of moving care provision into the community but lamentably the actions simply do not follow. NHI and HCCI members are working on the ground providing essential healthcare services within our communities. We’re not just witnessing a shortfall but a severe deficiency in the number of healthcare assistants required to meet people’s care needs across Ireland. Only last month, Minister for Health Simon Harris informed our annual conference he recognised services can’t be provided by nursing homes because of staffing issues that were also presenting for the HSE. He stated the work permits issue requires addressing and he was engaged with Minister Humphreys “to look at how we can have a better work permit system for people to work in the nursing home sector”. Have his representations been ignored?
“Previous to his address, the Minister went on record to state a shortage of homecare staff is resulting in non-delivery of healthcare services. And we have the Minister for Older People stating the biggest challenge faced in delivering homecare services is not funding but a staffing shortfall. Furthermore, the HSE communicated with the Department of Health in January to inform a shortfall of healthcare assistance was presenting across older person services. So while our Government publishes reports projecting thousands of additional healthcare assistants to be required in the coming years, it flagrantly ignores the reality that these staff are needed to deliver critical healthcare in our communities immediately. This decision flies in the face of the evidence across our health sector regarding shortage of healthcare assistants and it ignores the very serious implications for our health and social care system.”
1M additional funded hours for home care welcomed by HCCI
1M additional funded hours for home care welcomed by Home and Community Care Ireland
Tuesday 8 October 2019: Today, Tuesday 8th October 2019, Minister for Finance & Public Expenditure and Reform, Paschal Donohoe T.D., announced an increase in home care funding. Home care will receive an uplift from €436M in 2019 to approximately €481M in 2020. In 2019, the HSE plans to deliver 18.2M hours. This additional resource will allow the HSE to fund 19M hours in 2020.
The waiting list for home care, as of end May 2019, stood at 6,819 people[1]. Of these, 1,871 people are receiving some home care hours but require additional support.
Joseph Musgrave, Chief Executive of HCCI, said:
We welcome the announcement today from Minister Donohoe. According to our figures, the current waiting list requires around €50M and 2M hours to fully clear. If the HSE holds the cost of the home care service down, these extra hours will significantly cut that list and end uncertainty for thousands of vulnerable people. This is a hugely positive development and shows commitment from the Government and Opposition parties towards vulnerable people. It is appreciated.
However, as our Pre-Budget Submission explained, the increased funding today will only begin to help clear the historic waiting list. Ireland’s changing demographics mean that we are still in need of €93M in order to stop the waiting list starting to grow again.
Of course, Brexit looms large. But, if things look more certain, Minister Donohoe should consider a supplementary estimate to fully fund home care until the statutory scheme is introduced in 2021.
Whilst this additional resource is welcome, it is disappointing that none of HCCI’s recommendations to increase the labour force appear to be funded. We suggested a range of measures from changes to social welfare rules to more money to organisations like Skillnet Ireland in order to meet the expected demand for 7,000 carers in 2021. We will continue to argue for these measures as, without them, the planned statutory scheme for home care will be hampered from the beginning.
In its Pre-Budget submission to Government, Home and Community Care Ireland (HCCI) stated:
- Service provision would need to increase by 12% to clear the waiting list. This would add over 6,000 people and 2.1M hours, requiring an additional €53.5M (if the cost of the service is kept at 2018 levels).
- The health budget must increase by 3-4% per year to keep up with population growth and ageing. Based on the 2019 budget and service provision, HCCI believes Ireland’s demographics will mean the HSE need to add roughly 2,150 people and 725,000 hours to home support services in 2020, requiring an additional €18M.
- For those receiving home care, service provision should increase by 15% to fully meet assessed need. This equates to roughly one hour extra per person per week for a total of 3.2M hours, requiring €66.9M.
- HCCI’s total financial estimate for 2021 – that is, to clear the waiting list for home care and fully meet people’s assessed need – would mean an increase in the budget of €138M (31%) to a total budget in 2020 of €584M. This will allow roughly 24M home support hours to be provided to nearly 62,000 people.
HCCI published its report roadmap for the statutory scheme, Providing More Citizens the Freedom to Live at Home, for home care last Tuesday, 1st October. This contained several proposals for consideration by Government to inform the development of the statutory scheme for home care. Among these was the estimate for increasing the number of cares, and how the current social welfare rules act to penalise many carers.
65+ year olds willing to contribute 21% towards the cost of a home care package
At our first annual conference today (Tuesday 1 October), which is International Older Persons Day, Home and Community Care Ireland (HCCI) published a report into the planned statutory scheme for home care.
The average financial contribution that people (aged 18-65+) would be prepared to pay to fund a home care package enabling them to remain living in their own home is 19 percent, according to our first public Survey. This increases slightly to 21 percent in those aged 65+.
The HCCI Survey also revealed that 70% percent of older people (aged 65+) said that the ability to stay in their own home in later life would give them independence; 71% agree it would mean they would be comfortable; while 70% believe that it would mean that they would continue to have their freedom. The research shows that people (aged 18-65+) value ‘a sense of community’ (46%), ‘shops’ (44%) and ‘good quality facilities’ (41%) most in their own community, while people aged 65+ years of age rate ‘chatting to neighbours’ (62%) as most valuable to their quality of life.
The conference, which was attended by representatives from across the home care sector including the Government, the HSE, Health Information and Quality Authority (HIQA), NGOs and home care providers, revealed unique insights into home care, how it affects people’s lives and critical elements necessary for the future success of the service.
Speakers at the event included Joseph Musgrave, CEO, HCCI; Senator Marie-Louise O’Donnell, who hosted the event; Seán Lyons, Associate Research Professor, ESRI; Brendan Courtney (who presented the RTÉ documentary ‘We need to talk about Dad’); former Minister Nora Owen whose husband lives with dementia; Sandra Tuohy, Head of Operations & Service Improvement, Services for Older People, HSE; Liam Toland, Home Instead; and Jim Daly T.D., Minister of State at the Department of Health with special responsibility for Mental Health and Older People.
Jim Daly T.D., Minister of State at the Department of Health with special responsibility for Mental Health and Older People spoke at the event:
This Government is committed to supporting people with care-needs to continue to live with confidence, security and dignity in their own homes and communities for as long as possible. The development of a new statutory scheme for the financing and regulation of home-support services is a key enabler towards achieving this aim. We need to ensure that those who need support in their home can access high-quality consistent care in a transparent and timely fashion and I look forward to engaging with the HCCI as we continue to develop the scheme.
Joseph Musgrave, Chief Executive of HCCI, said:
Home care in Ireland is at a critical inflection point. We welcome the Government’s commitment, and in particular Minister Jim Daly’s dedication, to introducing a statutory home care scheme by 2021, a development that will place the service on a legislative setting for the first time. Resolving Ireland’s home care challenge will require a co-ordinated, whole-of-government response and engagement with stakeholders.
The home care service in Ireland is under unprecedented pressure; as of June 2019, 7,217 people are on the waiting list for home care. With one of the fastest growing and ageing populations in the EU this demand is projected to continue growing by 120% between 2016 and 2031.
Accessing support in a person’s own home – a safe harbour from the burdens of everyday life – should not itself become a burden. The benefits include improved quality of care, a more efficient and fulfilled workforce, and significant cost-savings to more expensive acute and residential care settings.
HCCI is asking that the Government start to implement the principles of Sláintecare in Budget 2020 – the most vulnerable people of Ireland should not have to wait until 2021 to see improved outcomes within the home care sector.
Redmond O’Hanlon, aged 64, who lives with Friedrich’s Ataxia and is a wheelchair user also addressed the conference. Redmond has completed a parachute jump each year for the past five years in aid of Ataxia Foundation Ireland:
It is very important to have good mental health and home care means I’m not stressed by the fear of being in a nursing home. I’m able to live in my own home as I’ve had carers from Home Instead for more than 10 years who get me out of bed, wash and feed me every morning. I have a wonderful network of close friends and family who take turns to cook lunch for me each day. Every evening another carer gives me some supper and helps me to bed. During the day I live a free and independent life for 12 hours; I go to football matches and concerts and enjoy the cinema. Home care enables me to live a free and independent lifestyle which means everything to me.
You can access HCCI’s report into the statutory scheme for home care, Providing More Citizens the Freedom to Live at Home, below.
2019 HCCI Statutory Home Care Scheme ReportHCCI publishes Pre-Budget 2020 Submission
Today (Monday 8 July 2019) HCCI published its Pre-Budget 2020 Submission. You can read the full submission below.
2019 HCCI Pre-Budget Submission_FINALHCCI Chief Executive Calls for Overhaul in Homecare
Over the past several days, HCCI’s Chief Executive has been active on media talking about the failures of the current home care system and possible solutions.
On Tuesday 4 June, he appeared on Senator Marie Louise O’Donnell’s podcast. You can listen to the full 40 minute episode above.
On the same day, Joseph was quoted in the Irish Examiner, saying about the current commissioning model for home care packages that:
There is a rush to reply. A provider has a very short time to respond to say they can provide a package. While the HSE does not set official time limits, if providers take more than five minutes to respond, they tend to find the packages are gone.
You can find the full piece by clicking here.
Yesterday (Wednesday 5 June), he was a guest on RTÉ’s Drivetime show on Radio One. You can listen in from 0:25:30 via this link.
Home and Community Care Ireland conducts first ever Annual Curám Baile Survey
Thursday 14 March 2019: Home and Community Care Ireland today released the results of its first ever Annual Curám Baile Survey. Joseph Musgrave, Chief Executive of Home and Community Ireland (HCCI), announced the results to members of HCCI at the organisation’s AGM in Dublin.
The results of the Curám Baile Survey show that:
- HCCI members directly employ 14,000 home care workers
- HCCI members currently care for over 21,000 clients in Ireland
- 13,000 of these clients are funded by the State
- 8,000 of these clients fund their care privately, and the vast majority do not receive any assistance from the State
The Government has undertaken to introduce a statutory entitlement to home care by 2021. HCCI supports this, as well as statutory regulation for home care, and would like all political parties to reiterate their intention to legislate for a statutory entitlement to home care no later than 2021.
Commenting on the figures, Joseph Musgrave (Chief Executive, HCCI) said:
“The Curám Baile Survey, which HCCI has conducted for the very first time, shows how integral our members are to the home care system in Ireland. We are helping to honour the wishes of so many people who wish to be cared for in their own home.
“HCCI’s 75 members provide excellent care 24/7, 365 days per year. It is a challenging job, but one we all know is vital as our society ages. As demand for home care grows, we help maintain the freedom of people to be cared for in their own homes and create employment opportunities for thousands of people.
“These figures also highlight the necessity of HCCI to ensure that the industry is supporting the delivery of quality home care through the provision of a regulated framework. Our members recruit, train and supervise the very best healthcare staff, and we will continue efforts to improve the employment conditions for all staff. To do this we need collaboration and support from the Government, the HSE and of course the staff themselves.
“Demand for home care is expected to increase by around 5% per year for the next decade. HCCI members expect to have an additional 7,000 posts to fill, as well as 10,000 more clients.
“We will continue efforts to ensure that there is a statutory entitlement to home care for everyone; and that we bring in sensible regulation making the care industry a more attractive career for people. We urgently need to draw up legislation for a statutory entitlement to, and regulation of, home care.”
Joseph Musgrave’s remarks at AHCAI Annual Conference
Good afternoon everyone.
I am delighted to attend the Alliance of Health Care Assistant’s Conference, and to see so many people here this afternoon. Thank you to Anne Marie for my invitation, and for her hard work in advocating for HCA’s and spreading word about the Alliance.
By way of background, Home and Community Care Ireland is the representative association for organisations that provide a managed home care service in Ireland. We have over 70 members who directly employ some 12,000 carers serving 20,000 clients. Next to the HSE, HCCI’s members are the largest provider of care in the State.
Although there is plenty I feel we can do now to improve home care, that is not what I am here to speak with you about today. Anne Marie asked me to discuss the future of homecare.
There are two things we know that will greatly affect the future – the statutory entitlement for homecare that the Department for Health is currently working on and, related to that, the Sláintecare reforms.
My understanding is that the Department is proceeding with work on the statutory entitlement for homecare, and that they hope to release more information in Q2 or Q3 this year.
In drafting the entitlement, the Department should, in my view, encompass four things:
- Outline what level, or levels, of home care provision that a person in Ireland can be entitled to
- Explain how this level of home care provision will be funded
- Describe the regulatory model for home care
- Ensure that all this is set against the context of Sláintecare, which means that it should be integrated into the community from the outset
Focusing on Sláintecare, one of my greatest hopes is that we get a true community health service. For home care, this would mean that we should see less home care packages awarded in the acute system – that is, fewer approved at the point where someone has taken a fall or is about to be discharged from hospital – and more awarded as a gradual scaling up of care for the individual.
We have to diagnose, manage and intervene in a more timely way.
Some other thoughts about the future of the service:
- We need to rethink our approach to home care workers. I think it is totally unacceptable that the current health service pays one hourly rate to a home care worker regardless of skill and experience. We need to look at this along with a range of other measures to support home care workers in the job that they do.
- Ireland does not need to reinvent the wheel when it comes to home care. We can draw on international best practice and be innovative in our approach to new technologies. As more and more of the world’s countries have ageing populations, this is an opportunity for us to design and incorporate technology to improve home care services.
- I believe in the power of individual choice, and think it is a good thing that clients have a range of providers. However, to function effectively, clients need to have information in order to make an informed choice. As we develop plans for the future of the service, we need to give careful thought about how we educate people from all sections of our society about home care and their choices.
This is not an exhaustive list about the future of home care in Ireland, but I wanted to share some thoughts with you to get our discussion started.
Thank you for listening to me this afternoon, and I will gladly take any questions that you may have.
Home and Community Care Ireland addresses Joint Oireachtas Committee on Health
On Wednesday 12 December, Joseph Musgrave, Chief Executive of HCCI, addressed members of both Houses of the Oireachtas at the Joint Committee on Health. Representatives from Age Action, the Alzheimer’s Society of Ireland, the Care Alliance and Family Carers joined HCCI at the meeting. During his opening remarks, Joseph highlighted several ways home care service could be improved:
“The current allocation of packages, which is done by fastest finger first as per the HSE’s 2018 Tender, is sub-optimal. HCCI would prefer to see a different model that would be uniform across all CHOs, allow providers to participate in holistic care planning and thus end the widespread practice of inefficient rostering. This would provide more meaningful work for carers.”
He went on to discuss the current shortage of carers in the labour force and that efforts to address this need to combine improvements to their conditions as well as the development of a career pathway.
“We need to change the HSE procurement rules so that the tendering process is a tool to improve the conditions of the workforce as well as deliver value for money. The reality is that the HSE sets the conditions of the market. That carers do not receive travel allowances, except in rare circumstances, is as a result of the procurement practices of the HSE.
“HCCI submitted a case to the Economic Migration Policy Unit to allow non-EEA workers into Ireland to become home carers. We think it is vital that we broaden the base of available workers. In addition, HCCI is currently working on a submission to the Department of Social Protection in the hopes we can end the current system that punishes a worker from providing home care whilst in receipt of state benefits.”
Joseph concluded HCCI’s opening statement with a call to increase dialogue among all those in home care:
“HCCI would like to see a framework that draws on the expertise of the relevant stakeholders and meets regularly to ensure that Sláintecare is a success. We need to clarify how we will fund the expansion in community services needed to support the reforms, as well as start preparing the entire sector so that it is ready to provide this care. The regulation of the home care is vital, and therefore we should be teasing out now what model of regulation will deliver the best outcome in the future.”
You can view a video of the session on the Oireachtas website by clicking here.
HCCI disappointed by lack of detail for homecare in Budget 2019
Home and Community Care Ireland (HCCI) is disappointed with the outcome of Budget 2019. Budget 2019 announced an increase in health funding of €1 billion, to €17 billion in 2019. But there was no detail by the Minister for Finance, Public Expenditure and Reform, Paschal Donoghue T.D. on homecare.
While HCCI appreciates the pressure on resources faced by the Government, Ireland has 6,500 people on a waiting list to receive a homecare package. HCCI is calling on the Government to urgently clarify what the situation is regarding homecare funding in 2019.
Every 15 minutes someone in Ireland turns 65 and every 30 minutes someone turns 80. And according to the ERSI report, Projections of Demand for Healthcare In Ireland 2015–2030, demand for home care will increase by 50% in the next 11 years.
The Minister did not have to announce significant new funds for homecare, although HCCI would have welcomed this. Instead, the Minister could have been creative and better utilised existing funds. One measure would be to end the ring-fencing of nursing home Fair Deal funds and homecare funds. Currently nursing home funding is over double that for homecare.
Joseph Musgrave, CEO of HCCI said: “Money should follow the most appropriate care path for a patient, not some arbitrary route determined by politicians. This Budget was a chance to correct that, and I am disappointed for the sector that the Minister was not more creative today.
“The Budget also failed to address the current social welfare rules, which unfairly penalises care workers.”
HCCI projects that the sector will need 15,000 to 25,000 additional carers over the next decade, and supports a number of solutions to meet this demand. Partly this is a change to social welfare rules and some of the problems could also be addressed by reforming rules around non-EEA workers.