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Homecare sector responds to the need of Ireland’s most vulnerable during the COVID-19 crisis

HCCI home carers to be temporarily redeployed to support the most vulnerable in the community and front-line health care colleagues in nursing homes

Thursday 2 April 2020: Home and Community Care Ireland (HCCI), the national body for home care providers, has agreed to the HSE’s request to accommodate the voluntary redeployment of some home carers to support other front-line healthcare workers in nursing homes and residential care facilities.  As part of measures agreed with the HSE, carers will be temporarily redeployed from caring for low dependency clients in their homes if these clients can be cared for by family members who are at home due to social isolation.

The redeployed carers will provide care for higher dependency clients in their own homes during the Covid-19 crisis as well as provide additional support to nursing homes where individual carers agree.  The HSE will work with home care clients to make the determination on which clients are willing to have home care temporarily suspended.

Part of the agreement includes a change in policy from the HSE. Previously, carers were only paid for the first two days when a client self-isolated. Carers will now receive full payment for any hours in March they would otherwise have lost. The package will be reviewed again in April by the HSE and HCCI with a view to continuing this much needed support for the workforce.

Commenting on the plan, Joseph Musgrave, CEO, Home and Community Care Ireland said: HCCI members and their carers are on the frontline of this pandemic, caring for the most vulnerable in communities across the country.  Our members support them to remain in the safety of their homes as they cocoon and self-isolate. However, we agree with the Minister’s belief that healthcare should not operate in siloes – the more collaborative we can be, the stronger we will be. We are ready and willing to do whatever is necessary to support those who need it most.

However, we want to reassure our clients that carers will only be redeployed where this makes sense for clients and if they have family who can, temporarily, take over the carer’s role,” continued Musgrave. “Once the Covid-19 crisis abates, and people go back to work, we understand from our conversations with the HSE that home care will be reinstated for these clients. We also recognise that redeployment is a decision for each individual carer to make but our members will work closely with interested carers if they wish to take on this temporary reassignment.

Home carers are playing a central role in managing this unprecedented crisis, alongside hospitals, nursing home and other community care supports. The wonderful work they do should be recognised as such. HCCI will continue to work with the HSE and Department of Health to play our part during this national emergency, concluded Musgrave.

Notes:

  • 3,202 clients are self-isolating. This is an increase of 23% on last week (Wed 25 March) and an increase of 357% compared to the week before (Wed 18 March).
  • 11 clients have tested positive for COVID-19 and all have been transferred to hospital.
  • 210 clients are self-isolating who are suspected to have COVID-19 or are awaiting a test. This is an increase of 42% on last week (Wed 25 March) and 488% on the week before (Wed 18 March).
  • 609 carers are self-isolating. This is an increase of 12% on last week (Wed 25 March) and an increase of 454% compared to the week before (Wed 18 March).
  • 416 carers are self-isolating who are suspected to have COVID-19 or are awaiting a test. This is an increase of 6% on last week (Wed 25 March) and 650% on the week before (Wed 18 March).
hcci chief executive

Home care sector seeks financial stability from the Government to maintain frontline capacity amid Covid-19 threat

Self-isolations: up 163% among home care clients and 216% among carers since 18th March

Thursday 26 March 2020:  Home and Community Care Ireland (HCCI) is seeking financial stability from the HSE and Department of Health as the organisation and its members works to maximise capacity in home care so that it is available to those who need it most.  The organisation has outlined a number of challenges to continuum of care in the community:

  • Some carers are applying for the COVID-19 Pandemic Unemployment Payment of €350 per week if their client(s) self-isolates. This is due to the current policy of paying providers for only two days if a client self-isolates voluntarily or upon the advice of public health.  HCCI is proposing that the HSE funds all HCCI member companies for March and April to the budgeted level as per the HSE National Service Plan 2020 and Budget 2020.  HCCI members will thus invoice for their full roster of client hours in March and April, but this will not change the amount – c.€26M – already committed for this purpose.  By ensuring this cash flow to HCCI members, they can guarantee the income of their staff will be above the level of the COVID-19 Pandemic Unemployment Payment and thus ensure they remain available to work.
  • As more and more cases of COVID-19 move into the community, a Government COVID-19 Carers payment of 12% should be awarded to companies to pay their staff who care for people with COVID-19. This should cost approximately €6.24M for March and April.
  • Government to fully fund all new home care packages as a result of COVID-19. This should be in addition to the stated 19.2M hours of home care budgeted for in 2020.

Joseph Musgrave, CEO, Home and Community Care Ireland (HCCI) said:

We appreciate the enormous challenge that the country is facing and HCCI wants to ensure that the home care sector can continue to play its crucial, frontline role in managing the Covid-19 threat.  Our industry has the infrastructure, expertise and motivation to play our part in this national emergency.  HCCI is available and willing to engage in robust COVID-19 planning with the HSE and Department of Health to cope with COVID-19 and the requirement to move people from hospital to the community as soon as possible.

Additional Information

HCCI members care for 17,000 clients who receive publicly funded home care through the HSE’s Home Support Scheme.  HCCI members care for approximately 3,000 clients privately.  To date:

  • 141 clients are self-isolating upon the advice of a medical professional. 2,336 clients of HCCI members are self-isolating voluntarily.  This is a total increase of 163% since Wednesday 18 March.
  • 340 carers are self-isolating upon the advice of a medical professional. 505 carers employed by HCCI members are self-isolating voluntarily.  180 carers are unable to work due to school closures.  This is total increase of 216% since Wednesday 18 March.
  • HCCI members employ 3,400 full time care staff and 9,500 part time care staff.

Home care providers seek emergency measures to continue operating in face of COVID-19 and alleviate pressure on hospitals

Home care providers seek emergency measures to continue operating in face of COVID-19 and alleviate pressure on hospitals

Wednesday, 18th March 2020: Home and Community Care Ireland (HCCI) – the national membership organisation for companies that provide home care services – has today published its COVID-19 home care action plan.  The plan sets out six urgent recommendations for government and the HSE to ensure home care providers can continue to provide essential care services to vulnerable people nationwide during the COVID-19 pandemic.

According to HCCI, home care services will play a crucial role in the coming months in alleviating pressure on hospital beds.

Commenting today, Joseph Musgrave, Chief Executive of HCCI, said:

Our COVID-19 action plan has two key objectives.  Firstly, we need to stabilise our sector to ensure it can fully play its part in the midst of the current crisis.

COVID-19 is an unprecedented challenge to our country, and our normal way of life.  The Taoiseach’s words last night spoke both to, and for, our country.  Our frontline care staff are immensely brave, and particular mention has to be made for the more than 50 care staff that our members employ, who are self-isolating upon the advice of public health.  Their service is courageous.

Over 800 existing home care clients are choosing to self-isolate, including from their home carers.  The current HSE policy is that, where clients choose to self-isolate, including from carers, pay for their carers is limited to the first two days of the self-isolation.  As a result, home care staff whose clients are self-isolating over several weeks are going unpaid.   This threatens their job security and, indeed, the viability of our entire sector.

We propose the current payment for carers whose clients self-isolate be extended from two days to up to six weeks.  The current limit unfairly penalises both carers and clients – who may lose their home care package if they voluntarily self-isolate.  An extended period of pay for carers would be more in line with government announcements on the COVID-19 sick leave policy and COVID-19 Pandemic Unemployment Payment.

The second aim of our action plan is to boost capacity in the home care system, thereby alleviating pressure on hospitals nationwide.  We are calling on government to amend social welfare limits that currently deter people from entering the caring profession or expanding their working hours as carers.  If we can increase capacity in our sector now, we can move more people out of much-needed hospital beds and into home care settings.

 Action Plan Recommendations

The HCCI Action Plan recommendations are as follows:

  1. Suspend the following social welfare rules to free up more working hours among current staff:
    • Suspend the requirement that limits employees on the Community Employment programme to 19.5 hours of work per week.
    • Suspend the rule that employees must earn €184 or less per week in order to retain their entitlement to a Medical Card.
    • Suspend the rule that limits employees from working over 38 hours in a two-week period if they wish to qualify for the Working Family Payment.
  2. Suspend, for the duration of the COVID-19 emergency, the requirement for new carers to shadow an existing carer for five hours.
  3. Amend the current policy of paying providers for only two days if a client self-isolates voluntarily or upon the advice of public health, so that payment is extended from two days to up to six weeks.
  4. Issue more detailed national guidance for home care providers on caring for clients during the emergency. This should include detailed guidance on dealing with clients suspected to have COVID-19 and how to limit the risks to carers at this time.  In tandem, issue a national directive that, if the need arises, sufficient Personal Protective Equipment (PPE) will be issued to all home care providers with attendant training.
  5. Expand Revenue guidance issued on 13th March 2020 to include payments, interest and penalties on PAYE, USC and PRSI, and extend this until the COVID-19 emergency is over. Employers will continue to file all returns as normal.
  6. HSE to immediately settle all outstanding invoices issued by HCCI members. HSE to put in place a robust invoice payments system that will operate efficiently throughout the period of the COVID-19 crisis.

Over the past week, we have been attempting to engage proactively with the authorities to prepare a robust plan for the home care sector in the face of the COVID-19 crisis,” said Joseph Musgrave. “We have been in constant contact with the HSE, the Department of Health and our own members since the onset of COVID-19.  To date, the authorities have issued some basic clinical guidance to home care providers and announced the damaging self-isolation pay policy, which caps pay at two days for affected carers.

“We all have our part to play in this national emergency. HCCI’s proposals are ready for implementation, subject to government agreement.  We are calling on government to implement our action plan now to ensure our sector is operating at full capacity and effectiveness when it is needed most.

hcci chief executive

HCCI asks all parties to sign the Home Care Promise and clear waiting list for home care

Wednesday 29 January 2020: Home and Community Care Ireland (HCCI) today made its election priorities public with the publication of the Home Care Promise.  HCCI is asking each Dáil candidate running in Election 2020 to commit, if elected, to:

  • Increase funding to provide 6M new home care hours by 2022 to meet rising demand and clear the current waiting list
  • Commit to legislating for a statutory entitlement to home care in 2021
  • Make home care work a protected and licensed profession to increase career opportunities for hard-working carers
  • Back the phased creation of a quality ratings system for all home care providers, including the HSE’s service, to help the public make more informed choices
  • Acknowledge the vital contribution of private home care providers
  • Include Health Care Assistants on the Critical Skills List to help alleviate the recruitment crisis

More than 1,000 copies of the Promise card have been distributed across the country to HCCI’s 80 member companies.   HCCI members will be presenting the Home Care Promise to Dáil candidates across Ireland in the final 10 days of the Election 2020 campaign.

Commenting on HCCI’s Home Care Promise, Joseph Musgrave (Chief Executive, HCCI) said:

Every 15 minutes, someone in Ireland turns 65.  Every 30 minutes, someone turns 80.  It is a positive thing that more of us are living longer, and healthier lives, than ever before.

“But Ireland’s home care service is under enormous pressure.  We have over 7,200 people on a waiting list for care, an increase of 125% since 2016.  Funding has gone up by 53% in that time, which hasn’t been enough to keep pace with demand.

“Therefore, we are asking all Dáil candidates to sign up to the Home Care Promise.  The 80 companies HCCI represents, the 20,000 people they care for, and thousands of Irish families who are looking for care deserve no less from our politicians.

2020 HCCI Home Care Promise

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 Report FINAL

HCCI 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.