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More than one fifth of all adults plan to cocoon for the foreseeable future, according to HCCI research
- 65+ year olds willing to contribute 25% towards the cost of a home care package – an increase of 4% from last year’s survey findings
- Family (76%) and health (59%) identified as the two most important things in life
- 15% of all adults planning to cocoon longer term and 23% of 65+ year olds say home care would support them to do so
- HCCI calls for home care pilot scheme[1] to be activated as soon as possible
Home care is more than just surviving in the home; it can and should support living in the community, says HCCI Chief Executive
More than one fifth (22 percent) of all adults (18-65+ year olds) are planning to cocoon for the foreseeable future according to the annual Home and Community Care Ireland (HCCI) Survey. Home care help was identified by 15 percent of all adults planning to do so as a support that would make cocooning feasible longer term. This increases to 23 percent for 65+ year olds. Home deliveries of shopping (62% for all adults, 72% for 65+ year olds), virtual social meetings with family or friends (61% for all adults, 66% for 65+ year olds), access to safe quality of life services such as hairdressing (46% for all adults, 55% for 65+ year olds), virtual medical consultations (43% for all adults, 50% for 65+ year olds) and home deliveries of medication (41% for all adults, 45% for 65+ year olds) were also identified as important cocooning supports.
The findings also reveal that the average financial contribution people are willing to pay to fund a home care package enabling them to remain living in their own home is 25 percent – an increase of 6 percent from last year’s survey findings. 65+ year olds would be willing to contribute the same amount, up 4 percent from the 2019 survey findings.
Joseph Musgrave, CEO, HCCI said: The current nursing home centric-model is broken. COVID-19 has been to healthcare what the financial crisis in 2008 was to banking – a massive wake-up call. We need to get creative about how we better care for vulnerable people. This survey shows that people need more supports to live in their communities, and not just survive at home.
We should ensure a closer integration of technology supports for all vulnerable people, and a more responsive, adaptive, home care service. Work stopped on the statutory home care pilot when COVID-19 swept onto our shores. Let’s get that back up and running, and look at an imaginative pilot scheme to test out new approaches.
Musgrave added, Home is proving the safest place to be with 66 cases of the virus recorded among HCCI members’ 20,000 clients at the moment. This low rate of infection is testament to the dedication of home carers, home care providers and the Irish people. This is the great unsung success story of the pandemic – home really is the safest place to be.
HCCI is calling on the Government to activate the home care pilot programme as soon as possible and establish a steering group for this scheme so that the home care service of the future can be developed.
[1] The home care pilot was being developed by the Department of Health, the HSE and stakeholders prior to the onset of COVID-19. Four pilot sites were identified for the scheme to be tested but the locations or pilot details have not been published. Work has been paused since the start of the COVID-19 outbreak.
HCCI calls for proactive testing for elderly and vulnerable to keep low rate of infection in home care
Wednesday 13th May: Home and Community Care Ireland (HCCI) is calling on the Government to implement a proactive testing regime for home care clients to ensure that home remains the safest place during the COVID-19 pandemic. As of Sunday 10th May, a total of 73 of HCCI’s 20,000 home care clients have tested positive for COVID-19. This is an increase of 35% since last week, highlighting the urgency of a testing plan for home care clients.
Joseph Musgrave, CEO, HCCI said:
Home is so far proving the safest place for people to be – however, we cannot be complacent. We know that the virus presents in atypical ways among the elderly and vulnerable, therefore we cannot wait for the usual symptoms before testing. The roll out of a proactive testing regime for home care clients is crucial to keep the rate of infection among vulnerable home care clients as low as possible and to secure the last frontier of the pandemic. As the lock down eases and people begin to move about more freely it is vital that we have a testing programme for home care in place to ensure we protect those who need it most. HCCI members, many of whom employ qualified nurses in their organisations, could potentially support the roll out of a testing programme. We are ready and willing to work with the Minister and the HSE to make this happen.
Musgrave continued:
COVID-19 has changed the paradigm for how we care for vulnerable people. Legislation for a statutory home care scheme is due to be delivered by the Government in 2021, an important element in offering individuals and families a real choice about their care. In light of COVID-19, and that our homes are the safest place to be, the statutory home care scheme is more urgent than ever and work needs to continue to empower vulnerable people to make choices about their care.
Crucial that Government focuses on Home Care – the last and sustained frontier in the battle against COVID-19
58 of Home and Community Care Ireland’s (HCCI) 20,000 home care clients have tested positive for COVID-19 but the virus will be in our communities for months or years to come. This makes home care both the last and the sustained frontier in the battle against Coronavirus. HCCI, the representative body for home care providers, met with Minister for Health, Simon Harris T.D., Minister of State for Older People, Jim Daly T.D. and HSE officials on Wednesday 29 April and agreed to a four point ‘Home Care Plan’. HCCI is confident that the HSE and Department of Health will quickly operationalise what was agreed at the meeting to ensure as many vulnerable people as possible can remain in the safety of their homes and that home care provision is supported in order to maintain the current low rate of infection.
Joseph Musgrave, CEO, HCCI said: “58 of our 20,000 clients have so far tested positive for COVID-19. Home is so far proving the safest place for people to be – but we cannot be complacent. Building on the meeting with the Minister and the HSE, we need to quickly lock in what was agreed, both to keep the rate of infection among vulnerable home care clients as low as possible and to secure the last frontier of the pandemic. An important part of this work is looking to the future and how we can maximise home care capacity as we adapt to the ‘new normal’ and continue to keep COVID-19 at bay. We welcome the Minister’s support for home care and his recognition of the wonderful and important work that home carers are doing right across the country.”
The four elements of the Home Care Plan discussed during the video conference are pay stability for the home care sector; cost and procurement of PPE; increased testing of home care clients and carers; and progressing work on the development of the statutory home care scheme as soon as possible.
Pay Stability
It was agreed that the HSE will provide more stability on the pay policy for cancelled hours, which currently represent 20% of hours normally serviced by HCCI members. The HSE said they will give the sector more notice of the pay position to facilitate planning and to maximise home care provision. HCCI care staff whose clients are self-isolating will be available to support colleagues in the nursing home sector under the terms of the voluntary staff redeployment agreement of Tuesday 28th April. This is understood to be a temporary and extraordinary measure with home care provision remaining the first concern for HCCI members.
PPE
As of Wednesday 22nd April, the National Public Health Emergency Team (NPHET) recommend that face masks should be worn by all home care workers. HCCI, HSE and the Department of Health will develop a transparent mechanism for the supply of face masks in the sector.
Testing
As of Sunday 26th April, just 58 of HCCI’s 20,000 clients have tested positive for COVID-19. It was agreed during the meeting that testing for home carers and home care clients would be scaled up to support maintaining this low rate of infection. HCCI members, many of whom employ qualified nurses in their organisations, could potentially support the roll out of testing.
Future of Home Care
Legislation for a statutory home care scheme is due to be delivered by the Government in 2021. While it is understandable that work has been paused on this during the present crisis, HCCI is urging the Government to resume work on this as soon as possible.
Musgrave continued, “COVID-19 has changed the paradigm for how we care for vulnerable people. The statutory scheme for home care is an important element in offering individuals and families a real choice about their care. Many people will want to remain in their home to receive care well in advance of a new home care scheme in 2021. In light of COVID-19, and that our homes are the safest place to be, the statutory home care scheme is more urgent than ever and work needs to continue to empower vulnerable people to make choices about their care.”
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).
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:
- 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.
- Suspend, for the duration of the COVID-19 emergency, the requirement for new carers to shadow an existing carer for five hours.
- 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.
- 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.
- 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.
- 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 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:
2020 HCCI Home Care PromiseEvery 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.
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.