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HCCI calls for a nuanced approach to covid-19 management, and new social interaction guidelines for vaccinated clients and carers
Home and Community Care Ireland (HCCI) is calling on NPHET and the Government to move forward with a more nuanced approach to managing covid-19, and to provide social interaction guidelines for vaccinated home care clients and their carers so that they can begin leaving isolation safely and confidently.
Joseph Musgrave, HCCI CEO, said, “A little over 3 weeks ago, the Centers for Disease Control and Prevention (CDC) in the USA released guidelines for how people who have been vaccinated can interact with one another. Although the vaccine programme in the USA is ahead of ours here in Ireland, we are approaching a point where a large number of home care clients will be fully vaccinated and most home carers will have received at least one dose of the vaccine.
Given this context, the sweeping national approach to managing the virus no longer makes sense. Although there are always risks to manage, and we must be vigilant against new variants of the disease, it is a fact that some HCCI clients have been in isolation for more than a year now. Whilst the resilience of clients and their carers is truly remarkable, this long lockdown has nevertheless had a hugely detrimental effect on their emotional and mental health.
The country needs hope, and leadership. We have endured about the severest lockdown in the developed world and, within Ireland, those who have been among the most isolated for the past year are our older and vulnerable people. As more and more of them receive full or partial vaccination, they must be given guidance as to how they can safely engage with society again. It makes no sense for a fully vaccinated older person to be told that they must remain locked down after enduring this for more than a year. HCCI is ready to contribute to the development of this guidance in any way we can. We understand the severity of the situation – indeed our members have been at the frontline of managing the threat. However, we think now is the time to provide guidelines to allow our older and vulnerable people to safely interact with their family and friends again. It is time for the strict lockdown to be tempered with hope of the vaccine dividend, which we are thankful is coming to home care before most sectors of Irish life.”
HCCI believes the guidelines should include how those who are fully vaccinated can interact with those who have either received one dose of vaccine or none at all. It should also cover interactions between fully vaccinated people to, for example, allow older people to meet in social gatherings together. The advice should include how a vaccinated person can safely socialise indoors and outdoors; and other types of potential community interaction.
Home care sector says up to 800 new carers needed to provide increased home care set out in Winter Plan 2020-21
- Social Care Workforce Review needed to make Home First achievable
- HCCI announce Carers Employment Taskforce to provide a roadmap to improve working conditions for carers
- A new home care study identifies key actions for home care providers, HSE and Government to enhance the service
Thursday 1st October 2020: Home and Community Care Ireland (HCCI), the national organisation representing home care providers, anticipates that approximately 800 new carers are needed in the private sector to provide the additional 4.7 million home care hours as set out in the HSE Winter Plan. HCCI says that Government should, in consultation with the HSE and home care providers, lead a Social Care Workforce review to deal with the recruitment challenge. Also, in a new study released today, it has identified key actions needed to ensure additional carers can be recruited.
HCCI’s annual conference took place by webcast today (1st October 2020) featuring national and international speakers discussing the future of home care, marking UN International Day of Older Persons. Stephen Donnelly T.D., Minister for Health addressed the conference as well as Michael Dowling, head of New York’s Northwell Health. The Limerick native spoke about his experiences leading New York’s response to the pandemic, the heroic efforts of his frontline colleagues and the critical importance of crisis planning.
Joseph Musgrave, CEO, HCCI, said, “We welcome the Government and HSE Winter Plan to increase the state’s home care capacity by 4.7 million hours over the next seven months. This is a big move towards Home First. We hope to see the same priority given to home care in Budget 2021 as in the Winter Plan, and to see home care become the default choice of care. The Plan is great news for vulnerable people and their families and will help to manage hospital occupancy and other healthcare facilities this winter. However, to make all this happen, we need Government to lead a consultation process, along with the HSE and home care providers.”
According to HCCI, the following actions are needed to make Home First a reality:
- A Government-led rapid Social Care Workforce Review to maximise carer recruitment and retention, including changes to the social benefits system so that carers are not penalised for increasing their working hours. Up to 800 new carers will be needed to provide the additional 4.7 million hours, while retaining the 10,000 already employed.#
- Wage protection for carers of Covid-19 positive or suspected clients. As these carers cannot work for other clients they are being penalised for work that entails increased risk.
- Additional support is required to train and upskill new carers (potentially those unemployed due to the pandemic) so that they can be fast tracked into the system in a safe and controlled manner.
- A targeted, rolling testing programme for the home care sector. HCCI has been calling for this since April. Right now, home care providers are having to alert potential close contacts themselves as the national system is too slow.
HCCI’s 15 recommendations are set out in its pre-budget submission, available here.
Musgrave continued, “As CEO of HCCI, I recognise that our sector and HCCI members have a responsibility to improve caring as a career choice. To this end, I have asked former minister and new HCCI board member, Jim Daly to chair a new HCCI Carers Employment Taskforce. The group’s remit is to convene members, carers and other stakeholders to set out a roadmap for how our sector can improve conditions for carers, including how we can move towards a living wage.”
A new study – ‘An inquiry into the lived experience of covid-19 in the home care sector in Ireland’ – comprised of anonymous feedback from 18 home care companies has been published by HCCI to coincide with its conference. The insightful findings concludes with key actions that should be undertaken by providers, HSE and Government. You can access the study here.
Jim Daly, former Minister for Mental Health and Older People, appointed to the Board of Home and Community Care Ireland (HCCI)
Wednesday 26th August: Jim Daly, former Minister for Mental Health and Older People, has been appointed to the Board of HCCI. HCCI is the national representative body for 80 companies that employ 10,000 carers, providing home care to 20,000 older and vulnerable people in Ireland.
Commenting on the appointment, Joseph Musgrave, CEO, HCCI, said: As Minister, Jim was an advocate for reform and for a more community-based model of care. He has also proved far-sighted in his analysis of the changes we need to make in healthcare, such as better housing options for older people. As we prepare plans to cope with covid-19 this winter and deepen our talks with Government and the HSE about how to fast-track Home First, Jim’s experience will be invaluable to our work at HCCI. I am delighted he has come aboard.
Home has proved to be the safest place during this pandemic with peak number of 91 covid-19 cases among HCCI’s 20,000 member base.
Jim Daly said: I am very pleased to accept the invitation of HCCI to join the organisation as a board member and continue my contribution to the development of care of the elderly. I remain very passionate and committed to creating real alternatives when it comes to care of our older people and believe that I can pursue this passion as a board member of HCCI. Contributing to the development of home care in Ireland through my membership of the board of HCCI allows me to continue improving the lot of older people outside of politics. I am very grateful to the CEO of HCCI Joseph Musgrave for providing me with the opportunity to continue inputting to this very important work.
Jim Daly was Minister of State at the Department of Health from June 2017 to June 2020 with special responsibility for Mental Health & Older People. During his time at the Department of Health, Jim significantly progressed a statutory home care scheme which will ensure everyone who wishes to stay in their own home will be entitled to home help by law from next year. Jim was a powerful advocate of older peoples’ right to have real alternatives to nursing home care and, along with developing a statutory home care scheme, he also led on the development of a housing options for older people policy. This policy framework provides real alternatives for older people to ensure they have the dignity of having their own home in which to live out their final years. Jim Daly retired from politics earlier this year and did not contest the 2020 election.
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.