Transforming Home Care in Ireland

As several headwinds batter the homecare sector, Micheal Harty, Director of Home Care Direct, advocates long-term reform which will extend beyond sticking-plaster solutions. Mirroring approaches in the UK and elsewhere, the agency has launched Ireland’s first online care platform.

The recent ERSI report, Projections of Demand for Healthcare in Ireland, 2015-2030 is sobering reading for the health sector and especially so for homecare. As a consequence of our rapidly ageing population, by 2030 demand in public hospitals is projected to increase by 30 per cent, demand for GPs by 27 per cent and the demand for homecare is expected to rise by an enormous 54 per cent.

This is particularly troubling when we take into account the fact that the homecare sector is struggling to meet existing levels of demand with waiting lists for homecare packages increasing at an alarming pace. The most recent figures indicate that there are almost 4,000 people on waiting lists.

We also have various ‘homecare black spots’ in the country where it is not possible or economic for existing providers to provide care, generally because of the remoteness of the person needing care.

There are several reasons for this important capacity issue. The first is that caring is no longer an attractive career. Low wages, little guarantee of work and a limited career pathway means that not only is the sector not attracting new carers but it is in fact losing existing carers in their droves to better-paying sectors which offer more secure work conditions. This trend is being exacerbated with our rapidly improving economy offering plenty of alternative work options for carers.

Secondly, we use our existing stock of carers very inefficiently. It is not unusual for several different care providers to be providing care within a single small geographic area with several sets of carers when, ideally, it should be one care provider covering that area. In addition, carers often spend a lot of time travelling. For instance, it is not uncommon for a carer who is available for 40 hours work travelling during a 15 hour portion of that time, meaning that in actuality they are only delivering 25 hours of care.

Thirdly, the sector is failing to attract potential part-time carers such as mothers and fathers who are free in the mornings before picking up kids from schools who would be available for work if the rewards were better.

Finally, we are also losing a lot of care capacity because of the rigid structures of our social welfare system and also how welfare recipients face a cliff-face drop in payments if they go above a certain number of hours of work.

In order to overcome these constraints, we need to start thinking outside the box. The issues we are facing cannot be resolved by merely increasing funding. We should be keeping the focus on the need for long-term reform and broaden the thinking beyond money. We need bold solutions that go beyond just plugging the gaps in the system. We need to move beyond conversations about how we fix the current challenges in homecare and set out an ambitious new vision for funding and delivering care that is truly fit for the 21st century.

In these situations, it is always useful to look at what is happening elsewhere as there is no need to reinvent the wheel if it can be avoided.

The UK homecare sector is currently going through a similar capacity crisis as evidenced by the recent Panorama programme as well as facing a race to the bottom on pricing with consequent quality issues. The end result is numerous providers exiting the sector or simply going out of business.

In the midst of this crisis there is a very interesting experiment going on in several areas in the UK with what are termed ‘micro providers’ of care. Here the local council and the NHS are tapping into local carers and local care groups to provide care where larger providers can’t or won’t. They are providing care at significantly cheaper rates and providing a highly personalised and quality driven service. Is this something that could work in Ireland? Could we better use local people and local groups to plug gaps in the provision of homecare? Could it also be a way to ensure costs from the larger providers are kept competitive?

Currently, the State commissions half-hourly and hourly visits on a tender-type basis every three to four years. How about moving towards a licensing arrangement and at the same time giving people more control over how, where and with whom funds are spent? Who better to decide the best use of funds than the people in receipt of care?

Another area where a significant impact could be had is by having a more nuanced social welfare regime that encourages part-time carers to take on more work or even move to full time caring which could significantly increase the resources available to support our older and disabled population which in turn means a stronger and better society for all.

Finally, another new approach we are seeing in the UK specifically and in other countries such as Australia, where there is a movement towards personalised budgets, is the emergence of online platforms that are empowering local carers to deliver care directly to clients where appropriate. By removing the expense of an agency from the equation, these platforms are delivering more competitive prices for families and the state while at the same time delivering better rewards for carers. They are also driving quality by incentivising carers to take ownership of their work. This makes caring a more attractive career and moves agencies to operate where they are genuinely delivering an added value.

We have recently launched Ireland’s first online care platform HomeCareDirect.ie. The platform empowers carers and families where appropriate, to work directly without the need or expense of an agency in between.

All carers on the platform are properly recruited having been interviewed, Garda-vetted and reference checked. The carers are all fully tax compliant as the platform handles all invoicing, administration and tax returns on their behalf, allowing carers to concentrate on delivering great care. The platform also provides insurance for all care delivered through it.

We feel HomeCareDirect.ie could also facilitate the HSE to provide a service in those areas where it has been traditionally difficult or uneconomical for agencies to provide care, by outsourcing to local carers in a supervised and transparent fashion. A service similar to the UK micro provider’s initiative mentioned above.

In addition, we feel HomeCareDirect.ie has an important role to play in aiding the roll-out of personal budgets in the disability sector by eliminating the barrier of service users having to become employers.

Home Care Direct is providing a real alternative for carers and families and we are very excited by the positive feedback we are getting from both.

These new ways of working are encouraging a more efficient use of the existing care workforce but also by increasing the rewards available, bringing in new entrants attracted by the better working conditions.

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