With the recent publication of the draft bill for the Licensing of Professional Home Care Providers, it got me thinking about how the home care sector is changing and how it needs to change into the future.

Up to recently with most of our existing provision, home care was and is, very much characterised by a top-down approach, with corporate providers offering services on their own terms and in ways that suit them. It’s a case of fitting the person needing support into ready-made processes and structures rather than the other way around and having services adapt to the individual’s needs.

The approach by corporate providers and indeed the HSE, is very much we know what’s best for you and we can’t entertain or trust that in fact you might be the expert in your own needs.

This dictatorial approach is finding more and more resistance amongst a Boomer generation of older and disabled people, who are healthier, more educated, more sophisticated and more demanding. A cohort who are demanding change. This is a generation who have redefined many issues throughout their lives and who are used to getting their way.

In addition, in Ireland we recently commenced the Assisted Decision Making Act and put in place the Decision Support Service and the Taoiseach also committed to ratifying the UNCRPD all of which are all about tearing down this top down approach and making sure that people have control over what their support looks like and who delivers that support.

One of the most important pillars in maintaining this top-down approach has been an excessive deference at the altar of safeguarding causing extreme risk avoidance and the squeezing out of any control by people needing support.

The assumption is always that someone needing support is vulnerable and can’t be trusted to make decisions by themselves. There is a certain amount of scaremongering on this issue which suits corporate providers as it helps them maintain their market share and profits.

Change is coming though, through the magical excelsior of choice. Personal budgets, direct payments and technology are the agents that will create and drive choice, bringing a home care sector that is more dynamic, more innovative and more in tune with what the needs of it’s users are.

The unfortunate fact is that home care is a service that people generally dread receiving, I think mainly due to their lack of control in shaping that service. Wouldn’t it be so much better if we could move home care to being a service people want and desire, rather than a service to be avoided.