The turnover of care staff in England is nearly 34%! While there are no official figures for the Irish market, I would be fairly certain that figures here in Ireland are similar, if not even worse.

This has huge implications for the quality of care being delivered, as continuity is one of the principle pillars of quality home care, especially where dementia is involved.

This also raises the question of how we measure quality in home care. No where in the present HSE tender for older persons, is there any measurement of continuity of care or any penalties for excessive turnover of staff.

Supervisions and assessments as mandated by the existing tender become somewhat redundant, when they are carried on on different carers every 2/3 months.

We have seen at Home Care Direct that enabling direct contracting between families and carers, which gets more money into the carer's pockets, makes staff turnover negligent.

Our commissioning system needs to concentrate more on outcomes and less on form filling inputs, that large corporate providers are so adept at filling in. Inputs can be massaged but outputs are a much truer way of judging quality.