Before the COVID 19 crisis unfolded, the Department of Health were planning the introduction of regulation and a Statutory right to home care.
The hope is that this crisis will just reinforce the need to bring in regulation and put home care on at least an equal footing with nursing home care. This should be done at the earliest opportunity once this crisis passes, to ensure that home care can play a fuller role in our health care system.
When deciding what a new system for home care should look like and to avoid reinventing the wheel, it is instructive to look at what our nearest neighbours in England are doing and the very significant changes they brought in, with the Care Act 2014.
The Care Act in England heralded some of the most the most significant changes to care and support in over 60 years. The main thrust of the Care Act is to put more control in the hands of people needing care.
Some of the key principles of the Act are;
- The person needing care knows best and their views and wishes should always take be considered
- The main focus of professionals should be on your well being and trying to reduce your care need in the future
- Any decisions made should be with the involvement of the person needing care
The Act is changing how home care is commissioned and managed in a positive way. The main developments in this regard are;
- Clear guidelines as to when care needs to be funded by local authorities aiming to ensure fair access to the system and avoid the post code lottery type situations, we have in Ireland
- A change in how assessments are carried out with a much greater focus on outcomes and what people want to achieve with their funding. This is in contrast to fitting people into preconfigured systems and processes that we tend to have in Ireland
- A greater emphasis on prevention so that people will need less support and particularly acute support in the future. In Ireland this would probably entail increased funding and promotion of home care to play a bigger role
- Clear information from local authorities so that people can make informed decisions about what their support should look like. Importantly here is the provision of choice for people on what their support looks like, who provides that support and what they want to achieve
- A greater emphasis on existing personal budgets which give people the power to spend allocated money on tailored care that suits their individual needs as part of their support plan. While some progress is being made in the disabilities sector in Ireland on personal budgets, very little is happening with Older Persons
- Examination as to how and when families will be asked to contribute to care. While homecare is not means tested in Ireland, the likelihood is some form of co-payment will be introduced in time.
One area of real interest, is that everyone in receipt of funding has the right to a personal budget and the control that goes with that, over what their care looks like.
They also mandate that as many people as possible should be able to take their personal budget in the form of a direct payment. A direct payment is a sum of money which people use to arrange and pay for their care and support themselves, so that they can stay in control of their care arrangements and in control of their lives.
There is no insisting of using certain approved providers, no predetermined visit times and no list of allowed tasks.
Instead, there is choice and trust that people and their families are capable of making decisions that best suit them and provide them with the outcomes that they want.
Yes, it requires more flexibility on the part of the commissioning body and also a movement away from the extreme risk aversion, we see with home care commissioning at the moment. A movement away from command and control, to support and trust.
Homecare can’t be just about compliance and minimising risk. Surely it would be better to move towards systems and processes that facilitate communities to help themselves. To facilitate people to enter into relationships because of commitment and a desire to contribute, rather than relationships based purely on external top down rules, regulations and corporate box ticking?
Could this present crisis herald this kind of change in Ireland? Will the powers that be see that the system doesn’t come crashing down if rules are less rigid and more encompassing? Are we now, more open to new ways of doing things?
Time will tell if personalisation will become the new norm and if we have the courage to open home care delivery to disruption, in order to provide new capacity and better outcomes for people needing care.