The COVID pandemic has highlighted the shortcomings of residential care for older people and the need for home care to play a larger role within our health sector.
Unfortunately, presently home care plays a very reactive role rather than a more proactive one. Home care’s role should be one of providing a real alternative to nursing home care and also a preventative one of keeping people out of acute settings.
The main reason for home care not playing its full role is the lack of capacity even with present demand levels. Rising waiting lists and unmet KPI’s are testimony to this.
The present commissioning and provision status quo, cannot provide the capacity necessary to meet the future demands outlined in recently published ESRI reports. If that demand is to be met it is essential, we introduce a new emphasis within commissioning and new models of provision more carer friendly, to generate that capacity.
Personal budgets and direct payments are ways of commissioning and providing home care that put control and trust into the hands of people needing support and if done properly ensures more funds reach carers. These kinds of approach are being adopted worldwide with success. Regrettably, in Ireland we are lagging behind in fostering and using this approach.
Our present commissioning system places huge emphasis on the appearance of risk assessment, safeguarding and policing. Huge amounts of resources are spent on these activities rather than on the actual delivery of care and support. I would calculate that about 30% of the present home care spend of €480M goes on those actions with probably at least the same amount again being spent internally within the HSE.
This is a huge diversion of funds, set up and justified by the assertion that people needing support must be protected from themselves and that it would be reckless to trust in the innate goodness and capabilities of citizens. As ABCD advocate Cormac Russell says, this is a form of commodifying human needs and a soft form of colonisation. It needs to be asked how much of this activity is to give the appearance of control and to provide cover for events that might or might not happen?
Take one example, that of continuity of care. Continuity of care is one of the main pillars of quality home care and achieving great outcomes, yet, it is not mandatory in any safeguarding or risk assessment process or part of any tender process. The only things that are mandatory in our tenders are those things that are easily measured such as form filling and reporting both of which can be massaged to give the right result.
How about we move our commissioning and home care provision systems more towards trusting people and empowering them? Towards support which is self manged and where we accept people are the experts in themselves and their needs? Where we accept people’s ability to exercise choice and control, to develop efficient personalised support environments?
This shift in emphasis also needs to be more local and human focussed, providing a diversity of options and choices and where we enable technology, local assets and local pride.
Great home care needs to be relevant to local communities and needs to benefit local communities in both an economic and social sense. Funds being lost to over zealous safeguarding and corporate overheads / profits rather than circulating in the local community is part of the reason why we lack capacity. If we want to create capacity in our home care sector, we need to ensure funds in as far as possible are controlled by people needing support and that in turn those funds get to frontline carers.
Personal budgets, consumer directed care or self-managed care, call it what you will, is the means to make home care relevant and make caring an attractive career. It’s the way we can develop capacity in our home care sector and allow it play it’s full role in our health care continuum.