In these unprecedented times, so much is happening in and to the home care sector, that I thought it would be an idea to put together some random thoughts on how the sector has been affected by the COVID-19 crisis and what it can learn from the crisis. When the crisis passes, do we go back to the way things were or will we see positive changes that will allow the sector to play a much bigger role in our health sector.
Importance of Community
Certainly, what the crisis has highlighted is how important community is and how community needs to be harnessed by the State, to help ensure better outcomes for us all in all sorts of areas. Importantly, that harnessing must be done not in a top down “we know best” manner but rather in a more consultative and “how can we help?” way. What communities and the smallest iteration of communities, families, are showing us during this crisis, is that they are capable and can be trusted to make decisions about what works for them. Let’s transfer more power to the Local.
This pandemic has highlighted the importance of one of the basic tenants of great quality home care, CONTINUITY. Providers sending in different carers to families every couple of weeks because of recruitment and retention problems has to stop. It’s bad for cross infections but it’s also just bad home care. Families, not providers, should have control over who visits their loved ones. Families shouldn’t be shoehorned into using providers if continuity can’t be provided. Families should have the option of organising their own care directly with local carers where appropriate. Let’s roll out aggressively personal budgets and direct payments, putting more power and control into the hands of families.
Guaranteed Hours Contracts for Carers
What this crisis is highlighting, is what the really important jobs are. Carers are at the top of that list, yet we don’t truly value them.
Connected to the previous issue of poor continuity within the sector, is the fact that the majority of carers are on what are termed “If & When” contracts. These contracts basically mean carers have no guarantee of work. They are a variable cost for the sector. This has to change. We don’t pay our firemen just when they are fighting fires! Carers need to have normal working contracts that give them guaranteed work, pay and visibility. Let’s show we value our carers with practical actions.
Support for the Sector
Demand for paid home care services is declining during this crisis due to families being at home and stepping up to the plate. Similar drops in demand, in some cases of 80%, have been confirmed to me from contacts in other countries such as Spain and France.
However, the fact is we will need providers of home care after the crisis and when families have gone back to work. With this in mind, we need to look at how the sector can be supported financially.
As mentioned above, currently most carers are a variable cost for care providers. That is, if there is no work, they don’t pay carers. As the government are already doing, it is probably best that carers who find themselves out of work are supported directly by specific social welfare payment schemes.
For companies, carers account for about 70% of company turnover. Home care companies are making net profits of around 15%, which means providers still have costs of a further 15% of turnover they need help covering, to ensure they can survive.
One of the problems with the HSE moving to block funding for companies irrespective of the care actually delivered, as some in the sector are pushing, is it only addresses HSE funded care. What about the fact that providers also do a lot of privately funded care?
One possible solution could be to pay providers a subsidy of 15% of their turnover, both HSE and private, based on their last years accounts, paid monthly over a year, to cover those fixed overheads.
In addition, why not provide families with an additional tax credit for the full amount they spend on home care during the crisis, added to their existing tax credits. This would help to bolster demand for services. Let’s support the sector so it can play it’s full role after the crisis.
This crisis has forced us to embrace technology in a way we haven’t before. Whether that’s remote working for office staff, virtual GP appointments, virtual training courses or Zoom meetings, technology has proven its worth. Could it also be that this pandemic will give a push to more robots delivering care? Hopefully one silver lining to come out of this crisis will be the more widespread adoption and use of technology. Let’s adopt technology to improve quality and efficiencies in the sector.
This crisis has necessitated the relaxation of rules and the need to be flexible in our processes. It has necessitated that our systems place more trust in people and recognise that there is not just one right way of doing things.
Regulation is expected to be brought into the home care sector once this crisis is over. When doing so, we need to make sure that regulation is not overly top heavy, just preserving the Status Quo. Rather it needs to be flexible and accommodating to new ways of delivering care and concentrate on great outcomes rather than just structures and processes. Let’s ensure future regulation learns from how the sector has adapted to this crisis and the importance of trust and choice.
In summary, this crisis has brought out the best in our society in many ways. Let’s hope these rediscovered attributes and attitudes aren’t forgotten and packed away once the crisis is over.