With imminent publication of the Department of Health’s report on home care in Ireland as well as Minister McGrath’s consultation on the roll out of personal budgets, to both of which we made a submission, I have been gathering my thoughts around what are the ingredients for quality home care provision for both older persons and disabled people?
Yes, introducing regulation will be important but I think there are other underlying aspects that play a vital role in encouraging quality home care and which it will be important that regulation fosters when it is introduced.
So what are these ingredients that will not only drive quality home care provision but also help to address issues the sector is presently facing such as lack of capacity or limited budgets? I think there are 4 main pillars that quality home care provision must be built on.
Happy Motivated Carers
It sounds simplistic but I think the greatest driver of quality home care is a happy and motivated carer. A happy carer is paid well, has a guarantee of work and is genuinely valued. This means paying carers a decent wage which truly values the incredibly important work they do. It means paying for travel time and it means guaranteed set hours so carers can live normal lives and get mortgages etc. like the rest of us. It means reasonably compensating carers in situations like the recent storm Emma.
We also need our carers to be motivated and feel ownership of their work. Many carers are much more capable than agencies or the system give them credit for. This reservoir of commitment and talent needs to be encouraged and liberated.
Choice
Choice for carers and choice for people needing care is a powerful tool that drives quality. What do we mean by choice? For families we mean being able to choose who provides your care. We mean being able to choose what your care and support plan look like. We mean having the HSE trusting and enabling your wishes rather than preventing and erecting barriers to them or trying to shoehorn you into already configured existing services.
For carers choice means when to work, who to work with and that should include working for themselves, as well as having a choice of pathways for career advancement. Presently, all state funded home care has to pass through a limited list of approved corporate providers and while these agencies have a role to play, carers shouldn’t be indentured to these companies whose past track record of valuing carers is patchy at best.
Continuity of Care
Having the same carers week in and week out, is vital to quality home care provision and especially so when the person has dementia.
Agencies often like to extoll the virtues of their wrap around service and the assessments and supervisions they carry out to ensure quality. However what they neglect to say is, very often those supervisions are carried out on different carers each time, as their retention of carers is abysmal.
Agencies inability to hold on to staff is a direct consequence of carers poor employment conditions and this leakage of carers has grown as the economy improves and carers have better job options with the local hotel or supermarket.
Families whether they work with an agency or directly with carers have the right to a stable roster of carers.
Local
The best home care is local. Local people looking after local clients. Local means familiarity and ease of access. It is not sustainable to have carers working with different agencies, criss-crossing cities and counties spending a large amount of their valuable time travelling to get to clients. It also means that in times of extreme weather, carers can’t get to work. Ideally, carers should be providing care to a small number of clients in their local area.
So how do we ensure these 4 pillars are in place even before regulation is introduced into the sector?
Firstly, we need to introduce the concept of choice through personalisation and specifically personal budgets. The HSE need to relinquish control and end the excessive hand holding that goes on within home care. The HSE had the same fears when the Fair Deal Scheme was introduced for nursing home care which were subsequently proven to be unfounded. The introduction of personal budgets also must avoid Henry Ford’s definition of choice when he said “People can have any colour Model T so long as its black!. Choice through personal budgets must go beyond a limited list of approved incumbent corporate providers and include smaller local providers, perhaps a carers co-op, as well as proactive local individual carers.
Secondly, carers whatever their employment situation must be properly valued for their tough and important work. A JLC for the care sector should be introduced setting the minimum carers can be paid. We should also enact the European courts TYCO ruling on mobile employees with no fixed work place such as carers. This would ensure carers are paid from the moment they leave their house. In an effort to attract part time carers, we should also introduce a gradual decline in social welfare benefits for carers as they increase their working hours rather than the cliff face drop they presently face.
Thirdly, we need to encourage new entrants into caring especially motivated local people who are embedded in their communities. These people might not be interested in working for an agency for barely above the minimum wage but they might be interested in working for themselves, choosing their own clients and hours, as well as their own charge rates. We can do this by allowing families use their home care packages directly with local motivated carers where appropriate. This already happens extensively where care is privately funded.
By enabling home care to play a much fuller role in the health care continuum and making caring a more attractive career, we can go a long way to reducing dependency on our acute sector and in turn bring significant savings to the table. Staying at home as long as possible is most people’s wish. Let’s truly facilitate this and drive quality while saving money at the same time!