One thing this crisis has done is shine a light on how we care and support our older population and people with disabilities. I think it is fair to say that it has raised questions over the suitability and quality of congregated settings. While it can’t be denied that congregated settings such as nursing homes have a role to play, it is now very difficult to justify the prominence and preferential treatment they enjoy over other care options such as home care.
Presently, we spend a total of nearly €1B on nursing homes through the Fair Deal Scheme while we spend less than €500M on home care. People have a right to nursing home care on very favourable financial terms with costs of up to about €1,100 per week. There is no automatic entitlement to home care which is budget rationed and typical packages are worth roughly €360 per week. Finally, nursing home care is regulated which means acute settings and medical professionals, are much more open to discharging and referring to nursing homes than home care.
This preferential treatment not only needs to end, it needs to be reversed, with home care being the first option for people needing support or being discharged from hospitals. For this change to occur, we need a statutory right to home care similar to nursing home care but rather than setting up a separate funding silo, we need one funnel for care and support of older and disabled people.
We need a single assessment process for people’s needs, which is available, with people then being given their care options to choose from and with those choices then being funded from one pot of money rather than the siloed system we have now, which creates artificial demand for one care option over another.
If home care is to be enabled to play a fuller role, we need some key actions implemented for the sector including but not exclusively;
- Regulation so that acute settings are comfortable discharging to the home and that people in general are comfortable with the quality of the services available. It’s vital in order to ensure the widespread adaption of home care, that regulation fosters a wide ecosystem of home care options for families rather than pushing families into preconfigured services which may not be suitable or wanted.
- Clarity on funding and any co-payment requirements, so that home care is not at a disadvantage to other forms of care and support. Ideally there needs to be one budget for care of older people, with families preferences deciding how funds are distributed
- Ensure there is sufficient capacity in the system to meet increased demand. The key point here is that caring has to be made an attractive career and not just an attractive investment. We need to make sure that increased funding flows to carer’s pockets and not just to corporate bottom lines. Happy well rewarded carers drive quality not padded corporate bottom lines.
Home care has proven its worth during this crisis. We can not let it continue to be such an untapped resource going forward. A professional and vibrant home care system, embedded in local communities and offering attractive career prospects, has the potential to revolutionise our health system, taking pressure off the acute sector and ensuring our older and disabled citizens, live the lives they want and deserve.