A new report launched this morning in Wynn’s Hotel, Dublin, exposes serious problems in Ireland’s home care services. The system is disorganised, fragmented and underfunded with social workers estimating more than half of the older people they work with could be at home instead of in long-term residential care if the appropriate services were available.
The report (copies available on request or downloadable in PDF format here) was jointly produced by the Irish Association of Social Workers, Age Action, the Alzheimer Society of Ireland and the School of Social Policy, Social Work and Social Justice in UCD.
The research was based on a nationwide survey of social workers working with older people, including people living with dementia. It also includes findings from in-depth interviews with social workers, employed in a variety of settings across the country.
Dr Sarah Donnelly, of the School of Social Policy in UCD and one of the authors of the report, said: “Home care in Ireland is in crisis. Acute hospitals and nursing homes are being prioritised over the kinds of community services that enable older people to stay home.
“Waiting lists for home helps and home care packages are growing. Community care is grossly underfunded and people are simply not getting the care they need.
“This means more people in acute hospitals who don’t need to be there. It means more people in nursing homes who don’t need to be there.”
Mr John Brennan, of the Irish Association of Social Workers, said: “All of the evidence and the feedback from the social workers that spoke to us confirm that older people, including those with dementia, want to stay at home as long as possible.
“Many of these people could be at home, where they want to be, where their families want them to be and where Government policy says they should be, but we are simply not providing the supports they need.
“The social workers we spoke with estimated that more than half of the older people they work with who have gone into nursing homes or are on the waiting lists for a place could be at home if the supports were there.”
The report also highlights that each of the nine Community Health Organisations (CHOs) has its own system for providing home care services and its own criteria for deciding what older people are entitled to.
Dr Emer Begley, Advocacy Officer with the Alzheimer Society of Ireland, explained: “You might be able to get a home help in one place but be refused ten miles down the road because you’re the other side of line on a HSE map, even though your circumstances are exactly the same.
“Another issue is in some areas older people have to be in receipt of a medical card to access community-based support services while in other areas they don’t.
“Even when older people can get home help services, many home helps are not allowed help with simple domestic tasks such as cooking and have very little time to spend with their clients.
“Family carers were identified as key providers of care to older people. However, social workers reported that routinely older people were less likely to get services where family members are providing care.
“Geography, not need, is deciding who gets home care in Ireland.”
Colette Kelleher, CEO of The Alzheimer Society of Ireland, said: “As 63% of people with dementia live in the community, home care is a vital support. “The majority of people with dementia receive care through older person's services and it is clear from our research that their preference for receiving care and support in their home and community is not being realised.
“The present social care approach has not been resourced adequately to meet the individual needs of older people.”
The authors of the report are calling for immediate investment and reform of community care services and for the Government to implement a fair and equitable way of allocating care and support services underpinned by legislation.
Dr Marita O’Brien, Policy Officer with Age Action, said: “It has been Government policy since the 1960s to support older people to stay at home as long as possible but this simply isn’t happening.
“Right now, the priority must be increased investment in community care services and putting in place a transparent, nationwide, system to provide home care.
“This requires ring-fenced, centralised, annual budgets. Need, not your address, should be used to allocate care services.
“But if, as a society, we are serious about supporting people to stay at home, with their families, in their communities, we need to go further. The Government should start examining how we can bring in a right to community care for all older people in this country.
“People have a right to a nursing home bed; it’s time they had a right to stay home.”