THE LACK of national standards governing the delivery of home help and other home care services to thousands of older people across the State is putting those older people at an “unacceptable risk”, according to a new report.
Commissioned by the Irish Private Home Care Association, it says high profile adverse incidents in nursing homes and other residential care settings have led to regulation of that sector which only caters for around 5 per cent of the over-65 population.
“Home care services cater for about 12.5 per cent of this population group but there are no standards or regulation.”
It says draft national quality guidelines for home care support services were developed for the HSE in 2008. However, they were never implemented.
Published today, the report was carried out by the PA Consulting Group. It says most home care is provided by the HSE, some by the voluntary or non-profit sector, and about 4 per cent is provided by private operators. An estimated €340 million is spent annually on home care in the State.
The report points out that “there is no minimum requirement for vetting and training of staff”, and research suggests it varies by provider.
Furthermore, it says many providers have not introduced monitoring of time spent on client care, a practice proven in the UK to increase client contact time by up to 12 per cent. “In the absence of guidelines and monitoring, there is no visibility of the quality of care delivered.”
It also stresses that in the current economic climate “providers may be under pressure to deliver more for less” and “in this situation regulation and monitoring that safeguard home care customers is even more vital”.
While it says there are costs associated with developing and implementing regulation, there are also costs associated with the current lack of regulation. These include “risk of abuse or system failure due to unsuitably qualified, vetted or monitored care givers”.
The president of the Irish Private Home Care Association, Ed Murphy, said there had already been court cases in which home helps had been prosecuted for a number of offences. One involved the theft of thousands of euro from a bank account.
The HSE said while it acknowledged there was currently no statutory basis for regulation and inspection of home care services, it does supervise its home help staff. “The HSE also provides training and induction for its home help staff, it undertakes Garda clearance for all new home help employees, and home help staff are supervised by home help organisers and local public health nursing staff on an ongoing basis.”
It also said national home care standards were in the process of being signed off on and once this was done they would be rolled out on a phased basis throughout the system.
Meanwhile the PA report estimates that the ageing population could increase demand for home care from 57,581 to 92,400 recipients by 2021.
It also says while there is “poor cost transparency” at present its analysis would indicate home care provided by the private sector is cheaper. It estimated the cost of HSE home care per hour to be €29.44, while it said in the private sector it was €21 an hour. Thus if all home care were outsourced to the private sector the HSE would save almost €80 million a year. This money could be used to provide home care to an additional 16,500 people.
However, the HSE said the costings in the report were inaccurate, and therefore its conclusion that millions could be saved did not stand up.
It said it currently provides 11.98 million home help hours each year from its annual budget of €211 million, which gives an average hourly rate of €17.61 per home help. The hourly rate for home care packages would be higher, it said.