IT IS government policy that every older person should be adequately supported to enable them to live in their own homes for as long as possible. That makes sense. It is a cheaper and more humane option than catering for their needs in nursing homes or in hospitals. It is also how the great majority of people wish to live out their declining years. Despite that, the administration of a homecare package scheme by the Health Service Executive (HSE) is nothing short of shambolic. It requires immediate and radical reorganisation.
A report from the National Economic and Social Forum is scathing in its findings. Launched by Mrs Justice Catherine McGuinness, it found the scheme was being operated by the HSE on a fragmented, local basis, with different means tests and medical assessments being operated. Not only that, potential users found it extremely difficult to access the service. The service providers – the HSE, private healthcare services and voluntary home-help organisations – failed to conduct outcome audits and to share information that could be used to improve the quality of services.
We have been here before. Some of the same failings and inequities formed an integral part of the HSE’s administration of nursing home care. Because of that, the pitfalls should have been avoided. But now, nearly three years after a homecare package scheme was introduced by Minister for Health Mary Harney, national guidelines on how it should operate have yet to be implemented. The result is that eligibility criteria varies between different HSE areas, as does the amount of funding that may be provided to successful applicants. This effectively involves discrimination by postal code. And because of the arbitrary nature of the assessment process, beneficiaries are reluctant to complain about the quality or adequacy of the services provided.
Some € 120 million was allocated to the scheme last year, which can include nursing care and home help, along with occupational therapy and physiotherapy services. About 8,000 elderly people benefited. In order to kick-start a badly-needed reform process, Ms Harney should set down universal qualifying criteria that will take account of available government funding. Restructuring should not stop there. The homecare package is just part of a range of social services that includes home help, meals on wheels, community intervention and respite/day care. They could all do with a shake-up. As could the HSE, which appears to be busy repeating past mistakes.