Private home carers refusing to take on rural clients due to travel costs

The HSE pays private home care firms to deliver most of the service, but changes last year that meant “not funding travel expenses and only partially funding travel time, ensured that private providers are increasingly only taking on clients who are close to where workers are based, otherwise the service becomes loss-making,” the Oireachtas health committee was told.

The warning came from Sean Moynihan, chief executive of charity Alone, who was before the committee to discuss proposed legislation to regulate home care services for the first time.

He pointed to a number of weaknesses in the current system and said that as soon as a client goes into hospital or residential care, the provider, and by extension the worker, stops getting paid.

The HSE also does not provide cover for weekends or overnights.

He expressed concern that “home support service has moved away from traditional home ‘care’ such as basic cleaning and changing bedsheets”.

“This service is vital for older people who are physically frail,” he said.

“We have seen a significant increase in older people looking for support with these basic tasks but many cannot afford private cleaners. This significantly impacts on people’s quality of life as their housing conditions and welfare decline.”

He also said that despite multiple reports by the Department of Health, there has been no progress relating to identifying a suitable funding mechanism for home support.

“We are concerned by reports of a Fair Deal scheme for home support, given the extensive bureaucratic process of Fair Deal,” he said.

“Currently, our home support services operate based mainly on trust. There are no regulations, no standards, no independent oversight, and very little data. So any progress is welcome”.

The HSE recruitment freeze is also having an impact, he said.

The committee also heard of the prevalence of loneliness among older people as some have never returned to the same level of activity outside their homes since cocooning due to Covid-19.

“Mental health difficulties remain a significant issue among older people. In total, 2,405 people assessed by Alone in 2023 indicated that they had issues with their mental health. The most prevalent mental health issue was dementia, Alzheimer’s, followed by depression and anxiety,” Mr Moynihan said.

“Research published this week by Aware and supported by Alone has found that 34pc of older people experience mild to moderate depression, 41pc have mild to moderate anxiety, and 14pc considered ending their lives in the last 12 months.

“There needs to be a tripling of acute mental health beds available for people aged over 65 and the implementation of a model of care for specialist mental health services for this age group.”

The committee heard that the “link between health and housing cannot be overstated”.

At least 50pc of all Housing Adaptation Grants that Alone works with older people to secure are for bathrooms. This is to increase access and ease of use for basic hygiene needs.