Updated / Wednesday, 15 Dec 2021 10:00
By Ailbhe Conneely Social Affairs & Religion Correspondent
The Health Information and Quality Authority has called for complete overhaul of homecare services, including the introduction of regulation.
The independent watchdog says while most people in Ireland want to age and receive care in their own home, there are complex conditions around the service influenced by funding, availability and geography.
A research report by HIQA says the current system is unsustainable and not meeting the needs of people.
Furthermore, HIQA notes that homecare services are not currently regulated to ensure their quality and safety.
The Regulation of Homecare: Research Report notes that successive governments failed to implement legislation to bring about change in the sector.
While HIQA welcomes that the Programme for Government committed to introducing a statutory scheme to support people to live in their own homes, it believes that there is only one opportunity "to get this right".
The report is advocating for an inclusive homecare scheme that protects everyone who receives care at home.
In order to do this, HIQA says a needs-led, integrated homecare system is required, where age is removed as an access barrier.
As part of the research, HIQA spoke to providers who expressed a need for services to be reformed through the introduction of regulations and standards that would "delineate and outline the scope and parameters of homecare".
This would enable them to pre-empt the changing landscape of health and social care into the future.
Many risks exist in the homecare sector according to the research and these are often "interconnected and intersectional".
For those delivering the services, lone working was cited as the greatest risk in the job.
A two-tier system means there are problems around the recruitment and retention of staff because it is perceived, according to the research, that HSE employees have better working terms and conditions.
Unless homecare becomes a viable career, the sector will not be able to deliver on its priorities according to HIQA.
Homecare visits 'often being rushed'
Geography was also highlighted as an issue in the research, resulting in homecare visits often being rushed due to the pressures on workers to travel between service users' homes.
"There needs to be a reasonable expectation of what can be delivered by providers", according to the report.
People receiving homecare services said a poor quality or unfulfilled service was the most prominent risk.
HIQA says a standardised assessment of need should be implemented immediately for people who are entitled to one, and a scheme of financial support established as a matter of priority.
As the provider and commissioner of services, the HSE was perceived by providers to be "a proxy regulator" through its agreements with homecare providers.
The HSE's own homecare provision is not subject to the same level of scrutiny as non-public homecare organisations according to the report, which also describes the funding of homecare as "problematic and inconsistent".
It recommends that the way in which tenders are awarded needs to be "re-evaluated" for efficacy".
In terms of regulation, the report stresses that homecare tasks need to be "fully defined and operationalised" in order to regulate the sector.
If this excludes nursing care or other paid tasks undertaken in a person’s home, then there needs to be consideration of how people in receipt of these services are protected, it says.
"The definition of homecare needs to be inclusive to ensure that it safeguards all those who use the service."
Regulated activities could be set out in legislation according to HIQA.
It suggests that providers who deliver regulated activities in a person’s home be registered and or licensed to do so and that the scope of service provision would be set out in the provider’s statement of purpose.
They would then in turn, be licenced to provide the services by the regulator.
This approach would provide a clear and stepped approach towards the regulation of homecare and delineate services that are providing more complex care which may provide a mechanism to help "future proof" the concept of moving more advanced services closer to home, it suggests.
Among the recommendations by the Health Information and Quality Authority is a root and branch review of homecare involving all stakeholders at national, community, service delivery and recipient level.
This it says is the only option to ensure that the needs of people who require homecare services are met and added that anything less is unacceptable.
While it acknowledges that the proposal is not an easy option, it states that it is the right one.
It points to the Sláintecare implementation strategy, which notes that the Irish health service is "facing extraordinary challenges" which require "an extraordinary response".
Legal right to home care
The organisation representing private home care providers is calling on the Government to expedite the introduction of the statutory home care scheme, giving Irish citizens a legal right to home care.
Home and Community Care Ireland (HCCI) says it has supported HIQA's review of how home care is commissioned and delivered in Ireland.
CEO Joseph Musgrave said the HCCI agrees with HIQA’s point that while it is understandable that the pandemic delayed the development of such a scheme it should not have held it back by years.
"It was due in 2021 and now we understand it will be 2023 before it is introduced. It is simply not good enough for the vulnerable people who need and rely on home care and carers who dedicate themselves to such important work."
The HCCI says it is recently published Winter recruitment action plan offers "workable solutions" to the current carer recruitment crisis.