Shortly, the HSE will publish a new home care tender. The HSE are saying this tender will run for 4 years and will serve until regulation is introduced. In essence it will set the role that home care plays or doesn’t play in our health care continuum during this period. This is at a time when more than ever, home care needs to step up to the plate and play its role in
- alleviating the pressures on our acute sector
- providing people with the choice to continue living at home rather than moving to residential care
- providing employment opportunities country wide
- fostering local community wealth for care and support
The HSE doesn’t have the luxury of waiting for legislation to bring in regulation for the sector and give home care a statutory footing, before taking action. The issues facing the sector need to be addressed now and not in 2 or 3 years when regulation might come in.
The HSE presently spends roughly €350M on home care through both the home help scheme and the home care package scheme. This is in stark contrast to the nearly €1B it spends on residential care through the Fair Deal Scheme.
This disparity in funding is despite the fact that home care is generally people’s preferred option for ageing but also that home care is more cost effective than nursing home care.
However, are we spending the present home care budget wisely? What are the issues this tender needs to address in order to ensure we are getting the most out of the available funding and is home care contributing fully to our health system?
Firstly, the HSE needs to end the distinction between home help hours and home care package hours and ensure that all delivery of home care, outside of what the HSE delivers directly through its own employees, is commissioned in an open and transparent fashion. It needs to move away from block funding of some home care which has proven to be inefficient and delivers poor quality provision.
Secondly, it needs to conduct this tender under a Consumer Directed Home Care (CDHC) approach, which puts more control and decision making into the hands of people needing care and their families. A CDHC approach shouldn’t be a burden on people. It should be a way to foster innovation, bring savings and encourage sustainable local solutions to supporting our older population. A move towards CDHC is happening in many other countries and it is the best way to ensure limited funding is being spent how and where it’s needed.
Thirdly, in an effort to ensure they are getting value for money, the HSE need to stop the cartel-like concentration of outsourced home care delivery with a few large private providers and encourage the growth of smaller more community based providers under a licensing type arrangement. Great care is always delivered locally, by motivated people who know and are involved in their communities. In addition this creates more competition, keeping prices to the HSE keen.
Fourthly and perhaps most importantly, the HSE need to use the tender to address the serious capacity crisis the sector is facing. This can only be done by making caring a more attractive career and especially so as our economy improves and carers have other career options.
Connected with a move to CDHC and encouraging local providers, the HSE needs to allow families use their home care packages directly with local carers where appropriate. This already happens with privately funded care so why not allow these same families to use their state funds in a similar way, so long as it is done in a tax compliant and transparent manner?
Allowing families opt out of choosing just from a list of limited approved providers and contract directly with suitable local carers will attract new people into caring and help to create sustainable local employment. It will push agencies to be involved only where they are genuinely adding value as well as forcing them to value their workforce more than they are doing at present.
Take a fictional Mary living in Tullamore who is involved in her local community through the local GAA club and community centre. Mary knows everyone and everyone knows Mary. Now Mary probably isn’t interested in working with a home care agency earning barely above the minimum wage and with precious little career opportunities. However, Mary might very well be interested in working for herself, setting her own prices and availability, as well as selecting what clients she works with.
Having the option of local carers providing care and support directly to local people without the costs of an agency in-between will help to foster a vibrant home care sector where people have real choice and control over what their care looks like, delivered by motivated and properly rewarded carers.
The upcoming home care tender needs to devolve more decision making to the local level, develop a wider range of options for families while allowing them assume increased responsibility where appropriate.
Activating local assets like our fictional Mary, helps to achieve these goals which in turn will help us meet the rapidly increasing demand for home care.