The Joe Duffy Show can often be derided as a loud hailer for extremists and malcontents but it also does at times highlight issues of real importance that otherwise get swept under the carpet and kept out of sight.
In recent days Joe has highlighted a real issue in our health sector, that of the plight of carers and the work they do and the extremely meagre rewards they receive.
Carers are one of the few health sector workforces who don’t have a strong voice to represent their grievances and because of this they are reliant on likes of Joe Duffy to do the work for them.
The recent ERSI report into the future needs of healthcare workers, highlighted that it was in home care where we would face the biggest increase in demand. A staggering 54% increase.
When we take into account that the home care sector is struggling to meet existing demand let alone the increased demand coming down the tracks, it is easy to see the importance of this issue.
The nub of the issue is the lack of carers in the home care sector. This shortage is as a result of two main issues.
Firstly, we use our existing carers very inefficiently and don’t get the maximum out of the fantastic people who are presently working as carers. Many carers on the Joe Duffy show highlighted the fact that they often crisscross the city and travel large mileage in rural areas to get to clients. It is not uncommon to have a carer who is available for 40 hours work but ends up only delivering 25 hours care as she is traveling for the other 15 hours.
The best home care is local home care. Home Care delivered by a carer living locally who knows the area and the people. Locally delivered home care is also much more sustainable and leads to continuity in care delivery which is the cornerstone of quality home care. If a carer doesn’t have to travel large distances to get to a client, they are much more likely to continue with the client in the long term. Living nearby also means less turning up late, more in common and increased ability to cover emergencies.
The second main reason why we are facing an acute shortage of carers is that caring is not an attractive career. Low wages, little guarantee of work and precious little career pathway means not alone are carers leaving the sector but the sector is not attracting new people into the sector.
The cost of home care to families and the state from agencies is around €25 per hour yet in general carers are only receiving wages of about €11 per hour. Agencies justify this margin by pointing out the full service they deliver and the costs involved in that. However the question is do all clients or families need that full agency service? How about allowing families to decide if they need that full agency service or if maybe a son or daughter feel they can assume some responsibility and contract directly with a local carer thereby getting increased hours for their budget.
In addition, because there are better rewards flowing directly to the carer, the family are getting a local person incentivised to deliver great care. If we are to address the carer shortage we must look at empowering local carers to deliver care in their communities. In many other countries they are moving towards what are termed personal budgets or consumer directed care. This is where the people needing care and their families, are given more control over what their care looks like and also who delivers that care.
We have to move away from the situation where we are 'shoehorning' people into getting full service agency care from a select group of agencies whether a person needs it or not. Agencies profess support for families’ personal budgets and people having choice over who delivers their care but their choice is in line with Henry Ford’s idea of choice when he said “When you buy a Model T you can have any colour so long as it is black!” Choice for them is selection from a limited list of approved agencies.
Exclusive use of agencies isn’t working as evidenced by increasing waiting times for home care packages and the huge discontent amongst carers apparent on Joe’s show.
Empowering great local carers and real choice are powerful tools that can be used to deliver more