The recent Irish Independent article by Laura Lynott highlighting economist Jim Power’s comments on the future costs of caring for our older and disabled populations is important. Too little thought and discussion has addressed this issue to date.
However, before looking at future funding, it is incumbent on us to ensure that we are spending existing resources in the best and most efficient manner possible.
The first issue that strikes home when looking at our present spend on care is why are we spending nearly three times more on nursing home care than on home care? Nursing home care is considerably more expensive than home care and significantly, countless studies have shown that people’s first preference is to stay living independently at home for as long as possible.
Ireland has approximately 6% of its older population using residential care and this is higher than many of our European counterparts.
The second issue with our current spending pattern, is that within the home care budget, we shoehorn everyone into receiving a full wrap around service from corporate providers with the costs that this entails, whether this is suitable or not.
Why not move towards personal budgets, as is happening in other jurisdictions and allow families the choice of who provides their care. This could include where appropriate, the possibility to contract directly with local qualified carers at a significantly reduced cost.
This move whereby families cut out the cost of an agency where appropriate, could help to stimulate a cohort of proactive, motivated carers to provide care in their own communities and help address the current capacity the sector is facing.
Indeed, Ireland has one of the world’s greatest examples of local communities doing it for themselves in the form of the GAA. Why can’t we bring this kind of thinking to the health sector and specifically to home care, reverting to a local focus and away from a corporate fixation?
Finally, are we spending enough on technology as a means for getting more bang for our health care buck? Home care provision presently is very inefficient with care rosters planned weeks beforehand independent of the actual needs of the people being cared for. It’s cheaper to remotely monitor peoples care needs, sending in physical care and support when it’s actually needed. Advances in AI, big data, sensors and voice recognition technology means we have the resources to make our care delivery much more efficient and targeted.
Home care is presently not means tested but with the increase in demand coming down the tracks, it is inevitable that similar to nursing home care, some kind of funding mechanism and means testing will have to be put in place. If we are to ensure these initiatives aren’t too onerous on the taxpayer, we must make sure that we are using existing funds in an intelligent manner and start thinking outside the box, as a continuance of the Status Quo is not an option.