Consumer Directed Home Care is step in the right direction as focus on service grows, says Michael Wright
The State Housing Agency asked people over the age of 55 where they wanted to live in later life. 90% of respondents said their preferred place to live in later life is their current home.
Similarly, in a survey of 1,000 citizens, Sage Advocacy found that in the event of ever needing care, 82% of respondents reported a strong or very strong level of support for care in their own home, opposed to anywhere else.
Contrast this wish to remain at home, with the spend of the HSE’s 2019/2020 Winter Plan. The €26 million plan allocated over eight times more funding to residential care services than it did to home care services. Such spending may be effective in reducing pressure on acute hospital care beds; however, it does not reflect the long term care wishes of Irish people.
Desire of Irish people to age at home.
To meet the overwhelming desire of Irish people to age at home, the State plans to pilot statutory entitlement to home care in early 2020. This will direct more resources to home care. Greater resources are required as the number of people waiting for home care increased by more than 10% between March and October 2019 and now stands at 7,667 people. Greater flexibility is also required as home care meets a greater range of needs from those availing of the service. The average HSE package of home support is less than one hour of care per day. Imagine a husband and wife living 20 minutes from the nearest town, and the husband has dementia. The husband receives a HSE-funded package of home support of one hour per day.
His wife is nervous about leaving her husband alone, and so travels to town to get messages when friends and family call and stay with her husband. Ideally, the wife would not want to be a burden on friends and family and would like to travel to town when her husband’s carer arrives. However, a 60-minute carer visit does not allow the time for this.
The HSE does have a solution for this called Consumer Directed Home Support (CDHS). CDHS was launched in 2018 and allows people receiving care to choose the day and the time of their services. CDHS also allows people to choose the type of service they receive, and so in the above example of husband and wife, the couple could choose home respite and aggregate hourly visits to allow time to visit town. This would mean for more days the couple would be without a service from the HSE.
Delivering such a service requires shared decision-making between the person receiving care, their carers and health care professionals. This needs time, and it also needs a service model that places the autonomy of the person receiving care as the foundation stone upon which their care plan is built.
The planned statutory scheme for home care has the opportunity to transform how services in Ireland are delivered. We hope the next Government takes it.