Our increased awareness of social distancing and frequent handwashing may reduce transmission rates of the common cold and seasonal flu, as well as Covid-19. The HSE, however, is taking no chances, with CEO Paul Reid suggesting the mandatory uptake of flu vaccines by HSE staff.
Fearing hospital overcrowding, the HSE’s new winter plan, due to be published this September, will allocate millions of euro to improve patient flow through its acute hospital system.
The consequences of hospital overcrowding on Covid-19 transmission are stark. Thus Covid-19 provides a catalyst for radical change, and a meaningful resolution of our recurring hospital trolley crisis. Policies that reduce the length of hospital stay and reduce the chance of admission in the first place will lower hospital Covid-19 transmission risk.
Taoiseach Micheál Martin’s new Programme for Government provides the HSE with solutions to prevent hospital overcrowding. There is a commitment to invest in additional home care hours and legislate for a Statutory Home Care Scheme. The ESRI published research in September 2019 showing that hospital stays for older people are shorter in areas with better supply of home care and residential care services.
The research showed that an increase of 1.5 million home care hours would equate to approximately 14,700 fewer inpatient bed days per annum, the equivalent of 40 inpatient beds daily. 1.5 million home care hours costs €90 million less than 14,700 inpatient bed days per annum.
Nursing homes face their own capacity challenges this winter, as they renovate congregated settings to allow social distancing, remove joint-occupancy rooms and provide isolation facilities for residents with symptoms of Covid-19.
Home care on the other hand is scaleable, requiring no additional capital investment to improve capacity or safety. More importantly, home is where older adults want to live. Home is also safe. Ireland’s home care sector’s representative body, Home and Community Care Ireland, reports that the number of Covid-19 cases amongst approx. 20,000 clients remained low, peaking at 91 positive cases in May.
The HSE’s 2019 winter plan invested two-thirds of its funding on nursing home capacity and only 8% of its funding on additional home care.
This year, this must change and home care needs to receive the lion’s share of funding. There is an opportunity to roll out new models of home care nationwide that offer alternatives to current short-term nursing home care. People requiring step-down care for respite and rehabilitation on discharge from hospital will want to go home as soon as possible, and new home care governance arrangements need constituting to enable this.
A renewed focus on home care need also re-imagine the range of home care services provided. The HSE expects some of its community services will not surpass 50% of their pre-Covid 19 capacity. The lack of socialisation opportunities from services such as day care has led to a significant decline amongst service users.
Broadcaster Teena Gates says: “I’ve been doing exercises with my 95-year-old father every day during lockdown because I could literally see his walk disimproving in front of my eyes.” With greater investment, home care can support people’s social and physical needs, and not only assist people with personal care.
Social Justice Ireland believes service users should have the right to choose from a ‘basket of goods’ that ranges from healthcare to home care, personal care to social inclusion, as part of any statutory home care scheme. Government has committed to introduce statutory home care as a priority and has committed to a scheme that is adaptable and responsive to those with complex needs, such as those living with dementia.
Whilst we await details of the Government’s statutory home care scheme, the HSE has an opportunity to place home care at the centre of its winter plan. The evidence is clear that people want to be cared for at home, and that home care can reduce length of hospital stays. With fear of a second wave of Covid-19 and recent County lockdowns in Laois, Offaly and Kildare we may not have any choice.
DIRECTOR OF PUBLIC AFFAIRS