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Home Care / Home Help

Coming reform presents chance to re-imagine home support

Dec 03, 2020
Regulation will enable home care providers to offer holistic plans as part of HSE services - and help keep more people out of hospital, writes Michael Wright

Ireland had 49 Covid clusters in nursing homes on November 18, and Level 5 restrictions had again postponed the re-opening of day care and respite services. Yet home care continues, despite challenges to rostering when Public Health requires carers to self-isolate.

Home remains the safest place for people needing support. Home and Community Care Ireland (HCCI), the representative body for home care providers, reported that only 64 out of 20,000 clients were Covid-19 positive on November 20.

The Department of Health has recognised this fact, and Home Instead welcomes Government’s commitment to fund an additional five million hours of home support in its 2021 Budget.

Health goals

The additional funding should clear current HSE home support service waiting lists and provide the HSE an opportunity to re-imagine home care. Currently for people over the age of 65, the average home support service provides less than one hour of care per day and predominantly focuses on supporting people with their personal care.

Whilst such support is critical for those that receive it, such a service will not compensate for the lack of day service or respite care, neither will it meet broader mental and physical health goals.

Part of the answer is to empower care providers to deliver a more extensive spread of services. When Home Instead Galway CAREGiver Eva Staunton was concerned about a client, who had become depressed since the closure of his day care service, she used her mobile to help.

“He was off form and missing people. I got him using my WhatsApp to talk with his children and grandchildren. This made a real difference to him, which I was thrilled to see,” Eva says. 

Eva operated as a connector and catalyst for her client’s uptake of IT; however, this can only occur when data privacy and data security issues are managed. Reform of the HSE’s home support service is on the agenda, with legislation for statutory home care included in the Programme for Government.

High-quality care standards

Such legislation will regulate home care providers for the first time, which will ensure not only high-quality care standards, but also allow divergence from the current task-based model of care. In strengthening provider governance, the HSE can empower providers to deliver a model of care that is more person-centred.

Governance creates the safety net that allows the HSE to delegate responsibility and autonomy to clients and their primary carers. If the accountability and clinical governance structures are in place, home support services can include exercise programmes to reduce falls risks, home-based activity programmes to improve brain health, IT coaching and support, or outings to improve socialisation and give carers respite in their own homes.

Home Instead Fairview are piloting a new exercise programme for their private clients. After initial screening by Home Instead Care Managers, Physiotherapists from Fit For Life virtually assess the client and then prescribe exercise. Home Instead CAREGivers support the client in implementing the programme, by counting repetitions, timing the length of exercises, or assisting with IT.

This information is fed back to the physiotherapist, who can then amend the exercise programme as appropriate. At least one-third of community-based adults over the age of 65 fall each year, risking bone fractures and hospital admission.

Flexible home support

Evidence shows that exercise can reduce the number of falls over time by around one-quarter. Currently, the HSE’s home support service does not provide exercise programmes.

The HSE may have an opportunity to explore a new home care model to help people with dementia. Within the Government’s 2021 Budget, 5% of the additional five million home support hours have been ringfenced for people with dementia.

Dedicated hours can allow funding of different models of care, with appropriate oversight from nursing or allied healthcare professional staff. Trialling more flexible home support will influence the development of statutory home care.

Statutory home care must provide the right to flexible home support for everyone. Age and diagnosis should not determine the service. Statutory home care provided by a regulated home care sector can deliver choice and quality, and keep people safe at home, which is where they want to be.

Michael Wright is Director of Public Affairs at Home Instead Ireland