Covid-19 has steeled the nerve for an overdue overhaul of HSE social care services. Embedded within the HSE’s 2021 National Service Plan are the words “There is an over-reliance on residential models of care”, and, “the HSE aims to reduce the number of older people in long-stay residential care through … significantly increasing home support hours”.

Government has increased this year’s HSE older persons’ home care budget by 25%, and the National Service Plan describes six different home care models the HSE intends to fund. All of this and more will deliver a ‘Home First’ strategy, discharging people home from hospital rather than to a nursing home, and assisting people remain in their own homes for longer.

Additional staff

Home Instead welcomes such an approach. In survey after survey, Irish people express their desire to receive care at home, rather than any other setting. Yet to enable Government implement ‘Home First’, our sector faces the challenge of recruiting up to 7,000 new carers to provide the additional 4.7 million hours, while retaining the 10,000 already employed. Additional staff must also be hired to meet rising demand in the Irish private pay home care market.

There are many reasons why people want to work in home care. CAREGiver Tara Concannon moved from nursing home care work to home care with Home Instead. “I spend more time with clients in home care, as I provide one-on-one care which you don’t get to do in a nursing home. You’re doing something good, and when you walk away you have that feeling you’ve accomplished something real.”

Whilst home care is extremely rewarding, home care is tough work, requiring a higher degree of autonomy and initiative as home care workers work alone. Most roles are part time, as demand for HSE-funded service is greater first thing in the morning to help with getting up and dressed, and then in the evening to help with the reverse.

Sustainable workforce

Our social welfare system discriminates against part-time hours spread over a number of days, and our care workers are not part of a regulated environment with obvious career paths. Consequently, our industry body, Home and Community Care Ireland, has called for a Government-led Social Care Workforce Review to assist in building a thriving, sustainable workforce.

Across the water, the UK Government has led the way with public information campaigns such as ‘We Care Wales’ and the Boris Johnson-fronted ‘Care for Others, Make a Difference’ campaign, designed to persuade people to consider a career in social care. Unfortunately, it is not clear that these multi-million-pound campaigns make a discernible difference. Paul Vetta, Director at Collab Consulting says: “Large broad-brush campaigns may raise awareness, however they often fail to provide a process that screens candidates and provides an efficient pathway to work, whilst supporting people through that process.”

Minimum qualification standards

Down Under, the Royal Commission into Aged Care Quality and Safety recently recommended to the Australian Government the registration of carers, and on-going professional development for home care staff. Registration of health care assistants was also mooted in Ireland in a joint 2019 HSE/Siptu report. The report recommended to protect the title ‘Health Care Assistant’ and register Health Care Assistants (HCAs) to raise the prominence of HCAs within society.

Any registration process requires a bureaucracy that Government must fund, as charging HCAs more than a nominal registration fee is not feasible. Whereas society is protected when rogue HCAs are struck off the register, the HSE/Siptu report authors stated existing HCAs did not relish the thought of such an existential threat hanging over their career.

Setting minimum qualification standards for care staff and developing career pathways to different grades and professions will also enhance the attractiveness of home care. Currently Home Instead invests in CAREGiver training via our online learning management system and carer coaching from our care management team.

Career pathways

Strengthening provider governance would allow greater delegation of clinical tasks to carers, enabling the creation of nurse auxiliary or nursing associate posts that can bridge the HCA and nursing roles. Recognition of such vocational training would allow Government to build career pathways for carers to other professions such as nursing or occupational therapy.

As nursing has become more academic, there is a requirement to ensure those with the desired behaviours and attitudes are supported in their advancement by ‘on-the-job training’, not just book learning.

Finally, social welfare reform is key. Many home care workers work mornings and evenings, rather than a continuous eight-hour day. Such working practice does not align with current welfare schemes such as job seekers, which assume someone signs off when they have a full day’s work and signs on when they do not. A carer working three hours in a day loses their day’s welfare, meaning work does not pay. Social welfare must remove iniquitous disincentives to take part-time work.

This and more needs to be part of Government-led Social Care Workforce Review.

Michael Wright
Director of Public Affairs
Home Instead Ireland