Whether you are an older person needing support at home or the loved one trying to organise it, the help has to be the right fit. If you use a private company, cost will be a factor too. Letting someone new into your home and into your life is a big deal. So if you want to plan ahead, what’s the first step?
It is no surprise repeated studies show most older people want to live at home and in their communities for as long as possible, receiving care when needed. It makes sense for the State too – care at home costs far less than a hospital or nursing home bed.
Those wanting support at home have a few routes to meeting their needs. They may qualify for home support from the Health Service Executive, they can pay for it privately themselves or a close family member may step in.
In the last case, that person may be entitled to some State supports. An older person may use some or all of these things at different stages.
Home support
The HSE’s home support services aim to help an older person remain and be cared for in their home. If you qualify, it entails a trained, vetted carer visiting at set times for a set number of hours each week.
The carer will be either a HSE staff member or a carer from a company contracted by the HSE. The support can be a help with things such as household duties, getting in and out of bed, dressing and undressing, personal care as well as more intensive care.
Primarily aimed at over-65s, the service is free and you don’t need a medical card to qualify – but that doesn’t mean if you need it you will get it.
For many people assessed by the HSE as needing homecare, the reality is that you will be joining a waiting list. Unlike the Fair Deal nursing home scheme, homecare is not a statutory service, says Corona Joyce, senior policy office at Age Action Ireland. This means that, though you may need it, you're not actually entitled to it.
The Government funds the delivery of a set volume of care each year. The National Service Plan for this year provides 18.9 million support hours to be delivered to 53,400 people. That’s an average of just under seven hours a week but hours allocated vary wildly, with a lower number likely especially in the early stages of care being required.
If the kitty is low or there are others in your geographical area determined to have a greater need, you will go on the waiting list along with the thousands of others assessed as needing it.
"Homecare supports are discretionary, so it really is a postcode lottery," says Catherine Cox, of Family Carers Ireland, a charity supporting family carers that also provides homecare services. Local funding and how it is prioritised means older people are more likely to get homecare in some areas than others. The lack of available carers is another limiting factor, meaning many older people with very real needs are living at home at risk.
Figures at the end of August show 4,030 people assessed as needing home support but are waiting for it. This includes 933 people in receipt of support but assessed as requiring more of it.
Priority on the waiting list works on the basis of need, the HSE says. People being discharged from acute hospitals who can return home if supported are prioritised. Covid-19 hasn’t helped either. Under the Government’s Living with Covid-19 plan, the HSE is further prioritising delivery to where it “is most required”.
A winter plan for 2020-2021 aims to provide an additional 4.7 million home support hours by end April 2021.
Applying
Despite the waiting list, it is advisable to apply for the HSE scheme. The first step is a chat with your GP or public health nurse. Alternatively, you or a family member can fill out the home support service application form. The form is essentially your consent to a HSE “care needs assessment”.
If you are unable to apply yourself, someone can do it for you. The person requiring the service, however, must sign the declaration and consent section, unless a family member has legal authority such as enduring power of attorney.
Someone such as a public health nurse or a physiotherapist will do the assessment, typically by visiting your home. Your ability to carry out daily needs such as washing, dressing, shopping and moving around will be discussed with you.
Any medical, family, social and community supports are considered too, as your wishes and preferences, the HSE says. If the assessment shows your needs can be met by another community service such as Meals on Wheels, then this may be the recommendation.
Even if you are granted homecare, you may not receive the full complement of what you need.
“In most cases families will be assessed as needing far greater supports than they will actually receive,” says Cox. What an older person receives could be as little as three hours a week. “Many families are placed on a waiting list and could remain there for months or even years, in some cases.”
The Department of Health and the HSE are reviewing the homecare scheme. Similar to the Fair Deal scheme, it may be put on a statutory footing with services co-paid for by those able to do so. This may also bring greater regulation of the sector.
Consumer-directed home support
Those eligible for the homecare service have the option of choosing consumer-directed home support. This is where you arrange home support from a list of HSE-approved providers yourself and the HSE pays the provider directly.
The waiting list for this can move more quickly, says Cox. A shortage of homecare workers across the State, and particularly in cities, is still a serious problem. “It can be difficult to get continuity of care which is very important for older people, as well as quality.”
While the HSE will have approved funding for a number of hours, the number of hours you actually get for the money will depend on private providers’ rates for the days and times you chose. Most private providers, for example, charge weekends at a higher rate.
While the provider is not allowed to charge rates higher than those agreed with the HSE, different providers charge different rates. It’s a good idea to check the pricing of a few providers before choosing.
When you’ve decided on a provider, you should agree a written “schedule of service” covering things such as the days and times of delivery, the notice period to rearrange this if needed and the duties to be carried out. If the older person is dissatisfied with the service, they can raise it with the provider and submit a complaint to the HSE.
Private home help
If you are ineligible for HSE supports or the waiting list means you need help sooner, you could pay privately. Many people also have to supplement their meagre number of HSE-granted hours with extra hours from a private operator.
If can be hard to know where to start. “We would suggest that a person looks up the HSE-approved homecare providers to ensure that the company will provide quality care,” says Cox of Family Carers Ireland.
Home and Community Care Ireland is a representative association of private companies offering a homecare service. Most, but not all, provide a service to the HSE as well as privately. Not-for-profit organisations such as Family Carers Ireland, also an HSE-approved homecare provider, is another good option. They also offer advice for those needing care and family carers.
Tax back
The cost of private homecare can range from €23 an hour upwards with evenings and weekends generally costing more, and bank holidays more again. You can claim tax relief on the cost of care, either for yourself or for a family member such as a spouse, civil partner, child or a relative, including a relation by marriage or civil partnership.
The relief can be claimed at your highest rate on the lower of two amounts – the cost of the carer or the maximum annual deduction of €75,000.
To qualify for the relief, the person being cared for must be totally incapacitated for the complete tax year (January to December), in which you are claiming the tax relief but the carer does not have to be employed for the full tax year.
“Totally incapacitated” means the person being cared for is disabled and requires a carer. You can’t claim tax relief for employing a carer if the carer only carries out housekeeping duties or if a dependent relative tax credit has already been granted.
Financial supports
In many families, it is informal care within the family that supports an older loved one to remain at home. Navigating the system to discover your rights and entitlements as a carer is not easy.
If you are on a low income and are looking after an older person, the carer’s allowance is a weekly means-tested payment worth a maximum of €257 for those caring for someone over 66.
The recipient must not be working or in education outside the home for more than 18.5 hours a week. If you are taking time out of work to care for someone, the carer’s benefit is a weekly non-means tested payment worth €220 a week.
Some of these payments increase if you are looking after more than one person. The carer’s support grant is an annual non-means tested payment of €1,700 to a family member providing full-time care. The grant is paid automatically to people getting carer’s allowance or the carer’s benefit and is usually paid in June.
There are some supports from Revenue too, the main one being the home carer tax credit. This is given to married couples or civil partners (who are jointly assessed for tax) where one spouse or civil partner works in the home caring for a dependent person, including a person aged over 65. The dependent can’t be your spouse or civil partner.
Local authority housing adaptation grants are available too for work such as adding a ground-floor bathroom or improving the accessibility of a bathroom or bedroom.
Ireland is aging fast. A spending review by the Department of Public Expenditure found that by 2031 more than a quarter of a million inhabitants in the State will be aged over 80 years. Central Statistics Office figures predict that those aged 65 years and over will increase significantly from a level of 629,800 in 2016 to potentially nearly 1.6 million by 2051.
With the number of older voters rising, Governments will need to start prioritising their needs fast.
