Older people suffer ‘postcode lottery’ in accessing home supports

Older people seeking home supports suffer a “postcode lottery” due to wide variations in waiting lists between different regions, according to a new report.

Although fewer people are waiting overall, the former waiting list for funding for home supports is largely being replaced by a waiting list for staff due to the difficulty in hiring qualified carers, the report finds.

In Wexford, more than 870 people were waiting for access to a home carer last December, while over 300 were waiting in Waterford, according to the report by Home and Community Care Ireland (HCCI).

More than 200 people were on the list in Cavan-Monaghan, Galway, Mayo, Clare, Kerry, South Lee in Cork, Meath, Dublin South-West and Dublin West.

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In contrast, there was no waiting list in Dublin Dublin South-East, Dublin North-Central and Dublin North-West.

North Dublin has the shortest waiting lists relative to the population of over-65s, while the south-east has the longest.

The report says waiting lists are generally shortest in areas where a high proportion of home care is delivered by private providers or non-profits rather than the HSE. According to HCCI, the data suggests that using private and non-profit providers “substantially increases capacity”.

More than 55,000 people, or one in 12 of everyone aged over 65, receives home care funded by the HSE. The average allocation is 7.1 hours of home support a week. The home support budget has doubled in seven years, to €666 million this year, but difficulties in recruiting staff are causing delays for older people seeking supports.

Private operators and non-profits provide about two-thirds of home supports, with the HSE delivering the rest directly.

Statutory rights

By last December, 5,322 people had funding for home support approved but were waiting for a home-care worker to become available. Another 474 were waiting for funding approval.

While the Government is committed to reforms, including the introduction of statutory rights to home support, HCCI maintains that progress is extremely slow. The statutory scheme is unlikely to be implemented in 2023 due to planning delays, it says. A separate delay in payment of the pandemic bonus to carers is affecting staff morale, the group says.

“Progress is at a snail’s pace,” said Joseph Musgrave, chief executive of the HCCI. “Whilst there has been a range of plans to develop certain elements of the sector, progress in implementing these have been limited and home care has not always been a priority within the HSE and across Government. This must change.

“The Government says that it supports a ‘home first’ policy but its actions, or lack of, says the opposite. Our providers are still experiencing significant challenges recruiting carers and clients are facing lengthy waiting lists for a home carer.”

Private providers are seeking a regulatory change that would allow them recruit carers from non-European Economic Area countries, as nursing homes can.

HCCI has also suggested the creation of a graded career structure for carers and greater training opportunities. It also favours payment of the living wage to staff but says this must be included in the next home-care tender as the HSE sets the conditions for the market.