Older people have less say in their care, and code is voluntary, writes PAUL CULLEN,Health Correspondent
A CONTINUING failure to legislate for standards governing home care and home help services may expose older people to abuse and serious harm, a new report warns.
Reductions in HSE budgets mean older people have less say in how their care is provided, with the time available increasingly determining how the care is given, the National Economic and Social Council (NESC) report says.
“The ability of the older person to choose how to spend funding they may be allocated for home care has also been reduced, as home care grants that could be used by an older person to directly employ a carer of their choice are being phased out,” it points outs.
In Canada, costs have been cut and better outcomes achieved by involving the user in managing their home care services, according to the author, Dr Anne-Marie McGauran. “We recommend that national standards and regulations, inspected by the Health Information and Quality Authority, be applied to all types of home care. This is already a Government commitment, but has not yet been implemented.”
Last year, almost 51,000 people received home help and 15,000 a home care package through the HSE.
Since last July, organisations providing home care packages on behalf of the HSE must demonstrate quality standards in a range of areas before being awarded a tender.
The report says this development is very positive, but it points out that standards for home help and home care packages delivered directly by the HSE, or by other organisations to private individuals, are voluntary or non-existent, so accountability for the quality of these services is weak. The fact that other forms of home care are not subject to standards “compromises the ability of the existing standards framework to prevent abuse and serious harm in the area of home care”.
The report calls for mandatory implementation of draft standards and inspections to ensure they are met. “This will become increasingly necessary in the future, with more older people likely to be cared for at home, in line with Government policy and the wishes of older people.”
The report says few of the draft home care standards are being implemented and those that are are voluntary, so there are no sanctions where standards are not met.
Meanwhile, supports to help home care providers to implement the quality standards are quite limited.
A separate NESC report on end-of-life care in hospitals highlights the impact of spending cutbacks on such care. Staff have less time to implement improvements in end-of-life care, it is more difficult to release staff from day-to-day work for training and staff have less time to spend with those who are dying. “Cuts in capital budgets are likely to have a negative impact on the prospect of more single rooms in hospitals, or viewing rooms in mortuaries – both issues that need to be addressed to improve the quality of end-of-life care and the experience of the bereaved.”
Almost 30,000 people die in Ireland each year, 75 per cent of them in hospitals, but end-of-life care is not seen as a core hospital activity, says the report.