Health (Amendment) (Home Support Providers) Bill 2025: Second Stage

Minister of State at the Department of Health (Deputy Kieran O'Donnell)

I move: "That the Bill be now read a Second Time."

I am very pleased to introduce the Health (Amendment) (Home Support Providers) Bill 2025 to the House. I look forward to hearing the contributions of Deputies today, and to working with all Members of Dáil Éireann and Seanad Éireann to progress this important legislation through both Houses. Home support is a vital service that is delivered to thousands of people nationwide every day. It provides a very important service to individuals of every age and their families, as it enables people to maintain independence and dignity while living at home. In line with Sláintecare, this Government is committed to ensuring that we take concrete actions that support and empower people to stay in their own homes and in their communities.

At the outset, I wish to acknowledge the services provided by the carers and service providers that deliver home support. Improving access to home support is an absolute priority for this Government, and home support hours have increased every year since 2020, from 17.8 million hours in 2020 to 30.6 million hours in 2026. This represents 26.7 million hours for older persons services and 3.9 million hours for disability services. The programme for Government commits to designing a statutory home care scheme to allow people to stay in their own home for as long as possible. The first, essential step towards the scheme is to ensure that home care is regulated and that there are quality standards in place that services can be inspected against. This legislation will therefore ensure that, for the first time in Ireland, home support providers - whether public, private or voluntary - are required to operate in a regulated environment.

There are inherent risks for service users in the provision of health and social care services by an unregulated sector. In vital areas such as infection prevention and control, staff training, and clinical governance, there are no standards or regulations that all home support providers must comply with. There are standards of service that can be expected from the HSE, through HSE funded services, or through the terms of private contracts. However, there are currently no consistent, minimum standards of care that apply universally to home support providers. There is also no independent oversight of the provision of services, therefore, there is no independent mechanism to ensure that the standards that do exist, such as HIQA's National Standards for Better Safer Healthcare 2012 are complied with.

The regulations that will be made on foot of this legislation will therefore offer quality assurance to service users that their service meets the same minimum standards wherever and however it is provided. The introduction of a statutory framework to provide independent oversight of home support providers will ensure increased compliance with regulations and quality standards, which will increase public confidence in home support services.

The Health Act 2007 established the Health Information and Quality Authority, HIQA, and the Office of the Chief Inspector of Social Services. It also provides the regulatory framework for residential services for older people, persons with disabilities and children in need of care and protection. The Chief Inspector of Social Services monitors compliance with this regulatory framework. The Bill before the House is modelled after the regulatory framework for designated centres as set out under the Health Act. This was outlined in the general scheme. It amends the 2007 Act, establishing a regulatory framework for home support providers who will be required to meet minimum requirements set out under Ministerial regulations in order to provide a home support service. This framework will be further supported by HIQA’s National Standards for Home Support Services.

These amendments will act to safeguard service users and raise the quality and consistency of home care nationally and will be a first step in meeting the programme for Government commitment to design a statutory home care scheme. The framework will extend to all service users regardless of age who by reason of illness, frailty or disability require a home support service. As such it applies to home support provision funded by both the Departments of Health, and Children, Disability and Equality.

The Bill will introduce, for the first time, the registration and regulation by HIQA and the Chief Inspector of Social Services of all home support providers in Ireland. Among other measures, it will provide the chief inspector with a range of powers and will make it an offence to provide a home support service without being registered. The chief inspector will also be responsible for monitoring and assessing compliance of registered home support providers against regulations and HIQA standards. The new system of regulation for home support will ensure that the public can be confident that the services provided are of a high standard and will bring Ireland in line with best international practice.

I will take the House through the Bill to briefly outline the content of each section. The legislation has two Parts consisting of 22 sections. Part 1 relates to preliminary and general matters and contains sections 1 to 4, inclusive. Section 1 provides for the Short Title of the Bill, collective citation, and for the commencement of its provisions.

Section 2 provides definitions of key terms used in the Bill.

Section 3 provides that the operation of the Act must be reviewed within five years of enactment after which a report on the findings is to be laid before the Houses of the Oireachtas.

Section 4 repeals a section of the Human Tissues (Transplantation, Post-Mortem, Anatomical Examination and Public Display) Act 2024.

Part 2 sets out amendments to the Health Act and consists of 18 sections. Section 5 amends the principal Act to provide for the definition of key terms relating to the regulatory framework for home support providers.

Section 6 amends section 8 of the principal Act to provide for new functions for HIQA to set standards on safety and quality in relation to home support services.

Section 7 provides for HIQA to conduct investigations of registered home support providers.

Section 8 expands the functions of the chief inspector to establish and maintain a register of home support providers, collect key data in relation to home support providers, inspect premises where he or she suspects the business of a home support service is being carried out, and register and inspect home support providers against both ministerial regulations and HIQA standards.

Section 9 inserts a new part, Part 8A, to the principal Act to provide for the registration of home support providers through the insertion of 29 new sections, Nos. 69B to 69ZD.

Section 69B provides for the definition of key terms used in Part 8A and provides for exemptions to the requirement to register as a home support provider.

Section 69C provides for a prohibition on carrying out the business of a home support service without being registered.

Section 69D provides for a prohibition on making false or misleading statements in a material respect when applying for registration or renewal of registration.

Section 69E provides for the application process for a person seeking to register or renew the registration of a home support provider.

Section 69F provides for the establishment of a register of home support providers.

Section 69G provides for the grant or refusal of the registration of a home support provider.

Section 69H provides for grounds under which the chief inspector can cancel, vary or remove a condition, or attach an additional condition to a registration of a home support provider.

Section 69I provides that the chief inspector may remove a condition attached to a registered home support provider's registration where they deem it is appropriate and will not adversely affect a service user receiving support from that provider.

Section 69J provides that a registered home support provider may apply to the chief inspector for the variation or removal of any condition that has been placed on their registration.

Section 69K provides for notices to be issued by the chief inspector to an applicant or a registered home support provider, as appropriate, in respect of a proposed decisions to an application submitted under sections 69E and 69J.

Section 69L provides that an applicant or registered home support provider, as appropriate, has 14 days after a notice is given of a proposed decision of the chief inspector under section 69J to make a written representation to the chief inspector concerning the proposal.

Section 69M provides that the chief inspector is to give written notice to an applicant or registered provider of a decision to refuse or grant an application, to cancel a registration, remove or vary a condition or attach additional condition or to remove a condition of a registration.

Section 69N provides for when the chief inspector proposes to make certain decisions where the home support service is provided or proposed to be provided by an applicant or a registered home support providers from more than one business premises and a single application has been made for registration.

Section 69O provides for required and prohibited conduct for registered home support providers.

Section 69P provides for the appeals process from a decision of the chief inspector regarding an application for registration.

Section 69Q provides for the chief inspector to seek a District Court order enforcing certain decisions under sections 69G, 69J, and 69H.

Section 69R provides for the chief inspector to seek a District Court order where they believe there is a serious risk to a service user due to the actions of a registered home support provider or person acting on their behalf.

Section 69S provides for the chief inspector to make an application under section 69R as an ex parte interim order.

Section 69T provides for a final determination of matters dealt with in an ex parte interim order under section 69R.

Section 69U provides that an appeal of a District Court decision under section 69N lies to the Circuit Court.

Section 69V provides that the chief inspector is a party to any court proceeding taken under this Part of the principal Act and is entitled to appear, be heard, adduce or give evidence.

Section 69W provides for the submission of information to the chief inspector by registered home support providers.

Section 69X provides for the collection of key data from registered home support providers, the sharing of information with the Minister and public bodies, such as HIQA and the HSE, and the publication of this data in aggregate form by the chief inspector.

Section 69Y provides that a registered home support provider shall not submit false or misleading information to the chief inspector under sections 69W or 69X.

Section 69Z provides that where a registered home support provider decides to cease to carry on the business of a home support service, they are to notify the chief inspector of the date in which they are to cease operating in accordance with the timeline set out under regulations. Section 69ZA provides that where a registered home support provider ceases to carry on its business, the chief inspector will make a note in the appropriate register and cancel the registration of the provider. Section 69ZB provides that where a person is appointed by or under law to take charge of the business of a registered home support provider, that person is to notify the chief inspector as soon as practicable and no later than 48 hours after the appointment. Section 69ZC provides for the notifications by the chief inspector relating to certain home support providers. Section 69ZD provides for transitional arrangements for persons providing a home support service immediately before this Bill comes into operation.

Section 10 provides for the HSE to appoint persons to examine business premises of a home support provider that is providing service on behalf of the HSE. A person appointed under this section will be authorised to enter any business premises of the home support provider and examine any records relating to the service and interview any employees of the provider.

Section 11 provides the right of entry and inspection by the chief inspector to the business premises used or proposed to be used by a home support provider or the private dwelling of a service user where a home support service is provided with the consent of the service user concerned.

Section 12 provides that if the chief inspector has reasonable grounds to believe that the business of a home support provider is being carried out on a premises which is not registered, the chief inspector may enter the premises to inspect it.

Section 13 provides for the District Court to issue a warrant to authorise the chief inspector entry to premises where the chief inspector suspects the business of a home support provider is being carried out, if required.

Section 14 provides the inclusion in the definition of dwelling of any part of the business premises of a registered home support provider that is occupied as a private residence by that person or a member of staff of the provider.

Section 15 provides for the inclusion of a reference to home support providers in relation to the further circumstances in which the District Court may issue a warrant.

Section 16 provides that HIQA may prepare and publish reports relating to the monitoring of compliance and standards by registered home support providers, and the manner in which those reports should be prepared.

Section 17 provides for the serving of compliance notices on registered home support providers. Under this amendment, where the chief inspector is satisfied that a registered home support provider has contravened a relevant provision of legislation, he or she may issue a compliance notice. A registered home support provider who fails to comply with the compliance notice by the date specified in the notice shall be guilty of an offence and liable to prosecution. Registered home support providers will have the right to make an appeal to the District Court within 14 days.

Section 18 requires the chief inspector to maintain a non-compliance list of providers on whom a fine or penalty has been imposed.

Section 19 amends section 79 of the principal Act providing for offences for home support providers.

Section 20 amends section 99 of the principal Act providing the Minister for Health, in consultation with the Minister for Children, Disability and Equality as appropriate, to make regulations relating to the registration of home support providers under the Act.

Section 21 provides the Minister for Health, in consultation with the Minister for Children, Disability and Equality as appropriate, to make regulations for home support providers to ensure proper standards in relation to the home support services they provide.

Section 22 inserts a new section 101C into the principal Act providing the Minister for Health with regulation-making powers to prescribe the collection, sharing and publication of data regarding registered home support providers. Regulations will determine the type of data to be collected, shared and published and the frequency of the submission and sharing of information.

It will be necessary to introduce a small number of Government amendments, including technical amendments, as the Bill makes its way through the Houses of the Oireachtas. The most significant of these relate to necessary enhancements of consent provisions to reflect the more recent policy change to include home support services provided to under-18s within the scope of the Bill. This legislation is the major first step towards designing a statutory home care scheme. The establishment of a regulatory framework for home support providers will act to provide new protections for service users and will raise the safety, quality and consistency of care nationally.

I look forward to the contributions of Deputies and to working with all Members of Dáil Éireann and Seanad Éireann to progress this important legislation through both Houses of the Oireachtas.

Deputy David Cullinane

I have ten minutes, and I am sharing time with two of my colleagues.

I welcome the opportunity to contribute. We will support the Bill on Second Stage because the private homes support sector must be regulated, and families deserve basic assurances of safety standards and accountability. However, supporting a Bill is the not the same, as I am sure the Minister of State will agree, as applauding the Government's record, which I wish to turn to. This legislation is necessary, but it is also a stark admission of how little has been delivered and how low the Government's ambition has fallen. The Bill's purpose is to amend the Health Act to create a statutory regulatory framework for registration, minimum standards, inspection, enforcement and data collection for home support providers. It brings the framework for home support providers into line with the model used for designated centres, HIQA standards and an expanded role for the chief inspector, all of which I agree with. It provides for a public register of providers, including key details and conditions of registration, a prohibition on operating without registration with offences and penalties, inspection and enforcement powers, including compliance notices and court applications where serious risk is identified, data collection and publication in aggregate form ensuring that we can finally see what is happening in the sector.

In plain language, this is about regulating providers, but it is not about delivering entitlements for patients. Not only is there a commitment to a statutory home care scheme in the programme for Government, but it was included in the previous programme for Government, . This was to operate on a similar basis to the fair deal scheme. We still have no details of how that will work. We still have no details of who will be entitled to it or who qualify, what equity issues will be in play and when this will see the light of day. I suspect that we have not seen a statutory home care scheme in place or any movement on this issue because we do not have the capacity to deliver it. The Government should be straight and upfront with people. We know and all deal every day in our constituency offices with families who are waiting for home care or intensive home care packages. Some families and some people get them. Some get partial hours, which is not all the hours that they need. Others do not get any at all and are stuck on waiting lists. Two of my colleagues in Donegal, Deputies Doherty and Mac Lochlainn, have alerted me to serious problems in the county in accessing intensive home care packages. There is a long waiting list. We have patients and families who need urgent support at home, and they cannot get it. I suspect that is what happening here. Statutory home care is a game-changer. It means that there will be a statutory right or a statutory obligation for a person to have access to home care. That will place more of a burden and obligation on the State to provide that care. The Government, HSE and Department are not equipped to deliver it.

It reminds me a bit of the Disability Act 2005 where the Government of the day decided rightly that we would confer a legal right for a child to access an assessment of need and that that assessment of need would look at the health and education needs of each child. On the basis of the aggregate assessment of need carried out, the Department would then be able to plan and provide the appropriate resources, including speech and language therapists, occupational therapists, psychologists and so on. That never happened. Of course, what has happened is that people are waiting, waiting and waiting. Parents are taking the State to court. I have a concern that is what is holding back the Government on this. It is saying, "Hang on a second here", or maybe it is coming from the Department saying, "Let us be very careful about statutory schemes because that places an obligation on the State." However, the reality is that this is badly needed for many families. Everybody has the right to the best available care. A long time ago - well before Sláintecare - it was an accepted principle in the health care system that if it is appropriate for a person to be cared for at home that is where they should be. We have far too many people in hospital who should be at home, but they cannot be discharged from hospital because the home care supports are not available.

I deal with this all the time as the health spokesperson for my party. I get queries in from all over the State relating to people who are in hospital and want to be discharged to their homes. Their families want them at home. It is the best place for them. They can care for them to a level, but they need additional supports to discharge them. They have additional needs, and they cannot get the supports. They are pleading with the hospital and community services. Sometimes there is not joined-up thinking between all those services but for the most part, the capacity is not there and the person cannot be discharged. If a person cannot get care at home, he or she ends up in hospital. There are major advances in health care. I am a member of the Joint Committee on Health, as is the Cathaoirleach Gníomhach. We are learning all the time of the advances in technology. For example, we hear about virtual beds, the principle of which is great. A person could be cared for and monitored, including their blood pressure, from home. Huge advances have been made where a person does not necessarily have to be in hospital to get certain care. Some people do, but there are categories of patients who can be cared for at home. The problem is that we cannot realise that potential because we do not have the capacity. What happens is that it is a postcode lottery, patients go on a waiting list, and they may or may not get the home care supports that they need. That is not what should be in place. That is not where we need to be.

I have seen it far too often in healthcare, particularly under the previous Minister for Health and indeed, the current Government as well. Big promises are made that we are going to do all these wonderful things with Sláintecare being the biggest one. It was the big vision for healthcare, but then we do not see the practical delivery of it. We have seen it in so many areas of healthcare. Beds that were promised were not delivered. Staff that were promised were not delivered. Pharmacy agreements that were promised were not delivered. The Government made these big announcements and then left people high and dry. That is what was done with the statutory home care scheme.

What is really frustrating is that despite two programmes for Government that promised a statutory home care scheme, and all of the years that have gone by, the best the Government has done is to say it will regulate the area, have a registry and make sure service providers are registered. That is great but it should have been done years ago. That it is taken so long for even this Bill to be brought forward, given the commitments we were given, is staggering. I imagine that most people probably thought this was already in place. That is something that is really basic. Of course all home care support services should be registered, of course they should be subject to regulation, and of course HIQA has to have the powers to look at these areas. For most people this is a no-brainer and they would have expected it to have been in place. The fact we are only dealing with this now is problematic, and we still do not have the statutory home care scheme, as I said.

I ask the Minister of State to examine the difficulties in the north west. It is an issue that an Teachta Doherty in particular has raised with me. I have spoken to the head of the HSE on this and he has acknowledged that there is an issue, which is a staffing issue.

I want to make a point on something I am concerned about generally in healthcare. When we are speaking about home care we have to accept that because of decades of a lack of investment in public home care, the vast majority of providers are now private. We have also seen this with nursing homes. At one point a majority of nursing homes were public but they are now private. The majority of home care is now being provided by private providers. I am not casting aspersions on the private providers, and the staff and the people do a good job, but we need to build up public capacity and we need to make sure we are getting value for money and bang for buck.

We are paying premiums to private providers to provide services that should be provided through the public system, given that we have all signed up to the principle of a universal healthcare system, public healthcare and Sláintecare. This is what we have all signed up to but what I see is more and more privatisation and systems dependent on the private sector. We see it with dentistry. We have more private dentists than public dentists. We have more private nursing homes than public nursing homes. We have more private home care providers than we have public providers. This is wrong and we need to rebalance the scales. We need to invest in the public service. We are not going to be able to roll out a statutory home care scheme unless we have public infrastructure. I imagine there is even push-back against this from some of the private providers.

The role of the State and the role of the Government is to make sure we can deliver on this. It is the job of the Minister of State and the Government to deliver on the promises made in this area. I do not believe the Government will be able to do it unless it builds public capacity. It has not built up public capacity which is why year after year it comes with Bills like this as opposed to a statutory home care scheme. It is simply not equipped or in a position to deliver it.

Deputy Natasha Newsome Drennan

A fundamental issue facing us is how we care for older people in society and for those in need of care due to a disability. The welfare and treatment of the most vulnerable people is a mark of the society in which we want to live. What we are being told by advocacy groups and by the people themselves is that they want support to stay in their own homes and live with as much as dignity as possible.

The Bill seeks to regulate private home care providers, establish a register, set minimum standards to be enforced by HIQA and create an inspector regime. While all of these are very welcome, the time it has taken for the Bill to be progressed shows how much of a priority it is for the Government. The Bill is yet another missed opportunity by the Government. The reform that the sector and families have been seeking for years is nowhere to be seen. The Bill represents a profound failure of ambition.

The previous programme for Government promised a statutory home care scheme. That was six years ago. Where is it? How many more years will the public have to wait for an equivalent of the nursing home support scheme that will deliver universal home care? We need to see universal and affordable access to home care. It is the right thing to do and it is the wise thing to do. Properly supported home care reduces pressure on our overwhelmed hospitals. It is better for the individual, the State and the entire health system.

After all the time spent on this legislation, what do we get? We get a register of private providers. The legislation is yet another example of the do-nothing Government getting the bare minimum done. Without a public scheme the Bill will only further embed the privatisation of care. The Bill is full of shortfall after shortfall. Affordability of care is completely absent. For the thousands of families who are crippled each and every month, the Bill will change nothing. It will police a system that is failing people and families across the State.

The Bill is needed but it does not go anywhere near far enough. It has become clearer by the day that Fianna Fáil and Fine Gael have little to no interest in building a genuinely fair and public system. The Bill is more proof of this. What we are seeing is the further embedding of privatisation. Two thirds of home care provided is private and public provision continues to drop. Can the Minister of State point to a single public service that has improved thanks to the Government pushing for further privatisation? Is there anything, be it housing, roads, water, infrastructure or the energy sector? All that "the market will provide" privatisation model has done is drive up the cost of services for everyone, from the State to ordinary workers, while driving down quality and services. Where is the recognition of different levels of need? The Bill treats the provider of basic assistance the same as the provider of complex high dependency care with no differentiated funding or support except for a tiny number of intensive packages. This is a blunt instrument that fails to match the reality of care.

While we are debating the Bill, 34,000 carers across Ireland are in a state of anxiety and fear. This has been caused by the Minister of State and his colleagues. It is fear about the thousands of euro that Revenue will be looking for as part of a back payment of tax for part of three years. This is yet another act of utter heartlessness by the Minister of State and his colleagues, going after carers who provide so much to our society. My father was one of the lucky ones as he chose to stay at home. There was space there and my mother could provide care for him. The vital care that carers such as my mother provide goes unnoticed. A clap on the back is not good enough. They are not getting near minimum wage for 24 hours, seven days a week. To tax them on this is ridiculous. They get the respite grant but it does not go anywhere near respite. It pays bills and pays for electricity. This is all it does.

As I said, my father was one of the lucky ones. A report into a nursing home in Kilkenny stated that people were cold and did not have enough bedsheets and there was a strong smell of urine. HIQA inspectors concluded that the residents in the home did not receive a good standard of care. Carers continue to shoulder the consequences of decades of underinvestment in home care supports, all while saving the State billions in care each and every year. How can the Minister of State justify going after so many who are already struggling to get by while, at the same time, giving massive tax breaks to the likes of Starbucks and McDonalds. It spells out clearly where the Government's priorities lie.

Will the Minister of State provide an update on the adult safeguarding legislation in his closing remarks? The policy framework was published in December but we are still none the wiser as to when the Government will bring forward this much-needed legislation. The Law Reform Commission has done most of the work. When will the Bill be brought forward?

Deputy Claire Kerrane

I am really glad to have the opportunity to speak on this very important legislation.

In reading through the Bill, I was reminded of the very damning HIQA report that was published at the time, which called for a complete overhaul of home care services. That report raised concerns around the fact that there are no minimum standards of care when it comes to home care services. I recall raising this very report during Leaders' Questions. At that time, I was assured the regulations were being worked on by the Minister. That report and that Leaders' Questions were from December 2021, over four years ago.

I have always found it disturbing that we have home care workers going into homes, particularly where older people live on their own where they are extremely vulnerable, and there are no regulations in place. The Minister of State said in his statement, "There are inherent risks for service users in the provision of health and social care services by an unregulated sector." It does not really bear thinking about what those risks have been in all the years gone by, and how they have played out in some circumstances. It never made sense to me that when we raised questions in terms of home care, the HSE was not in a position to provide a list of private providers who go into homes of older people, people with disabilities and our most vulnerable citizens. This legislation is long overdue and it is extremely welcome, but it is really urgent that it is moved on as quickly as possible. For many in the sector who have waited so long for this, such as those represented by Home and Community Care Ireland, HCCI, we need to give assurances that these regulations will be fit for purpose. We also need to give clarity on the timeframe for this.

As we know, some private providers are very much partnered with the HSE and essentially do the work of the HSE. They provide the home care that the HSE cannot provide. I have referenced Roscommon Homecare Services in the Dáil before in terms of the excellent care they provide. This not-for-profit organisation provides so much home care support and services in our communities and in the wider area.

It is important when debating this Bill to acknowledge that this is just one issue. This legislation typically deals with the regulations and the need for regulations but there are many other issues that are constant in terms of home care, particularly the waiting list. The latest figures I have for Galway state that 357 people are waiting for home care. It is significant that 248 people receiving the service have been found to be entitled to additional hours but are waiting to receive those additional hours. That puts so much stress and worry on the person and on their loved ones.

The question of rushed visits has been raised many times, particularly for the workers themselves. We have to acknowledge not only that workers are being rushed in terms of these visits with the travel and all of that, but also the impact that has on the person they are caring for, who is made to feel merely like a ticked box. It must be a horrible feeling for someone who is vulnerable. It is so important we get this Bill through as quickly as possible. I hope the Minister of State might be able to provide some kind of timeframe for that.

Deputy Marie Sherlock

I very much welcome this Bill. It is long overdue, as we badly need to have a statutory regulatory framework for home care support in this country. There is a glaring need to have minimum standards and a licensing regime for providers. Others have referenced the scandal we saw within the nursing home sector last year and in many previous years. We do not really have any idea of the quality and standard of the much-needed care that is taking place within peoples' homes.

This Bill will, for the first time, allow for licensing inspection and enforcement of minimum standards. It is important to say that how the ministerial regulations will be set will be critical to the success or otherwise of this legislation. I am particularly mindful of the timeliness of this now, given that the approximately 28 million home care hours provided across the State in 2022 will almost double in about 18 years by 2040. The reliance on home care support packages across the State with an ageing population means getting this legislation right is going to be critical.

Before I talk about my concerns about the Bill and indeed about what is not in it, I am conscious that 100 staff in Coolock from Northside Home Care Services are currently on strike because of their failure to be recognised within the section 39, section 56 and section 10 pay deal that was agreed 18 months ago. It is wrong that they have been excluded. We should decide whether they are part of our health service. The reality we have known for some time is that when we try to get services on the cheap, we end up in very serious and dangerous territory in healthcare. We need to make sure that these workers who are going in and out of people's homes day in, day out are afforded the dignity and respect of proper pay. SIPTU has also balloted for industrial action with a 95% vote across counties Donegal, Clare, Cork, Kerry and other counties because of long-standing failures to meet proper working conditions in the sector in those particular organisations.

Regarding the Bill itself, today we are talking about a statutory regulatory framework for providers. A critical part of the jigsaw is the statutory right to be cared for within one's home. As we all know, there is a statutory right to access public hospitals in this country, but there is nothing regarding care within our homes. That has to be a critical part of ensuring people get the care, dignity and service they are entitled to and deserve within their home in future years if the Government is serious about moving care out of our acute hospital system and into the community.

I also have a concern about what I see as the growing marketisation of the home care sector. For a long period of time it was very much based on the co-operative model. It was based on voluntary providers and community-based providers providing home care assistance within communities. That is now slowly changing, and we are seeing corporate entities come into the market and it is not so different from the nursing home sector in terms of their ability to swallow up smaller operations. In terms of some of the requirements set down in this Bill, there is a very real question for the Government regarding what kind of model of home care support it wants. Does the Government want it to be driven and delivered by large corporate entities, or does it still want to accommodate that community-based model? That is a question I would like the Minister of State to answer today because failings in how the Government has responded over many years with regard to the nursing home sector paved the way for the mess that happened last year. I know there are some changes now within HIQA with regard to having to declare the ultimate beneficiary. That is important but it is not enough because we have to be mindful of who is ultimately going to be controlling the market or the sector for home care. Another key thing is the financial support to be made available to HIQA, not just to administer the licensing but also in terms of the inspections regime. There are also the exemptions within this Bill, particularly with regard to personal assistance and those other carve-outs which are very concerning.

We know there are about 200 home care support providers in Ireland with up to 29,000 staff. I do not want to see in five years that 200 figure go down to 50 or below, but it could because of the administrative requirements envisaged within this Bill. The key question, which is outside this Bill but is very much for the Minister of State in terms of deciding the budget, is whether sufficient funding will be allowed for in the tendering process for this additional administrative requirement? If there is, the Government can ensure the survival and, indeed, the thriving of the many home care support providers at the moment. If there is not, we know the direction of travel and we are going to see a much smaller number of very big entities.

We also know that the 29,000 people who are providing home care support at the moment are not enough. There are massive shortages in certain parts of this country, including Cork, Kerry and parts of Limerick. Some 900 people are waiting for home care support in Cork and Kerry alone. Some 4,945 people are on a waiting list, as of June of last year. That is a huge amount of unmet need.

The cost of keeping people at home is relatively low compared with the alternative, which is that if they do not get support and care, they end up in a nursing home or they are readmitted to hospital. We must do much more to ensure we attract people into these roles, and that comes down to pay and conditions. I spoke about the strike that is happening at the moment, and the ballot for industrial dispute. It also comes down to the hours that are worked and making sure that people get proper transport and other allowances. It is also about reaching out to the many people, in particular women, who are outside of the labour force. We often talk about the unemployment rate in Ireland being about 4% or 5%, but the potential labour supply in this country is of the order of 16% to 18%. I refer to people who would like to work but cannot do so because of structural circumstances in their lives, whether it is a lack of childcare, a lack of transport or because they are caring for an elderly parent or relative. There are people who would like to work and we must figure out a way to bring such people in particular into a sector like this. For example, they could work part time or full time. We need to tap in to the untapped resource that exists.

I am concerned about how much in this Bill we are not hard-wiring into primary legislation but instead delegating to ministerial regulation. I refer in particular to the consent piece and the access piece into people's homes. It is important to work out the detail on that. That is something that should be debated here on the floor of the Dáil and the Seanad, as opposed to confining it to ministerial regulation.

The second key issue relates to the qualifications of home care providers. Very serious questions were raised during pre-legislative scrutiny of this Bill on the desired minimum training and education, but the Bill does not provide any clarity on this. It would be worthwhile to hardwire this into the legislation.

There is always a danger of there being a loophole with the exclusions. I understand why exclusions are put in place; we do not want to completely strangle or muffle a system. However, the reality is that if a provider has four clients or fewer, they should be regulated as well.

Deputy Kieran O'Donnell

It is three or fewer.

Deputy Marie Sherlock

I apologise. We all understand if there is an informal arrangement in place for looking after a relative or a neighbour, where it is only one person, but it is a business if a person is looking after three or fewer clients. I do not want us to be in a place in a number of years time where we are talking about the disaster of not regulating these entities. We are talking about people's lives. We are talking about people in a very vulnerable situation. In some situations they may not have very strong family support or they may have no family support around them at all. Who are we trying to safeguard here? We are trying to safeguard the person being cared for in their home and indeed the worker as well. That is critically important. To be frank, some of the workers involved last year were thrown under a bus. They were scapegoated and blamed for what took place in the nursing homes when, arguably, management and the owners got off scot-free. I have serious concerns about the exemptions.

The other key concern is the classification or designation as a personal assistance service. There is a fine line between the two. I am worried that we would see organisations trying to classify themselves in that space and then being exempt from this legislation. At the end of the day we want to prevent abuse and exploitation of the person who is being cared for, and we also want to look after the worker who is providing that service.

On the market and the cost of regulation, I spoke about the larger for-profit organisations that are effectively buying up voluntary and community-based organisations at the moment. There must be provision for the administrative burden in the funding provided to these organisations, through the tendering process.

My last point relates to HIQA. In 2024, HIQA estimated that it would cost €1.1 million per annum to introduce licensing. In the first instance, we must get a commitment from the Minister of State, Deputy O'Donnell, that the comprehensive costs of licensing will be covered by the Department. I am sure it is much more than €1.1 million now. I have had serious concerns about the HIQA inspection regime, in particular with regard to nursing homes. We articulated that last year. We accept there has been an increase in the number of inspections and that is to be welcomed, but as I articulated earlier, there are concerns about how HIQA is going to enforce the licensing and how it is going to inspect and access people's homes. Ultimately, if licensing is not going to be a superficial act of these Houses of the Oireachtas, and if it is to mean something, we need to have a clear sense of what the enforcement framework is going to look like. In regard to nursing home registration, HIQA had to go to the District Court to seek the cancellation of a licence. I believe we need to do something stronger here. HIQA needs to be invested with greater powers to cancel the licence of a provider if wrongdoing is found. A much clearer message must be sent to the public that much swifter and more comprehensive action will be taken by HIQA if there are concerns. Right now, there is a belief among the public that we do not have an enforcement regime that will speedily respond when there are concerns and that too much time is taken. The reality is that abuses may continue to take place in the time it takes to make an application to the District Court. We must take more immediate action.

We very much welcome this Bill. We want to see it move at a timely pace through this House and on to the Seanad. We need to see a substantial beefing up of the substance and content of the Bill for us to have the confidence that we will have a comprehensive and rigorous licensing, inspection and enforcement regime for home care support in this country.

Deputy John McGuinness

There is no doubt that the Bill is needed and that the regulatory framework to which the Minister of State commits is needed. In fact, it is long overdue. I am happy to see the service providers in this area regulated. I am also happy to see HIQA applying standards and that there are safeguards for the users of the service. Likewise, the role of the chief inspector and the work to be undertaken by that office is necessary. I read through the Minister of State's statement and I found no fault with the intentions of the Bill, and the reasons it is needed.

However, the question I have for the Minister of State is whether he has costed the consequences of the implementation of this legislation because there is no doubt that all of what he is going to enforce through it is going to cost the service provider and, at the end of the day, it is the customer that will pay. As private and not-for-profit companies implement what is necessary under this Bill, they will incur huge costs. I have not seen any breakdown of the expected consequences of those costs for individual service providers. How is the Minister of State going to regulate for that? Are we going to have a situation like that of the nursing homes? They are price takers. They constantly complain that there is no profit in their sector because the Department is the entity that makes them price takers and that the Department has little or no consideration for the actual cost. If you do not acknowledge the actual cost, you risk the possibility of a lower standard being applied when the chief inspector or HIQA is not watching. That is my very serious concern.

The current situation is that the Government pays for up to 3.9 million hours of disability services. Over the period from 2020, this has increased substantially. There is also provision for 26.7 million hours of older people's services. I support care of the person in the home. I want to see more of it. However, for a hospital to promise families that the service providers will provide a certain level of care to older people being discharged to their homes only for that not to be delivered is a bad way to do business. Those in the hospitals should be truthful to the families concerned so that they know what they will be given rather than being promised a lot more. The Minister of State has to address that because it is not fair to families who opt to care for these people at home. It is not fair for them to be misled by the hospital as to what can be delivered.

I am not saying it is the hospitals' fault. The expectation is that the staff will be there. However, the reality is that staff are forced to make all sorts of efforts. They are forced to do five minutes here and then 15 minutes over there, which really makes little or no contribution to the person's state of care or to the family. They are pushed to the pin of their collar to fulfil the hours given to them by the service providers. Many of these are commercial entities as distinct from not-for-profit or community-based entities. I would like to see far more community-based providers so that people in local nursing homes would be getting care provided by people who are deeply interested in a standard, even without the legislation being in place. I am deeply concerned about the current situation. It is not right that people are not given the care their families are promised.

I will make reference to a matter I have raised here and was referred to earlier on in the debate, the taxation of carer's allowance. Today, Revenue informed my office that it would not be undertaking inspections that might identify where arrears have arisen. I accept that. With regard to value for money, I ask the Minister of State to look at the money we are currently spending on caring for people in their homes and tell me whether he believes we are getting value for that money. Does he believe those being cared for are getting value?

Deputy Michael Cahill

Home support services are vital for our older people, people with disabilities and their families. They allow individuals to live independently in their communities and their homes and help to reduce pressure on hospitals and residential care settings. Despite ongoing investment, the home support system in Ireland is facing deepening challenges that require urgent policy attention and sustained resourcing. It is fair to say that the majority of us wish to keep our loved ones at home for as long as possible.

Today, 5,500 to 6,000 people remain on home care waiting lists in Ireland. Waiting times vary significantly by region. People in rural areas wait far longer than those in urban centres. In the Cork-Kerry region, some 1,300 people are on waiting lists due to staffing shortages. This represents nearly a quarter of the national total. The waiting list in Cork-Kerry is the longest. It is equivalent to 25% of the national waiting list. That has to be addressed.

I recently received a reply from the HSE regarding respite care. It said that, unfortunately, due to exceptionally high demand for respite services, the HSE was only able to allocate a maximum of two weeks' respite to clients requesting it. This is a new change. The service has been halved. Families usually got four weeks. My office is dealing with numerous cases in west Kerry, throughout the Iveragh Peninsula, in mid-Kerry, in east Kerry and in north Kerry. It is just adding to the pressures on families who wish to look after their loved ones in the home.

Persistent problems with recruitment and retention hinder service delivery. In some rural counties, recruitment has been extremely low. In large parts of Kerry, only a handful of carers have been hired for more than year. The average time to hire a home care worker can be long, which compounds delays in service provision. Workforce scarcity contributes directly to waiting lists and limits the number of home support hours available to clients. The Department of Health has criticised the HSE for rationing home care hours to stay within budget. This practice is seen as having negative impacts on individuals' health and on patient flows through the wider health system.

Although the provision of home support hours has increased compared with previous years, the system is still under strain and access can feel arbitrary without statutory entitlement. There is a lack of statutory home support rights. Ireland does not yet have a fully implemented statutory home support scheme, meaning there is no legal entitlement to home care comparable to the provisions of the fair deal scheme for residential care. This contributes to unequal access, a lack of transparency, variable standards, inconsistent waiting time data and a lack of formal quality benchmarks tailored to home care needs.

There are financial and administrative barriers for carers. Family carers are under significant strain. Many face long waits of more than four months for decisions on carer's allowance appeals, exacerbating financial stress. Current eligibility rules and means tests for carers' supports are seen by advocacy groups as outdated and not reflective of modern care realities. The 18.5 hour limit on carers' working hours has an impact on continuity of care and recruitment as some carers cannot work additional hours without losing support.

The Home Care Coalition, a group of more than 20 organisations, has called for increased investment and has highlighted that home support receives significantly less funding than long-term residential care despite rising demand. There is strong sectoral support for the implementation of a rights-based statutory home support scheme; a dedicated workforce strategy; carer career pathways; better pay, training and retention supports for home care workers; and reform of financial supports for family carers. It is critical that the Government fully implements a statutory home care support scheme with guaranteed entitlements and national quality standards; invest significantly in workforce recruitment and retention, including pay, training and career pathways; address the rural-urban disparities in waiting lists and targeted regional strategies; reform carer's allowance and supports to reflect modern care demands and reduce administrative delays; and increase home support funding in future budgets to close the gap with residential care investment.

Home support is more than a service. It is a lifeline that enables dignity, independence and quality of life. Today's statistics show that Ireland's ageing population and rising demand make reform urgent. With the right investment and policy leadership, we can build a home support system that truly meets people's needs. I welcome the Bill and ask that the Minister of State look closely at County Kerry's situation. We need more home support and carers.

Deputy Thomas Gould

The Bill is a step forward but it is a really small step forward. What we needed was a giant leap to really take this by the scruff of the neck. Five years ago, loads of promises were made and we were expecting to make further progress in relation to regulation and the provision of care. What we are seeing now is more privatisation when we need more community-based services. We need more resources and people. The reality is that without addressing affordability, the Bill means nothing. I am really concerned. I am contacted regularly by people who are stuck in hospital beds. They want to get out but there is no package, no care plan to get them from the hospital bed to their home where they want to be. Sometimes the package is granted but there is no package there. It is all well and good. Does the Minister of State know the guilt that families are feeling when they are told to take their loved ones home and they have no one at home to mind them? There is no care package to mind them. They are being put under pressure in the hospital because the hospital is crying out for beds. The person themselves, the mother, father or family member, wants to get home. Who is going to look after them? I know of people who have given up their jobs and got a shift. I know families that are lucky and are big enough that someone is staying there every day. The pressure it is putting on the families is just immense. We do not need privatisation. We need more HSE care assistants to provide services for these people.

There is a nursing home in my constituency, Heather House, Gurranabraher, on the old orthopaedic campus, the St. Mary's campus. There are 19 beds in a special dementia unit. In August the HSE said it was being snagged. On 16 October, I was told it was completed. On 22 November, I was told they were waiting on registration. Yesterday they were still waiting on this registration. With the number of people I am aware of in the north side of Cork, I could fill it. Not the HSE, I could fill that dementia unit today at Heather House.

Deputy Kieran O'Donnell

Write to us on that.

Deputy Thomas Gould

I will. I could fill that today. I am dealing with one family. The back garden of their house backs onto the wall of the hospital and they cannot get into it. The man's family are looking out the door when they are caring for their father and there is a dementia unit right there, 200 or 300 yd from his house. Another lady has to stay miles away because there is a shortage of dementia units and beds where people can go. The staff tell her daughter that when she comes to visit, the improvement in her mam is visible and that they can all see it. She is miles away; half an hour or 45 minutes away. When you have a small family with just two people who have their own families trying to make that journey, we need to provide this care locally.

We want to take giant steps forward. We want to work with the Minister of State on home care supports and services. The healthcare assistants are going on strike, the HSE support services in Cork, the home care assistants. I want to send my support to and express my solidarity with them. I ask the Minister of State to do everything in his power to resolve the case because they are really needed.

Deputy Sinéad Gibney

On behalf of the Social Democrats, I welcome this Bill to finally regulate home care services. The Social Democrats have long advocated for a statutory right to home care and this regulatory framework is an important element of that. As it stands, home care services remain unregulated, despite the vast majority of home care hours being funded by the HSE. While State-provided and State-funded home care is subject to HSE standards and policies, that is no replacement for statutory independent oversight. Unlike the nursing home sector, HIQA has no role in regulating services. For instance, it does not set standards, monitor compliance or register providers. This regulatory vacuum has prevailed for far too long despite the potential risk to service users. In reality, there is no barrier whatsoever to entering the home care sector. If a provider is not receiving State funding, there is no obligation for them to comply with HSE standards and policies. Given that millions of hours of home care are privately funded each year, that should be a cause for real concern. This Bill to regulate services is therefore long overdue, as is a statutory right to home care.

We can all accept that residential care is rarely anyone's first choice. Most older people prefer to stay in their homes and the State should support that. Remaining in the home can allow people to retain their independence. It is associated with better health outcomes and is much more cost-effective than residential care. More importantly, every person deserves a meaningful choice in how and where they live. Home care provides that choice. It provides the respect and dignity that we all aspire to towards our older years. The current model of long-term care in Ireland, with its over-reliance on nursing homes, denies too many people any real say in where they live.

In 2023, Sage Advocacy published a report on long-term care in Ireland from a human rights perspective. One of the key issues identified by Sage was the infringement of people's right to liberty. Why? It is because there are insufficient long-term care services in the community that would enable and support people to remain in their own homes. I would like to take a moment to commend Sage Advocacy on the incredible work it does in this space.

This is not just theoretical. The lack of home care services in some parts of the country means that nursing home residents are not prioritised for home care. That further compromises their liberty, as they have to remain in a nursing home setting against their wishes. Sage found that many of these residents would require relatively little assistance to live in their communities but the support simply is not there. The easiest option, and often the only one seriously pursued, is therefore for them to remain in a nursing home. Without the necessary services in the community, nursing home care is presented as a fait accompli.

When it comes to waiting lists, at any one time thousands of people are on a home care waiting list. They have been assessed and approved for home care but no carer is available. At the end of September, 5,392 people were waiting for home care, up from 4,805 at the beginning of 2025. In the waiting lists there are significant regional disparities, with particular black spots, as we have heard, in Donegal, Mayo and rural parts of Cork. The worst performing integrated healthcare area, IHA, is Cork South Lee. It consistently has the highest waiting list in the country and accounts for over 40% of the entire south-west region home care waiting list. Although this is not captured in the data provided to TDs by the HSE, we know that some older people are waiting over a year for home care services.

With this level of unmet need, it is particularly galling that there is no action plan to tackle home care waiting lists. It is all well and good to pontificate about the importance of home care and moving away from the State's over-reliance on residential care but what is this Government actually doing to make that a reality? Demand is not going to taper off, it is only going to rise. A 2025 ESRI report found that between 2022 and 2040, annual home care hours would need to increase from 28.7 million to between 44.9 million and 54.9 million.

At the higher-pressure end of that projection, that is a 91% increase.

I acknowledge that the number of hours provided by the HSE in 2025 exceeded expected activity by 1.46 million hours but that has not had a substantial impact on waiting lists. The target of 24 million home care hours for 2025 was too low to begin with. The 2026 target also lacks ambition at 26.7 million hours. We also know from ESRI estimates that over 7.6 million home support hours were privately purchased in 2022, accounting for 26% of all home support hours provided that year.

Clearly, there is a huge level of unmet need in this country. In the absence of a statutory entitlement, large numbers of people will continue to pay out of pocket for expensive private home care. From my observations of constituents who have come to me with these issues, it is often at the end of a conversation, when we are talking about the other pressures in their lives, that they also mention they cannot get the care they need for their father, for example, who is at home and needs support. It is when they come to me with other issues. There is also a massive amount of unseen pressure that is simply not reported by people.

A statutory right to home care, despite this Government's stated commitment to introducing a statutory home care scheme, remains undelivered. Delivery of this key Sláintecare reform has been allowed to drift for almost a decade. In 2017, the current Tánaiste and then Minister for Health, Simon Harris, committed to a statutory right to home care. That very same year, the current Minister for foreign affairs and then Minister of State for older people, Helen McEntee, said the statutory scheme and necessary regulations would be delivered in two to three years. In 2019, the Secretary General said that a statutory entitlement was an absolute priority for the Department of Health and was going to be introduced shortly. In 2020, when the statutory scheme was originally earmarked for delivery, the new Minister of State, Deputy Mary Butler, committed to delivering it by 2022. In the years since, the statutory scheme has largely been sidelined. As of last September, the Department was still researching different funding models more than five years after it was supposed to be delivered.

The Minister of State may deny it but it is quite clear that the statutory scheme is not a priority. In the latter part of the previous Minister for Health's tenure, he stopped talking about the statutory scheme almost entirely. Any requests for updates were met with stock responses about the importance of progressing regulation. The new Minister has continued to stick to that narrative. I accept that progressing regulation is important but if it was so important to the current Minister and her predecessor, why are we only taking Second Stage of the Bill now in 2026? While regulation is an important step on the road to a statutory scheme, it is a far cry from delivering the radically different model of long-term care that is so desperately needed, which was promised after Covid. The reality is we still only have a statutory scheme for nursing home care and not home care, which is discretionary. In 2026, the system still incentivises residential care, despite the clear preference of many to be cared for at home. Why is this disparity still not addressed? I sincerely hope that the delivering of a statutory right to home care has not been put on pause until the work of the commission on care concludes. That is not to say the work of that commission is not important but we do not need another report to tell us that a statutory scheme is required. We just need a Minister and Government willing to deliver it.

On the commission on care, I will make a couple of broader points about our elder care model, which I hope will be addressed by that commission. One of my primary concerns with the current model is the financialisation of services. Increasingly, care is being viewed as a commodity. We see this most aggressively in the nursing home sector, where 80% of beds are privately run. Increasingly, the nursing home sector is being financed by international investors. All the while, smaller community-based nursing homes, which should be supported, are on the verge of extinction. We also see this worrying commodification of services in home care, with just 36% of home care provided directly by the HSE in 2024. This move towards increasingly contracting out public services is often thought to result in efficiencies but the argument does not hold up. This is because most of those supposed efficiencies have costs, as we just heard from one of the Minister of State's colleagues. Those costs tend to be borne by workers, patients and service users.

The commission on care should articulate a new vision for elder care, one where the State leads in the provision of publicly-funded integrated care delivered primarily in the community. All of this, of course, is the vision of Sláintecare. This new model should have a deliberate bias towards the home in sharp contrast to the current elder care model. Groups such as Sage Advocacy and ALONE have consistently advocated for alternative care options. Unfortunately, a major deficit in delivery has prevented the realisation of such ageing-at-home policies. I note that the EU care strategy - there was a national action plan for 2023-24 to respond to that strategy - looks at that visionary, end-to-end system of care, where we recognise that across the course of all of our lives, we all receive, and many of us give, care. That is where we need to be at. That is about radical reform, not this piecemeal progress.

Returning to the Bill before us, I once again reiterate the Social Democrats' support. It is welcome that the Minister has taken on board concerns related to paediatric home care packages, which my colleague, Deputy Rice, and others raised with her last year. Children were omitted from the draft scheme but the Ombudsman for Children, HIQA and the previous Oireachtas health committee all recommended their inclusion. According to the ombudsman, over 650 children with complex needs are in receipt of paediatric home care packages. Providers of these services should be subjected to the same level of scrutiny as adult home care providers. I welcome that these providers are now captured in the Bill. I do, however, have concerns about other provisions, for example, the exemption from regulation, as we heard, of service providers with three or less clients. The pre-legislative scrutiny report recommended that all State-funded services should be covered by this legislation and the associated regulations but this was not accepted. This exemption presents potential risks for clients in terms of standards of care and protections. Equally, there are very real risks for workers in terms of exploitation and bogus self-employment. In particular, I have concerns about migrant workers who might be more vulnerable to exploitation when it comes to pay and conditions. I do not accept the Department's response that this exemption is needed to ensure the legislation is proportionate.

I will raise a couple of points on the subject of workers. The biggest challenge facing the home care sector is the recruitment and retention of staff. In response to this looming crisis, the Minister of State, Deputy Butler, established the strategic workforce advisory group in March 2022. Six months later, that group published a report with 16 recommendations. For a while, there seemed to be momentum behind this group but that has stalled completely. The implementation group has not met or published a quarterly progress report since July 2024. Implementation just stopped without explanation, even though only three of the 16 recommendations had been implemented when the most recent progress report was published. A further three recommendations were paused due to the HSE recruitment freeze that was in place at the time. What of the other ten? At the end of last year, my colleague, Deputy Rice, was told that an updated strategic workforce advisory group report would be published following a survey of home care workers and healthcare assistants. You would have to wonder why this is only happening now. Where is the sense of urgency?

While it is regrettable that implementation has been put on ice once again, I hope two issues in particular are finally addressed this time. The first is a real living wage for workers and not this Government's version of the living wage, which of course is not a living wage at all. The real living wage currently stands at €15.40 per hour. Anything less would show a complete disregard for these vital workers. This must also be accompanied by a commitment to maintaining parity with a real living wage going forward. Another pressing issue that must be addressed is the payment of mileage rather than travel time because that is a real problem for those workers, particularly in rural areas.

Ultimately, this Bill is a step in the right direction, albeit a small one, which should have been taken years ago. Clearly, the provision of person-centred care is just not a priority for this Government. If it were a priority, there would not be this piecemeal approach to reform. Frankly, it is unforgiveable that almost six years on from the first Covid lockdown, we have made virtually no progress on developing a new model of care for older people. Reports have been published, evaluations are ongoing and a commission is under way but what has actually changed for people in receipt of this care? It is very little, more importantly, for those who are not in receipt of this care. The whole system of elder care is still weighted towards residential care, with the wishes of older people still seen as little more than an afterthought. Rights-based care will continue to be purely notional in this country without more radical reform. This Bill may be welcome but it represents the bare minimum intervention.

I spoke with my daughter this morning; we had breakfast together after our Pilates class. She worked in the home care sector right after she left school a number of years ago during Covid.

She loved the work. She loved being with people, providing them with care and providing them with the dignity and respect they need. She worked for a private home care provider under HSE funding. I started to tell her about this Bill and what is being done. She was passionate about it and wanted to share with me her experience, which I said I would share on the floor of the Dáil today. She said that as a worker in that space, the pressure you are put under to commodify care and simply move in half-hour slots between one service user and another and to try to provide them with dignity in that time was virtually impossible.

When we talk about privatisation of care I am not saying there are not good people in those places who are trying to provide care. Quite the opposite, people get into that work because they want to do this. They want to provide care for people and provide them with dignity and respect in their most vulnerable time of need. Many of those business owners are trying to do exactly that. Ultimately, care cannot be commodified.

In the AI space, we hear about this massive labour displacement that is coming. Do you know what you cannot automate? Care. We need to invest in it as a State and respect the work of care that has been largely undervalued by our society across the globe, mostly because it is done by women. That goes for paid and unpaid care. We need to start thinking about it differently, looking at it differently and start valuing it.

Deputy Liam Quaide

I welcome the opportunity to speak on the home support providers Bill. It is long overdue, as my colleague Deputy Gibney said, that there is a statutory scheme for the registration and inspection of home support providers. Regulation and oversight are essential, particularly where care is delivered behind closed doors in people's private homes and to people in vulnerable circumstances. This Bill establishes a process for registration and inspection but it is largely silent on the principles, standards and obligations that should underpin the delivery of professional care in a person's home. That silence is not a technical oversight. It is a substantive gap, and it needs to be addressed. The Bill does not set out the scope of home care, the professional duties owed to care recipients, or the safeguards required when care is delivered to people who may lack decision-making capacity. This omission is particularly striking, given the extensive work already done in this area.

As far back as 2011, the Law Reform Commission in its report on the legal aspects of professional home care identified key principles that should inform any legislative framework. These include independent living, privacy and dignity, quality of care and the protection of adults receiving professional home care. These principles are not adequately contained in this Bill. Section 21 of the Bill allows for regulations concerning needs assessments, the care, welfare and well-being of service users and the preparation of support plans. This is positive but regulations alone are not enough. There must be a clear statutory requirement that home care is delivered through a rights-based approach, one that not only considers needs but the outcomes desired by the person receiving care.

The Bill is also silent on contracts for care. There is no legislative requirement for a written agreement that protects autonomy and independence and safeguards against financial abuse. This is despite the fact that contracts for care in nursing homes are already subject to oversight under consumer protection legislation. There is no justification for a lower standard simply because care is delivered in the home.

Safeguarding is another critical gap. Many recipients of home support lack decision-making capacity and may have no family or informal supports. Questions therefore arise such as who signs the contract, who receives information and who can raise concerns? These are safeguarding issues, yet the Bill does not address them.

The Law Reform Commission's recent work on adult safeguarding informed by national safeguarding standards provides a clear framework that should be reflected in this legislation. While the Bill provides for complaints procedures, complaints are only one part of safeguarding. There must also be statutory provision for the recognition and reporting of safeguarding concerns, appropriate information sharing, the appointment of safeguarding officers and the mandatory training of staff on human rights and respect for will and preferences.

Crucially, the Bill makes no provision for access to independent advocacy. We already recognise the necessity of independent advocacy in nursing homes and disability services. The Department of Health's own safeguarding policy confirms its importance. There is no credible reason why people receiving care in their homes should have fewer protections.

The Bill lacks guiding principles. The Law Reform Commission has been clear that principles matter because they shape how statutory powers are exercised. Accountability in particular must be explicit for providers and individuals within organisations, for their actions and interventions. This is especially important where care is provided to people in vulnerable circumstances out of public view.

Registration and inspection are necessary and welcome but they are not sufficient. The legislation must be strengthened to include guiding principles, enforceable standards, safeguarding obligations, access to independent advocacy and accountability mechanisms. If we fail to do so, we risk regulating the process of home care without really protecting the people who rely on it. This would be a serious missed opportunity and one we should not allow pass.

Deputy Peter 'Chap' Cleere

I am delighted to get the opportunity to speak on the home support providers Bill. The Government is committed to supporting people to stay in their homes as long as possible. It is something I feel passionately about, and the Government feels passionately about. The State currently invests heavily in the provision of home support through the HSE. Home support is provided by the HSE and then indirectly through national contractual arrangements with private home support providers and not-for-profit organisations. Huge funding has gone into this area over the past number of years but there is still a huge amount of work to be done. As our population ages and more individuals prefer to stay in their homes for as long as possible, the demand for quality home care increases. However, with this demand come significant challenges we must address.

First and foremost, funding and resources are major concerns. Many home care providers struggle to secure adequate funding to meet the needs of their clients. Current Government supports often fall short, leaving both care workers and recipients in precarious situations. Many families are forced to pick up the financial burden, which can lead to stress and anxiety.

For me, the biggest challenge is the workforce shortage. Recruiting and retaining qualified home care givers is becoming increasingly difficult. In my constituency of Carlow-Kilkenny, the HSE is at full capacity in terms of what it can do on the home care side of things. It outsources to different providers but still every single week I have somebody in touch with me who has challenges. They have the hours approved and are delighted to have them approved but the workforce is not there to meet the demand. In rural Ireland in particular, this is a huge issue. I spoke with a woman recently. I will not give her exact details but she is almost 100 years of age. She was in hospital before Christmas but is back out. She has been approved for three visits per day, one hour each, for 21 visits over the course of a week. They cannot get anybody to service it.

Deputy Kieran O'Donnell

I will work on that.

Deputy Peter 'Chap' Cleere

I will speak to the Minister of State specifically about it offline. It is these sorts of incidences. It is approved. The will is there but the specific person is not there. I appreciate that the Minister of State, Deputy O’Donnell, will take that on for me because I have another case as well of a lady in her early 40s who due to her medical condition is unfortunately wheelchair bound. When this lady left hospital they could not get anyone to cover the hours, so she ended up going into the local nursing home. She was in the nursing for six weeks all the while her hours were approved. Huge work was done by the HSE and the providers but they simply were not there. Something might need to be done on the education side of things such as making sure there is more access to home care packages qualifications but it is a huge issue in rural Ireland.

I am from a place called Skeaghvasteen in County Kilkenny. There might be somebody in Kilkenny city but to drive from Kilkenny city to Skeaghvasteen for a half hour or an hour will not pay them in terms of paying for diesel. It is a huge issue, and it needs to be addressed. The lack of standardisation across services can also be problematic. If you have different agencies providing home care, there is inconsistency in training and quality of service but I think this Bill will really help. I really welcome this element of the Bill where you get that consistency. If we could join it up with some sort of ETB or education training course - a level 5 or level 6 course - that would be really helpful.

We also have to consider the emotional and psychological challenges for families and care givers alike with the stress, pressure and anxiety these families are under. By the time they come to me they are on their knees. They are nearly begging. These people are going to the wall themselves but they need that bit of hope and support. The right to be in your own home is huge. That is really important.

Addressing the challenges in home care and home help packages is not just about improving services but it is about enhancing quality of life for our elderly and for our vulnerable populations.

Together we can work towards a future where everyone has access to compassionate and reliable home care. I trust in the Minister of State that when this Bill is brought through, it will make a difference to families right across the county, but in particular in my constituency of Carlow-Kilkenny and my constituents who I represent on a daily basis. I appreciate him taking a couple of individual cases on board.

I am going to finish up now because myself and Deputy O'Meara have a Pilates class at 6.30 p.m. and we need to get to it. We are meeting the Social Democrats afterwards.

Deputy Ryan O'Meara

I am more interested in the food after the Pilates class. I welcome and support the Bill, which provides a registration framework for home support providers while making it an offence to operate a home support service without registration and incorporating transitional arrangements for existing home support providers.

Home support providers will be required to adhere to a registration framework supported by national quality standards developed by HIQA and meet minimum requirements set out under ministerial regulations. The Bill will safeguard service users and raise the quality and consistency of care nationally.

It is on the consistency of care nationally that I want to focus some of my contribution I acknowledge that the Minister of State and I represent constituencies in the same HSE region, which is HSE mid-west, and I also want to acknowledge his work and passion in this area. I particularly want to acknowledge his recent visit to the Newport day care centre and the work he is doing there. Among other issues we are working on in the constituency, I want to recognise that.

I also want to recognise and discuss the major challenges we are facing in north Tipperary in relation to home help hours. As many other speakers I am sure will say in the debate and have experienced, it is not really an issue getting hours allocated for someone who needs them, particularly an elderly person in their home, but there is a major challenge in getting those hours filled.

I have two examples I would like to share without giving personal details. These are two really challenging cases. We have lots of cases out there of people who need the help at home, but these are two cases that I find hard to understand how these individuals are still in their homes while their care hours have been pulled because private providers are no longer able to meet their contractual obligations.

One individual had two carers coming in twice a day, but consistent care ceased in October. I am told that sometimes they receive a reduced schedule or none at all. They no longer receive a schedule in advance, which is highly unsuitable for a family trying to cover the level of care for this individual. This person has motor neurone disease. The person has no mobility and requires the use of hoists to get in and out of chairs and beds. It came as a massive blow to the family to find out that the hours were being cut because the contracted provider could no longer fulfil its contractual obligations. I do not know how a family with the added stress and worry of a family member who needs to be cared for at home can function when people are trying to go to work or to school and having to fit this in around schedules. This person can be cared for best at home with their family in a loving environment, but the family is really struggling now.

Another case I have relates to an individual who was getting three calls a day, with one hour for each call, seven days a week. There were three different individuals calling to the home. The family recognised the level of care was exceptional and the individual getting the level of care relied on it, but really appreciated it, needed it and never had a complaint about it.

Of the three people who called, one went on maternity leave and another left the job to go into another one, which resulted in the contract being pulled. I have been over and back with the HSE on both of these cases. I will send them on to the Minister of State straight after this debate and thank him for that. To be fair to HSE, it has been very good to come back to me during my engagements with it, but the responses have not solved the problems for us. That is the reason I am highlighting both cases. They are high-dependency cases. These are two individuals who can stay in their own homes, but only if care is provided.

That brings me to my overall point and one that others have made, which is that the contracted hours to private providers clearly are not working in my part of the country and I imagine they are not working in many parts of the country. There is a battle with the HSE to get those hours filled. It can only do so much when it does not have all of the staff to cover the hours that are being allocated to people. It is creating enormous uncertainty, worry, anxiety and massive pressure on the person relying on the care but also the family members who are then trying to step in and cover the care when they simply cannot do it.

For those carers who are caring for a loved one at home, that hour in the day or couple of hours in the week could be their only respite. It might be the only break they get to get out the house for an hour or even half an hour and do something for themselves. In the cases where the contracts are being handed back, that is being pulled from them. It is just being taken from them. It is the one respite they can get.

While I am on carers and family carers, I want to acknowledge the Leas-Cheann Comhairle and the issue he raised last week relating to the Revenue during Questions on Promised Legislation. I understand the good news he got today in relation to back taxes that were being claimed. I acknowledge that the Leas-Cheann Comhairle did an extremely important piece of work.

Carer's allowance should not be taxed. The amount that carers save this State by caring for loved ones at home - in their own home or the loved one's home - is absolutely astronomical. The level of personal care they get and the love they get from the loved one who cares for them should not go unrecognised in the sense that the allowance is being taxed like an income. The carer does not do that work for an income. They do it out of personal care, love and affection for their family member and should not face a tax bill. If that carer did not do that work, how much would it cost the State to have their loved one in a healthcare setting or in a hospital bed when we need those beds, particularly in the mid-west?

I acknowledge the challenges that are there for homecare providers in terms of the level of staffing that is there and the challenges placed on loved ones and family members when that care is pulled, but also the stress that is being put on carers by being taxed. That is something we really have to look at in the context of a budget.

Deputy Cathy Bennett

I welcome the Government bringing forward legislation to regulate the private home care sector. What is disappointing is that after five years, all the Government has to show for itself is this Bill regulating the sector. What was promised was a statutory home care scheme, which would be a better and improved version of the nursing home support scheme.

Sinn Féin believes that people deserve to live in their homes as long as they can. The Bill falls well short of what is needed. It addresses nothing about access or affordability and more deeply entrenches the privatisation of care. Crucially, it fails to recognise the difference between funding for basic assistance and high-need care with few exceptions. We often talk about the need for issues to be addressed more wholly or holistically. The Government needs to place a greater priority on supporting people to age in place through home support and adoption grants to ensure healthy age-friendly homes.

Long-term residential care needs to be available for those who need or want it but it should not be the default. We should seek to reduce our reliance on nursing homes and re-orientate care to support this. I recently saw an age-friendly home development down the country and it looked like an incredible development. I also commend the work of the team in Monaghan County Council on its age-friendly programme, but a greater priority needs to be placed on this issue and more resources directed there.

Part of why this Bill is disappointing is not only does it not appear that it is simply one part of a whole strategy in terms of care and housing for people as they age, it does not even appear to be the level of substance needed to address this one area - home care within the home. Facilitating people to age in place reduces pressures on our hospitals. It facilitates people to continue to live in their own communities. I say "facilitates" rather than "allows" because unless it is necessary, people should be entitled to age within their homes or facilitated through appropriate accommodations to age within their own communities as much as is possible.

In only the past day, the media have highlighted what has been described as a growing crisis in the number of older people becoming homeless.

The Simon Communities have highlighted that hundreds of people over 65 are living in emergency accommodation. Ireland's ageing population necessitates a whole-of-government response, in terms housing, our funding models and care. That is the Minister of State's specific remit. What I ask him take away from this is that the Government is not doing enough and certainly not at pace. For all the announcements, statements of strategy, implementation plans, action plans or whole-of-government announcements, it often seems that we actually get very little done and that something needs to change radically. What is needed now is for access and affordability to be addressed and the Minister of State to outline how the Government intends to address the difference in funding based on need. I would really appreciate if he could do this in his reply.

Deputy Brian Stanley

The debate around this is very important. I generally welcome the Bill, which is important. Safeguards for users and providers are important. That it covers the care of both the elderly and those with disabilities is the crux of this. However, there are issues around provision and standards that we need to keep an eye on as well as the availability of home help hours and home care hours. We have censuses and we have them for a reason. They allow the State to plan for what is coming down the tracks. Everyone knows that we have an increasing age profile in our population. By 2030, we will have over a million people over the age of 66. County Laois is estimated to have between 13,000 and 14,000 people over that age. According to the 2022 census, 11,978 people were over that age. That is four years ago. We know that the population overall of the county has increased and certainly the population of the elderly in the county has increased. Rural isolation is a problem in Laois and we have big rural areas across the Slieve Bloom Mountains and Slievemargy to the east and west and to the south of the county down to Ballaghmore and places like that, back across to Erril. Loneliness and isolation are damaging both mental health and physical health. I have dealt with a number of cases where there is a shortage of home care hours. People are what is called waitlisted and they will get word that they are entitled to hours and the HSE is granting hours but it is not in a position to provide them. I have to say this to the Minister of State because his party has been in power for 15 years. The emphasis has been on private nursing home care but, in general, people want to be at home. Nursing homes should be last resort and only if they really want that and if the level of care required requires them to be in a residence. Private nursing homes have been the number one Government option and they have mushroomed. We have seen the scandals in County Laois, in The Residence for example, not too far from my own house. We have seen the Drumneen situation and that is an unfolding story. We have seen difficulties in Kilminchy Lodge. Some private nursing homes have been good and Ballard Lodge was one but, unfortunately, it has been closed due to HIQA. This was one that had good reports and good satisfaction from residents and families was being reported.

We need to enable people to continue to live independently and to do that there are a few basic requirements. Homes being adapted to meet people's needs is obviously important. I want to pay tribute to the housing section of Laois County Council. In my experience, any money that is granted is matched by the council in terms of alterations for stair lifts and extensions and making a house wheelchair accessible. That is really important. The provision of day care centres is important. It is important that people go somewhere one or two days a week to have a meal with other people and meet their contemporaries and have a social event, etc. The meals on wheels service is really important. That is the other part of it but the most important element is the home helps. They are the four legs of the stool and if one is taken away it will keel over. That is the best way of saying it. We also recognise the right of the people to have a level of care in their own home and to continue living there. All of these provisions are far less expensive than nursing homes or acute hospitals and the preferred option of the majority. I want to highlight that I deal with cases where people are being discharged from hospital, but the home care package is not in place. I have had to intervene and I recall one case where an elderly woman was being sent home on a Friday evening and there was absolutely nothing where she was going home to. The ambulance was on its way with her and was subsequently turned around and brought back. She would not have survived over the weekend without the appropriate care. She did not have what she needed in her own home at that stage. There needs to be proper joined-up thinking between the hospitals and the home care services and that needs to be sorted out. We need to be sure that we have the home care package that the person needs when he or she goes home.

I also want to address the issue of the stopwatch approach where 15 minutes is given for this and 15 minutes for that and the person has half an hour. We have home helps racing around in rural areas. Laois is a sizeable rural county and I have outlined some of the extensive rural areas in the county. If people are racing from one place to another, they are not able to provide adequate care. There is not time to carry out the tasks. There needs to be flexibility to allow the home care workers, as they are now being called, to provide that level of care. Very little can be done in half an hour. We all know that sometimes in our office we can get very little done in half an hour. It could take an hour or an hour and a half to deal with one issue. The same applies for a home help going to look after an elderly person. We need to be mindful of that.

Another issue I want to address is the quality of the employment. There is a labour shortage in the sector, but we still have a lot of people who are not employed or under-employed. I find it very frustrating that some of them are not trained to provide the level of care. I know from my time on the Committee of Public Accounts that HSE employees are cheaper in the long run and in the short run than staff provided by private companies. Private companies are providing care and they are doing a good job but less than 40% of care now is being provided directly by the HSE and that needs to be looked at and that needs to change. Those directly employed by the HSE have better terms and conditions and we need to make sure that they are upheld. The quality of jobs in the sector is really important. It is important that all people have a proper living wage whether they are employed by the private sector or public sector.

Travel times and travel costs in rural areas need to be looked after because a home care worker might be visiting seven or eight people in a day. It is also important that we have trained and vetted staff, because the safety and well-being of the service user has to be paramount. There is a need for clarity regarding how home care will be funded. There is a Bill coming and we need to make sure that this can be paid for and that the people who need it, regardless of whether they can pay for it, should not be prevented from getting home care.

On the Bill itself, the overall provisions relate to registration, which is a positive move for the HSE, voluntary and private providers and a chief inspector of social services. In England the social services departments are very local. They are based in the local council areas, which is very interesting. They organise home helps and home care and they have huge powers. We do not have that here. The State will have to examiner whether the big HSE model is the best one for doing it. Does that need to be separated out? I do not know. I do not want to create another quango. I am not going to tell the Minister of State to do that. I am all for reducing. A lot of these bodies are needed and I am not going to get into the populist argument about doing away with quangos.

However, the question of who provides this needs to be examined. The regulation of providers and the minimum requirements and standards are really important. The Bill has provisions for the inspections of businesses and homes, including private homes. That needs to be very sensitively handled, as do the interviews with service users and home helps plus the families. That could get into a really tricky area. Without running away with ourselves, I think we can see that would need to be handled in a very careful way because you could get bogged down very easily in that, but, obviously, it is important that there are interviews with the service users.

I urge caution on the exemption for the providers with four or less clients. I will not come down on it completely-----

Deputy Kieran O'Donnell

Three or less.

Deputy Brian Stanley

-----but it is an area that may need to be looked at. I know what the Government is trying to do. It does not have to do away with the informal pieces that are there. I think Deputy Charles Ward is okay with my taking another minute or two. As regards the informal care and what the Government is trying to cater for there, I do not want to kill that off altogether, but it may need to be examined. I am not totally sure about that. It makes sense to have informal arrangements.

Overall, I welcome the Bill. The Minister of State has heard what I said about the labour shortage. That is directly related to the quality of the jobs. The HSE is the cheapest way. That has been proven. If the Minister of State looks at the figures, he will see it. The last I saw, I think the private providers were €34 an hour or thereabouts. That is two years ago now. What is important here is that we increase the number of people in this. Surely within that 5% who are unemployed at the moment we can find some people who can be trained up to provide care in their local communities. We need to be able to keep this local. A few people driving across the county, from Ballylinan over to Camross or somewhere like that, will not work. We need to be able to keep it within local areas. It does not work otherwise for the home helps. I hope the Minister of State will look at that area.

Deputy Charles Ward

I thank the Minister of State for the opportunity to speak on the Health (Amendment) (Home Support Providers) Bill 2025. It is long awaited. Initially, it was due before the House five years ago. Repeated delays in its publication have had a detrimental effect on carers and the people who require home care support. This Bill means that home support in Ireland will be independently regulated for the first time. It shows a troubling disregard for home support providers and users in this country. It is all about regulation. I look at it from my unique point of view as somebody who has worked in this sector and been a victim of a lack of regulation with regard to defective concrete. The two go hand in hand. To me, looking at this, the sectors are completely unregulated. This is going on in 2026 and it needs to be looked at seriously.

There are currently no regulations that home care providers have to adhere to in areas such as staff training and infection control, which is vital when we are dealing with people with sickness in certain elements. There are no consistent minimum standards of care that apply to home care providers universally and there are no independent oversight provisions for home care services, which is vital. Due to absence of regulation, there is a huge disparity between the level and quality of care geographically. If you are dealing with somebody in Malin Head who has to go to certain parts of Malin or into certain parts of Buncrana, they are on the road and they are on the clock, basically. In Donegal, for example, there are severe shortages of home carers for quality services. It varies massively due to enormous pressures put on home care workers. It is about that time element again whereby you are going in to look after and care for somebody and you are getting them ready for bed but you are also conscious that there is somebody else waiting for you and that the clock is ticking and the time is running down. According to the HSE, there are nearly 3,000 people receiving home support in Donegal and over 350 people waiting to avail of that support.

Speaking of such cases, I will not mention names, but during a phone call today a cousin of mine who is in Letterkenny general hospital told me about a 93-year-old lady in the hospital who wants to go home. She is ready to go home. She has been in there for nearly a fortnight but they cannot get the home packages in place. They are close. I would be grateful for anything the Minister of State could do to intervene in this. I will get back to him on that.

Any further delays could push the implementation of this out to 2030, which would be another unacceptable delay. As we have heard throughout the House, we have a population that is ageing and we need to evolve with that. We need to ensure that the sector is regulated and that quality and consistency of care is raised nationally in order that we have a standard that is the pride of Europe. It is all about the standard and the pride in your work. That needs to be really looked at, especially when it comes to home care. The impression you make on that person determines their day. It is very hard to encourage people to come into this sector because it is demanding and you are on the road for 12 hours a day. You leave your house at 7 o'clock in the morning and sometimes it is 9 o'clock at night before you get home, when you have put the last of your clients to bed. Steps need to be taken to encourage home care providers to continue this service. More people need to be working in this sector.

There are definitely ways around this. When I was training, the HSE would come in to try to recruit, but it was not flexible. I was willing to do that type of work but the issue for people like me was that we were needed on full-time contracts. A full-time contract would not have suited me because I was providing care for my four children, but I had time during the day - four hours, perhaps - when I could have provided care in the community. I definitely would have done so if flexibility had been provided for. That flexibility leaves open the possibility that when your children grow up, you could go into it full-time. If that were sorted out, it could be a real game-changer because a lot of parents would be willing to go into this area and, if they were paid properly, would make it their career. We need to look at that in the long run.

In 2016 the Government made a commitment to introduce a statutory right to home care through a statutory home care support scheme. A decade later, this has still not been implemented. We need to make sure it is done. The fair deal scheme provides statutory rights to residential care, but no equivalent scheme currently exists when it comes to home care. We need to look at that because, as has been said, we have an ageing population. In Donegal, for example, we have a heavy reliance - when they are operating - on our hospitals in Lifford, Dungloe and so on. We need to make sure we have sufficient beds in place. There will be people who need care, but the majority of people can be provided with care at home and they will stay in their home for as long as possible before they have to go into some form of care. I recognise that.

There is a way out of this if we get the staffing levels right and look at the model. The HSE model is a good example, but the flexibility would be a game-changer. It is a matter of allowing parents to come on board properly trained. That is a very important aspect of this. If you are training somebody to do this properly, it takes two years to go in, do your modules, come out of it with a good standard and then do your work experience. Then you go out into the community and you are doing that with a family. It is challenging and hard but it can be done. I look at the private model and I believe we are missing a trick here. The private providers charge a certain amount of money. If we were to pay people the right wage, we would attract numbers that would actually solve this issue. Going forward, we need to look at that. If the Minister of State looks at the model in place now, which does not have that flexibility, he will understand that by allowing somebody to come in at certain times of the day, tied not to a full-time contract but to some kind of contract that means they will give part-time hours, they will be able to fill a gap and help to meet staffing levels, and in the long run they will be attracted to come into this sector.

Deputy Paula Butterly

I thank the carers and the home helps who come into our homes and take such good care of our mothers, fathers and loved ones.

Without them, quite frankly, I am not sure if I or my family could function properly day to day. That is my first thought on this Bill.

Overall, the Bill is very positive. It is timely that the sector is regulated. I still see some gaps, however. First and foremost - I have heard my colleague speak about this - the time stops and gaps of half an hour, three quarters of an hour or an hour two or three times a day need to be looked at further and addressed. In rural areas, constituent after constituent comes to me to tell me that their mum or dad has been approved for a home care package, which is in place, yet they cannot find the staff. It seems that once the street lights finish, people do not want to travel further and further into the rural areas. One of the reasons for that could be the fact that many of these agencies are not paying mileage to their staff. As a result, it is a far more efficient use of their time to do three or four calls in Drogheda or Dundalk rather than spending 20 or 25 minutes travelling to Togher or Tallanstown to do one call for half an hour, only to come back into town to do the rest of the calls. That is an issue the length and breadth of the country, not just in County Louth.

I wish to speak about the most important gap in the Bill. I am grateful that we have somebody who may call for half an hour two or three times a day but with the passage of time, some of our loved ones will need more care. We know that people thrive in their homes and are healthier for longer when they are able to stay in their homes, but the unfortunate reality is that the cost of getting somebody to stay in the home with their loved one and provide that care is way beyond the means of the vast majority of people. We have the fair deal scheme, which is very effective, but now we are seeing that people who do not necessarily have to go into a nursing home at a particular stage are now seeking to apply for the fair deal scheme and go into a nursing home because the alternative is not there. Two or three calls a day are no longer sufficient. The family cannot make up those gaps. Therefore, the alternative is to seek a place in the nursing home. I am looking for a statutory footing on which we would adopt a fair deal scheme to allow people to stay in their homes. It might seem complicated, but at the same time, I do not think it needs to be overly complicated. This is a scheme where I believe an entity like Revenue could be brought in. At the same time, we provide a value of the asset, which is the home, which evaluates the care, and we pay the nursing homes. If we come in and have an agency taking care of our parents or loved ones, we are invoicing them and we can upload it to Revenue, surely there is some way to make a scheme that is simple and effective for families so they are provided with care in their homes and can stay in their homes, hopefully to their very last breath? They would not go into nursing homes until the very last second.

There is a practical side to this too, because in County Louth the nursing homes are full. The waiting lists are long. If people ring a nursing home today to look for a place for a loved one, the home will ask if they have started looking in County Meath or County Dublin because the waiting lists in some cases are closed. We are not addressing that issue because the demand is so strong. I believe we are handing over our care to too many private companies. We have to look at the community model once again. The issue, in essence, stems from the fact that if we give people the option to be able to stay in their home and use their asset to provide for the care in their home, we alleviate the pressure on the nursing homes and we guarantee the best type of care to people in our society.

Deputy Peter Roche

Like previous speakers, I welcome the opportunity to speak on the Health (Amendment) (Home Support Providers) Bill 2025, which represents a significant and long-awaited step in reforming how home support services are regulated in this State. I want to quickly touch on my hope and expectation that this legislation becomes a real enabler of access to home supports across our country, particularly in regions like the west, where the need is acute. In the west, we are crying out for home care supports. I have many constituents, especially older people, people with disabilities and their families, who have been assessed as needing home support and are still waiting for months on a list. There are people who want to remain in their own homes and are trying to avoid hospital admission or premature placement in residential care, yet the supports they need simply sometimes are not there.

This Bill matters because it begins to put structure, consistency and oversight into a system that has grown rapidly but unevenly by regulating providers, setting national standards and bringing transparency to who is delivering services. We finally have a foundation on which access can be expanded fairly and sustainably. For too long, access to home supports has been dependent on geography. In some parts of the country, services are available. In others, including large parts of the west, providers struggle to recruit, services are fragmented, and families are left waiting. Regulation alone is not a fix, but it is a necessary first step if we are serious about building capacity, supporting providers to operate safely and ensuring that services can be delivered consistently across our regions.

My hope is that this Bill will not be an end to reform but, rather, the beginning. I hope it will support the development of a stronger home support sector, encourage provider stability and ultimately lead to shorter waiting lists and better access, particularly in areas that have been historically under-served. Regulation must mean more than standards on paper; for the people waiting at home in the west, including Galway East, regulation must translate into real supports. Delivery must be timely where we live.

I concur with Deputy Butterly in acknowledging the people caring for and supporting people who want to remain at home. Like most people here, we are fundamentally aware of the daily challenges for carers. Sometimes all they need is respect. The one thing that is damning for them is that the respect is not shown from the legislative side. That is why I welcome moves that we are making here.

We are all well aware of people who, as was mentioned, are caring on a 24-7 basis and do not look to the State for anything. They are doing a magnificent job out of love for a loved one who wants to remain at home. I want to say to those who do not demand pay, and those who are getting pay and need respect and support, that I thank them for that.

An Leas-Cheann Comhairle

I acknowledge Deputy Malcolm Byrne and his group in the Public Gallery. It is the second time I have seen him there this evening. I hope they are enjoying their venture into Leinster House and I hope their visit goes well.

Deputy Louis O'Hara

I welcome the moves in this Bill to regulate private providers and to set minimum standards for services. However, this Bill is far from what it could have been. The current and previous programme for Government promised a statutory home care scheme but after five years, the Government has only got as far as a register of private providers. There is nothing in this Bill about access and affordability of different levels of care.

It is a system designed around private provision. The ambition of the Government should be to build a genuinely public health and social care system accessible to all. In County Galway, 362 people are waiting for either a new home care package or additional supports that they have been found to be entitled to. These are often very vulnerable people. Many are suffering because they are not receiving those supports they are entitled to. This is a critical support to ensuring people can continue to live independently in their homes for as long as that is their wish. Government failure is pushing older people into hospitals and nursing homes and adding to the pressure on those services, when people could and should be cared for in their own homes.

I was recently contacted by a woman who had spinal surgery. She is unable to move out of the bed by herself as a result. She is not getting the full allocation of hours she needs. A man who recently had been in hospital for 15 weeks has Parkinson's disease, heart failure and other health issues. He cannot walk. He needs help to be fed. He needs to be hoisted in and out of bed. The family was told he would not get all the hours he is entitled to and not in the evening time or at weekends. We cannot underestimate the human impact of this situation. Some of the most vulnerable people are being failed. Delivering proper home care would reduce the length of hospital stays and reduce the risk of hospitalisation, which would, in turn, reduce hospital pressure. We have an ageing population. We need to plan and prepare for this and do everything we can to support people to live independently and take the pressure off hospitals and nursing homes. The long-promised statutory home care scheme centred on access and a legal entitlement to home care must finally be progressed to ensure people have that choice, alongside proper resourcing and building up the public system instead of relying on outsourcing.

I also want to speak about healthcare assistants who provide these services. The HSE has not fulfilled previous agreements with staff around working conditions and issues like the lack of a roster system and overtime pay. All of this is leading to stress and burnout. I know the staff in a number of counties have been balloted by their union but the same issues are replicated across the State. I call on the Minister and the HSE to engage with their representatives and get these issues resolved. They are a very important group of workers who deserve to be treated fairly.

Finally, I just want to express concern regarding the letters that have been issued to family carers, who do Trojan work as we all know. We need absolute clarity that family carers will not be pursued by the Revenue. They have been treated shamefully for so long, despite the fact they save the State billions of euro every year. Pursuing them for tax liabilities would be in stark contrast to the treatment of Government Ministers who have been overpaid and have failed to pay back money owed. These family carers play a vital role. The Government's objective should be to support them and not to pursue them for tax liability. We need absolute clarity on this.

An Leas-Cheann Comhairle

I should have mentioned a group that is representative of the British-Irish Chamber of Commerce. I call Deputy Tóibín.

Deputy Peadar Tóibín

This Government has significantly neglected older people for many years. We saw during the Covid crisis the number of older people who were moved out of hospitals and into nursing homes were in their thousands. It happened all of a sudden. It happened on the direction of the HSE and it had the effect of bringing older people from hospitals, without testing them properly for Covid, and placing them into nursing homes. It seeded Covid in nursing homes throughout the country. It led to hundreds of deaths, no doubt. I have a letter from the National Treatment Purchase Fund which proves this was a policy of the HSE at the time. It was a shocking, horrendous action.

We also know that when the nursing homes tried to close first, the National Public Health Emergency Team, NPHET, said they could not and had to reopen and allow people in and out of the nursing homes, again seeding Covid in those nursing homes. When people were dying in those nursing homes on their own, the Government had a policy of not letting their families in to be with them when they died. Hundreds of people died on their own in solitary confinement in this country during that time. It was an incredible injustice to them. Even when those people died, their families were often prevented from even attending their funerals. Supplies of oxygen for nursing homes were actually taken, intercepted by the HSE, and stopped going into the nursing homes. Testing was inadequate. In the end, about 2,300 people died in those nursing homes. Of all the deaths that happened during Covid, 27% happened in nursing homes. The nursing homes were the ground zero of the Covid crisis and the most exposed place during the Covid crisis.

One of the real angers people throughout the country have at the moment is that most Governments internationally have had fully public inquiries with the powers to compel people and papers. This Government did not do that. It resisted it. All it is having instead is a review, one where there is not the power to compel people and papers. It is not being held in public. I have no confidence in that review. I believe it is likely to be a whitewash. I believe this Government does not want to have an investigation into its own actions during Covid, and that is a big problem.

I will just give one example. There is a constituent in my county called Mary Bartley Meehan. Mary had a husband and a son in a nursing home at the time. Unfortunately, her husband, Ultan Meehan, had cancer in the face and wounds in the face. So badly was he treated that when Mary went in to see her husband, there were maggots in the wound of Ultan's face. It was a shocking situation. It is an absolute disgrace that Ultan died and Mary has never received justice for the treatment or death of Ultan. Why? It is because HIQA does not have the right to regulate and oversee the clinical decisions in nursing homes. If the Minister is seeking to really update the legislation in terms of protecting older people, can I urge the Minister to give somebody the opportunity to regulate and oversee the clinical decisions made in nursing homes? The ombudsman for older people has cried out and urged the Government to do this. It is a necessity to do this. I think it is really important.

Turning to another issue in terms of older people, I got an answer to a parliamentary question recently that showed 100 patients in the country still occupying beds two months after they had been clinically discharged. Two months after the doctors said they could do no more for people in hospitals and they should be somewhere else, either at home, in a rehabilitation centre or some step-down facility, 100 patients are still occupying those beds. That is not on. We found out, shockingly, that 12 of these individuals have been stuck in hospital for more than nine months. Actually, two people have been clinically discharged for more than two years and are stuck in a hospital for the want of a step-down facility, a nursing home or home care.

In terms of home care, so many of the people who do home care in this country do the most wonderful work. It is actually incredibly hard work. If anyone has cared, they will know it is really hard, intense and difficult work but it is fiercely rewarding as well. In this country, though, we do not match really important work with income. Those who mind our children, our older people and children in State care are among the lowest paid in the country. We will give plaudits and patronising conversations here all day long but we will not pay the same people who are looking after our mothers and fathers and that is quite something. If you want to know what the Government values, watch where the money goes.

I will say that there is a significant problem, which has been mentioned before, with the lack of home care hours. That has the effect of forcing older people into nursing homes, which usually shortens their lives somewhat. It is also more expensive for the family and the State. Another major problem, because of the lack of the proper resourcing of this, is that so many nursing home hours fall. There are old people around this country today who expected to have a carer in at 5 p.m. to help them with their dinner or to help them to get ready for the evening. Those carers did not show up. Those nursing home companies did not provide them. No shows are happening at a rate right across the country and this is having a significant impact. There is a lot that can be done but I do not believe the Government means business in terms of older people in this country.

Deputy Paul Nicholas Gogarty

I welcome the Bill. We all recognise the benefits of being able to allow people who need some level of support to remain independently in their homes as long as possible. In amending the Health Act 2007, the legislation will create the first statutory regulatory framework for home support providers, with mandatory registration, HIQA-led standards, inspections and criminal penalties for unregistered operators, bringing Ireland into line with other jurisdictions, including our neighbours in the UK. This is all well and good, but it is about the enforcement.

Over the years, the HSE has been gradually outsourcing services for older people and persons with disabilities to private companies. Between 2018 and 2022, the total home support hours increased by 22% but the HSE-delivered hours only increased by 7.6%.

By 2023, according to HSE data analysed by Home and Community Care Ireland, the independent sector, made up largely of private operators and a small number of voluntary community providers, made up 61% of all home support hours, with the HSE only accounting for 39%. The outsourcing trend has been driven by a number of factors, not least that the HSE is struggling to recruit and retain home support workers due to public sector pay issues, rostering and the basic demographics of the country with an ageing population, creating a demand that apparently rose faster than the HSE could hire staff or pay for them directly. This is what has led us to this situation where we are dependent on an insufficiently regulated sector and we need to bring in meaningful legislation. Hopefully, this is meaningful.

With so many private operators, there are massive turnovers of staff, and the risk to the patient care is suited to fit the schedule of the company rather than the needs of the client. I have seen this myself where a constituent who was catered for directly from the HSE was shifted into a calendar that did not suit her needs. However, when you try to raise issues with the provider, you are routinely ignored. There are no checks and balances or parliamentary questions, only an indirect means of seeking an inspection. This is why an enforceable, HIQA-led standard is important, along with a system of proper inspections, stiff penalties for companies that operate without being registered and meaningful consequences for operators that do not provide adequate levels of care for clients.

Of course, these higher standards may require more training and more staffing in a sector already facing shortages, which may mean people rightly needing to be paid more. That is all well and good, but the Minister of State needs to accommodate the additional outsource costs. We need guarantees that people will be paid properly. Compliance demands could also reduce the available care hours. We need some form of grant system to ensure that the companies will do this without taking away the actual hours for service.

Ultimately, what we are trying to do is keep people at home. This legislation, by the time it is scrutinised and amended, will hopefully create the framework. The resources for training, inspection and enforcement absolutely need to be provided, as well as measures to make the sector more attractive for the additional workers needed.

Deputy Richard O'Donoghue

Independent Ireland had asked the Government that there would be no means test for carers. It said that there should no means test for carers for one very good reason: how can you put a price on care? People are coming into people's homes for an hour. They are driving ten miles, driving to different parts of the county and giving an hour to a family member. The statistics show that with the way the birth rate is going at the moment, we will not have the population to care for the older generation - maybe in two decades' time when the Minister of State and I will be looking for care. There will be no carers if the Government disincentivises them now.

I was very lucky that my father was cared for at home. As a family, we cared for him but we also had carers who came in to help us. They came in and lit a fire while we were out. They came in and did the basic things. From a security point of view, he knew they were coming, what time they were coming at and he knew everything about it. They became part of the family. To me, carers are family. They are looking after our loved ones in their homes, in their own environment, and in the years when they need it most. These people who looked after us and gave us benefits to make sure we could rear our own families. They paid their taxes, worked hard and looked after us as a generation. The least we can do is provide them with care in their own homes.

A woman I know very well from my parish phoned me. She has to drive to the Kerry border every day to look after her father because they cannot get a carer. That is what she has to do. They cannot get the adequate hours. She is trying to work in between doing that and being a mother. She is trying to run all of this because we cannot get the carers.

We talk about nursing homes. People have called me trying to get people in for nursing care. They cannot get into places because they are full. Why are we putting an obstacle in the way, stopping people being cared for in their own homes? If we took in the financial aspect of it, it makes economic sense for them to be cared for in their own homes if it is possible to do so. It costs the State less to have them cared for in their own homes. Why are we putting an obstacle in the way of care when the Government itself cannot provide it? We do not have the staff for it. We do not have the infrastructure in place for it.

Independent Ireland started by saying that it did not want carers to be means tested. Yet, they are getting letters now from the tax office. They are calling me asking what the letters are about. The letters are hostile. Anyone who gets a letter from the tax man says they are hostile. It puts the fear of God in them. We are saying to the carers to go out and care but we are going to frighten the life out of them in case they have a dot out of place. There is no price on care. Remember that for our own families. Would you not love to see your parents being cared for properly in the confines of their homes? We have had it. Why are we not giving the opportunities to other people to have the same?

Deputy Michael Collins

This Bill is about something very simple, namely who we trust to go into homes of our older people and people with disabilities and what standards we insist on. Independent Ireland supports strong, common-sense regulation. Nobody wants low-quality or unsafe care happening behind closed doors. There are positives here. For the first time, home support providers will have to register with HIQA. There will be national standards and proper inspections with the person's consent. There will also be a public register that families can check and emergency powers to stop dangerous services. We will finally get real data on where home support hours are going and who is providing them.

Regulation on its own is not enough. There is still no statutory right to home care, promised since 2017. It is still missing today. This Bill does not deliver a single extra hour of support. You cannot regulate your way out of the staffing and beds crisis. Once again, family carers are invisible. There is no relief, no supports and no move to end the means test. Home help workers, who have been doing an incredible job, are being contracted for one set of hours, and then pressurised to work far more.

A worker might have a 20-hour contract on paper, something that affects their mortgage and family life but is regularly pushed to work 30 hours or more. Others with 39-hour contracts are only given 30 hours in a week, with the rest pushed into the next. Split shifts are now routine. Workers sit at home, unpaid for hours, only to be called back out while the agency staff are being brought in to fill gaps. If they get sick, take a holiday or need a day off, they are expected to arrange their own cover without proper rosters. They are missing out on overtime and other entitlements. That is a direct loss of income for people who are already stretched. These workers are not asking for anything extra; they are simply asking for management to honour their contracts, proper 39-hour rosters issued four weeks in advance, and agencies used only when absolutely necessary. In my own constituency, families waited months for basic home help hours. An older person should not have to choose between a nursing home they do not want and no support at home. Independent Ireland stands for safe care, fair care and a real choice to age at home.

I just had a case where an 82-year-old man in west Cork with stage 4 cancer has been discharged from Bantry Hospital after three months and cannot get home help. This gentleman needs help with personal care and administering his medication but there is no home help available to this vulnerable man. In another case, a gentleman in west Cork has been waiting for over four months for home help. The HSE is unable to provide it as it has no staff available. That is what we are being told. Private operators, such as Bluebird Care, that work for the HSE were unable to provide it due to the lack of staff. Interestingly, Bluebird could provide it if the family were to pay privately, rather than through the HSE.

In another case, a young man, again from west Cork - I have the addresses here but I do not like reading out addresses because it might identify someone - is farming and caring for his mother who has dementia. He can only get home help Monday to Friday. There is no home help at the weekends. He wishes that farming was a five-day week job but it is not. Another case features a gentleman in a retirement village in west Cork who is looking for home help for his wife who has numerous medical issues. He is unable to get the home help.

The bottom line is that the home helps can do the extra hours but they will not be given them. Those at the top tell me that there are no home help hours available. There is strange carry-on going on behind the scenes that I would like to get to the bottom of but if I opened the can, there would be worms flying everywhere. There are people who get home help in the evenings and the home helps are calling at 5 p.m. or 6 p.m. and putting the person to bed. There seems to be no allowance for people who would like to go to bed later. CoAction is adopting a new method for training their recruits called "earn as you learn" whereby those who are training to work as home support workers with CoAction do not have to have a QQI level 5 in order to apply for the position.

They do the practical work with an experienced qualified support worker, study in the evenings and get paid from the get-go.

Deputy Ken O'Flynn

I have read through the Bill entirely. When we look at the opening sections of this Bill, it is about people entering the home and the quality and standard of the type of person who comes in as a home carer. I find it amazing that we are now in 2026, and we are discussing that. This Bill should have been before this House 20 years. It is totally outdated. This Bill does not push for oversight. It risks more bureaucracy and costs for the people. I have been in the House for the entire debate. It has been mentioned that there are four- to five-month waiting lists to apply for carer's allowance. That is the average in this country at the moment. That is the average that TDs around this House are telling the Minister of State. I will be honest with him: I have seen it go up to six to seven months with people applying for carer's allowance. We now have a situation in the Cork-Kerry region where we have 1,300 people on a waiting list. A total of 25% of the national waiting list is in the Cork-Kerry region waiting for home helps. That is an absolute disgrace. Nothing has been addressed about that. We are not addressing that in this Bill. We are not addressing it in this House. We are seeing the figures go up week after week and month after month but we are doing nothing about it. The one thing this Government is good at and has excelled at is waiting lists and statistics. That is what it is really good at. However, the waiting lists are not going down. They are only going up. That seems to be continuously the situation here.

Deputy John McGuinness and I brought up an issue relating to the Revenue in this House last week. Deputy O'Donoghue also just spoke about the Revenue letters that went out to people and home carers. I am delighted that Revenue has written back to some of us as TDs over the past number of days and said it will not be pursuing people prior to 1 January. There is a lot more on people's plate when they are a carer for somebody when they are stressed out of their minds about how they get the dinner and cleaning done and a small bit of a break in the day to receive a letter like that from Revenue. I have yet to see a revenue commissioner in this country or any other country leave a bundle of cash behind them when they have to collect it. I would be seriously questioning the intent of Revenue after that. With the style and standard of the letter it sent out to everybody and what I have read through, and I have seen plenty of copies of them come through my office, I would seriously question the intention of the Revenue.

The Bill is good. In fairness, there are an awful lot of standards in this Bill, which mean a lot of bureaucracy. There are HSE and ICT systems that cannot provide the virtual beds that we are being told about where people can convalesce at home and be monitored. That system is not in place. That system was meant to be there two years ago. There are regulations on the State that the Government will not be able to deliver in this Bill. While the intent might be great, the Government will not be able to deliver it. It cannot bring down waiting list. How will it deliver this?

Deputy Martin Kenny

As the Minister of State is well aware, there are an awful lot of problems regarding the provision of home packages. One of the big issues that strikes me is the privatisation of it. At the moment, about 60% of the home care packages are provided by private companies. It used to be the opposite way around. It was 60% to 40%. A total of 60% or 70% of packages in years gone by were provided by the State through the HSE. That is still the way it should be done if possible. While this Bill is about regulation, one of the issues is that if a person signs up to be a home care provider at the moment in this country, he or she will be paid about €16 per hour. The minimum wage is €14.15. It is not even €2 above the minimum wage for somebody to go out there and care for an elderly person or a person with disabilities. That is something that needs to be looked at. Yet, when the State provides that and 60% of it is provided by the private companies, it is paying nearly double that per hour because it has to pay for the administration fees and the profit margins that the companies have to make. That is their business. Fair play to them. That is fine. The State should be ensuring that they pay adequately. I talk to all of the people on the ground, and they keep telling me that they cannot get carers and people to do it. It is because they are not paying them enough. We need to be pay over €20 an hour to attract people to go in to do that kind of work. That is the reality. If the State does not step up to the mark in respect of that, it will simply not be able to provide that service.

The other issue we have to recognise relates to what they are doing when they go out to provide the care. It has now moved from being just care services only. If an elderly person needs to have a shower or whatever, they can get that done. However, if they need a few dishes picked up off the table and put them in the sink and run the brush around the floor for two minutes, the carer is not allowed to do it. The carer cannot do that. If there is something spilt on the floor, which could be a slip hazard, the carer is not allowed to mop it up. They are not allowed to that because it is not a care service. That is one of the key things that changed in the past number of years, which an awful lot of elderly people that I talk to tell me is a huge problem. There needs to be a way in which they can provide service that they need as well as the care services out there.

Deputy Donnchadh Ó Laoghaire

It is vitally important that we do not take carers and care workers for granted. Too often that is the case. Regarding carers themselves, there was an awful lot of talk about that in the general election. What has happened since then has not been anywhere near what was committed to. We are very lucky in this country that we have such a strength in terms of family carers who are willing to offer support out of duty, responsibility and love. The truth of it is that we should not take that for granted. Abolishing the means test for carers is not only the right thing to do, but in recognition of the fact that many people are providing an amount of care that the State could never provide and are getting very little and in many instances nothing for it. We need to redress that. The Government has not moved fast enough. That is also true of people who are working in care.

There is the whole issue that we used to call the home helps. There is huge respect for home helps given the work they do. They are now called healthcare assistants or home support workers. When we talk about them being taken for granted, which is too often the case, they have balloted for industrial action because of their frustrations at trying to get the HSE to implement things that it has already agreed to. That includes being paid for their 15-minute break. Most people who are working in jobs that are paid by the hour are paid for their break. That is what they are expected to be able to do. In many instances, they are not getting the required 11 hours between shifts. That is a breach of the working time Act. When that happens, the HSE is breaking the working time Act. There are split shifts too often and outsourcing. As my colleague emphasised, it is more expensive in the end. It does not provide the same standard of care. We need to tackle the issue of the HSE increasingly moving towards outsourcing home care. We have some of the best people working as what were previously known as home helps. They are fantastic and committed people. They are committed to their clients, but they need the support and recognition that they deserve. The HSE has to implement those things that it was previously holding back on. I fully support the actions of the health care assistants and home helps.

Deputy Barry Heneghan

Bhí mé ar an nguthán le Sonia Borwick díreach ansin. I was just on the phone with Sonia Borwick. Northside Home Care is on day five of strike in relation to caring. Sixty men and woman are on strike because what is happening them is unfair. In relation to the Bill, the carers have been on strike since 16 January. They are not doing this lightly. They are doing it because they have been pushed to the edge. These people who looked after my grandparents are all proud northsiders. Yet, speaking on the phone to her, she informed me that six of these workers had been made homeless while working as a carer. They are living in a hub in Coolock while still going out every day to care for others. That really sunk in. For years, these workers had pay parity with other healthcare staff. When the recession hit, they were included in the Haddington Road agreement. Through decisions that were made in this House, they effectively lost out. They also lost section 39 status. This was not because their work rate changed, but because decisions were made in here. These were always workers who were working the best they could. The only thing that changed is how they are being treated.

Speaking to them, they told me that their pay has gone down since 2007. This policy choice needs to change. The Minister of State agrees with me. There has been a lot of work done. I welcome some of the work that his Department has done. There is no price that we can put on care. There is no price on seeing and knowing that your loved one is being cared for correctly. These workers are not asking for us to change the world. They are asking for us to change their world. It is very simple for us to do that. I will continue to raise this with the Minister and the HSE. It is day six of the strike tomorrow. They will be outside of the Dáil. It is important that we listen to them. They need to be seen. The Northside Home Care Services is vital in north Dublin. They look after all of elderly, sick and anyone with a disability. They are vital. They are tireless workers. We need to look after them. I urge the Department to look at and change what is going on with these men and women.

Deputy Carol Nolan

I welcome the Bill because there is an urgent need for the Government to prioritise the enactment of legislation aimed at setting out a registration framework for providers of home support services. I want to reference in particular those sections of the Bill under which the chief inspector of social services at HIQA will have responsibility for establishing and maintaining a register for home support services operating in Ireland. The Bill will also provide for criminal liability to be assigned for unregistered home support services and the ability to cancel registration of a provider where serious non-compliance is established. As I understand it, the HSE currently operates under its non-statutory home support authorisation scheme, which was established in 2023. Approved providers are merely obliged to adhere to the authorisation scheme's service specifications and associated standard operating procedures. This is not about pointing the finger at any individual home support service provider, many of which provide compassionate care every day and, along with their staff, do incredible work under very difficult conditions at times.

Increasingly what I see and hear from my constituents in County Offaly is that there is a sense they are caught between a rock and a hard place when it comes to the care delivered by staff, who appear to have very little training or who are, in some cases, literally unable to communicate with either the person receiving the care or their families because of language barriers. This is becoming a source of frustration. The staff are often visibly under enormous pressure to get in and get out and onto the next house. This can be very upsetting for everyone, including the staff members themselves. We need to ensure we have a national home support service capable of delivering care according to the highest standards.

In terms of the provision of home help, serious gaps need to be addressed. It has come to my attention many times in my constituency offices that when the staff or home helps take their annual leave, as they are entitled to do, or if they are ill, they are not replaced. This causes a lot of frustration and a lot of difficulty for families struggling to cope to try to fill the gap until the home help comes back. It is unfair on the home help who happens to be out that there is no substitute or replacement while they are gone. This seems to be a recurring theme. It has been brought to my attention too many times and I hope it will be addressed.

We need national legislation to be introduced as a matter of urgency. Reliance on guidelines and what are effectively voluntary codes is not ideal and it needs to be changed urgently. The fact remains that we need to respond far more effectively to the concerns of those families who can clearly identify the failings in the standard of care delivered to their loved ones. We need to listen to these people and take on board what they are telling us. These people are sometimes fearful of speaking out because they feel they are risking the minimal care time they have and receive. They fear it will be withdrawn. It is important that we listen, that we acknowledge the failings in the services, that we strive to improve and that we bring forward legislation to make sure that providers are protected and that the recipients of the care are also protected.

Deputy Danny Healy-Rae

I thank all of the people involved in home care and all of the home helps around the county of Kerry and around all of the other counties. I know the great work they do in the confined time and space they are given to do it. While I welcome regulation, and the Bill states it will ensure home care is regulated and standards are in place for all home care support for all who need it, the question I ask the Minister of State is whether there is a deficiency in the amount of home help that older people are getting. Will this be highlighted in the Bill? Is the Bill catering for this? I know of too many people who are not getting enough home help. They are left behind on weekends and holidays. When the staff, who are entitled to their holidays, go on their own holidays and things are arranged, no one is there to take up the slack. These elderly people are then otherwise compromised. Will the Bill ensure they are looked after properly? This is what it should do.

We need an awful lot more home help. When someone goes into University Hospital Kerry with a virus or whatever it is, they fully intend to come home but they may have to go to a community hospital or district hospital in the various places. A home care plan should be put in place at the time they leave University Hospital Kerry because they will spend a certain number of days, a week or two weeks at the very most, in a community hospital or district hospital. This is not happening. This is where the void and hurt happens. The family may be not available or may be far away. If we want to keep these old people, and these people who are not able to manage for themselves, in their own homes then some home care plan should be put in place at the point in time they leave University Hospital Kerry. It should not be left to the managers of the district hospitals, who are asked to make the bed available for someone else after a week or two. The conveyor belt keeps going on, people do not stop needing help and another person will need to go into the bed. The home help should be in place and we should have enough home helps.

I know young fellows who have trained to be home helps and I have often asked them whether they are working and they have told me they were not. At the same time, I know of elderly people who cannot get home help. It was awarded to them and allocated to them but no one showed up because we keep getting told there is no staff. I have known these cases and I cannot understand it. If the Bill is going to mean anything, this issue needs to be dealt with to explain whether or not home help is available and whether staff are trained up. If they are not trained up, they should be. As other Deputies have said, maybe we are not paying the home helps enough. Maybe too much pressure is being put on them. I hear they are being told to go here and there and to the next person. It hurts me very much when I hear that a home help is not allowed to do certain things for elderly people who may be not agile or mobile enough to do something for themselves. I know that some of them do so anyway. As I said, they are not supposed to be doing some of these things and this is ridiculous.

We need to develop a model like they have in Denmark. There are hardly any nursing homes there. Why is this? It is because everyone is looked after in their own homes where it costs a lot less. The Government needs to look into this a whole lot more and go into it in greater depth. I appreciate that it is looking after the issue of people not being properly trained or Garda vetted and there could be other problems. It will look after that side of it but we need to work harder on the side of it whereby the patient, elderly person or disabled person is being left without home help.

We have other issues in Kerry also which all concern elderly people. We have a new community hospital in Killarney that has been finished for almost a year. It is a community hospital and nursing unit. It is there on the side of the bypass but it has not been opened. When that is opened, we are supposed to develop the old district hospital and St. Columbanus Home to have a primary care centre and more respite beds. People are being told that where carers mind people at home and have to be with them all the time they are entitled to four weeks of respite in the year.

Those people are entitled to a bit of respite, but they are not getting it because we do not have the beds for respite in Killarney, Kenmare, Listowel, Dingle, Cahersiveen or anywhere else. We do not have enough respite beds. Then we are waiting for a minor injuries unit in the town of Killarney. This could be put into the old buildings and it could be a new modern unit. The space is there but we are waiting for the new hospital to open. What is the cause of the delay? Has the Department the staff engaged? Has the Department found the staff? Those are the questions people are asking.

Carers provide invaluable service. Some of them were terrorised with the notion that the Revenue Commissioners were going after them. Many of them were wondering what they would be done for and what they might be caught for. These things are terrible. The amount of lines the media gave it was totally out of balance and out of kilter when most of it is not true at all.

One of the things we looked for in our programme to support the Government was the abolition of the means test because many of those who care for their people at home are doing it voluntarily and they would do it anyway if they were to get nothing for it. It is very unfair. No one could put a price on the amount of money these family carers are saving the State. They need to be looked after. The means test is totally out of kilter. We are helping them in a small way this year. It is supposed to be abolished over five years. I am asking the Minister of State to expedite that.

For elderly people I see a great need for therapy and for physiotherapy. When old people go into hospital, they have other problems like viruses and they have different issues. We do not have enough physiotherapists in our hospitals. What would be wrong with having physiotherapists call to people's homes? If a person cannot move around or if there is something stiff with their leg or hand, physiotherapy works for a lot of people and it will work for those people as well. We would save a lot of money if we were to help people with those therapies and ensure they get them in their home or wherever they are. Whatever hospital or whatever care setting it is, we should be providing more physiotherapy for those people. There are lots of other therapies that elderly people would benefit from because when they are not moving around at all, they seize up and the problem gets worse. Two people are needed to operate hoists and such things whereas if the elderly people were kept going as good as they could be and for as long as they could, we would save the State a lot of money. We need to look into a lot of those things.

Why do we not look at the Denmark model to see what is happening there and why they have hardly any use for nursing homes? I appreciate the great work our nursing homes are doing. Indeed, our community hospitals like Kenmare Community Hospital and St. Columbanus Community Hospital do great work for long-term care as well as short-term care. People are very appreciative of those settings as well as the private care that is provided. In County Kerry we have great private nursing homes and they are doing great work but they are all under savage pressure and it is hard at any stage to get a bed for someone. When people are ready to go home, we should have a home care package. There is a lot of talk about it, but it does not materialise. When the person is a good bit better and can and should go home, they do not seem to be able to do so. Even though they are awarded a package and the hours are allocated, it does not materialise for whatever reason.

When I meet the youngsters who are trained up, they say they have not got any work yet. When I meet the elderly person or their family, they say they were awarded home help on a certain date but no one has arrived yet. In line with this new Bill, which is being brought in to protect and look after other measures, I am asking the Minister of State to get some section working to see how long people are without home help. How long after they leave the university hospital and go to the district hospital are they waiting for home help? That is what is happening. What happens when it gets out of order altogether? They have to apply for the fair deal scheme and try to go into a nursing home. The family does not want that, the elderly person certainly does not want it and the Government should not want it because it is costing a lot more. That is what I am saying.

There is some good in the Bill, but I hope a lot more good will come out of it because we need to ensure anyone who needs home help and is awarded it gets it. It should be included in this Bill that someone is going around to see what is happening and why people are not getting home help.

Minister of State at the Department of Health (Deputy Kieran O'Donnell)

I thank the Members for their contributions. There were 27 contributors in total and they spoke on a range of aspects of this issue. I welcome the general support for the Bill in terms of regulation. To recap, the objective of the proposed legislation is to improve the safety and quality of support services by ensuring that registered home support providers do not operate below the standards set by ministerial regulations and that those regulations are provided in a consistent and systematic way. Before getting a registration, providers must satisfy the chief inspector of social services that they can comply with these regulations and other requirements under the legislation.

In the limited time I have, I want to go through a number of the points that were raised by TDs. Deputy Newsome Drennan brought up a number of points. I want to deal with family carers. Deputy John McGuinness referenced this and brought it up last week. The Revenue Commissioners have said today that they will not in any way be looking at previous years. That is to be welcomed. I want to put on record the fantastic work that family carers do. It is acknowledged and respected. They do phenomenal work for their families and loved ones. Hopefully the measure today from Revenue will bring reassurance in that area.

Deputy Newsome Drennan made reference to the adult safeguarding legislation. At the end of last year, for the first time ever, we brought out the first national adult safeguarding policy. Legislation is being prepared and I want to bring it forward as quickly as possible. It was a priority for me as well as the home care providers legislation. I want to see the safeguarding legislation coming forward as quickly as possible. It is something I am absolutely committed to doing.

People made reference to consent for the under-18s. The under-18s are now included in the Bill. They were not included in the general scheme. There was a discussion with the Department of children and they are now included. We will be bringing forward amendments around the whole consent area for people under 18 years of age. That is a very important point.

The other issue was the personal assistance, PA, exemption. It was exempted under the general scheme. It continues to be but there is work ongoing by the PA review group under the Department of children. We want to respect the work it is doing. Depending on the outcome of that, we will look at amendments if the review group wishes to bring them forward but we want to respect the integrity of the PA service. It is hugely important. We want to allow the PA review group under the Department of children to do its work within the HSE.

The three or less clients provision is included in the Bill because it is proportionate.

It was in the general scheme and we want to ensure it is proportionate.

This is all about improving the service. Deputy John McGuinness raised the funding model. Based on the regulatory impact that was done, it was estimated that the cost would be €1.1 million over the first three years for HIQA to be able to bring in the legislation and the process itself. We will engage with the sector on the regulation of costs. We are conscious of that issue.

It is important that Members are aware that the legislation is to regulate home care providers, regardless of whether they are in the public, private or voluntary sector. That is going to bring about an increase in the quality, safety and consistency of service delivered throughout the length and breadth of Ireland.

It is also important to note that this year alone we are looking at 1.7 million additional home care hours. Since 2020 we have increased from 17 million hours to 30.6 million hours. This year there are 26.7 million hours for older person's services and 3.9 million hours for disability services. I am conscious that, like me, Members here represent people the length and breadth of Ireland. I am in continuous engagement with officials in the Department and the HSE on the issues that arise in respect of the current home care service that is delivered. I will continue to engage with them on the particular points Members have raised today. These are matters I will take up with the HSE in terms of the delivery of the service. We want to get value for money. We want to look after people that are in receipt of the home support service. It is something that I will continue to work on. Regulation is hugely important.

We committed in the programme for Government to design a statutory home care service in the lifetime of this Government. When I came into the brief I looked at it in great depth with the officials. The first step in doing that is to regulate the home care providers, which we are doing with this Bill. I want to get the Bill through. I will work with Members, both here and in the Seanad, to get this legislation through as quickly as possible. I am committed to working with the officials and my Government colleagues to progress the design of a statutory home care scheme. It is an absolute priority, but it must be built on a process. As it stands at the moment, the sector is not regulated. I want to see the home care providers sector regulated. We owe that to the people to whom they deliver the service. The Bill is welcomed by the sector itself. It is something I want to work with it on to ensure we get it up and running as quickly as possible.

The other issues that were raised by Members relate to their own areas and regions. That is something we will take up and work on with the HSE. Regardless of where someone lives, I want to ensure the quality and safety of the level of service that is provided to the public. That is something that is hugely important.

Many of the speakers in the House today have worked in this sector, and that came across. I very much take on board what was said. No one has a monopoly on knowledge in this area. I very much want to work with colleagues to improve all aspects of the home care service. The issue we are debating today relates to the regulation of the sector, which is the first step in the roll-out of a statutory home care scheme.

Other issues that were raised include the work healthcare assistants do. That is hugely important. I very much value that. Members have raised particular issues that currently arise. My understanding is that the HSE is engaging on those aspects. I hope a resolution can be arrived at. Ultimately, this is all about getting to a point where we can put in place a statutory home care scheme in Ireland. This is something the Government and I are utterly committed to, but to get to that point we must regulate the sector.

We have had a very constructive debate here tonight. We will continue to work through the legislation. I welcome further ideas or amendments from Members on Committee Stage when the Bill proceeds to that Stage. The single most important point is that we have now published a Bill to regulate the home care providers sector, which will involve independent regulation of the delivery of the service. I believe this will greatly enhance both the safety, quality and consistency of the home support service delivered the length and breadth of Ireland. I thank all Members for their very comprehensive contributions tonight. I look forward to continuing to work with them on the legislation.

Question put and agreed to.

Dáil Éireann debate - Tuesday, 20 Jan 2026

Health (Amendment) (Home Support Providers) Bill 2025: Second Stage

Dáil Éireann debate -
Tuesday, 20 Jan 2026