Dáil Éireann Debate, Tuesday - 9 July 2024
763. Deputy Cathal Crowe asked the Minister for Health the progress made in improving access to older person's health services since 27 June 2020; the additional funding provided in successive budgets; his plans for 2024; and if he will make a statement on the matter. [29613/24]
Amharc ar fhreagraIn 2020 the overall funding available to the HSE for Older Persons was €1.97 billion, in 2024 that has increased to nearly €2.62 billion. A wide range of core services is provided throughout the country for older persons including home support, day care, community supports in partnership with voluntary groups and intermediate care as well as long-stay residential care when remaining at home is no longer feasible.
Investment in social care services has been a substantial priority for this Government. In 2024, the HSE is funded to support 23,280 people in long-term residential care and to deliver 22 million hours of home support to 54,100 people at any one time, which represents over 70,000 people receiving home support across the year. Through its own services and through commissioning services from private and voluntary providers, the HSE exceeded the 22 million hour target in 2023 and will exceed it again in 2024. This also means that more people are receiving home support than projected, with over 56,000 people receiving home support in April.
The delivery of home support hours has increased every year since 2019, when under 18 million hours were delivered. The waiting list has also reduced from over 9,000 people at the start of 2020 to under 6,000 people today. At the same time, numbers of people in long-term residential care have stabilised, the average length of stay has reduced and the 4-week waiting time for funding approval has remained consistent throughout. Funding for transitional care has also increased, with €22 million being provided in 2024 to ensure that people are not delayed in being discharged from hospital, either to residential care, rehabilitation or home with supports.
The triangle of supports that help people to stay at home is made up of home support, day care and the meals on wheels service. Day care and meals on wheels have proven to be important components of the community services offered to older people, particularly in rural communities where these services can be essential in addressing loneliness and isolation. In 2024, we are investing an additional €3.7 million in over 300 day care services, in-home dementia day care and meals on wheels across the country. Meals on wheels are delivered from over 300 locations and are expected to deliver nearly 3 million meals this year.
In 2019, 3.4% of people over 65 were in long-term residential care. In 2024, the HSE is meeting its target to have less than 2.9% of people over 65 in long-term residential care. This indicates that our investment in the community is working to keep people at home, in line with the principles of Sláintecare: right care, right place, right time.
Dementia
I have also continued to champion services for people with dementia. Through successive budgets, I have worked to prioritise Government funding for the development of dementia diagnostic and post-diagnostic services, in line with the Dementia Model of Care.
Through Budget 2024, I provided an additional €500,000 to increase the provision of in-home dementia day care, for people who cannot, or do not wish to, attend centre-based day care. This was first introduced during the COVID-19 pandemic and is universally viewed as beneficial, improving both the quality of life of clients and providing a break for family carers. 52 dementia-specific day centres have also opened.
Alongside this, I allocated €300,000 in funding to the Alzheimer Society of Ireland to provide weekend activity clubs for people with young onset dementia. This new service will have the benefit of also providing respite to the family carer. Up to 120 people with dementia and their families are expected to benefit from this weekend service.
During my time as Minister I have also introduced ringfencing for new home support hours for people with dementia. This proportion of ringfenced hours has increased each year since 2021 and this year a minimum of 18% of all new home support hours is ringfenced for people with dementia.
Going forward there will be a strong focus on dementia-specific services, which have developed in recent years, like the Memory Technology Resource Rooms and National Dementia Adviser Service which provide invaluable information and supports to people with dementia and their family carers to help them adapt to a dementia diagnosis and continue to live as well as possible.
COVID-19 and other pressures
The Government has provided substantial support to the private and voluntary nursing home sector over the pandemic and to address cost pressures.
• Over €151m of financial support was provided to private and voluntary nursing homes through the COVID-19 Temporary Assistance Payment Scheme (TAPS).
• The provision of free PPE and oxygen to private nursing homes.
• A €10 million Temporary Inflation Payment Scheme (TIPS) was established to support private and voluntary nursing homes with increases in energy costs, covering 75% of year-on-year cost increases up to a monthly cap of €5,250 per nursing home.
• I introduced a new €10m Resident Safety Improvement (RSI) scheme in 2024 to support private and voluntary nursing homes with HIQA regulation and compliance measures.
Strategic Workforce Advisory Group on Home Carers and Nursing Home Healthcare Assistants
Delivering all the services that we have funded is reliant on the availability of carers to work in the sector. There is a shortage of care workers in Ireland, which is seen in many other countries with similar models of care. Addressing this shortage is an urgent priority for the Government.
To this end, the cross departmental Strategic Workforce Advisory Group on Home Carers and Nursing Home Healthcare Assistants was established in March 2022 to examine and formulate recommendations to address the challenges in front-line carer roles in the home support and long-term residential care sectors. The Report of the Strategic Workforce Advisory Group on Home Carers and Nursing Home Healthcare Assistants was published on 15 October 2022, and it contains 16 recommendations. Implementation of these recommendations is underway and is being overseen by a cross-departmental Implementation Group, chaired by the Department of Health. The group meets regularly, with its next meeting schedule in July. Progress updates are published and are available at:
www.gov.ie/en/publication/66dd1-strategic-workforce-advisory-group-on-home-carers-and-nursing-home-healthcare-assistants/
Significant progress has been made in implementing these recommendations. A new HSE Authorisation Scheme, which governs the payments to providers, and terms and conditions, was agreed in August 2023. This delivers on commitments for sectoral reform such as payment for travel time for home support providers, paying carers the National Living Wage at a minimum, and bringing legacy rates in line with the new revised rates of funding, ensuring fairness in the sector. This is the first time that all home support workers delivering care are entitled to receive payment for their travel time.
The Advisory Group’s ninth recommendation has also been fully implemented. The statutory instrument authorising the issuance of 1,000 employment permits for home support workers was signed in December 2022. These permits will be for full-time positions with a minimum salary of €27,000 per year. 917 permits have been availed of to date.
Healthy Age Friendly Homes
On 10 July 2024, I will launch the national roll-out of the ‘Healthy Age Friendly Homes’ (HAFH) programme, which is aimed at enabling access to services in the community.
HAFH is a support coordination programme that aims to enable older people to age in place and reduce the need to transfer to long-term residential care. HAFH is an innovative collaboration operating at the interface between health, housing, local government and climate action to address these wider determinants of health through the Age Friendly Ireland Shared Service.
On referral into the programme, a local co-ordinator carries out a home visit and conducts a holistic needs assessment for the older person in the areas of health, housing, community and social supports, assistive technologies, climate and finance. The co-ordinator agrees a personal plan with each individual older participant and supports them to access a range of services such as housing adaptation grants, home energy improvements, health appointments, befriending or other community services, or technology supports.
During the course of the piloting of the programme across nine sites between 2021 and 2023, local coordinators carried out over 4,600 home visits and provided over 9,000 supports to older people. In Budget 2023, I secured €5.2m in annual recurring funding to roll the programme out across the country.
As part of the national roll-out, using a population-based approach, each of the country’s 31 local authorities will host a local coordinator, with some areas receiving more based on their population's needs. Regional managers will be aligned to HSE Health Regions, to ensure alignment with health and social care services. Once launched the programme will support approximately 10,500 older people each year.
Telehealth
Finally, I am committed to improving access through the innovative use of technology. A telehealth project in CHO5 and Ireland East Hospital Group was approved for 1.5 million euro of funding under Sláintecare Integration Innovation Fund.
CHO5 will run a pilot project of 70 clients awaiting home support and the Hospital Group pilot is for 25 clients on the Delayed Transfer Of Care list. The project will run for two years with appropriate governance and oversight. It will include smart wireless devices which are integrated into homes. These devices ensure both personal and environmental safety, and home monitoring.
There is a 24/7 expert care, phone-based team, which oversees the safety and wellness service. This team provides “comfort calls”, where prompts can be given regarding medication, nutrition and activity. There is a digitally inclusive adapted tablet to support social interaction and family members have access to an app, where the complete day story is available. They will receive calls from the team if there are unexplained changes to the normal day. The aim of the fund is to test innovative models of care and provide a ‘proof of concept’ with a view to mainstreaming successful projects through the annual budget.
