Home care for up to 40,000 now in jeopardy as providers say they may pull out

HSE extends deadline for agreement as Department of Health withholds sanction for fees increase

Services to more than 40,000 recipients of private home care across the State have been placed in jeopardy after the HSE withdrew a pay offer to providers. The offer is understood to have been withdrawn as the fee increase has not been sanctioned by the Department of Health.

The HSE last December asked private home care providers to continue to accept pay rates set in 2018 for another four months while requests for additional fees, including payment of the “living wage” for private sector workers, were addressed.

Most of the home care supplied in Ireland is delivered by members of two organisations – Home and Community Care Ireland (HCCI) and The National Community Care Network (NCCN). Some 40,000 people receive care through these organisations, which is charged to the HSE on an hourly basis of some €26.50 per hour.

The HSE also provides its own direct care, which costs the State about €45 to 47 per hour, according to Joe Musgrave, chief executive of the HCCI. Mr Musgrave told The Irish Times that HSE officials told him in March that a new rate of €34.44 per hour would be implemented for private workers. However, this rate was not forthcoming and the HSE on April 19th announced a new “rate card” for service providers, which calculated the base payment at €28.50 per hour.


Mr Musgrave said this was “significantly below average costings given by both HCCI and NCCN to provide a high-quality service for clients, as well as living wage and mileage to carers”.

He said that inadequate as it was even this rate “was inexplicably withdrawn on April 25th, and the HSE said it was giving itself a further nine weeks, until the end of June, to set a rate which would be offered by a new tender for services”.

Mr Musgrave said saga had “destabilised” the home care industry, and he labelled the handling of the matter as “shambolic” and “a total failure of leadership”, which he said would not be tolerated in any other European country.

He said the Government had produced a report in October which set out a strategic policy objective that workers would have a living wage and additional expenses such as travel time and mileage provided for, where appropriate.

Now, he said, many private home care providers were looking to the future with considerable uncertainty. “They are looking at two scenarios. The first is that they would hire more staff, increase pay and continue to provide services; the second is that they would withdraw from parts of the country where the rates were just not viable. Some would undoubtedly be unable to continue in the business.”

According to the HCCI, the impact of low rates of payment for home care services is that some not-for-profit providers will likely be unable to continue offering their service, which would put home care for older or vulnerable people in jeopardy and the employment of more than 2,200 carers at risk.

The organisation said providers cannot confirm when they can increase wages and pay travel time or mileage as the HSE’s timeline has continuously changed. Meanwhile, the organisation says the waiting list for home care stands at about 6,700 people and is lengthening all the time.

A spokeswoman for the HSE said engagement “has been ongoing in relation to finalising the current home support tender”. She said the HSE was also in “parallel” high-level discussions with its funding agency, the Department of Health, and had sought a further extension of the current arrangements “pending” these talks.

The HSE said contracts due to expire at the end of April have been extended to the end of June so as to facilitate the conclusion of “these high-level discussions and the current tender process”.

Tim O'Brien

Tim O'Brien

Tim O'Brien is an Irish Times journalist