Homecare services in ‘dire need’ of regulation, watchdog warns

The country’s homecare services are in “dire need” of being regulated as an ageing population places more demands on the sector, the State’s health service watchdog has said.

The Health Information and Quality Authority has called for an immediate overhaul of the unregulated sector, including the introduction of oversight and standards for the homecare services, as most older people would prefer to age and receive care at home but will require more complex care.

Homecare services received their latest State budget for funding in their history this year as funding for almost 24 million hours of home support was provided for 55,675 older people.

This was in addition to more than three million hours of home support and more than 1.7 million personal assistant hours provided for adults with disabilities and 533 packages of care and about 18,000 hours per year for children with complex needs.

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There are about 20,000 paid homecarers working in the country.

Hiqa's chief inspector Carol Grogan said that homecare operates in complex conditions affected by funding, availability and geography. However, the current system was "not sustainable and is not meeting the needs of people, with some vulnerable people unable to avail of support in their home", while the lack of regulation meant that quality and safety were not ensured.

Minimum requirements

“It is in dire need of regulation because it is very, very complex and our research shows that,” said Ms Grogan.

“There is care delivered to older people and you can see really from the level of hours that go into all the support and homecare for people with a disability and for children with complex needs. At the moment, there isn’t any standard of care and no minimum requirements that a homecare provider has to meet.”

In two detailed research papers published by Hiqa, the regulator says that homecare service providers offering services on behalf of the Health Service Executive outside of tender or service arrangements theoretically do not need to adhere to any standards.

“In this regard, there is no control over who can provide such services and how they are monitored. This is a very real and significant concern,” said the Hiqa research report.

The watchdog has said that the ageing population, difficulties with the recruitment and retention of social care staff and the impact of the Covid-19 pandemic since March 2020 means that there is a "fundamental need' to regulate the homecare service providers in Ireland.

‘Complex context’

“Hiqa has advocated for the regulation of homecare services over a number of years,” it said.

“However, this is challenging as homecare operates in a complex context where there are interactions between the recipient of homecare, informal carers, homecare staff, provider organisations, the HSE and allied health professionals.”

Ms Grogan said regulation could be a “catalyst for improvements” in the sector as was shown when Hiqa became the regulator of care for older persons and for people with disabilities.

The regulator is developing a set of national standards for home support services to improve standards and support the development of primary legislation and regulations in the area.

Minister for Health Stephen Donnelly has said his department is developing draft regulations in advance of a public consultation next year to inform further amendments.

“We have the expertise, we have the knowledge and we will work with the Government to progress this as soon as possible,” Ms Grogan said.

“We are able to regulate this area and we want to see it regulated as soon as possible.”