People receiving homecare services face charges under Government reforms

Co-payments to form part of proposals to be presented to Cabinet in January

People receiving homecare support in the future face having to pay some of the costs themselves, under proposed new reforms to the sector to be presented to the Cabinet in January.

Minister of State for Older People Jim Daly suggested the co-payment would be based on the person's income and not be linked to property assets.

At present, home support services are provided free of charge, however residential care under the Fair Deal nursing home scheme involves individuals having to make a contribution to the cost.

The Department of Health had been looking at the idea of introducing some form of charging system for homecare. However, it has now been confirmed that a system of co-payments by individuals availing of such services will form part of major reforms to the sector to be recommended to the Cabinet by Mr Daly.


He said if the Government accepted his recommendations for future financing and regulation of home support services, the Department of Health would work on the precise funding model over the coming year.

He suggested as an example that if a co-payment of 10 per cent of the cost was put in place, it could fund an additional two million hours of home-help services across the country which would go a long way towards addressing unmet need.

The costs of homecare services can vary depending on the number of hours required, the needs of the person concerned and the number of staff involved.

Waiting list

The Health Service Executive revealed earlier this year that there were about 7,300 people waiting for home-help supports.

Mr Daly told a conference in October that he felt “ashamed” at the waiting list for home-help hours.

The HSE announced in December that an additional 230,000 homecare hours beyond the 2019 target level are to be provided in 2020.

Home support services for older people are funded by the HSE, and provided by people directly employed by the health authority or by voluntary and private providers who have arrangements with it to deliver these services.

Over €445 million was allocated by the HSE in 2019 to fund provision of 17.9 million hours of home support to 53,000 people this year.

However, last June HSE chief Paul Reid told his board that demand for home support could not be met from existing resources. Mr Daly indicated that any new co-payment system approved by the Cabinet would come into effect in 2021 and would require new legislation.

Mr Daly is expected to tell the Cabinet in January that the aim of his proposed reforms is to improve the model of service delivery and to develop legislation for the financing and regulation of these services. It will seek to provide equitable access to services based on an assessment of need that will operate consistently and fairly across the country.

Under the proposed reforms a new centralised office will be established to manage applications for home supports similar to the centralised facility in place for the Fair Deal nursing home scheme.

Care packages will be approved based on a standardised assessment of care needs, using a single assessment tool selected by the HSE.

New care bands will be put in place based on the scale of the needs of each applicant and each care band will have a budget ceiling to provide/purchase services.

It is also proposed, under the new reforms, that providers of homecare services in both public and private sectors will have be licensed.

Martin Wall

Martin Wall

Martin Wall is the former Washington Correspondent of The Irish Times. He was previously industry correspondent