'I love my patients. But the HSE seems to want us out'

IN THE 2011 Programme for Government, the Labour Party and Fine Gael say additional funding will be provided each year for the care of older people.

“This funding will go to more residential places, more home-care packages and the delivery of more home help and other professional community care services.”

The HSE is just beginning to implement a second wave of deep cuts to home-help services: about 500,000 hours by the end of the year on top of the 500,000 hours already cut earlier in the year. Protests against the cuts are escalating with two due to take place in Dublin next Wednesday and Thursday and another in Cork on November 3rd.

Public and voluntary home helps, who many people consider the backbone of community support to disabled and older people in their own homes, speak of having had their hours cut, the amount of time they may spend with clients cut, of seeing their work being handed over to private operators and uncertainty about whether they will have jobs in 12 months. The majority are women who work part-time with no or insecure contracts of employment.

Organisations such as Older and Bolder, Age Action Ireland and the Irish Wheelchair Association say the planned cuts to home helps must be reversed because they do not make economic or social sense.

Kathleen McLoughlin, the chief executive of the IWA, says in the past six years she has never seen its “members so frightened about what is going to happen to them if they lose their home-help hours. The loss of even one or two hours a week to a person is potentially devastating and will, without a shadow of a doubt, see many being forced into expensive long-term care.”

The HSE, which funds more than 10 million hours of home-help care to more than 50,000 people, says most local health offices have spent their budget for the service. It says this budget must be cut drastically, but promises people’s needs will be assessed and the cuts will be proportionate.

The home-help sector is fragmented, complex, changing and, most dangerously in a time of rapid flux, unregulated.

There are about 9,300 home helps in Ireland, working either for the HSE or for voluntary organisations that it funds, with an annual budget of €195 million. This figure is down from 12,350 home helps in 2007. There is also a growing but unknown number working for private home-care operators, the biggest of which are Home Instead Senior Care, All in Care and Comfort Keepers.

Samantha Byrne will be one of the people joining the People Before Profit protest in Dublin on Wednesday. She has worked for six years as a home help with Marino-Fairview Home Help, a not-for-profit service funded by the HSE. She is also the Siptu shop steward in the organisation.

Explaining how the job has changed in the past few years, she says where it used to be mainly light housework, some cooking and companionship, there has been a move to more professional, personal care provision.

“The cleaning thing has gone, really. Now we’re doing more medical care, grooming, dressing and washing.” She and her colleagues have completed two-year courses to Fetac level five and standards have increased. “That is a good thing and we welcome that,” she says.

However, their hours have been cut in the past year. “I used to work 22 hours and now I’m getting 12. It is getting to the stage [where] we’re worried whether there will be a job in a year.” She says as their clients die or move into long-term care, they are not getting new ones. “The HSE won’t fund any new patients with us. It’s all going to the private companies.”

“I have had the same clients for years. I know their local chemist, local post office, the people in their local shops . . . It’s a very emotional job, a very responsible job. I love it. I love my job. I’m passionate about my patients. I know I’m like family to some of them. But [it seems] the HSE wants us out.”

A HSE spokeswoman says a procurement process had been completed this year for the provision of enhanced home-care packages for which private and voluntary operators can tender. The packages include occupational therapy, physiotherapy and chiropody as well as home-help hours.

“The arrangements commenced on July 1st, 2102, for a minimum of 12 months. The new arrangements refer to new packages to be allocated during that time,” she says. A number of providers have won the contracts in each region, and about three-quarters of those are private operators.

The HSE’s home-help budget is separate to its home-care package budget. As new clients emerge, the majority are being funded through the home-care package; they can “buy” their home-help hours from an approved provider, most likely to be private.

According to Sharon Cregan, a researcher at Siptu, home helps currently working for the HSE or for voluntary groups are working fewer hours. The client list is reducing and the staff are under more pressure to complete tasks in less time.

“At a meeting in Cork this week there were women who have seen the numbers of hours they work cut from 20 a week to two . . . In Kerry we know where they were spending an hour with patients they are being told to stay only 45 minutes, or where they had half an hour they are being told to complete the tasks in 15 minutes. It’s inhumane for the client and stressful for the workers.”

One of the biggest grievances is the continued nonimplementation by the HSE of an agreement reached with unions in 2009 to provide contracts of employment to home helps and compensation where hours were reduced. Despite a Labour Court ruling in June that the home helps’ claim was “reasonable” the HSE has still not offered contracts. A spokesman for the HSE said the home helps “have to realise it is not in the nature of their work to be guaranteed hours. It has to be flexible and built around the patient.”

Meanwhile the amount the HSE spends on private home-care is increasing dramatically. In 2007 it paid Home Instead €621,000; last year it paid the company €6.02 million. It spent almost €300,000 on All In Care in 2007 and €4.16 million last year.

Patricia Conboy, the director of Older and Bolder, raises questions about the monitoring of standards of care by some private operators. She acknowledges that there is space for both private and public home helps, but she is concerned at the move to privatisation without regulation. She wants to see Hiqa inspect all home-help providers and set up a register of people engaged in home help.

For its part, Home Instead, the largest private provider of home care, points out it has won multiple awards for quality, systems and service. A spokeswoman said the company had been lobbying the Government to “regulate the market as a matter of urgency”.

According to Des Kenny, chairman of the Not For Profit Business Association, essential to any home-help service must be the roots in the community of which Samantha Byrne speaks. “Attacking a familiar, locally run home-help service is an attack on the community. People need to trust it. If the HSE keeps tearing at the fabric of our communities, there’s going to be nothing left.”

Caring by numbers

€195 million

The HSE budget for home help

In 2007 there were

12,350

home helps in Ireland.

Now there are

9,300

500,000

hours of home help, costing

€8 million

will be cut by the end of the year

In 2007 the HSE paid Home Instead, a private home-care company,

€621,000

Last year it paid the company €6.02 million