Home help shortage makes carers ‘prisoners in their own homes’
TD says it seems HSE ‘depending on people to die, or to get better’ before others assisted
Tiasha Kelly in her home in west Sligo. A home help used to visit her house to assist her at lunchtime but that service stopped a while back. Photograph: Brian Farrell.
“I don’t cook now,” says Tiasha Kelly, an 81-year-old widow from west Co Sligo.
“I’m afraid of my life. If I have a chop, it goes into the oven.”
A home help used to visit Mrs Kelly’s house to assist her at lunchtime. But that service stopped a while back.
Soon after, Mrs Kelly, who walks with the aid of a rollator or two canes, dropped a heavy saucepan of boiling water when preparing her midday meal.
“I broke one toe and scalded my legs,” she said.
Mrs Kelly now cooks her potatoes in the microwave.
Since the accident, she has been offered a 15-minute home help visit at lunchtime, but it would come at a cost. The quarter hour would be deducted from her morning assistance allocation.
Even the most efficient home help, she says, would “hardly have her coat off” before the 15 minutes expires. The HSE is offering her a half hour every second day at lunchtime. However, this would be part of her weekly 10½ hour allocation, which the HSE says cannot be exceeded.
Mrs Kelly was in hospital on life support nine years ago following surgery. She does her best to make the most of every day. She flew to Australia last Christmas to spend time with her family, but knows that she needs help with some things at home.
“It was suggested that I should get the home help to multi-task in the morning. When I’m in the shower, she could boil a pot of potatoes to have later,” says Mrs Kelly, who is upset about some of the responses she has received from the HSE about her concerns.
She needs help when showering but says there seems to be an attitude that “one shower a week should be enough”.
Doctors, politicians, relatives and home helps have long cited a crisis in the home help service with few or no resources available for people in need of assistance who are coming into the system. Others have had their home help allocations reduced.
“It seems as if they [the HSE] are depending on people to die, or to get better, before they can offer anyone else home help,” said Sligo-Leitrim Fianna Fáil TD Marc MacSharry, who recently told the Dáil that the crisis in the service was having a knock-on effect on hospitals.
There were 6,310 people on waiting lists nationwide for home help services at the end of April and it was reported last week that the HSE had effectively closed the home help scheme for all new entrants for the next five months.
The HSE denied this but said that local managers have been told to stay in line with their budgets “which may impact on their ability to provide new hours into the system”.
“The allocation of new hours will be based on clients’ needs and the resources available,” the HSE said in a statement, which noted that 17.9 million home help hours would be allocated to 53,000 people this year.
It seems there is funding available for end-of-life care but absolutely zero for others needing home help
The HSE said additional funding had been provided in this year’s budget following an agreement that home help staff would for the first time be paid for time spent travelling between clients. This development is believed to have put the budget for home help visits under further strain.
Sligo-based consultant Dr Donal Murray agrees that the shortage of home help is affecting hospitals. He recently highlighted the case of a 92-year-old man who spent 70 days in Sligo University Hospital, despite being fit for discharge after 10 days, because home help was unavailable.
Dr Murray feared the man would become institutionalised and when he was allocated home help “after the fuss”, he spent a few days in his own house before moving into a nursing home.
“By that stage he was not able to cope at home,” Dr Murray says. “It seems there is funding available for end-of-life care but absolutely zero for others needing home help. That is leading to situations where people are being delayed in hospital or being sent to community hospitals, people who could have gone home but for a lack of home help.”
Asked about the logic of keeping people in hospital for lengthy periods at considerable expense, when home help care seems like a cheaper option, Dr Murray says: “If you think about my man in hospital for 70 days, if he had not been in that bed there could have been a stream of patients undergoing expensive procedures, which would have driven the hospital budget through the roof.
“My poor man just had bed and breakfast here with a modicum of nursing care. He was a very cheap patient. There are all sorts of angles to this.”
Asked if he thought some might be happy to have a person occupy a bed for weeks on end as a cost-saving measure, he replied: “A cynic might say that.”
He believes that there are other delayed discharges in the hospital because there is no home help available for some people when they go home.
I am not cribbing and I am grateful for the help I do get, but a little bit more would make a huge difference
“It certainly is frustrating for me but it must be much more so for those people in the emergency department who are sleeping on corridors,” he said. “I get to go home to my bed at night. These people do not.”
The issue has recently been highlighted at meetings of Sligo and Leitrim county councils where councillors told of constituents who have been approved for home help but told there is nobody available to provide it.
Cllr Martin Baker (Fianna Fáil) said some people in Sligo were being sent out lists of private providers who they could employ at their own expense, which he described as an insult. Cllr Michael Clarke (Independent) highlighted a number of cases including that of a woman who has to assist a home help who uses a hoist to get her husband out of, and back into, bed each day.
The woman, who has had serious surgery, does not have any home help on Sunday evenings and has to get her husband (74) back to bed alone if none of their family are around. He has vascular dementia, is confined to a wheelchair and is totally dependent to the extent that his wife now has to feed him.
“I am not cribbing and I am grateful for the help I do get, but a little bit more would make a huge difference,” she says.
Mr Clarke said full-time carers like this woman were being turned into “prisoners in their own homes” because of the shortage of support.
“I can’t really leave the house now but I pay someone to stay with him for a few hours every week if I need to do the shopping or go to the doctor,” the woman says.
One home help said the situation deteriorated about six months ago and there now appeared to be an embargo on taking on staff.
“We are always rushing and it is not fair to the clients,” she says. “You might have half an hour to get someone out of bed, washed and dressed and to get their medication and breakfast. We’re not supposed to cook but we know that with some people if we do not cook, they don’t eat.”
The home help agrees that some clients have good family support, but others have nobody. “I got a call from a garda at 1.30am recently because one of my clients was hallucinating and walking the streets. He did not know who else to call.”
The HSE said it could not comment on individual cases.
“The allocation of funding for home support across the system, though significant, is finite as services must be delivered within available resources.
“Despite the significant level of service provision, the demand for home support continues to grow. All those waiting are assessed and provided with a service based on clinical need and as soon as resources become available.”