Home is anything but a safe haven for some vulnerable elderly citizens

The RTÉ documentary A Breach of Trust that aired last Tuesday night exposed bad practice involving very young children in Irish creches. The programme rightly sparked controversy, anger and calls for the inspection regime to be stepped up to safeguard Irish children.

However, another vulnerable group, elderly people who require home help or home care packages to enable them live at home, have no statutory inspection programme in place to safeguard them from abuses which could potentially occur within their own homes.

In 2012 almost 55,000 Irish people availed of home help and home care packages, amounting to 9.8 million hours worth of services.

In the main these services are invaluable to clients and their families, giving elderly people the helping hand they require to allow them to remain in their own houses instead of entering nursing homes. Many of the staff who provide these services are competent and caring and some go over and above the call of duty to provide a high level of care to the elderly people they cater to.

Bad practice
But as today's publication of complaints received by the HSE around the provision of home care services in 2012 reveals, bad practice continues.

It is not the first time that such problems have been highlighted. It is now almost 2½ years since a Prime Time programme used hidden cameras to expose home support staff threatening older people, force-feeding and theft.

In late 2011 The Irish Times revealed details of a number of complaints lodged with the HSE in relation to home help services.

In one case investigated by the HSE, details of which were released under the Freedom of Information Act, a home help was reported to have “bounced off walls” having attended work under the influence of alcohol. Having admitted to being “half cut” in a text message before showing up for work on one occasion she was found guilty of serious misconduct.

Another complaint centred on a worker who was alleged to have administered medication to a client in uncertain doses, some of which may not have been necessary.

A follow up FOI request by this newspaper for 2012 found evidence of continuing problems in the sector.

Although documentation released by the HSE would seem to indicate that allegations received by it are subject to a formal and thorough complaints procedure, there is undoubtedly also a cohort of clients availing of home help and home care services who, because of their advanced age, do not have the capacity to complain. This means there could be examples of bad practice which are simply not on the HSE’s radar.

Complaints and allegations
Also, there may be other complaints or allegations in 2012 which are not published here as, when this newspaper sought details of all complaints about home care services lodged with all 32 of the HSE's local health office areas for 2012, the executive demanded €1,340 in search and retrieval fees for the information. The request was subsequently narrowed to cover half of all local health office areas and a fee of over €500 paid for the information.

Home help services are either provided directly by HSE staff or by voluntary or private service providers and are subject to national guidelines. Since 2012, non-HSE service providers have to meet certain standards, criteria and agreed contract documentation when providing home care packages.

Outside the services provided by the HSE and agencies contracted by them there are also an unknown number of home care agencies providing private care in the home.

How many of these companies exist or what standards these private operators are adhering to is not known as, by the Department of Health's own admission, "There is currently no requirement for service providers to register with any statutory agency, therefore we are not in a position to say how many private home care providers are operating in the
country".

Asked prior to the 2011 general election if he would regulate public and private home help and home care services if he came to power, the now Minister for Health
Dr James Reilly answered: "Yes, and Hiqa will have a major role in this in terms
of setting standards and ensuring that they are adhered to."

To date no such regulation has been put in place, although the Department of Health says it is committed to do so under the programme for Government for 2011-2016 .

However, the bottom line is that no statutory regulations are currently in place for home care providers in a country where controversies over
care in nursing homes and creches have already proven that a lack of an inspection regime can lead to the
mistreatment of some of
the most vulnerable people in Irish society.