OPINION:RTÉ's revelations about the homecare system shows that regulation is needed urgently
THE PROPORTION of our population over the age of 65 is projected to increase dramatically over the coming decades.
The 2006 census revealed that 11 per cent of the population was aged 65 or over and the Central Statistics Office has projected that by 2026, older people will comprise 25 per cent of the population.
It is the preference of many, if not most, of them to continue living in their own home as long as possible. Furthermore, the desirability of enabling them to continue to live in their own home is well established as State policy.
Notably, the 2006 social partnership agreement, Towards 2016, saw the Government and social partners marking their commitment to ensuring that “every older person would have adequate support to enable them to remain living independently in their own homes for as long as possible”.
In many cases, this is only possible with the assistance of providers of home care. Some homecare is directly or indirectly funded by the HSE and some is privately funded by the older person or their relatives.
Despite the laudable objectives of home care, there are considerable risks for vulnerable older people who are dependant on a single homecare worker coming into their home to help them with a variety of tasks such as dressing, bathing, administration of medication and shopping.
It is therefore important that providers’ management and staff are suitably trained and that adequate monitoring, complaints and investigation mechanisms are in place. Furthermore, although not currently legally mandated, appropriate background checks including Garda vetting are vital given that the client base is vulnerable.
In the absence of regulation, there is, however, no guarantee that the work will be properly performed and there is the real possibility of neglect as well as the potential for psychological, physical and financial abuse.
Despite the obvious risks, currently the professional provision of homecare is not subject to targeted regulation and is simply subject to general law requirements, for example, health and safety legislation and employment law.
Sadly, in the absence of regulation, there is some evidence of a race to the bottom in terms of standards. Those homecare providers who are endeavouring to provide a quality service may consequently find themselves at a competitive disadvantage.
Following the Leas Cross controversy, the enactment of the Health Act 2007 resulted in mechanisms being put in place to regulate long-stay institutional care. The Health Information and Quality Authority (Hiqa) was established under the Health Act 2007 as an independent regulatory and standard-setting body. As a consequence, nursing homes are now subject to registration and inspection and must comply with regulatory standards. Unfortunately the Health Act 2007 was silent in relation to home care providers and as a result Hiqa has no express powers in this regard.
What needs to be done to address this regulatory gap?
Although it is understood that the HSE has proposed issuing guidelines in relation to homecare packages for which it provides funding, the reality is that guidelines alone would be insufficient and would, in any event, have no application in relation to privately funded home care arrangements.
A proper regulatory scheme for the home care sector requires statutory backing. This would accord with the Law Reform Commission's recommendations in this area in its Consultation Paper on Professional Carersin 2009.
It would make eminent sense to extend Hiqa’s existing statutory remit to include professional homecare providers. This would complement its existing standard- setting role in relation to long-stay care facilities.
Provision also needs to be made for a registration requirement for the home care sector. The Social Services Inspectorate’s independent inspection role could also be extended to the sector.
A meaningful approach to regulation would also entail real consequences for failing to comply with standards, including fines, loss of registration and criminal offences. It would be sensible for whistleblower protection to be provided for those who report allegations of abuse or improper conduct where they have acted in good faith.
The need for legislative action to protect our at-risk population who wish to live out their final years in their own home with appropriate support from home care providers is clear. This necessitates joined-up thinking by pursuing an integrated regulatory agenda which reflects the risks to vulnerable members of our society in both residential and homecare settings.
Deirdre Ahern is a lecturer attached to the School of Law in Trinity College, Dublin, and is a member of the colleges Consortium on Ageing