Dáil Éireann - Volume 472 - 04 December, 1996

Adjournment Debate. - Home Help Service.

Mr. Ring: There has been outrage in Mayo and in the Western Health Board region because of the reduction of hours for home helps.

On 1 October a change was made by the health board to the home help scheme but it did not notify the relevant people until November. For many years an increase in pay was sought by those in the scheme. They were getting £1 per hour which was subsequently increased to £2 per hour, but the health board reduced the hours and did not notify them until a month later. People found they were getting the same money because they were doing less hours. That was not the spirit of the scheme. It was done in an underhand way with no prior notification to the home helps, the GPs and the patients and no medical reason was given for the cutback.

It was the worst time of the year for this type of cutback. There is more illness during winter and it is therefore the time when home help is most needed. The home help's basic work includes laying fires, shopping and washing to assist people confined to homes. There are 832 part-time home helps in the Western Health Board area.

The Minister gave an extra allocation of £100,000 to the health board. However, what it [866] did was unacceptable. It is unacceptable to me as a public representative that a health board should reduce the hours without consulting the home helps and patients involved. The health board wrote to the Minister saying it had comprehensive discussions. That is not true. Many people came from Achill, Westport, Ballycroy, Ballina, Belmullet and as far away as Tuam to my clinic expressing outrage at the cutback in the home help scheme, especially coming up to Christmas. Naturally enough, if a person from the health board asks an elderly person if they are fine, they will say the are because they do not want to be a burden to anyone. Those who had the home help service needed it.

I compliment the 825 people involved in the home help scheme in the Western Health Board area. These people, although they might only be paid for two or three hours per day, never complain and do an excellent job. Most of these people give more time to the job than they are paid for. We should care for our elderly who have contributed to and assisted this State. If they need to be cared for and want to stay at home rather than being put into a hospital, they should be able to do so.

To those who made this cutback, I say it was shameful and taken at a terrible time of the year. I want the Minister to investigate who made the decision and ensure that the Western Health Board reverses its decision and pays at the rate of £2 per hour for the same hours people worked before October. This is a scrooge element before Christmas and I condemn the people who made the decision. They hurt many elderly people and the home help people.

Minister of State at the Department of Health (Mr. Currie): As the Deputy will be aware, since the publication of the report, The Years Ahead — A Policy for the Elderly, the main focus of care for the elderly has been to enable older people to continue living in their homes for as long as they wish and are able to do so. It is recognised that the home help service contributes enormously to the maintenance and dignity of frail and dependent older people at home.

The National Council for the Elderly recently published a report entitled Home Help Services for Elderly People in Ireland. The research undertaken points to the strength and value of the home help services. For example, the report finds that the number of home helps has increased from just over 5,000 in 1978 to more than 10,500 in 1993. The report also records that the satisfaction of clients with the home help service is overwhelming, while a further strength of the service is the speed and flexibility with which a person in need can be supplied with a home help. While it is acknowledged that the report also draws attention to problems with the home help service, we should not underplay the real strengths and benefits of the service.

[867] Under section 61 of the Health Act, 1970, health boards may make arrangements to assist in the maintenance at home of persons who, but for the provision of such a service, would require to be maintained otherwise than at home. This section empowers, without obliging, health boards to provide or support services such as home help, laundry and meals.

Health boards are not limited in the categories of persons they can assist at home and may charge for the service. The services are, however, usually provided free or at a nominal charge. The health boards consider individual cases on the basis of need and in the light of resources available to the scheme. In practice, about half of the home helps and the vast majority of meals are provided by voluntary organisations with funding from health boards. The remaining home helps are employed directly by health boards. The balance between voluntary and health board input to the home help service varies from one health board to another. Home helps are predominantly part-time, though a number of full-time home helps and home help coordinators are employed by some boards. Voluntary involvement also strengthens the sense of neighbourly obligation towards the elderly and encourages the self-development of the home help.

The underlying philosophy governing the operation of the home help scheme is that it is a community-based good neighbour scheme which would attract people primarily motivated by the desire to engage in community services. Accordingly, the remuneration of volunteers does not come within the realm of conventional employment. Volunteers who work as part-time home helps are paid a stipend or gratuity for the service they provide. As operated in many areas, this is meant only as a contribution and is not intended to compensate fully for the task undertaken. The service is essentially a local client-based service. The rate paid to part-time home helps employed throughout the country varies from place to place and is related to the requirements and type of task undertaken in each case.

I understand that the Western Health Board has recently carried out a comprehensive review of its home help services which includes an assessment of the dependency levels of those in receipt of the service. A framework is now in place to identify low, medium and high dependency levels of clients to which specific hours are committed reflective of their need. Based on their dependency rating, the home help client is to receive five, seven or nine hours home help per week. This is in line with the average in other health boards. Under the revised scheme, clients will not need to supplement the part-time home help unless they choose to do so themselves on a voluntary basis for help given beyond the assessed level of hours. In addition, this framework has enabled the board to increase the [868] hourly rate of pay to £2 per hour, effective from 30 September 1996. This increase was made possible by the additional funding of £100,000 made available by the Department of Health to the board earlier this year.

The revised framework was discussed with the board's public health nursing staff and a number of existing home help clients to establish their views on the proposals. Those canvassed expressed unqualified support for the revised scheme. The board is satisfied this revised scheme has allowed it to standardise its home help services in line with other health boards and to provide a more equitable service to the elderly in their catchment area.

The issue of funding for the home help service has been raised on a number of occasions in the recent past. The Department of Health in consultation with the chief executive officers of the health boards, has under consideration a number of aspects of the home help scheme, including the overall organisation of the service and the diversity of arrangements which exist within the health boards for the provision of this service. A discussion document submitted by the chief executive officer group forms the basis for this examination.

Following these discussions it was decided to have an examination of the operation of the home help service carried out by an independent body which will advise on measures to ensure the equity and high quality of the service in respect of providers and recipients. The Department has invited tenders for this review and it is expected that the review should be completed in three to four months. It should be noted that in the recently published health strategy, “Shaping a Healthier Future”, the role and potential of the home help service in adding to social gain is acknowledged. Indeed the strategy states that over the next four years priority will be given to strengthening the role of the general practitioner, the public health nurse, the home help and other primary care professionals in supporting older people and their carers who live at home. I would like to assure the Deputy that the Department is committed to this aim.