Seanad Éireann - Volume 149 - 29 October, 1996

Adjournment Matters. - Home Help Service.

Ms O'Sullivan: I know the Minister is aware of the importance of the home help service in the various health board regions, particularly in relation to the aims of health and social gain outlined in the Department of Health's strategy document, Shaping a Healthier Future. There is, as the Minister is aware, quite a divergence in the payments made to those who carry out the home help service, the amount of the budget and the extent of the scheme in the various health board areas.

All health boards allocate a certain amount of money for the scheme but there is a great demand for it. In my health board region, with which the Minister is very familiar, in the financial report for the third quarter of the year, which is the most recent one we received, the vast majority of the budget had already been spent. There might not be any finance to meet new cases in need of the service.

I accept it is primarily a matter for the individual health boards and I have raised the issue with my health board. However, it is also a national matter in so far as it would be desirable to have a more co-ordinated scheme throughout the country. The home help service has both economic and social gains. There is a growing number of elderly people in our communities and it is more cost effective if they can stay at home. The home help service is valuable in that regard. In addition, it is a better social solution for the vast majority of individuals involved. Most elderly people would prefer to stay at home if they possibly could. It is more costly to maintain people in nursing homes or other health board institutions than at home and it is not the desired choice of most people.

The remuneration of those working in the home help service can vary from as little as £1.40 an hour to £4 an hour in parts of the Eastern Health Board area — there is not a set figure in that area. The work clearly receives very low remuneration in some health board areas. People who work in the service often put in more hours than those for which they are paid. They develop a genuine rapport with those whom they look after and sometimes give their time without any remuneration.

It is essential to look at the scheme at health board and Department level to ensure its advantages for the individuals concerned and the economy and that we get the best possible options for meeting individuals' needs. Staying in their own homes with a home help, in addition to the other necessary services such as nursing, will prove to be the preferred option of many people. The home help service is greatly valued and under used.

[132] Unfortunately, due to financial constraints some home helps find themselves without patients. In my health board area the yearly allocation is £511,000 and because the budget is practically used up new cases are not being taken on. Consequently, some home helps who have worked with the service are considering working privately. It would be a shame to lose their services because the health board cannot afford to employ them.

For the reasons I have outlined, I would welcome the Minister taking whatever action he can at national level to ensure this valuable service can be continued and, more importantly, developed in accordance with the growing needs of elderly people, in particular, and the desirability of keeping those people in their own homes.

Minister for Health (Mr. Noonan, Limerick East): I thank Senator O'Sullivan for raising this matter. As the Senator is aware, for many years the main focus on care of the elderly has been to enable older people to continue living in their own 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 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 very real strengths and benefits of the service.

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. The 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. However, the services are 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 health board to health board. Home helps are predominantly part time, though a number of [133] 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 local client based. The rate paid to part-time home helps employed throughout the country varies from place to place and is related to the particular requirements and type of task undertaken in each case.

The issue of funding for the home help service has been raised on a number of occasions in the recent past. My Department, 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 health boards for its provision. A discussion document submitted by the chief executive officer group forms the basis for this examination.

Following these discussions, I 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. I am pleased to say that my Department has invited tenders for this review and it is expected that it should be completed in three to four months.

I wish to add 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. The strategy states that over the next four years priority will be given to strengthening the role of the general practitioner, public health nurse, home help and other primary care professionals in supporting older people and their carers who live at home. I assure Senator O'Sullivan that I am committed to this aim.

Ms O'Sullivan: I thank the Minister and welcome the fact that the operation of the service will be examined by an independent body.