Could social care in Ireland be more efficient with less 1-to-1 care?

iptba

I wasn't sure where to post this. Earlier tonight, between 9 PM and 10 PM, I heard a caller on FM 104 saying he was on his way to work in social care. He will be up all night until 9 AM in case the individual with an intellectual disability he is taking care of wakes up during the night.

This 1-to-1 model of care sounds like a very expensive model of care. I recall hearing an estimate that social care probably costs in the region of €25 per hour, between the wages and expenses of employing someone plus salaries of supervisors and infrastructure. It sounds like this person was going to be working for 10 or 11 hours. If one says 10 hours, that would be €250 for this one night. [If the person needed this every night, this would be €91,250 per year; if they have a family who are in a position to look after them some days, then this would be less of course]. This is only the costs of night cover. Then there are all the costs involved in looking after this individual during the day.

I recall hearing from someone else that they were involved in looking after a household of 4 individuals with intellectual disabilities and the costs were massive (many hundreds of thousands per year). I have seen people with physical disabilities mention getting 60+ hours of personal assistance to allow them live on their own which again would be very expensive each year.

I'm not saying the total social care budget needs to be reduced. But there are lots of people who can't get any hours at all of care.

A HSE service vital to ensuring that elderly people can remain in their homes has been largely closed to new applicants until next November at a time when there are more than 6,000 people on waiting lists.

https://www.irishexaminer.com/breakingnews/ireland/hse-restricts-access-to-home-helps-928534.html

Many people who do get home help and the like only get one or a few hours a week and could do with more.

I know that things were not good in Portrane/St Ita's, but should living in bigger communities be taken off the table as an option that shouldn't be used much, if at all.

Squall Leonhart

I have very close experience with somebody who works in similar circumstances as the caller you mentioned.

She often works a night shift, 8-8. She works in social care as a care assistant in a house with some people with high support needs. She does not just twiddle her thumbs while those she is on care duty for sleeps.

There is medication counting to be doing, floors and surfaces to be scoured and disinfected and mopped etc, paperwork on incidents during the day (of which there are regularly many). It is a health hazard breathing the air in some of these places it is that foul with excrement.

She often has to get distressed people back to bed when they get up at 4am, or change their nappies or vomit or urine. Frequently gets hit, pinched, bitten, kicked, even if not quite deliberately but as part of an outburst. Or faeces in her hair or clothes, or vomit. It is feral. It is also all around us, hidden in plain sight.

All for the princely sum of 11.80hr.
Try telling some of the families of these people that they don't need 1 on 1 care. Feck off.

100% there are ways that things can be made more efficient, but those running these places are out to make profit, but it sure as hell isn't the person doing the donkey work seeing it. The cost of some of these medicines alone for just one individual for a year can be be staggering, hundreds of thousands for some, staffing and medicine would be in the millions per annum.

Yes you're throwing money at something that is unlikely to yield results much better than making life another day longer for some people, but their lives are miserable enough without cutting out what they do have with budget cuts.

Cockadoodledoo

If someone has 1:1 24 hour supports then there is a very good reason for it, especially waking nights. You are talking very high support needs, high risk to staff and the person themselves. There could be medical issues that require 24 hour monitoring.

They don’t hand out care packages willy nilly to anybody.

Are you suggesting that they be all grouped together to reduce costs? Am I reading that correct?

iptba

Thanks for the post, Squall Leonhart. I found it informative.

Squall Leonhart wrote: »

. The cost of done of these medicines alive for just one individual for a year can be be staggering, hundreds of thousands for some.

In the UK, medication that costs on average more than £30,000-£40,000 per year added on average is often turned down as not value-for-money by NICE and similar bodies. Ireland is starting to grapple with this issue with a figure of E50,000 per year added being considered as a threshold in something I saw recently. There have been some illness groups who have managed to get more expensive drugs alright.

Be right back

Squall Leonhart wrote: »

I have very close experience with somebody who works in similar circumstances as the caller you mentioned.

She often works a night shift, 8-8. She works in social care as a care assistant in a house with some people with high support needs. She does not just twiddle her thumbs while those she is on care duty for sleeps.

There is medication counting to be doing, floors and surfaces to be scoured and disinfected and mopped etc, paperwork on incidents during the day (of which there are regularly many). It is a health hazard breathing the air in some of these places it is that foul with excrement.

She often has to get distressed people back to bed when they get up at 4am, or change their nappies or vomit or urine. Frequently gets hit, pinched, bitten, kicked, even if not quite deliberately but as part of an outburst. Or faeces in her hair or clothes, or vomit. It is feral. It is also all around us, hidden in plain sight.

All for the princely sum of 11.80hr.
Try telling some of the families of these people that they don't need 1 on 1 care. Feck off.

100% there are ways that things can be made more efficient, but those running these places are out to make profit, but it sure as hell isn't the person doing the donkey work seeing it. The cost of some of these medicines alone for just one individual for a year can be be staggering, hundreds of thousands for some, staffing and medicine would be in the millions per annum.

Yes you're throwing money at something that is unlikely to yield results much better than making life another day longer for some people, but their lives are miserable enough without cutting out what they do have with budget cuts.

And sometimes the residents could be awake all night and doing the above behaviours.

iptba

Cockadoodledoo wrote: »

Are you suggesting that they be all grouped together to reduce costs? Am I reading that correct?

Yes, grouped together in bigger co-living arrangements.

antix80

1 to 1 care is a shambles if it's meant to be covered by public funding. Either pay private, have family members roster their efforts (a tax credit may be appropriate).. Or reduce the quality of care.

On topic.. Ever see a late stage dementia patient? I'm not advocating euthanasia but don't have a team of healthcare workers keep them alive on liquid diets, changing nappies and physio and nebs to breathe for them.

It's real elephant in the room stuff. These people deserve compassion but don't necessarily warrant expensive healthcare.

One eyed Jack

Cockadoodledoo wrote: »

Wow.

There are many other ways money can be saved in this country than going back to the 1960’s institutional type care.

And there are many ways to give a poster the benefit of the doubt rather than assume they’re arguing that we go from one extreme to the other. I don’t know why you imagine the concept is from the 1960’s either as institutional type care is still very much a thing in Irish society and it costs the HSE millions to fund what is essentially a poor provision of care which is grossly inefficient and provides little value for money and even poorer standards of care.

To answer your question OP - yes, it could be done, but all too often a drive towards efficiency means a lower quality service for what turns out to cost even more in the long run in terms of it’s cost to society. There are a couple of housing projects I’m aware of which purports to offer a community model of care for the elderly for example, but the quality of the services provided and the quality of life an elderly person will have in them is based upon the idea of elderly people being surrounded by elderly people, it’s not really a community IMO but rather like a scrapyard for elderly people.

The idea with providing care in their homes to people who need it is basically to enable them to live with some degree of independence and dignity, as opposed to being institutionalised in a facility which would undoubtedly be more efficient and could be run at significantly less cost to the HSE (it wouldn’t be, but it could be), but it’s not the best approach to enabling people to live with a degree of independence and dignity who are contributing to society far more than their care costs. Their contribution to society can’t be measured in monetary terms, but certainly the provision of their care can be, and I would suggest the money that is spent could be spent more efficiently, than the amounts which are currently being wasted by the HSE on organisations that constantly have their hand out looking for more money to provide their substandard services.

REHAB was only one of these services which exploited people to line their own pockets. There are many, many more.

Glass fused light

antix80 wrote: »

1 to 1 care is a shambles if it's meant to be covered by public funding. Either pay private, have family members roster their efforts (a tax credit may be appropriate).. Or reduce the quality of care.

On topic.. Ever see a late stage dementia patient? I'm not advocating euthanasia but don't have a team of healthcare workers keep them alive on liquid diets, changing nappies and physio and nebs to breathe for them.

It's real elephant in the room stuff. These people deserve compassion but don't necessarily warrant expensive healthcare.

So are you volunteering to hold the pillow over someone's face then ??
Or what's your idea of how to deal with the elephant in the room