Homecare packages - yet another HSE shambles

BrianD3

Situation is, a family member's health (dementia and other problems) has declined in recent years. We/the GP/geriatrician first requested homecare hours in early 2019. Was refused. Requested it multiple more times after that, each time refused. Eventually I was forced into paying for some private care and also left my job.

Subsequently, (nearly two years after initial request) the HSE provided a homecare package of a few hours per week. Seemed to be part of their "Covid winter plan" so we probably have Covid to thank for them somewhat removing their heads from their asses. 

Next problem is, the manner in which the service is provided is completely unsatisfactory. The homecare is outsourced to two agencies and there are issues with: 

Carers not turning up, 

Two carers from different agencies turning up at the same time

Constant turnover of staff

New carers turning up at the wrong time having received no handover, not knowing what to do, not able to find the house and annoying the neighbours for directions

Carers not wearing Covid PPE 

Massive variation in the times of calls

Dire communication even though everyone involved has my mobile number

And lots of other examples of shambolic service

When I ring the HSE to complain (assuming that the phone is even answered), I get the usual HSE, public service rubbish of 

"Ah, Mary is dealing with that and she's on leave" 

"I don't know, I'm just back from leave"

"That's terrible, we'll look into it"

"I can't find the file on that, we will locate it and get back to you"

"Yeah, we're having a meeting about that next week" 

End result - nothing.

The agencies blame the HSE and the HSE blames the agencies. I don't give a crap which one of them is more at fault, I just need the service provided as agreed and from my POV the HSE is providing the service and it's not my responsibility to fight with agencies engaged by the HSE. 

Are the majority of those working in administration and management in the HSE complete imbeciles? I've found the public health nurses to be useless too. E.g. taking 8 weeks to sign a form with the old reliable of annual leave and being "busy" used as excuses. Oh, I've also gotten veiled threats from a PHN that if I complain too much, they might withdraw the service entirely. Then there are the HSE employees who try to extract information from you about money so they can gauge whether you'll just pay for services privately yourself, getting them off the hook. 

I don't know how to go about resolving this and I doubt that turning up at their offices shouting my head off will do any good. Anyone have any idea on a way to put manners on these pricks?

This is on top of many many issues with hospitals and other healthcare services. Don't get sick and don't get old in this country. Also, ANY statement, PR or communication that emanates from the HSE, Dept of Health. Minister etc. needs to be treated as a lie unless proven otherwise, This should be borne in mind when interpreting anything that they say on anything, from Covid to the cyber attack.

Strumms

Your experience of healthcare here in Ireland and you summarizing of it is 100000% accurate and reflective of how my family has experienced it...

you can get lucky, extremely lucky or extremely unlucky with carers... a couple I’d class as absolute superhero's, brilliant human beings and healthcare professionals ...one though was a super zero, I don’t know how she got herself out of her bed without instructions she was that useless....

Did they give you a reason as to why your family member was denied home care hours?

I would log each and every time there’s an issue with staff and write (because the HSE probably won’t accept emails still) weekly to the HSE, the GP, the consultant, the PHN. Be civil but be firm stating that this is having a detrimental effect on both the family member requiring care and also you as their principal carer.

Also call the PHN every time there’s a cock up. They have a duty of care to your family member and it has to be easier to get the issues sorted and you off their back.

BrianD3

https://www.boards.ie/discussion/comment/117694724#Comment_117694724

Agreed but I must say that the actual carers have been mostly excellent. Caring and competent but treated and paid badly by their employers. The issue I mentioned with not wearing PPE, I would bet that is not due to the carer but because it hasn't been provided or communication has been a shambles.

Communication from agencies to their employees is generally bad and communication between agencies and HSE appears to be very poor also.

Another thing I have found is that many paid carers seem to have ended up in those jobs having been unpaid family carers and have direct experience of the ineptitude of the HSE and other public service bodies. Careers given up to care for elderly or disabled family members, then trying to pick up work here and there to bring in some income. Same thing may happen to me,

Strumms

Yes, the company I’m referring to were not great... with all of the stress of the family they found themselves having to ‘manage’ the care provider too which is a stress they didn’t need.

Flinty997

In this case the issue is not with HSE, but the agencies you are using. Which I assume are privately run, just paid for by the HSE.

If you don't like the agencies or the staff, keep changing them until you get one thats competent. We went through quite a few.

These carers are very poorly paid for an extremely difficult job. So the good ones are like gold dust, and there's lot of staff turn over, and lots of people try it as they are desperate for staff, so you get a lot of unsuitable people trying it.

They (carers) are extremely under resourced, and over stretched. Ultimately if someone needs a lot of care in the home, you will find its almost impossible to provide that at home.

In which case your looking at nursing homes. But you will find the same issues there. Good ones like gold dust, and very under resourced.

Strumms

A problem too is that if you are a younger person or person with less of a healthcare challenge you seem to fall down the list of priorities for the care company....

they tried to move times, multiply times, change carers to suit other people who were not getting on with their own carers...

you need to stick to your guns with them.

BrianD3

https://www.boards.ie/discussion/comment/117694849#Comment_117694849

First few lines of your post are one of the cruxes of the issue - who is responsible for overseeing these companies? Surely there is a contract /SLA between them and the HSE? I didn't engage them, the HSE did. Yet I'm expected to manage poor performance? Completely unacceptable but a typical HSE stunt if true. Basically half arsed nonsense with abdication of responsibility. Like me buying a TV in Argos and when it develops a fault, being told to take it up with the manufacturer?

Also, while I don't have any experience of carers employed directly by the HSE, I have heard of other people having serious issues there too e.g. care stopped for a considerable period with almost no notice given because someone was on annual leave, there was no cover and shur, the family can just sort it out themselves. Another good one from the HSE is steering people towards charities/NGOs which did happen to me at one stage. Family Carers Ireland would apparently be able to arrange (paid) care - except when I contacted them, they didn't have carers in my area.

Flinty997

No ones forcing you to use the service. You can just pay privately and full control of the services you want.

Its well known that the public system is in crisis and failing.

Strumms

https://www.boards.ie/discussion/comment/117695268#Comment_117695268

You are being forced if you cannot pay for private care which 95% of us can’t I’d say.

as is every single tax payer IS paying as the companies the HSE use are being paid for by the HSE ie. Taxpayers.

Flinty997

That's just life.

It will be worse when we are older, more older people and even less tax income to pay for it.

Strumms

https://www.boards.ie/discussion/comment/117695452#Comment_117695452

We don’t have to accept it and threatened action that ultimately got us the satisfaction we and the patient required.

it will be worse... for the reasons you say as well as others.

Flinty997

Thats why I said keep changing agencies and carers until you find one you're happy with.

But to be aware the limitations of the resources.

TheValeyard

Have experienced something similar as OP as stated for a family member. Home Care is not fit for purpose and needs a major overhaul.

The buck does stop with the HSE. They decide whether to send their own employees or outsource to agencies. Keep reminding them of this

You can of course take on the role of selecting an agency yourself but it’s not really realistic, is it? I mean, the majority of people caring for a relative at home have been thrown into the situation without any prior medical or caring knowledge. Where would you even start when asking an agency questions?

Go private? Yeah, see how quick your 219 a week carers allowance disappears

Log all the mistakes and contact an advocacy group of some kind Alone or some group like that.

The old “Home Help” system was great. They would cook, clean as well as personal care. That’s no longer the case. Personal care only with family doing the rest. Some families can cope with this, but not all can. Unfortunately, the only alternative is a nursing home.

Strumms

I’m not sure if the HSE can do spot checks by calling to somebody's home, I’d doubt it, but the company is supposed to periodically enable management to do so... do home visits, check that the care is being delivered adequately, checking the care log / diary or equivalent..

Jellybaby_1

My heart breaks for the OP. I've heard the same story from my friends too. I also have an elderly relative who needs a carer but has had so much trouble with them. Carers not turning up, turning up too late, and very little English to the point when the carer was asked merely to hand something to my relative the carer didn't understand the words "will you hand me my cardigan please"! If they can't understand English how helpful can they be? Another carer just left the country without letting anyone know! My relative sat in bed waiting for a carer who didn't care! Makes me really angry.

Flinty997

https://www.boards.ie/discussion/comment/117696665#Comment_117696665

I've never seen a HSE carer. Over many years it was all outsourced agencies. Is it even a thing, a HSE carer?

There's nothing the OP mentioned that needs experience. Its all basic stuff and they take you through what they will do and what they won't do.

I ran out of patience and if I wasn't working out, just asked them to switch agency or staff until we got people who were reliable.

antix80

For my gran, we just paid cash in hand for a reliable lady.

HSE is a money pit. And honestly, even if it were "properly run" the demand for services will always far outweigh supply.

BrianD3

One other thing - as the HSE homecare package is inadequate, I engaged one of the agencies privately for some extra hours. I was very careful to state exactly what I needed before signing the SLA.

The service for the private hours seems to be better than the service from the same agency for the homecare package hours

I would have thought that a small fry client like me would get a poorer service but perhaps it is the opposite if HSE management and staff are incompetent and apathetic in terms of procurement and contract management. Shur who cares about that - the taxpayer will foot the bill, the care recipient's family will pick up the slack if there is a poor service and staff will get their pensions no matter what happens 🙄

mariab21

https://www.boards.ie/discussion/comment/117697791#Comment_117697791

Switch agencies until you find someone reliable is your solution?

The FF/FG way ffs

Flinty997

https://www.boards.ie/discussion/comment/117702740#Comment_117702740

Yes. If a service is bad, I don't keep using it. Same with a tradesman, a shop etc. Carers and agencies are no different. Got nothing to do with politics.

Flinty997

https://www.boards.ie/discussion/comment/117697841#Comment_117697841

I'm not sure people get that. Homecare is completely unable to meet demand.

Even if you get the full allocation of 2 hrs or so a day. You will eventually have a massive gap in care that the state can't fill.

https://www.boards.ie/discussion/comment/117697791#Comment_117697791

Yep, they’re are carers directly employed by the HSE. My personal experience a few years ago was a huge recruitment drive by the HSE where they poached the best and most experienced carers off of the agencies whilst expecting the same agencies to still provide the extra staff/backup from the staff they had left. They agency I know we’re rightly pissed off about this and pulled all their staff from HSE contracts.

In 2017 the care package allowed a person to have a maximum of 21 care hours per week but could be increased based on need. Ours was increased in late 2018 by a further hour and currently we get 31.5 hours per week (the new agency insisted on this).

Deeec

I completely agree with you BrianD3. Last year I had to assume the role of carer for my elderly Uncle who developed Dementia. It became clear he needed more help in April 2020 when his dementia began to rapidly worsen. Trying to access any services for him was impossible ( covid was used as an excuse alot of the time). I found the whole lot from GP, public health nurse, elder care services disgraceful. Although care was promised nothing actually happened. The only advice the public health nurse had was to get him an alarm - which for someone with dementia is useless as they forget to wear it or what its for! He lived rurally with no neighbours or family living close by. Eventually for his own safety we had no choice but to get him into a nursing home ( fair deal scheme - dont get me started on that!- whole other story). Being honest Im not sure if the nursing home care is much better but at least he is safe from danger and gets fed. My uncle worked hard all his life and was never even in hospital - he cost the state nothing over the years. Its absolutely disgraceful to see how our elderly are treated. They deserve so much better - in many ways elderly were cared for better years ago.

SEPT 23 1989

Pay the carers properly

they would earn more working in Aldi than they are for looking after your elderly loved ones at the last stage of their lives

something seriously wrong there

why such little value put on such an important role?

Deeec

https://www.boards.ie/discussion/comment/117702981#Comment_117702981

I do agree that carers should be paid more. But your comment that families should pay more is very unfair. There are many elderly people/families out there who cant afford to pay for private care. The HSE should be paying the carers more and provide a service fit for purpose.

SEPT 23 1989

https://www.boards.ie/discussion/comment/117703025#Comment_117703025

people have paid enough tax throughout their lives to cover a few hours a week

the HSE should be paying the lot

emzippy

Hi OP,

In terms of making a formal complaint, there is "Your Service Your Say." It's the official complaint form for the HSE. I don't know if they are of use but it's the formal avenue of complaint so they have to escalate it and respond to you. I hope things get better. The HSE is an absolute shambles!

Flinty997

https://www.boards.ie/discussion/comment/117702957#Comment_117702957

What we did was sew a hidden pocket into their clothing and hide a tracker in that. Though its only useful for a short time, as many will need 24hr supervision eventually, and secure accommodation.

Flinty997

https://www.boards.ie/discussion/comment/117703025#Comment_117703025

I don't think they were saying families should pay more but the state should pay more.

But it costs a lot more to provide care in a one to one setting at home. Than it does in nursing home where a few carers can look after many people at the same time because they are in the same location.

There are disadvantages and advantages to both and many people prefer to be at home. But that's the economics of it unfortunately.

mariab21

https://www.boards.ie/discussion/comment/117702802#Comment_117702802

Do you not think we should have higher standard across the board by carers and having to shop around to find a suitable carer?

Flinty997

https://www.boards.ie/discussion/comment/117703457#Comment_117703457

Sure.

But fixing the system is entirely different to fixing your immediate issues with an agency.

antix80

https://www.boards.ie/discussion/comment/117703457#Comment_117703457

You can tell which carers are useless just by looking at them,however hse just take anyone who ticks the boxes and private companies take anyone willing to work for peanuts

Strumms

One of the good or actually great carers my family member had was on peanuts, a shade over minimum wage she told us... the managers and team leaders were driving around in 50,000 euro spec’d SUV’s which were for no more then visiting clients and going to meetings....there was about four or five of them in their fleet. We’d presume leased but who knows...

she asked them in a meeting wtf was the craic, could they not have Ford Focus or the like and was told they were for branding/advertising so a big vehicle was necessary... as their client the HSE... were obviously already aware of who they are...they were disputing that..

she was earning then 11 euros per hour.

@Strumms

@Strumms she was probably paying her own driving costs out of that minimum wage too.

https://www.boards.ie/discussion/comment/117704208#Comment_117704208

No. They do get a mileage allowance. I seem to remember remember some controversy over travel time being included in their wage being changed to a mileage allowance.

https://www.boards.ie/discussion/comment/117704291#Comment_117704291

That’s good. I know the agency we have right now offer mileage The wear and tear on their cars on the backroads round here would take a big chunk of it though.

It’s a tough job and doesn’t suit everyone but I admire anyone that gives it a go at least. All the fetac courses in the world won’t prepare you for what’s in store.

scheister

Over the years my mum has had both a home help and someone to assist her with washing, I cannot fault either of them but the system is a different thing.

The home help went on long term sick leave and was never replaced.

There is also a limit to what they can do due to "health and safely". The washer is unable to put the bath seat in the bath in case she puts her back out. I dont mind doing this myself but would like the back up to be there for the odd time that I forget to do it.

The home help was unable to do any tasks where her feet were not on the ground for example washing windows where a step ladder may be needed in case she fall off.

I would never want to put anyone in danger but appears "health and safely" is used where they want to remove risk from the long shots of dont want the staff to be trained correctly.

https://www.boards.ie/discussion/comment/117702740#Comment_117702740

FF/FG are in the business of organizing care now? I thought they were political parties.

Can you please provide a link showing where these political parties are now involved in procurement and oversight of care and that they have side-stepped the HSE is in performing this activity?

BrianD3

Things have gotten worse since the first post. A staff member from one of the agencies went on annual leave, she said she booked this months ago. Result, a reduced number of care hours, no cover in place, lots of excuses and "shur what can we do" with the HSE blaming the time of year. Also, communication non existent, I had to inform the HSE what was happening. They should have been informing me that the agency THEY ENGAGED wouldn't be providing the agreed service for several weeks.

I don't really blame the agency, they are private sector and will try to get away with as much as they can within the terms of their contract (and will breach their contract if the useless HSE won't do anything about it).

The icing on the cake will be if it turns out that the agency is getting paid for the care hours that they aren't providing which could well be the case given the ineptitude I've experienced.

The whole thing is a complete shambles, Even the way the agencies are engaged - you'd have to question whether this is managed or planned or just done in a haphazard, ad hoc, reactive way. In our case, there are two agencies for a relatively small number of hours. The carers who work for these agencies don't know what they're going be doing from one day to the next and often seem to be expected to be in two places at once. While being paid peanuts.

And this morning I see the public health service unions lobbying for Covid bonuses. No doubt lots of simpletons will support this. Will there be bonuses for homecare agency staff, will carers benefit/allowance for family carers be increased. Will they f*ck. But no doubt public health nurses (many of whom are utterly useless) would get a bonus, maybe admin staff would too.

BrianD3

Things have gotten worse, no shows and bad communication are becoming more common. In a previous post, I said that I had gotten good service from an agency when I engaged it privately. This is now no longer the case as they don't appear to have enough staff. The ones they do have are increasingly angry about everything from communication to lack of travel expenses and, naturally, pay and zero hours contracts.

Also, carers who are employed by agencies seem to be maneouvring themselves to doing cash in hand work for desperate families. The more this happens, the more shambolic the system gets. Chicken and egg scenario. If an agency employed carer gets 13 quid per hour and doesn't know how many hours they'll be asked to do from one day to the next and families that they have built a rapport with are willing to pay 20+ ph cash in hand - no prizes for guessing what happens.

I have already formally complained to the HSE about the situation. The senior person I got talking to on foot of the complaint agreed with me that it was indeed a shambles. They also stated that the HSE, not clients, is responsible for managing the agencies engaged by the HSE to provide homecare. They also stated their intention to sort it out and sit on the agencies but looks like that might have been just talk to fob me off.

I have been fobbed off by other HSE people to NGOs. The NGOs do what they can which isn't much, services provided this way cannot be relied on.

Lies from other HSE people "if the HSE was providing the service directly this wouldn't be happening". No - I know one person who has homecare provided direct by the HSE and has the same issues.

Clearly, given staff shortages, poor pay and staff turnover the situation is a crisis that will only get worse. No recent news on the Fair Deal type scheme for homecare that has been mooted for many years and mentioned on several occasions last year by Varadkar, more spoofing probably.

steddyeddy

https://www.boards.ie/discussion/comment/117695268#Comment_117695268

But yet we're being forced to pay for this service through taxes.

BrianD3

Public consultation on regulation of homecare services. This closes this coming Thursday 4th August.

https://www.gov.ie/en/consultation/81506-public-consultation-on-draft-regulations-for-providers-of-home-support-services/

Since I started this thread, despite several formal and informal complaints to the HSE, things have not improved. This is a far bigger issue than just some homecare companies providing a disgraceful service. From what I'm hearing from other family carers there are major issues with almost every company and with homecare provided directly by the HSE. It's fundamental and systemic.

Deeec

https://www.boards.ie/discussion/comment/119410760#Comment_119410760

It's a national disgrace Brian how our elderly are treated. Nothing has changed or will change because those in charge bury their heads and ignore - it's all about making money. I had to try and get care for a few elderly relatives in the last few years. It's absolutely impossible to get the services when needed and then when you do it's unreliable. I am sure that the amount of elderly who die due purely to neglect of care goes completely unreported - it's hushed up. As we speak there is elderly people alone in their homes unable to get out of bed, wash, dress or feed themselves because social and care services don't give a damn.

It's a disgrace. Unless you have very deep pockets don't get old in Ireland.

BrianD3

https://www.boards.ie/discussion/comment/119410839#Comment_119410839

It's particularly bad at this time of the year - carers go on holidays and care recipients/their families who have been receiving a barely acceptable level of service for the rest of the year are now left high and dry. The gobsh*tes in the HSE seemingly get taken by surprise every time "shur what can we do, it's summer, people are on holidays".

I've heard some horror stories in the last few weeks - elderly people distressed from lying in soiled beds after carers that they were depending on didn't turn up. With no communication from either the agency or the HSE to family.

Even leaving aside the distress, there's no doubt that this sort of thing causes or aggravates physical problems like pressure sores and skin breakdown. It is relatively easy to cover up neglect given the lack of record keeping and traceability. The tangled web of incompetence and difficulty gathering evidence is probably why there hasn't been a massive scandal in the homecare sector.

BrianD3

Bumping this as it is vital that people make submissions on the regulations. The survey is anonymous and is a combination of yes no tickboxes plus ample space for adding text.

If anyone thinks that this doesn't apply to them, think about this quote from the former First Lady of the US, Rosalynn Carter.

“There are only four kinds of people in the world. Those who have been caregivers. Those who are currently caregivers. Those who will be caregivers, and those who will need a caregiver.”

i stand over every single thing I've written in this thread about the problems with homecare, none of it is exaggerated.

I am surprised to see so little about this consultation online. I didn't see anything on Family Carers Ireland's social media - then again, that NGO is both a provider of homecare services (which would be subject to regulation) as well as an advocacy group for carers so perhaps it is in an uncomfortable, vested interest position here.

StrawbsM

My parents home care has been an absolute mess (again) since March this year. If I started listing out the current issues with the HSE’s lack of service, I’d be here all day typing. We’ve had no shows for the last few days even though one of the agencies could have provided cover (I know as I asked). The HSE coordinator didn’t bother asking them if they had anyone available so have left us high and dry with no contact at all.

I’ll fill out that form, OP

HSE home care is a disgrace. The only time you are “entitled” to avail of public health home visit care of any kind is if you have one of those precious Medical Cards. Otherwise it’s an uphill battle.

Some years ago when I was 56, I underwent a serious emergency surgery and developed a post-op infection after discharge from hospital. Hospital surgeon said I needed to be tended to daily by a nurse for about two weeks, and when she tried to arrange this came upon the answer “no”. Being a Spanish national she was stunned and tried to assert her patient had to have wound checked & dressed daily. The only solution was that I attend my GP daily by taxi, and quite frankly I was in no fit state to leave the house every day as I was running a fever. So the simple matter is that unless you have a medical card you are entitled to zero home care.