Homecare packages - yet another HSE shambles

Wanderer78

https://www.boards.ie/discussion/comment/119415028#Comment_119415028

im not sure those cards are what theyre cracked up to be, they just seem to be plastic cards that dont offer a whole lot

https://www.boards.ie/discussion/comment/119415091#Comment_119415091

Probably far from satisfactory but they are are the start point for access to many services otherwise absolutely denied by default.

Wanderer78

https://www.boards.ie/discussion/comment/119415103#Comment_119415103

...its a shambles, those that are largely paying for the system, are definitely not getting it back

Brucie Bonus

https://www.boards.ie/discussion/2058201873/homecare-packages-yet-another-hse-shambles

Anytime I see outsourcing, I assume some FF or FG pal is making a fortune off the tax payer.

The alledged point of outsourcing is to curtail waste and make it easier to act if the results are not satisfactory.

KildareFan

https://www.boards.ie/discussion/comment/117696747#Comment_117696747

Agree - my father lived with us and was allocated 45 minutes 'care' per week - just about enough time to help him have a shower. The carer was not replaced when she was ill or on holidays. My father got more immobile as the years went on and needed help with getting out of bed & chairs, bathroom, washing etc and my back was breaking, I had numerous chest infections, and I couldn't leave the house as there was no one else in the family available to provide back up.

It all became to much for me to handle and my father went into a wonderful nursing home, five minutes walk from where we live. He actually settled in well and enjoyed the company of his peers (or fellow inmates as he called them), their visitors and the staff. He thrived on the various activities during the day and didn't want us to interrupt his meals or the bingo or whatever, so we were welcome to visit after 6pm, which we did every day. I will never forget the care and support we received from the nursing home especially in his last few days.

I know no one wants to spend their time in a nursing home, but sometimes it is the only option which guarantees safety for the older person, and sanity and health for the family carer.

BrianD3

https://www.boards.ie/discussion/comment/119415028#Comment_119415028

That scenario isn't even covered under the new regulations - services provided by nurses and other registered professionals are specifically excluded.

Anyway, the regulations appear to be about quality when services are provided rather than access to services. AFAIK the HSE is under no legal obligation to provide homecare although I'm not sure of their obligations for providing community nursing etc. services with or without a medical card.

Actually that makes me question if the cart has been put before the horse here. For years, Spoofer Varadkar and others have been "talking" about a statutory right to homecare and a homecare Fair Deal scheme.

In the absence of such a statutory right, it would not surprise me if the HSE provides less homecare in response to regulation. As they won't be able to comply with the regulations because of their massive ineptitude when it comes to both providing services directly and managing performance of agencies to which services are outsourced. Alternatively the regulations may have to be watered down to allow both the HSE and HIQA to save face and kick the homecare problem can down the road by a few decades.

Deeec

Outsourcing is transferring the problems and responsibilities to someone else wiping their hand clean.

gameoverdude

https://www.boards.ie/discussion/comment/119414568#Comment_119414568

I can see where you're coming from here. The word neglect is important. It's not neglect of funding though.

It's a neglect of testicular fortitude to sort out the HSE (or ovarian fortitude).

There are some wonderful people working there, mainly front line staff. The fat needs to me trimmed.

As mentioned by many posters, the wages for such a responsible and important job are ludicrous! I know I couldn't do the job, but then again people might look at my job and look askance at me enjoying it.

Carers are so important, not just for the elderly. There are no standards for them. The good ones must me frothing at the mouth that they aren't a recognised profession!

BrianD3

What's the alternative to homecare? I see Tadhg Daly of the private nursing home representative body (NHI) has been in the media warning of cost pressures in the sector and how a number of smaller nursing homes have closed recently because of this. NHI is claiming that costs rose 10% in 2021 with projected 22% increase this year. Mention of food and energy inflation.

Private nursing homes currently charge between about 900 and 1500 per week under the Fair Deal. I would have thought that energy and food costs would be a small proportion of that. Have private nursing homes given pay rises to their staff or increased the number of staff? My experience of these places is they don't employ enough staff and do the bare minimum to keep the regulator off their backs.

Here again we have a situation where important public services were outsourced to the private sector and now there is the implication that if the taxpayer/resident does not come up with more money, nursing homes will close and we'll have yet another crisis which gets crisisier.

Floppybits

I feel for you OP. The HSE are awful to deal with, I remember when my own father went into hospital and it was discovered he had stage 4 bowel cancer and we had a meeting with the Palliative care team and the team looking after him and all they wanted was him out of the hospital. So we asked what supports would there be for my mother who would be looking after him and they said will we can get you an hour in the morning and an hour in the evening, we said that my mother who was 80 and suffering with arthritis wouldn't be able for that and would more than likely kill her as well and their response was to say that well couldn't we the family all take a leave absence from work to take turns looking after him, when they said that we asked how long as he left and they said could be 3 months or a year but couldn't say. We told them No that they would have to find another solution, thankfully St Francis Hospice came to our aid. I don't know what we would have done with them, they are the only charity I will give money too, even saying that the HSE were about to send him to the wrong hospice only for one of us were at the hospital and had to fight the management to have sent to the correct hospice. Absolute shambles and all that to me just showed how the HSE don't care, I'd say if the HSE management could get away with putting people down they would do it to get them off their hands.

Heighway61

It is a shocking organisation from top to bottom. All covering their own asses, hoping not to be found out. Not only the over-paid middle-managers, supervisors and PHNs but, in my family's experience, the care assistants also. Wannabe nurses and doctors with a not-in-my-job-description attitude. Meanwhile, my elderly mother goes unshowered, her hair unwashed, her nails unfiled and cutting into her toes. It's all about them, not the needs of the vulnerable, infirm, disabled, sick.

StrawbsM

I had to take a “leave of absence”, floppy, under duress from the HSE. I’m now in year 7 of caring with no end in sight. Carers leave from a job is only for 12 months so that’s gone now. I’m getting older and job opportunities for me are reducing and I doubt I’ll get into a 9-5 office job again.

”Life begins at 40” they said. Not for me it didn’t. I’m existing not living.

Floppybits

https://www.boards.ie/discussion/comment/119464221#Comment_119464221

Sorry to hear that. It is a terrible situation that the HSE put people into. When they were saying this to my family they were expecting not only would I and my brothers take a leave of absence but also our wives and they didn't care that we had bills to pay, their only goal was to get my father out of hospital. In the end we turned it back on them and said we will take him home when you have all the supports in place that put a stop to them.

Patrick2010

And yet there are unlimited funds to care for unlimited numbers of Ukranians. Think how much difference a fraction of the 3 billion earmarked for Ukranians care next year could make if allocated to home care for our own elderly.

BrianD3

https://www.boards.ie/discussion/comment/119464221#Comment_119464221

Similar here except I'm out of work for "only" 2 years. Thanks to a poor choice of degree, I found it tough enough to carve out a mediocre career over a period of 20 years. Gone now.

No carer's allowance either as I don't pass the means test thanks to my savings. That's my reward for saving.

Previously, I had some experience with an elderly relative with dementia who went into a nursing home this was about 16 years ago before the Fair Deal came in. Absolute sh*tshow. Now I'm going through a homecare situation with a different relative - another sh*tshow.

BrianD3

Just to show how long "they" have been "talking" about regulating the homecare sector.

https://www.irishtimes.com/news/new-homecare-regulations-promised-1.868811

12 years later and only now are we reaching the stage of public consultation on draft regulations and who knows how long it will take now. These absurd delays are a terrible indictment of our politicians and civil service.

FF, FG, Martin, Varadkar, a succession of Ministers for Health - all useless spoofers. Or, alternatively, looking after their buddies in the homecare agency sector, how much profit has been made by these companies over the years? Public money handed over by the inept HSE, corners cut and still no regulation as of August 2022.

https://www.boards.ie/discussion/comment/119464083#Comment_119464083

As I said in an earlier post, the home helps of yesteryear have been replaced by caregivers. Home helps could and did so much more. Personal care, a bit of housework, cook a dinner, friendly banter…..

Caregivers do the bare minimum. A quick wipe with a flannel. Throw on whatever clothes come to hand. Then goodbye.

BrianD3

https://www.boards.ie/discussion/comment/119465548#Comment_119465548

I wouldn't have too much of a problem with caregivers focusing on personal care and not doing housework etc. Personal care has to be the priority and home HCA should be treated as professional healthcare workers.

The travesty is that personal care is NOT being done. It doesn't take long to wash a person well with a basin and sponge but carers are often in too much of a rush to even do that. Calls that should take an hour (as agreed with the HSE) are being done in 15 minutes. Is the carer and /or the agency being paid for the hour?

BrianD3

More problems this week with no shows and rushed care calls. I complained to the HSE again and as has happened previously, I got a "Mary is dealing with that and she's on leave" response.

If someone is doing a HSE funded homecare call in 15 minutes that the HSE has stipulated as being a 60 minute call:

a) somebody, either the carer or the care agency is stealing from the taxpayer and the HSE is too useless to do anything about it.

b) it is highly likely that ABUSE is taking place. Abuse takes many forms and rushing, cutting corners and not facilitating independence can easily result in it. E.g. if the care recipient can dress themselves slowly with prompting and assistance but the carer is in too much of a rush for this so just does it all themselves to save time - that's abuse.

These homecare companies are all over social media promoting themselves and their "client centred approach". It is sickening stuff.

https://www.boards.ie/discussion/comment/119501010#Comment_119501010

Just wondering. Does the 60 minutes include traveling time? I know that there was a dispute a few years ago over traveling allowance.

zg3409

https://www.boards.ie/discussion/comment/119501255#Comment_119501255

No. In my experience it's a full hour on site, although some may try arrive late and leave early. We asked around and found names of good and bad people and we were lucky.

In terms of practical advice.

The local nurse must visit before you get more hours. If you are requesting more hours and nurse has not visited then you won't get more hours. If nurse visits then you might get more.

If you can get finances, from family, savings, pension, remortgage house etc.you may be able to buy services but they tend to be expensive and you may run out of money after a few years. 24/7

You may also be able to claim fuel allowance, carers allowance, home insulation, help from meals and wheels, de Paul, various elderly care charities.

You may be able to get help on site by family and cousins or grandkids ideally a rota with people who care.

There are "not approved" carers such as cash in hand, illegal immigrants such as phillipino groups, or Brazilian, who can be contacted through Facebook. Many of these live in and undercut official services.

Depending on needs the live in home help may have a day job, or work part time elsewhere. Just having someone for nights only can really help.

The HSE or other groups or charities may offer crisis or emergency help. This can be handy if family home carer is sick or needs to take time off.

We found previous home help paid direct through mindme.ie website

We also got help from check Republic from a local there and job postings there. Ask polish friends is someone job hunting or willing to move to Ireland.

We also advertised on Facebook etc.

We have gone through various live in carers some good, some bad, it's tough to get anyone even paid.

The HSE is a disaster, in our case we need overnight person at house, asleep and someone a few hours a day. The HSE only provides 5 hours a week with the rest paid by family and shared rota. We are lucky we found a foreign couple who needed accomodation and they do weekday evenings and overnight cover. They both have day jobs. It's not ideal but it's working and it's within our budget. We expect to be out of funds in 6 years based on burn down of assets. We are 3 years into the system and have gone through about 4 live in carers. We have had no paid carers for months at a time while we looked for replacements. Relatively speaking we are fortunate. We could offset some of the cost through taxes but I don't know the details.

batman75

Every county should have a health care team. If your relative is elderly and needs homecare. You approach the head of the team. They then liase with you and devise a plan to provide either homecare or where required assist you in transitioning your relative into a nursing home. Once a homecare plan is devised then the head of the homecare team should make contact with you once a month to monitor how it's going and where required revise accordingly. It would be up to homecare head of the county to make sure, without needing to contact the relative to make sure that the plan is being delivered.

Each person being given homecare would remain an open case until either transfer to a nursing home or passing away. If the head of the team is taking holidays hand over responsibility to a deputy.

A huge problem in this country is that there is simply no accountability. My own interaction with the health service revolves around mental health. I've gone privately. The first person make a diagnosis on our first meeting. She wasn't seen again by me. The second person said I was sufficiently ok at the time of meeting not to need tablets. No follow up by the second person to see how I was. Not even one call. The best I ever got was after a GP consultation. My doctor fair play rang me to check in and see how I was. Honestly that alone was better than any tablet. To know that someone cared.

These 'experts' that we are sent to regarding mental health have their degrees and they may theoretically understand depression but I found they haven't a clue.

Dilbert75

This topic is currently becoming relevant for my family. This is the most grim reading I've had in quite a while.

StrawbsM

https://www.boards.ie/discussion/comment/119731992#Comment_119731992

If you need to vent, feel free to tag me on this thread or PM me. I won’t be able to change your situation but I understand that we sometimes need a vector to let off some steam. I wish you and yours well.

Still not a full cohort of carers back. HSE still won’t put their own workers alongside agency workers in order to fill in the gaps. I’ve sent details onto a legal practice. Can you all keep your fingers crossed that they take up my case?

BrianD3

It's the October holiday weekend/school mid term break and surprise, surprise, the outsourced service that is bad at the best of times is now even worse. As predictably happens every Christmas, Easter, mid term break, public holiday weekend and for the entire summer.

To anyone who has yet to go down the road of needing homecare from the HSE/agencies for a relative, either paying yourself or with a package, expect to have to give up your own job or at least significantly reduce hours to provide an unpaid service. Meanwhile, agencies will be providing a less than half arsed service for the 100+ million euro of taxpayers' money that they receive per year from the HSE.

IME there are constant problems with truncated calls or no shows. Is the HSE paying for no shows? Also, If a recipient has one hour's care under a homecare package and the agency carer rushes through it in 15 minutes and then does the same for the next three calls, is the carer and/or agency getting paid for 4 hours having only worked 1? And what value is added by the many managers working for these agencies - seems to be a lot of them and they never have a clue what is going on with the carers. It seems to me like a case of public money given with inept oversight to the private sector who then rip the piss. An epic scandal in the making I'd say.

Heighway61

We finally gave up on them. The final straw came when two different "carers" missed or mixed up my mother's medication. She is coming to live with us and we will provide her personal care ourselves. She's not happy leaving her home of the last 40 years but it's for the best.

If you can afford it, go private, watch them like a hawk and hire and fire until you get someone who is a professional and who cares.

If going HSE, good luck. It is possible to get one good HSE carer but highly unlikely to get more than that, the partner if a team of two, shift/holiday cover etc. Make full use of the allocated PHN if a good one (works for the client first) to fight your corner. If PHN is not so good (works for company first) then the whole thing is going to be a real struggle, never mind trying to navigate offices full of managers, coordinators, supervisors, administrators.

https://www.boards.ie/discussion/comment/119809092#Comment_119809092

Carers are not supposed to give medication. They’re not qualified to.

Heighway61

https://www.boards.ie/discussion/comment/119809369#Comment_119809369

Yep, they prompt the client to take them. My mother's carer missed several prompts and prompted twice instead of once.

xxxxxxl

https://www.boards.ie/discussion/comment/119465548#Comment_119465548

My partner works as a care assistant and does all of the stuff in the first few lines. Are we thinking of HSE ones ?

https://www.boards.ie/discussion/comment/119809495#Comment_119809495

I’m going back almost 5 years to my MILs home help. She had one lady for about 10 years, who would do anything. The later ones got her up, washed, dressed and fed. Couldn’t give eye drops! We had to do that and give her tablets. If the bed needed changing, we had to have the clean set left in the bedroom. No more washing floors. Personal care only. Yes, these were all HSE.

BrianD3

Things are getting worse - we get about 10.5 hours of homecare per week (after waiting for over a year to get anything) and the service gets more shambolic all the time. Considerably worse than when I started this thread. There is now a problem EVERY day - no shows, calls done hours late, truncated calls, carers rushing and being sloppy. Very poor record keeping. Seemingly no management or supervision on the part of their employer.

I'm now pretty much convinced that homecare agencies and/or their employees are stealing from the taxpayer and that time card fraud is going on while care recipients get neglected.

I should be complaining every day but it is exhausting to have to do this.

This should be borne in mind the next time someone says that more homecare packages would help alleviate he latest trolley crisis. Some of this probably comes from homecare agencies who see it as an opportunity for more money.

HSE are a bunch of useless apathetic morons who won't manage the service that they have outsourced to greedy agencies.

They can't even get basics like communication right. I have already made formal complaints about the HSE's homecare administration dept. The HSE's complaints officer agreed with me that communication was unacceptable and that he would be recommending changes. Nothing has changed.

Floppybits

The whole system seems to be broken from top to bottom.

Flinty997

Have to say carers are unsung hero's. Some amazing people working in it. But it's a poorly paid profession, and its hard to retain good people in it.

Its that lack of investment in people that causes a lot of the issues.

Like others had experience of it for years, with the same experience and problems others have listed.

SAMTALK

The lack of organisation / ability in the HSE is frightening to say the least

It's like they have lost control and are finding it hard to regain it again. There are too many admin staff in HSE first and foremost, especially high up and no accountability whatsoever. Everything is passed around and around until you give up

You to into a shambolic A & E with 2 options , die or get better straight away. unfortunately this is not the real world and there is no provision made for the inbetween

14 years ago my father was in hospital and the mad in the bed beside him was there over 12 months. One of the staff told us that medically he was well fit to be released but the family refused to take him as there was no support in place and so there was a standoff and this man was taking up a valuable bed for way longer than needed.

It's a shambles and we dont seem to have anyone to take the bull by the horns and knock some heads together

Flinty997

https://www.boards.ie/discussion/comment/120089664#Comment_120089664

I think you are missing part of the puzzle point.

While the HSE has it problems. There simply isn't enough money for home carers. So while in total its costs a lot, the people working in it, don't get paid much and the quality of the service suffers.

https://www.irishexaminer.com/news/spotlight/arid-40856981.html

https://www.irishtimes.com/business/work/2022/08/16/homecare-sector-called-out-by-government/

SAMTALK

https://www.boards.ie/discussion/comment/120089780#Comment_120089780

I think you missed my point. The money is being spent in the wrong areas IMO. Too may high up admin on big money but not delivering the goods

Caring is one of the most difficult times in life. You can find yourself a carer at any age, and indeed you could find yourself an 80 year old carer for 50 year old son or daughter, but most commonly it’s between 35-55. As posters have said it often means giving up or cutting back work, or greatly struggling to hold down a job with hospital appointments & unexpected events intervene. Trying to get supports is a mess, ever more so.

I was fortunate in that, though my late mother had physical frailties, she was very much together in her mentation and had simple practical & some innovative solutions to her own care needs, always having in mind that I should continue working for my own pension needs etc. She had the system worked out then, but it has become so complex now I do t know how she’d fare now.

Flinty997

https://www.boards.ie/discussion/comment/120089882#Comment_120089882

Be that as it may. The money allocated can't meet demand. Also money allocated to the private companies isn't being passed on to the carers working in those private companies.

SAMTALK

https://www.boards.ie/discussion/comment/120090115#Comment_120090115

It would be a start along with better investment in the HSE. Re the private companies , this needs to be investigated.

Again there is no accountability and money leaking everywhere, including the shambles of the new hospital

Flinty997

Much as I'm critical of the NCH its a different issue.

SAMTALK

https://www.boards.ie/discussion/comment/120090328#Comment_120090328

In a way, but it's still a bottomless pit for money, money that could help elsewhere

Mrs OBumble

I imagine they have the same labour market issues as everyone else does.

It's not a badly paid job for the qualification and skill levels required. No everyone is on the starting wage rate, either.

But fieldwork can be difficult and unsupported, and it's hard to get enough hours (clients all want to get up, have dinner, go to bed at roughly the same time).

Available staff probably prefer hospital based jobs where they at least have colleagues to hand. I'm not sure there are any easy fixes in the current labour market.

Flinty997

I think it's a very different job to most.

spaceHopper

My experience of this seems to be the total opposite of everybody else’s. My mum is in East Meath. I got a call one day from a lady working for the HSE my mum has been approved for 1 half hour call a day. What? We never applied, oh the Public health nurse did. Talked to her, “I visited you mother one day, she’s had a fall so felt she needed it.” A year later mum is in hospital for an operation, she chocked on some toast. Parkinson’s is affecting her swallow. She’s sent to rehab under the care of a great Dr, but there is only so much they can do. Eventually Mum want’s to go home, they arranged an enhanced care package that has since been increased. She get 3 calls a say. When she left hospital she asked me to arrange overnight care for a week I convinced her to do for 3 weeks. I made it my business to get on with the agencies and cares. That worked out well the agency wasn’t in position to provide overnight care long term. It’s not part of their core business but they told me where to go to get great care privately. Mums Parkinson’s  is getting much worse and she really need the help. So far I’ve filled out no paper work. I’ve had to make lots of call but I always manage to get a visit from the public health nurse, OT. They have no problem approving a sit stand electric chair or bed…

yourdeadwright

My mother & father have carers from the HSE & i have to say they are a god send,

The carers themselves are amazing people & do an amazing job on very little pay , Honestly i can't praise them enough

Both parents have dementia to different degrees & can be very hard work & without the carers we would be at a huge lose,

washiskin

My Mum ended up in step-down for months after a hospital stay because extra hours took so long to get approved.

The existing service couldn't cover the extra hours and the HSE couldn't find anyone to fill them.

We had all but given up hope when she was diagnosed with cancer and died without ever getting home.

Her existing Home Helps were incredible for the most part, although in fairness to Mam she was a very easy "service user" (a phrase I loathed). It took a long time to get the balance right, but when it did it was a godsend.

The one piece of advice I'd give anyone lucky enough to be approved and have the hours filled is don't accept anyone who lives locally if possible - we had a nightmare with one person.

BrianD3

Since my last post I am even more convinced that widespread fraud is happening, facilitated by the useless HSE that pays 150+ million p.a. to homecare agencies. I am having constant problems with agency staff not staying close to the allocated time and rushing the "care". They often stay less than half the time that has been allocated. Then when filling out their logsheets they either "forget" to enter the end time or else falsify it.

I complained - again - to the HSE. First thing I wanted from them was written confirmation of the hours that have been allocated to us under the homecare package. They tell me the hours over the phone and say they'll confirm in writing but then don't. Red flag.

They also tell me to "just get on to the agency" with my complaints which I have done with predictable results.

I am offering on a plate to the HSE objective evidence (incomplete agency records) and my own records that show potential fraud. All I'm getting back from them is avoidance and apathy.

Seems to me that the HSE know full well what is going on but are adopting a see no evil strategy with some token auditing, see below. An Irish solution to an Irish problem?They clearly haven't learned from the scandals of the past.

https://www.irishexaminer.com/news/arid-41049539.html

I have never signed or been asked to sign anything to confirm that a homecare visit has taken place.

https://m.independent.ie/irish-news/health/no-proof-of-visits-in-many-homecare-invoices-38298554.html

Invoices submitted with no proof. HSE logo used by private companies without authorisation. This is the sort of thing I expect from travellers calling to the house offering to do work and presenting a flyer with SEAI, tradesman guild etc. logos on them.

Deeec

https://www.boards.ie/discussion/comment/120204188#Comment_120204188

Brian the issues arise because both the HSE and the management of the homecare agencies dont care what level of care is delivered. They are just interested in box ticking ie. Elderly person gets carer calling to them but management couldnt care less about the quality of the care.

Also the quality of the carers varies widely. The carer industry also seems to attract a large number of people who not at all suited to the role but just see it as a job. It seems that anyone who wants to be a carer can be - which is wrong in my opinion. It is such an important role and the good ones should be paid more. The selection process should be tougher and carers should only be selected based on their suitability not because they are available.

My parents in law had an excellent female carer calling to them who became a friend to them - she was happy to do little jobs around the house aswell as delivering personal care. She always turned up on time and actually cared about their welfare. She had the sense to see what actually needed to be done and would alert the family to any important issues or observations.

She was moved on and replaced by a male carer ( because father in law was deemed to need more care). He is completely useless - the best thing I can say about him is that he turns up. He comes in makes himself a cup of tea and sits down and chats. He probably does the same in every house he calls to. He does literally nothing and sometimes seems to irritate father in law alot. When you complain you are made feel that you should be grateful to have him. His management dont care what he does or what he doesnt do as long as he is there. The guy should not be in the caring profession.

BrianD3

https://www.boards.ie/discussion/comment/120204711#Comment_120204711

Sounds like your female carer was one of those who didn't need managing while the male did. He might have been an ok carer had he been properly trained and managed. If nobody is managing the staff, the result will be that the quality of service depends on individual staff members' work ethic, diligence, morals etc.

We expect private companies to rip the piss, why bother managing the staff if you'll get paid out of public money no matter how bad the service. Cut corners, turn a blind eye to time card issues and get away with as much as you can.

The travesty here is the apathy of and incompetence of the HSE. If they're going to outsource services to the private sector, stringent oversight needs to be in place. It's not rocket science. E.g. Itemised invoices that contain details of exactly what is being charged for that are checked by HSE staff. Audits carried out regularly with documentation and time cards checked and cross referenced with invoices. Care recipients and their families proactively contacted by the HSE, encouraged to keep their own records and report issues to the HSE.

As someone who worked in the public service for many years including in auditing, procurement and contract management of outsourced services, I suspect that most of what I mentioned in the paragraph above is not being done, or is being done sporadically, by the HSE. If my experience is replicated throughout the country, given that the HSE spends 150 million p.a. on homecare, there is likely fraud to the tune of tens of millions happening every year Does no-one in the Dept of Health or HSE give a crap? Or do they care about as much about public money as they do about elderly people being mistreated.

it would also make me wonder what is happening in hospitals and other settings where the HSE is relying on agency staff.

What next, will we hear that FG and FF TDs have family members in senior positions in agencies that provide services to the HSE.