Homecare is in dire need of regulation

BrianD3

I've posted about my experiences of homecare of my elderly relative before and things keep getting worse. The quality of the service provided is abysmal. I'm talking here about "care" delivered by the HSE and well known organisations and franchises of international companies - not private cash in hand arrangements. 

There has been "talk" about regulating the homecare sector going back to at least 2010 with HIQA also calling for regulation on many occasions in recent years. There have been several public consultations and the Dept is now, apparently, "developing a regulatory framework". According to Stephen Donnelly in a written answer to Fergus O'Dowd on 6th July this year

"The Department of Health is currently preparing primary legislation to accompany regulations. It is envisaged that this will be brought before the Oireachtas this year"

Yeah, I'll believe that when I see it.

To give some idea of the current situation, nursing homes are regulated by HIQA and have been for years. Yet, there have still been scandals, rape and sexual abuse, financial abuse, court cases etc. Also, when HIQA inspect nursing homes, they generally find multiple non compliances. 

Now consider how much worse things must be in the homecare sector. It is unregulated, seemingly uninspected and care is provided behind closed doors by HSE workers and for profit, private companies. The HSE outsources public homecare to these companies and they are also engaged by clients privately. Regardless of who is providing or paying for care, there is little to no supervision of carers and numerous problems with the quality and safety of care. Many staff have poor English which affects communication and record keeping. Complaints about problems are not dealt with by providers or the HSE.

I have major doubts that the HSE even knows what it is getting for the at least 150 million (it might be a lot more now) it pays to homecare companies every year. If it pays a company 30 euros for a 1 hour care call, and the call is rushed and done in an incompetent, unsafe manner in 15 minutes with staff falsifying the times on their logsheets, does the HSE know, want to know or care? 

Oh and this week this story came out about a home carer Lesley Dyer who stole from a dementia patient and avoided prison due to a sob story and being apologetic. 

https://www.breakingnews.ie/ireland/woman-who-stole-from-vulnerable-pensioner-with-dementia-avoids-jail-1547280.html

Strange how the individual's employer is not named. However I see on Facebook someone called Lesley Dyer from Dublin who just happens to have many posts giving glowing reviews for a particular well known homecare provider. Must be a coincidence. 

In general, social media and customer review websites have plenty of fake positive reviews of these companies. Positive reviews are left by employees, including managers and marketing people, who fail to state that they are employees. 

Even leaving aside thieving and fake reviews, the level of incompetence I have witnessed from some carers is stunning. Their managers also seem incapable of managing. I think one of the reasons that such individuals end up in homecare is not just because of the pay but because it is a job that they can get away with behaviour that they wouldn't get away with in other jobs where there is competent management and where public funds and the inept HSE are not involved. 

I'd say the reason why there has been such a delay in regulation is because the government and Dept realise that homecare and the HSE are a sh*tshow. If/when regulation is brought in, will it be effective or watered down with the HSE and providers given years to get their acts together? Will HIQA be given the resources to enforce the regulations? As with any public service outsourced to private companies, there's always the chance there are vested interests influencing decisions. Even if that isn't he case it is sickening to see the amount of launches and other publicity with senior people from these homecare companies pictured with politicians such as Mary Butler, Stephen Donnelly. Michael Martin, Robert Troy and others.

BrianD3

Any news on this or is it, as usual, "we're working on it". 

No hurry lads. 6 figure salaries will still be paid and pension service will still accrue. The unregulated HSE home support service will continue to outsource work to unregulated, private, for profit homecare providers, handing over hundreds of millions of euros per year to them. Politicians including Ministers will continue to hob-knob with CEOs of said providers. All while vulnerable and elderly people and their families are abused, neglected and disrespected.

Some links and info

Stephen Donnelly on 07/03/24 "Drafting of the primary legislation has been added to the priority list for the Spring Legislative session and the General Scheme is expected to be published this quarter"

https://www.oireachtas.ie/en/debates/question/2024-03-07/366/

Donnelly on 23/01/24 "The primary legislation provides for the licensing of home support providers. Transitional timelines are being finalised for the registration of home support providers under this framework. Further details will be available following the expected publication of the General Scheme in Q1 2024"

https://www.oireachtas.ie/en/debates/question/2024-01-23/581/

Donnelly on 03/10/23 "The Heads of Bill are currently being drafted by the Department in order to bring the Heads of Bill to Government for approval before the end of the year"

https://www.oireachtas.ie/en/debates/question/2023-10-03/593/

Donnelly on 07/07/23 "The Department of Health is currently preparing primary legislation to accompany regulations. It is envisaged that this will be brought before the Oireachtas this year"

https://www.oireachtas.ie/en/debates/question/2023-07-06/332/

Donnelly on 16/05/23 "It is envisaged that the Heads of Bill, Memo for Government and Regulatory Impact Analysis will be brought to Government for approval before the end of this year"

https://www.oireachtas.ie/en/debates/question/2023-05-16/690/

etc. 

etc.

December 2021 - HIQA calls for regulation of homecare services

https://www.hiqa.ie/hiqa-news-updates/hiqa-calls-regulation-homecare-services

August 2020- Ireland behind the curve on homecare regulation, dangerous.

https://www.thejournal.ie/carer-pay-conditions-covid19-part-three-5167184-Aug2020/

July 2020 - Professional Homecare Bill 

https://www.finegael.ie/fine-gael-cork-north-central-td-colm-burke-has-today-tuesday-introduced-the-health-amendment-professional-home-care-bill-2020-to-the-dail-saying-this-new-legislation-is-designed-to-provide-re/

Nov 2017 - Dept to bring forward proposals on regulation and establish a project unit to hopefully makes things move more quickly

https://www.irishexaminer.com/news/arid-20462893.html

Oct 2017 - HIQA calls for regulation

https://www.irishexaminer.com/news/arid-30808249.html

May 2017 - Department of Health is currently engaged in a detailed process to design a new system of regulation 

https://www.oireachtas.ie/en/debates/question/2017-05-23/485/

Jan 2017 - Minister to launch a consultation process

https://www.irishexaminer.com/news/arid-20462893.html

Nov 2016 - Law Reform Commission...A key recommendation was that the Health Information and Quality Authority, HIQA, should be empowered to regulate and monitor undertakings that provide professional home care,

https://www.oireachtas.ie/en/debates/debate/seanad/2016-11-09/7/

May 2016

Government to examine possible regulation

https://fora.ie/home-care-regulations-ireland-2743124-May2016/

etc.

etc.

Dec 2010 - Concern over unregulated home care industry

https://www.rte.ie/news/2010/1213/295483-care/

Mar 2007 - Call to make regulation of homecare a priority

https://www.independent.ie/life/health-wellbeing/elderly-face-abuse-from-unvetted-care-workers-at-home/26270217.html

etc.

Even if homecare is regulated it won't solve all issues. Nursing homes have been regulated since 2009 and there have still been scandals. However one would shudder at how bad things must have been before this. Reference the goings on in the Rostrevor Nursing Home from at least 2000 (and probably 1984 when it was founded) to 2011 when it was finally closed and taken in charge by the HSE.

2011

https://www.thejournal.ie/elderly-residents-allegedly-kicked-and-slapped-at-rostrevor-house-nursing-home-151312-Jun2011/

https://www.independent.ie/irish-news/horror-nursing-home-director-defends-patient-treatment/26740927.html

2004

https://www.independent.ie/irish-news/stomach-churning-details-of-nursing-home-squalor-and-neglect-revealed/26227914.html

As an aside, Jesus Wept

https://www.independent.ie/regionals/herald/rozs-stunning-sister-sarah-ties-the-knot/27997023.html

https://www.dailymail.co.uk/news/article-2005426/Rostrevor-House-Abuse-allegations-daughters-pretty.html

Oscar_Madison

Care of the elderly and this forum are not great bedfellows in that as you found yourself, traction on such discussions is minimal - maybe it’s the user profile of the forum in that they’re much younger and as a result have limited first hand knowledge of elderly care? I dunno but I’ve experienced similar in the past when starting similar threads.

Great posts btw.

Yeah “support” services for elderly are very dodgy overall -thankfully the elderly people in my family circle are and were looked after primarily by family and then a nursing home but supported greatly still be family.

My key point is, even in a nursing home, there are massively different standards of care- as you say many staff have poor English- a lot of the agreed procedures not implemented - it’s a case of when the senior staff are off duty, some of the carers retreat to a quiet room and go asleep (I kid you not) .

People not bathed, dirty clothes, etc etc - so even in a nursing home, a place you’d think have some basic standards they adhere to, you’re left chasing staff the whole time.

Get old by all means folks- but never get old and incapacitated - I’ll be off to Switzerland or where ever it is that you can die in peace - I couldn’t take the low standards of care in nursing homes no less the sho1te that passes as community care which the OP is alluding to.

yourdeadwright

Just to balance it out my folks get home care & its brilliant, Ye the odd day when regular cares are off & things can be a mess but that is life some days don't go to plan ,

But all in all its been brilliant for 2 years now .

Oscar_Madison

https://www.boards.ie/discussion/comment/121942240#Comment_121942240

Fair enough and I’m very glad it’s working out for them - I guess at the very least standards are very mixed out there - and costly too. I’ve experienced the care in two different nursing homes around 3 different people over the last 10 years and counting - yes overall care is goodish but you really do need to keep on top of them and check certain things are done- much harder to govern home care it must be said - do they have key tasks they must perform each time ie washing, walking etc, are you able to keep track on ensuring these activities happen?

yourdeadwright

https://www.boards.ie/discussion/comment/121942311#Comment_121942311

I have heard all kind of stories but we have just been lucky i guess ,The 2 main carers are wonderful ,

Yes they have task they do each day we are lucky that we have a lot of family members in the are so a family member will be there at least once a day so we can always see what has been done , We get 3 calls a day so its a huge help,

Communication is vital if something is off or a task can't be done for whatever reason once we are aware we can deal with the issue,

Oscar_Madison

https://www.boards.ie/discussion/comment/121942376#Comment_121942376

Yeah you don’t mind the odd thing going wrong and it’s brought to your attention - unfortunately with nursing home experience it’s constantly raising issues with them - bed sores not properly treated, hygiene etc - I see you keep family close too - that’s really the secret sauce of elderly care I’m afraid - it’s not about dumping the responsibility on someone else - it’s more about outsourcing certain tasks -whilst you do less tasks, you’re still majorly involved in oversight to ensure all care implemented correctly

L.Ball

shur they're looking to bring in assisted dying so the problem will solve itself

Montage of Feck

Homecare is a sham, the government are doing their damnedest to remove themselves from the responsibility of the wellbeing of their citizens. Trying to fob it off as "care in the community" when in reality it's a route to the privatization of the health and education services.

Ella108

If you tell people you are a full time care provider at home you'd be seen as " person of leisure" at best and dole at worst. Root of the problem is carers are unrecognised,undervalued and under paid and over worked. Also when care is provided at home, someone has to give up their "career" .

Mrs OBumble

https://www.boards.ie/discussion/comment/121942718#Comment_121942718

Except that Covid showed that congregated settings are also bad places for caring for older people. (And we kinda knew that anyway.)

Flinty997

https://www.boards.ie/discussion/comment/121942463#Comment_121942463

Exactly this.

Flinty997

Home care is a very difficult job and for the most part poorly paid. So as a result its difficult to hold on to the best people. We had very mixed experienced with it. Some really good people and some really not great people. Same with facilities, some really good, some really poor.

Oscar_Madison

https://www.boards.ie/discussion/comment/121942718#Comment_121942718

I totally agree with you - and given my comment earlier around younger people not really paying much heed to such threads and discussion, (understandably so in fairness why would they) ironically it is they that will suffer most in years to come

Oscar_Madison

https://www.boards.ie/discussion/comment/121942957#Comment_121942957

It’s a totally undocumented “service” that provides huge value to society and saves the government literally billions per year - if you think our health service is bad, just think if every stay at home career brought their loved one to emergency A&E this evening and said “you deal with them I’ve had enough” -the health care service would collapse

Flinty997

Govt really hasn't done much about anything. Home care and elderly care is not much different only that it gets even less attention.

But it's true people tend to do much better at home, in familiar settings until they don't. But with an increasing population it's only going to get worse.

Oscar_Madison

https://www.boards.ie/discussion/comment/121943441#Comment_121943441

I think it’s really good we have this thread here - for younger people it’s a world away but it highlights that there’s just so much wrong with our health service - from overspend on the still unopened “new” hospital in Dublin to the terrible care of the elderly and indeed not so elderly but not independent people.

Ive seen people in their 40s as residents in nursing homes because there was no other suitable place for them (they had certain care needs) - I mean that’s fcking crazy - people who are mentally ok but physically not, in a nursing home at that age?

yourdeadwright

https://www.boards.ie/discussion/comment/121942463#Comment_121942463

i 100% agree wit hyou ,

We go out of the way to try help them at home with the one goal of keeping them out of a nursing home for as long as we possibly can ,

Wibbs

https://www.boards.ie/discussion/comment/121942957#Comment_121942957

I did it for many a year, but I never got that "person of leisure" vibe at all. Quite the opposite in fact. I got lots of sympathy, though less so from the HSE and other state arms.

I was also very lucky in getting a homecare company that were very good(after years of trying to get it and the carers allowance). I really couldn't fault them and I would have been lost without them. The first company I dealt with, well that was a very different story. Overworked and underqualified people showing up late or not showing up at all. I didn't blame them, but I did blame the employers and those tasked with regulating and inspecting the services. I recorded everything(very important) and complained until I was offered what turned out to be the much better outfit.

Respite care services were variable. Again too many staff seemed to be clueless and on a few occasions harm was done. To the degree I refused respite breaks for over a year until a much better outfit with qualified folks was offered.

Again I would advise anyone going the carer route to record everything in your dealings with agencies. If I hadn't things could have gone very differently. I was lied to and lied about too often. Even when evidence of this(including witnesses) was demonstrated, the brass neck of some I dealt with beggared belief.

The other thing to keep in mind and like you note your career and life are essentially over for that period. Unless you work from home and the care needs are low enough. What's also easy to forget in the middle of it is the after when it's over. Trying to restart after usually years away and usually in middle age is a real struggle and you're essentially on your own and pretty suddenly too. State services see and treat you as like any other long term unemployed person rather than an ex carer.

Oscar_Madison

https://www.boards.ie/discussion/comment/121944743#Comment_121944743

Great point around how carers are treated like long term unemployed when heading back to work - they should have an allowance for a while and free education to retrain if needed - a drop in the ocean compared to the savings their years of caring made on the exchequer

Manach

Unfortunately, the OP's take on the state of the Homecare industry is accurate. The burden does dispropriately fall on the home carers (paid/unpaid) to pick up the slack and the HSE seems indifferent beyond ensuring their report records are keep up to date.

Mrs OBumble

https://www.boards.ie/discussion/comment/121943425#Comment_121943425

I was surprised to learn that granny-dumping is a thing. But it is.

Happens more the UK than here, as due to the smaller population people are more likely to be recognised.

Oscar_Madison

https://www.boards.ie/discussion/comment/121970687#Comment_121970687

Oh it happens in Ireland too -A subtle but “effective” method of “granny dumping” is actually bed blocking in hospitals - a horrible term I know - essentially granny enters hospital with genuine ailment - her carer is long past able to take care of her - as a result the hospital scrambles looking for suitable accommodation - they try and push back on the carer to no avail - eventually granny moved to respite home (if available) until suitable nursing home accommodation becomes available -,otherwise, granny stays in hospital, “blocking beds”

BaywatchHQ

One of my grandmother's home carers often makes unprofessional remarks. She is a traditional Ulster Protestant and she was complaining about the locals putting up republican flags for Easter. That would never be allowed the other way around. Imagine a Catholic carer going into a Protestant house and complaining about 12th July decorations.

BrianD3

The news on this is…there is no news. Development of the General Scheme is still at an "advanced stage". Bill "expected" to be enacted in 2024. Public consultation "planned" for 2024. If we have an election within a year, what happens then.

. https://www.oireachtas.ie/en/debates/question/2024-04-09/1215/

As per the title of this thread, homecare is in dire need of regulation. In the UK where it has been regulated for decades, there are still problems with providers not meeting standards. Reports can be viewed on the CQC website (England) and RQIA website (Northern Ireland)

https://www.rqia.org.uk/

https://www.cqc.org.uk/

Regulation hasn't stopped a "horrifying" level of abuse in Northern Ireland but at least inspections are being done and the BBC could obtain a figure (20,000) for the number of alleged abuse cases.

https://www.belfasttelegraph.co.uk/news/northern-ireland/horrifying-level-of-alleged-home-care-abuse-against-elderly-and-vulnerable/35488626.html

I'd say our "wonderful" state agencies don't have a bull's notion what's going on here - or maybe they do and that's why there are such delays with regulating this disgrace.