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.

BrianD3

Surprise surprise, and related to the failure to regulate the sector, statutory homecare won't be in place during the lifetime of this Dail. There is no timeline and junior minister Butler has demonstrated once again just how useless she and this government are. She's "finding it hard to grapple" with the issue of what people would have to contribute to the cost of their homecare.

https://www.independent.ie/irish-news/long-delayed-home-care-scheme-will-involve-a-charge-but-still-no-timeline-on-roll-out/a2078818158.html

Statutory homecare is in the programme for government, Varadkar was spouting about it on The Late Late Show a few years ago. In 2021, the "aim" was to have the "much delayed" scheme in place "next year".

https://www.independent.ie/irish-news/four-areas-chosen-to-trial-state-homecare-scheme/40905917.html

Also, still nothing on regulation that was also supposed to be in years ago/this year/by the end of the year/this quarter. Let's see how that goes. Ah, they're working on it, they say. Won't be long now until the Dail recess and the annual Civil and Public Service summer holidays slowdown is underway already, then it'll be Halloween and mid term break and Christmas and bang, it'll be 2025 and an election.

And on we will go with poor quality, non statutory homecare delivered in an ad hoc, shambolic manner by the HSE and outsourced to vile companies.

Maybe people with HSE and political connections will get a decent service though as some seem to do at present.

But others will have no other option but to go into nursing homes which in many cases are found by HIQA to be non compliant with regulations and with several scandals, including sexual and financial abuse of residents, in the NH sector in recent years.

But never fear, Mary Butler is on the case, she's "not happy" that 80% of NH beds are provided by private entities and she is "trying slowly to change the narrative within the department and the HSE" . Jesus wept.

https://www.irishexaminer.com/news/arid-41414839.html

Gregor Samsa

https://www.boards.ie/discussion/comment/121970737#Comment_121970737

We had to engage in this "bed blocking" with my dad, and I'm unapologetic for it.

He was at home and living independently. He brought himself to A&E one evening - turns out he had a heart attack and minor strokes. Spent 3 months in the cardio ICU - much of it on death's door having more strokes - he received great medical care, and eventually recovered from the cardiac issues.

But when he did, he was left with quite severe vascular dementia that the hospital refused to diagnose. He knew who we were, but little else, and was unable to care for himself. Yet the hospital wanted to discharge him on the grounds that his heart issues were "under control". I remember one specific day going to see him, and he was telling me about wasn't it weird that there were so many beds in the Motor Tax office, and how Howth Harbour was just down the corridor - and at this point he couldn't walk and had to have help eating.

I went to one of the doctors and pleaded with them to look into his mental state. Doctor came back with a "dementia test" that was 15 questions on a photocopied page. First question was "What is your name". My dad's response was "A Guard wouldn't ask you that!". But the doctor ticked it off as answered successfully as "he was only joking, I'm sure he knows his name". Next question was "Who is the current Taoiseach?". My dad answered "the gay fella". Again, this was deemed to be a correct answer. Down the list it went, and despite the fact that my Dad thought he was literally waiting in a Motor Tax office, the doctor said that they couldn't diagnose dementia because he had scored 10 our of 15 (or whatever it was) on this clearly useless test, and he should go home immediately. Had to go and plead with the head consultant cardiologist to get the geriatric and occupational health teams involved to assess him properly, which they did over the next few weeks, and they diagnosed severe vascular dementia and said that under no circumstances should he go home, and that he was not suitable for home care, so he needed specialist nursing home care.

We were willing to pay for the nursing home - not using Fair Deal or anything like that - but it still 4 took months to find one that could take him - most have massive waiting lists, and many won't take residents with dementia. All this time, he stayed in hospital - because he had severe medical needs that needed 24 hour medical care - yet every 3 days we'd get an abrupt call from patient services asking when were we going to take him home and that he was blocking a bed "for people that needed it". We spent all our time calling and visiting dozens of nursing homes ourselves looking for a place for him. The hospital offered nothing and did nothing to help. Eventually a place came up, and got him out of hospital within an hour of the place being available.

My experience is that while they treat the likes of vascular dementia and Alzheimer's disease as mere "behavioral issues" rather than the severe medical issues that they actually are, then some people are going to have no choice but to "bed block". Absolutely heartbreaking to have to stand in front of a doctor and say "I refuse to take my father home to look after him", but that's the position we were put in.

I had an uncle in his 70's who suffered a stroke and following initial treatment was placed in a nursing home for recovery for apx 6 months. He was the owner and occupier of his family home and instead of finding him a permenant place in residential setting, his brother decided that the family home wouldn't be used as collateral to fund a placement for him under the fair deal scheme and instead was placed in a private apartment in a secluded residential community with zero medical care. Over the years he was transported over 50km each way to hospital appointments and returned back to his facility, even having spent time in icu following pneumonia.

The crack is his brothers wife was senior management in the HSE and was the one who organised all placements and care for him. He died in the bathroom of his apartment and was there for some time before a cleaner found him. Immediately following his passing the fight for his home ensued and both will and deeds magically went missing and brother claimed everything when it went to probate. The brother passed shortly after and the house passed to his former HSE manager wife who conveniently found a eager buyer in the local council who paid above board for the delaipated dwelling through a compulsory purchase order. (it remains delapidated and has never been used despite the council claiming it had been bought to convert into social housing)

I worked for the HSE during this time (not as a carer) and following my departure a prospepective employer contacted me and informed me that the HSE were refusing to transfer my garda vetting or give references. They know how to deal with whistle blowers in the HSE so you'll rarely find anyone with standards working in these areas, hence the saturation of unqualified migrant employees in the system.

Oscar_Madison

https://www.boards.ie/discussion/comment/122258603#Comment_122258603

Don’t blame you one itoa- hopefully your dad is doing ok

ax530

Thanks for raising this and all the information in posts.

Useful to be aware of these issues when talk of general elections gets underway.

Limited experience myself but do remember years ago my granny who was in her 90s had some 'homehelp '. The helper would come an hour most days sit down my granny would prepare lunch & tea for her have some baking done in the morning for her to bring home! Turns out as well as being fed the 'helper' was also helping herself to tea bags and some other supplies!

Strumms

one situation in our family…. the carer was allowed by their employer, don’t know the HSE’s take but they could leave the call 10-15 minutes early in order to reach the next client on time.

So the roster, an example of which someone in the family was shown….

J. Smith 0800-0900

K. Doyle 0900-1000

S. O’Reilly 1000-1100

Only about 45 minutes of that hour was spent per client

Instead of….

J. Smith 0800-0900

K. Doyle 0915-1015

S. O’Reilly 1030-1130

The above allows travel time between clients and every client still gets an hour, but you need more carers.

https://www.boards.ie/discussion/comment/122259131#Comment_122259131

more likely just poor management

Strumms

https://www.boards.ie/discussion/comment/122259155#Comment_122259155

Yep, but which isn’t regulated.

BrianD3

https://www.boards.ie/discussion/comment/122258603#Comment_122258603

IRC from previous posts, this was Beaumont hospital - based on the below story your father was fortunate that he received good medical care at certain points.

https://www.independent.ie/irish-news/courts/grandmother-died-after-she-was-given-eight-times-the-recommended-dosage-of-blood-pressure-medication-mistakenly-inquest-hears/a1842915255.html

Disgraceful incident, they killed her. There are numerous red flags in the story including the lack of a policy for review of medications by pharmacists.

I'd regard that prescribing error as gross ineptitude. It's not as though the patient was undergoing some highly complex surgery where a tiny error was made.

There are over 100,000 adverse incidents in Irish hospitals each year. And 500+ deaths due to these incidents. That doesn't even include the voluntary hospitals like, eh, Beaumont. Adverse incidents include things like prescription errors, surgical errors, patients wandering, falling out of bed etc.

I've personally witnessed numerous such adverse incidents in healthcare. In general, I find one of the biggest problems with healthcare staff (from physicians to OTs, HCAs, nurses) in every setting is that they don't communicate with each other or listen to patients and their relatives. Too arrogant to listen - which added to their sloppiness and carelessness is a lethal combination.

On a couple of occasions, I have saved doctors arses by questioning an incorrect prescription for a relative - of course instead of appreciating it, they were fuming. One NCHD was also pulled up by his consultant in front of me after she overheard what he was about to prescribe. He was raging but as he couldn't take his rage out on his boss, he resorted to (badly) imitating my Midlands bog accent instead to make himself feel better.

Then there's the "my budget, my job" thinking - get those "bed blockers" out of this hospital, I don't care what happens to them after that, that's for the family and community services to deal with, not my problem, **** em.

This is what is happening all the time in healthcare. Now think about what is happening in homecare behind closed doors with very vulnerable people and the HSE outsourcing services to for profit providers. Who in the HSE is manages the contract? IME, no one. They haven't a clue what is going on, don't acknowledge let alone respond to complaints. 100k adverse incidents in hopistals, how many in homecare, I bet nobody has a clue.

BrianD3

https://www.boards.ie/discussion/comment/122259131#Comment_122259131

It's worse than that. Homecare companies are scheduling morning calls for 6 am despite

a) nobody wanting a call at that time

b) company policies stating that morning calls commence at 8 am

What happens then is that carers either turn up when they aren't wanted and drag people out of the bed. Or else they ignore the schedule and "squeeze in" the 6 am call as well as the 8 am call at 8 am.

Falsification of records in carer journals is common. They'll claim that there were in a call for a hour when they actually left after 35 minutes.

Result is rushed calls and poor quality care. At the end of a day, a carer may have "done" 15-20 calls all of which are either 1 hour or 30 minutes. Plus travel time. Not possible. The company then submits their invoice to the HSE. Who checks it? Is it itemisied down to clients and hours? Are there audits? Does anyone apply a sanity check to see if what is being claimed is actually physically possible or would it require a carer to be in two places at once? Any cross reference checks with journal entries or app clockin data?

Either the HSE is completely inept or else they know full well what is going on and adopt a "see no evil" approach. I brought time concerns to the attention of the HSE. Nothing happened. I believe that widespread fraud is likely happening under the nose of the HSE with the taxpayer paying for x number of hours of care when a smaller number is being delivered.

BrianD3

https://www.boards.ie/discussion/comment/122258947#Comment_122258947

Re: whistleblowers, if I ever go back to employment after my unpaid caregiving ends, I'd love it to be in the HSE. From day one I'd be quietly gathering evidence of any wrongdoing and I doubt I'd have to make any effort to find it. Have FU money so don't need to work.

The HSE would want to dissuade people like me from getting jobs with them. Maybe include an interview question "how much financial independence do you have" and "what's your views on Maurice McCabe". LMAO.

Then again, the same useless HSE managed to employ a doctor from the UK who had been struck off for racism and poor performance with this being widely publicised. But in HSE land it seems that recruiters can't use google on computers.

https://www.dailymail.co.uk/news/article-3359106/Syrian-surgeon-said-Indian-doctors-allowed-clean-toilets-downfall-NHS-struck-off.html

https://www.thejournal.ie/doctor-seven-irish-hospitals-struck-off-in-uk-5623115-Dec2021/

https://www.boards.ie/discussion/comment/122260091#Comment_122260091

The only reason I survived is because I'm in social housing, I sh1t you not. There are bad people and there are cruel people and then there's gutteral evil.

micosoft

I keep hearing the same argument in this country - everything is the governments problem and if only they put some ink on paper everything would magically get better. But they won't write the policy/regulation because of some vast, complex conspiracy theory. If only I or X were in power we'd fix this overnight.

The simple answer is that Irish People don't want to get into construction or caring. Most of the carers in this country are immigrants who are taking bottom rung jobs as this is unskilled work. This is a problem across the western world. While the idea of "regulating" seems like a magical cure it will in fact lead to a massive increase in costs and a significant reduction in capacity and frankly can't and won't address the quality issue. For those suggesting we pay more please flag the other services you want to cut or the tax you want to increase (recognising the implications of that tax).

It would be more productive to ask about the societal implications of a rapidly aging population and the shift to outsourcing familial caring duties and what that would realistically look like. I don't have a simple answer and anyone positing there is a simple answer like regulating it does not understand the problem. The quickest way to end the conversation is asking what % if not 100% of inheritance people would like to give up for the service you expect. Folk get very silent then.

https://www.boards.ie/discussion/comment/122260346#Comment_122260346

That's a bit simplified version of how the system works. I don't know about construction but I imagine like caring, that there are various levels of skill from engineers and architects to electricians, carpenters and general labourers. Most care roles require a minimum standard of qualification and most social care roles at least a level 6 or 7 (degree) so not especially low rung work or lowly paid. They do (or should) require garda clearance and at least a basic understanding of patient care and safety. Regulation would make those things compulsory specifically in roles outside the direct provision of the HSE, like those in private facilities or agencies providing home care.

Statutory care was proposed by the DoH in line with their own programme for Government and as part of the Slaintecare reforms in the hope of providing better care and regulating an industry currently outside their remit. It would require home care providers to hold a license from HIQA in order to operate. It's provision of care for the vulnerable and better supports for familes and those already providing care at home.

you can read more about it here https://www.gov.ie/en/publication/56ab1-draft-regulations-for-providers-of-home-support-services-an-overview-of-the-findings-of-the-department-of-healths-public-consultation/

tarvis

What is required in this day and age are

a) dedicated and well staffed care homes for young people with disabilities/ injuries who are unable to live in community.

b) nursing homes where the frail elderly can live with company , warmth and security to the end of their days.

c) And for those with the greatest need we need geriatric hospitals which are properly set up and staffed and independent of general hospitals for those who require hands on 24 hr care. The old county home fulfilled this need at one time.

We also need to revive the old “home help “ system - local people working in local areas and giving care to people in their homes , not on a timer but according to the need of the elderly person.

This requires an acceptance that caring is NOT a low skill job. Communicating with the frail and the sick is anything but low skill. It cannot be left to the lowest bidder and needs to be paid for just as much as a GPS secretary or a ministers assistant. It cannot be provided by someone with only a limited knowledge of English and no knowledge of the habits and lifestory of their elderly client.

Somewhere along the line our Dept of health allowed the health care baby to be thrown out with the bath water and someone needs to call a halt.
It’s time we saw some service being factored into health care and lots less paper pushing.

In my understanding what is desperately lacking across all sections of the health service is accountability. It's all good and well drafting new policy if it's never going to be implemented and that tends to be the way things go with the HSE. If the digital health framework recently launched is realized it will go a long way toward enchancing a basic standard of care because by it's nature will facilitate accountability. It will streamline care in multiple sectors and assist better communication, record managment and regulation of service providers. It will probably help eliminate a lot of the paper pushers too and give better access and control to patients and clients and service users. Just imo

BrianD3

I see today is apparently World Elder Abuse Awareness Day. Vomit inducing stuff to see Mary Butler and vile homecare companies using ribbon nonsense to promote themselves on social media. Also HSE and Dept of Health posting about it.

hte irony. They were happy enough to employ Mr Z for 11 years in one of their own care facilities. I hear he was a good christian and a hard working man though.

“Too often the review heard that there has been acceptance of poor-quality care, defensive practice, tolerance of abusive behaviours, putting organisational reputation above the needs of the individual and how the very institutions set up to care for people became instead unsafe environments,” the report said.

report published yesterday

https://www.irishtimes.com/health/2024/06/20/hse-safeguarding-structure-needs-transformational-change-report-finds/

BrianD3

If ever a comment should alarm people, this one, from Sean Moynihan of Alone should.

“Currently, our home support services operate based mainly on trust. There are no regulations, no standards, no independent oversight, and very little data”.

https://www.independent.ie/irish-news/private-home-carers-refusing-to-take-on-rural-clients-due-to-travel-costs/a314051966.html

yourdeadwright

My parents both receive home care & i have to say its been a god send, without it we simply couldn't keep them at home,

The care team we have are amazing people, i know we have been really lucky,

The odd time when a number of them are off or away at the same time the replacement can have a hard time & it causes stress & hassle but look my parents have dementia & need routine so there is not much of away around that,

On whole its been great for us to date