Pauline Tully (Cavan-Monaghan, Sinn Fein)
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I am raising the issue of gaps in home care provision because it is having a detrimental effect on the everyday lives of people, whether elderly or disabled. I am contacted regularly by family members of older people and disabled people who have been approved hours that are not being filled. This is where a home care package has been put in place, the person has been assessed and the hours required are approved, but they are not being filled. This happens regularly. For example, I was talking last week to a young man, Finn, who is almost 23 years of age. He has a condition called Duchenne muscular dystrophy and his mother, a single parent, is his sole carer. He has been approved for a package for seven days a week, twice a day, where two carers are to come in to get him up in the morning and change him for the day, and then are to return to put him back to bed at night. Invariably, carers do not turn up or only one will turn up when two are required, given it requires two people to turn him. This means the mother has to ask a neighbour or friend to come in and while those neighbours and friends do not mind, they may not always be available, and she should not have to rely on that sort of help on an ongoing basis.

The mother states that some of the carers are directly employed by the HSE. They come in during the week and they are generally reliable, they are trained, they know what they are doing and they stay the length of time they are supposed to. However, the HSE also relies on an agency to provide care for an amount of the time. She says that it is no exaggeration to say that 20 different people have been through her door, and they are not trained or even informed of Finn’s care needs. One carer came in and tried to move him from the back of the neck, not knowing that he has a rod in his spine. He was hurt and spent two weeks in considerable pain. The mother said this agency is not reputable, although she did not say that about all agencies. The HSE needs to review the agencies it is employing to provide the care. Preferably, I would like to see the HSE directly employing carers so this situation does not arise.

A 34-year-old lady, Lindsay, has locked-in syndrome and can only move her eyes following a stroke. She has an intensive care package of three visits a day from carers, seven days a week, with three carers at a time being required. Her parents are her carers. Again, invariably, only one or two of the carers turn up and it is not sufficient, so she is not getting the care she needs.

When I write to the HSE about this and other cases, I am given an outline of the care package approved but am told that the carers are not available. That is not good enough. People with the most need have to be prioritised so they get the care they require. We cannot have people left for a whole weekend. Finn’s mother was telephoned last Friday at 4 p.m. to be told there were no carers for the weekend. When she tried to call back, she could not get through to anyone. Sometimes the lines are only open for two hours a day and it might be that nobody answers or returns calls.

People are being left high and dry. It is a huge issue that is preventing people from going into nursing home or residential care. To be kept in their own home is their preference but it also saves the State money. While the care packages can be expensive, they would not be as expensive as if this person had to receive round-the-clock care in a nursing home. They should be facilitated to stay in their homes and given the proper care by trained professionals, who show empathy and understanding and act in a professional manner. That is not happening on an ongoing basis and families are at their wits' end.

Thomas Byrne (Meath East, Fianna Fail)
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I thank the Deputy for sharing those stories. It is important that she shared them on the record of Dáil Éireann because it is important that those types of situations are not allowed to continue. We all hear stories like that. Nonetheless, there is actually more home care taking place. To give the exact position in Cavan, 724 people there are availing of home support services. The waiting list is currently at 146 people and, of those, 26 people on the list have no care and are waiting for their package to start. The remaining 120 people have care but are seeking more care, or perhaps staff are not available.

Joint targets have been set for Cavan and Monaghan and the target set for 2024 is for 608,416 hours of care. This year, we expect the total number of hours to be 662,000, which is 9% above the target. I accept what the Deputy says with regard to the deficits that exist, but this figure suggests 50,000 more hours this year than last year.

The HSE tells us that priority is given to those in the community with acute needs and people waiting in hospitals who want to return home with supports, although the Deputy has listed cases where that has not worked out. While there is a significant level of service provision across the area, demand continues to grow. The HSE recently reported that Cavan and Monaghan had a rolling campaign for the recruitment of healthcare assistants for home support. Since 2021, 88 new healthcare assistants for home support provision have been employed across Cavan and Monaghan and there is now a panel in place for healthcare assistants following interviews in April.

The HSE has assured the Department that it is fully committed to supporting people at home. We are committed to addressing gaps in home support in Cavan and Monaghan and nationally by supporting the recruitment of home support workers within the sector and continuing to deliver on the recommendations of the strategic workforce advisory group on home carers and nursing home healthcare assistants.

Pauline Tully (Cavan-Monaghan, Sinn Fein)
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People are living longer and their care needs are going to increase, and we will have more people with neurological conditions. Rather than having them go into homes, we prefer to see people make the choice to stay in their own homes and receive the care they need. It is recognised that they need the care, and they have been assessed and approved for the hours, but those hours are just not being filled. There is a crisis in the home care sector. A further recruitment campaign is needed, as well as proper training for individuals who are going to take up that work. I believe there are people in the community willing to do that work but pay and conditions are an issue. There is a difference between the pay and conditions of someone who is directly employed by the HSE and someone employed by an agency, and we need to fill that gap. Home care providers are often driving around rural areas, such as Cavan, where some of the roads and lanes they have to travel are very poor, but they get nothing towards travel, which is another issue.

It was also brought to my attention in September that homecare providers in CHO 1, of which Cavan is a part, were told that a recent pay and numbers letter had been issued, based on directives from the CEO and CFO, and with immediate effect, there would be no increase in hours implemented unless they are reallocated from previously ceased hours.

They are saying that new home care packages can still be approved but those awaiting additional hours will not be funded for those hours that they have been clinically assessed as needing. There seems to be a pull-back here because of money in not providing this essential care that people need in the community. That is very serious. We cannot have a blunt instrument where we cut people off and tell them we are not giving any more money, whether people need it or not. People have to be assessed to ensure they are given the hours they require to live comfortably and safely in their own homes.

The young man, Finn, I spoke about earlier, has now got to the stage where he is nearly afraid to let others help him get out of bed because they are not trained and he is afraid of falling. He is almost confined to bed because of the lack of trained carers who are coming in to him.

Thomas Byrne (Meath East, Fianna Fail)
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The details of Finn's case and the other case the Deputy mentioned should be provided to the chief executive of the HSE and the Secretary General of the Department. As I said, the number of hours this year is 10% higher than we budgeted for and it is approximately 9% higher than what was provided in 2023, so there are a lot more hours available. There have been some improvements, including the new HSE authorisation scheme for home support, which has been in place since August, for payments to approved private and voluntary providers to deliver home support on behalf of the HSE. This delivers on commitments for sectoral reform, such as payment for travel time for home support providers, paying carers the national living wage at a minimum, and bringing legacy rates into line with the new revised rates of funding. We think this will help. This is work that has been done under this Government. I know there is a lot more to do but we have recognised some of the points the Deputy has raised and taken steps to address them. However, we need to do more; there is no question about that and we certainly want to do so.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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Táimid tagtha chun deiridh le clár oibre an lae inniu, clár oibre na seachtaine agus deiridh na hoibre den 33ú Dáil. Arís, gabhaim buíochas le gach ball den fhoireann as ucht na cabhrach a thug siad dúinn le blianta beaga anuas. Tréaslaím leo an sárobair a dhéanann siad. Go n-éirí go geal le gach ball, iad siúd atá ag éirí as agus iad siúd atá ag dul ar aghaidh arís ag iarriadh teacht thar n-ais go dtí an 34ú Dáil. Leis sin, tá an Dáil ar athló sine die. Go raibh míle maith agaibh.