Tuesday 11th April 2017
Speaking on the publication of the evidence review, the Minister said “My priority is to ensure that our older people get the best care possible. For many that is long-term nursing home care, but for many others that care can be provided in their own homes, surrounded by the people and communities that they love. Unfortunately, as a country, the only statutory scheme we have in place at present to care for our elderly is the Nursing Homes Support Scheme, ‘a Fair Deal’. As Minister of State for Older People I am determined to change this and to establish a new statutory homecare scheme.
“Homecare is an increasingly important part of the supports we offer to older people, and will continue to increase in importance into the future, as our ageing population grows. It is estimated that about 20% of the over 65 population receive some form of community-based support service annually from the State. I am committed to enabling more care in the community for older people, so that they can continue to live in their own homes for as long as possible.”
The Minister went on to say “This evidence review carried out by the HRB concludes that there are several principles included in regulated home care in other countries, such as standards, transparency, consultation, choice, equity, and sustainability. These principles are implemented through legislation, policy, strategy, service planning and financing. The experience of other countries will help to inform the debate around future consideration of approaches to formal homecare regulation and financing here in Ireland. This is an important step towards the development of a new statutory homecare scheme for Ireland.”
The Minister went on to say that “The development of a new statutory homecare scheme is a complex process which will require detailed preparatory work. A dedicated unit has been established within the Department of Health to progress this work as a matter of urgency. A consultation process, which is planned for the end of May, will allow all those who have views on this topic to have their say, including older people themselves, their families and health care workers.”
The Minister thanked the Health Research Board for their work and said “This review is an important step in the process, currently underway in the Department of Health, to determine what type of homecare scheme is best for Ireland, in relation to both regulation and funding. I am committed to progressing this, as a priority.”
The Health Research Board’s evidence review is available on the Department of Health and Health Research Board websites.
Health Research Board Report – Approaches to the regulation and financing of home care services in four European countries. An evidence review.
NOTES FOR EDITORS
This evidence review describes approaches to the regulation and financing of formal home care services in four European countries – Germany, Netherlands, Scotland and Sweden.
The overarching research questions were:
1. Describe the regulation of formal home care services in the selected countries.
2. Describe the (staff and client) experiences of, and effectiveness of, regulation for formal home care in the selected countries.
3. Describe the approaches to assessing, financing and financial management of formal home care services in the selected countries.
Summary of Findings and Conclusion
There are several principles included in regulated home care such as standards, transparency, consultation, choice, equity, and sustainability. These principles are implemented through legislation, policy, strategy, service planning and financing.
Standards in home care are based on best practice which is generally agreed between stakeholders, and implemented through an accreditation, training, monitoring, and inspection process. Monitoring agencies also investigate complaints. Standards in formal home care services use transparent performance indicators and public reporting in order to ensure that users can make an informed selection of home care provider.
Consultation is a major principle in regulated home care and is achieved through care recipients and other stakeholders having a voice in the development of standards. Care recipient’s own needs assessment and care planning as well as surveys on user satisfaction help to facilitate the consultation process. In addition, most countries and their citizens explicitly agree that home care is preferable to residential care where possible. The wider approach of having a basket of services which individuals can select services to meet their needs rather than a one size fits all approach also enhances consultation and promotes user choice.
Patient choice is an ideal in many strategies and is implemented through choice of services, choice of funding approach (personal budget or service provision) and choice of provider. As already mentioned choice of provider is facilitated through access to publicly available quality reports.
Equity is another principle that runs through access to formal publicly funded home care and is implemented through standardized health needs assessment, services provision based on need and means adjusted payments.
Sustainability is approached in a very thorough manner in Germany and the Netherlands through compulsory long-term care insurance and means adjusted co-payments. In tax-based countries sustainability is introduced by increasing tax-based funding, raising the threshold for access to formal home care so that only people with the highest level needs are cared for, introducing or increasing co-payments, and charging full costs for services where people can afford to pay. Personal budgets are also used to control costs.
Costs: The foremost cost in home care is paying for trained carers. Nevertheless, controlling costs in formal home care can result in reduced pay for trained carers, reduced hours of care, or the use of untrained carers who will work for a lower hourly rate. The downside of personal budgets may be a lack of implementation of regulated standards and a lowering of the quality of care.