Homecare shortage leaves more than 1,000 patients stuck in hospital

More than 1,000 patients approved for home support had their discharge from hospital delayed this year due to a shortage of carers, Health Service Executive (HSE) figures show.

Data obtained by The Irish Times under Freedom of Information laws show 7,866 patients were unable to be discharged despite no longer needing hospital care between the start of the year and October 13th.

The largest reason, affecting 1,013 patients, was due to the individual being approved for a home support package, but there being no carer available to meet their needs.

A total of 553 patients remained in hospital as they were waiting for funding approval for a home support package, while 108 delayed transfers of care were due to an intensive home care package of more than 21 hours being required but needing approval from a community healthcare organisation.

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A further 375 patients who were approved for funding for the nursing home support scheme (NHSS) had their discharge delayed due to having to wait to secure a place in a care setting. A total of 1,144 people had their discharge delayed by various lengths of time, in order for the NHSS application to be completed and submitted by either the patient themselves or their family.

A 2018 government report found there were “consequential risks” to delayed discharges, such as healthcare associated infections, general physical deconditioning and other adverse outcomes, such as falls.

Tony O’Brien, former director general of the HSE and now chairman of the Home Care Providers Alliance, said staying in hospital for longer than necessary was “not good for you, especially if you’ve already been in hospital for a while”.

“There’s a thing called decompensation, where your ability to readily adapt to coming home can become diminished,” he said.

“They’re [hospitals] also a place where you can pick up other infections. There are risks to your health to continuing to be in hospital beyond the date the doctor decides you’re ready to go home.”

Mr O’Brien said there was only a finite number of hospital beds and there were “more people needing to get into them through the emergency departments and elective care than beds available”.

“Waiting lists and overcrowding in emergency departments are perhaps worse now than they’ve been in some time. The restrictions in access to homecare just makes that worse,” he added.

The HSE said the Covid-19 pandemic had posed “additional challenges”, which affected delayed transfers of care (DTOCs) within acute hospitals. “Demand for services in general is greater than normal at this point, and both acute hospitals and community services continue to address capacity.”

Plans to improve the situation included working in an “integrated way” to increase home support, and enabling and building capacity in rehabilitation, nursing home and community nursing units, publicly and privately, it said.

Minister of State for Older People Mary Butler has said the national shortage of carers is the most urgent problem in homecare. According to recent figures, more than 6,000 older people are on a waiting list for the service.

A report from the strategic workforce advisory group on home carers and nursing home healthcare assistants, published by the Department of Health in October, noted an “acute shortage of care workers against a background of rising demand”.

The fact that many of those “providing home support are themselves older people” would likely “exacerbate existing workforce shortages” in the future, it said.

A spokeswoman for the Department of Health said the Government was “committed” to addressing workforce challenges in the home support sector. Work to implement the 16 recommendations of the workforce advisory group had commenced, she added.