ANALYSIS:If the health authorities care about dignity and wellbeing of the elderly, they must act right now
THE NEED for proper regulation and supervision of home help services provided to vulnerable older people has been talked about for some considerable time but to no avail.
It is only when undercover cameras are used to show us in black and white the danger older people can be put in when carers, untrained and unvetted, go into their homes that those in authority begin to sit up and take notice.
They have had plenty of warning before now, however, of the potential for abuse in this sector. There have been anecdotal reports of sons and daughters applying for homecare packages for elderly parents and drinking the money, as well as reports of older people being verbally abused by carers – things that will always be denied without CCTV footage.
Outside the realm of the anecdotal, there have been several complaints to the Health Service Executive (HSE) about home helps, many of them from private companies, not turning up on time or at all, and there have been a number of court cases in recent years in which home helps were prosecuted. In the most recent case earlier this year, a HSE home help who found a pensioner’s bank card and pin number and withdrew €17,500 from his account without his knowledge received a fine and a suspended sentence at Kells District Court.
A study carried out by the UCD-based National Centre for the Protection of Older People also found 2 per cent of older people who were victims of elder abuse named the perpetrator as their home help. Some 13 per cent of the 2,000 older people surveyed for the research were receiving home help.
About 65,000 older people in the State receive homecare services either from the HSE or the growing number of private companies which have established businesses in this sector – obviously because it is pretty lucrative. The HSE spends about €340 million a year on homecare and 10 per cent is channelled into the coffers of private operators – a not-inconsiderable €34 million a year.
The major growth in the private homecare industry has coincided with the setting-up of the HSE in 2005 and the appointment of Mary Harney as Minister for Health shortly before that. She began the idea of homecare packages to keep more older people in their own homes, which is where they want to be if at all possible.
There are now about 150 private companies providing homecare, up from about 10 a decade ago.
But there are no statutory regulations or standards governing this huge industry. Anyone can open a homecare company. Anyone can set up a website and say all their staff are trained and experienced. But, as we saw from Prime Time Investigates, on Monday night claims are one thing, the reality can be very different. It featured one homecare provider, Jennifer Sarsfield, discussing with an undercover care assistant before visiting the home of a vulnerable older person how she would lie and say the new care assistant had worked with the company for some time and had received training. They had no idea how to use a hoist but would ask the ill man's wife to show them how when they arrived at their house.
In another case, a supervisor with Clontarf Home Care Services was seen dumping some of an older person’s medication into a bin when the client didn’t take it. In theory, nobody would know. But the hidden cameras couldn’t disguise the reality.
A care assistant with Clontarf Home Care Services was also shown force-feeding a woman and also insisting on wiping the client after she went to the toilet, even though the client was able to do so herself and wanted to do it herself. This carer told the undercover worker it was her job to do it because the lady was old, all in earshot of the older woman as if she didn’t exist.
It was heart-breaking stuff.
Three staff have been suspended by the Clontarf service, a voluntary not-for-profit provider, pending a full investigation.
The cases highlighted on the programme all involved homecare provided by private companies. But some private homecare companies undoubtedly provide good quality care to older people. The problem now is nobody knows which ones to trust in the absence of agreed standards.
The HSE, in responding to the disturbing programme, tried to reassure us by saying it provided 90 per cent of homecare services to older people itself. But, however well-intentioned, this was not reassuring because neither the private nor the public sectors are regulated. The reality is we actually don’t know if the public home help services provided by the HSE are safe either, though the executive says it does ensure all new staff get Garda clearance. It also says it has 66 home help co-ordinators or organisers to oversee its 4,256 home helps and that public health nurses would also be picking up on problems if they existed.
But many who avail of home help never see a public health nurse, and one home help organiser told this newspaper she rarely ever has time to supervise home help visits.
We know from past experience too that the HSE’s own inspection of services doesn’t work. Take Leas Cross for example. It had ample notice of problems in that private nursing home in north Dublin but didn’t act to shut it down until another powerful expose by Adrian Lydon left it with no option.
So we will never be sure homecare services, be they public or private, are properly monitored until an independent outside agency is given the job of policing the sector. This task must go to a body like the Health Information and Quality Authority which must be adequately resourced to do the job. It now inspects nursing homes but these only cater for 5 per cent of the over-65 population. Homecare services cater for more than double that but do not come under its remit.
The HSE also says it only received 38 complaints from eight local health office areas in Dublin about homecare services over the past 3½ years. This is not reassuring either. It shows a complete lack of understanding of the client base. Many, including those who are bedridden, would be unable to complain even if they wanted to.
While the focus must now move quickly towards addressing the lack of regulation in this sector, we must also ask ourselves why action has not been taken before now given the range of organisations that have been seeking change. The Commission on Patient Safety in 2008 and the Law Reform Commission report on Legal Aspects of Carers in 2009, both recommended regulation of the sector. So too did a report from the Irish Private Home Care Association earlier this year, a body which represents about 50 of the private homecare companies in the country and has its own standards which members must meet. And the National Economic and Social Forum, in a report published more than a year ago, expressed concern about lack of training and supervision, as well as a lack of Garda vetting of some people providing homecare services under the homecare package scheme. It also drew attention to the fact there were no set standards for the care being provided and little monitoring of outcomes.
So why has nothing happened? Why is it not illegal to send an unqualified care worker into an older person’s home? It seems to come down partly to the low priority accorded older people in our society, as well as the complex nature of homecare, which will always be difficult to police. And policing it will be costly and this may also be a factor.
There is now a chorus of calls for all these issues to be addressed. And so there should be. We owe it to our growing population of older people so they can feel secure when supported by carers to live in their own homes during their twilight years.
But as far as the Department of Health is concerned, the question of possible changes to legislation, including regulation and inspection for homecare generally – which is a policy matter for it and not the HSE – is just “under consideration”. Not much urgency there then. Must we wait for disasters to happen?