Bríd Smith criticises for-profit home care and respite cuts

Thank you very much, very interesting discussion and I am sorry I missed the presentations earlier, I had to go to the chamber, but there are a couple of questions from what I am hearing that I would like to hear a little bit more about, and one is one Kathleen touched on about the idea of the profit making from the industry, and I know this in a very scientific way of approaching it, but I am just looking at my own community at Ballyfermot, there is a huge amount of people in that community, women mainly, but some men as well, who are carers and who traditionally would have worked for what we call the home help teams, and they were locally based, they were run in local offices, the HSE, nuns and all sorts of people around them, but everybody knew everybody who they were caring for, and when you said being cared for is also about being loved, that was a huge element of that job, because one woman for example on my road looked after three of her neighbours, and she was mad about them, and she was there for them all the time, they could pick up the phone if something awful happened, but she would spend a couple of hours with each of them every day, now she works for a company, because despite all the protests we had to try and maintain the home help system, she works for a company, and she is tied to time, she can only spend 15 minutes with this one, half an hour with that one, and they follow her on a mobile app, to make sure that she is in and out on time, she is totally pressurised, she hates the job, she has not got the same rapport, because she is not necessarily minding older neighbours that she grew up with, and it just seems to me that the concept of privatising and making care a for-profit business really, has demoralised and dehumanised the whole sector, both the workers in it and the people receiving it, and then you have got the added problem that a lot of migrant workers go into this because it is also so badly paid, so badly regulated, and a lot of migrant workers find it hugely difficult, I suspect there is a whole level of exploitation, you might comment on that if there has been any research on how migrant workers fare out in the sector, but you also have the other problem that older people and sometimes that are deaf and they do not understand an African accent or an Indian accent and they feel alienated from it, so it just strikes me that that whole movement away from the state extracting itself through the home help system in the community and allowing all these companies, and there are so many of them, multinational companies flourishing on the back of this around the country has been a disaster, and I know so many people and I am sure all the other deputies and senators do as well, who cannot get out of hospital because there is no home care package ready for them, so they are occupying beds that they do not want to be in, they want to get out, but there is no home care package because all this for business model is messing it up, but just some direct questions on your research and the work that you do is around migrant workers, also around respite, around respite, there is, I was a home care myself for about six years for my mother, the respite grant would come to you in June, 1500 euros or something, but mostly use that to pay your car insurance or some big bill you had, because the money you were getting during the year did not cover it, and the respite never came, and then also in my own community, there was a great little community hospital called Cherry Orchard, but they have closed all the respite wards, where people used to be able to get a week off, put their daddy in, or their daughter or whatever, and get a week off, the whole thing to me seems to be in an awful mess, and I think what I am hearing here is confirming that, so it is just around migrant workers, respite care, and the question of mental health, I have just finished reading David Morphy's autobiography, and it is extremely sad how the mental health of the carer, and also who they are caring for, starts to disintegrate if you do not get support. The vote has been called in the Shannad, so I know our senators may wish to leave for a few moments. Thank you Brie, you have raised a lot of important issues there. Can I go to Kathleen first, I think this time? Kathleen. The thing I was trying to say at the beginning, I know it may appear academic, but it is actually what you have just said. Caring is about relationships, and when you get old, it is not just a matter of being kept clean, and there is research showing particularly, I refer to it there, Professor Timman and Trinity, where they have done a lot of studies of older people about who are being cared for, and a former student of mine, Luciana Lulidge, and they say exactly what you said. They want to be cared for. They want to be cared for by people with whom they have relationships, not just somebody who comes in and washes you, or who is only five minutes, and time defying care becomes supervision. It is not care. Many people who need care. Many people who need care on their own are lonely, and they come back to the mental health issue. The reason they want somebody who can talk to them is because they need company. They often need company more than they need washing. And I think that what you're saying is we need relationships to build up in care. And that means that people have to stay. And as you know, as in the childcare sector that was discussed at your last meeting, there's even more so in the home care and in the residential sector, there's constant mobility of people out of the sector. So you have no relationship. But it's often the relationship that matters to the person. So I'm absolutely you are 100% right on that. And you mentioned about migrants. Yes, the Migrant Rights Centre have done some work in this area. And yes, many people are working that sector who are migrant workers. And we know very little about them, except they claim that there is a lot of exploitation. I can't say that that's definitive because we haven't done a national study and say it for definite. But I referred to a report there in 2015, where they say, for example, a lot of places in nursing home care, there are a lot of people who are migrant workers. And that's wrong. It's fine. Except that how long will they stay? You know, what's the security? There are a lot of issues there. And it's about the quality of relationships. That's what I want to say. Care is not just about making sure we've so much focus on a medical model of care, which is about bodily cleanliness, if I may say so, and physical safety. But in fact, when you're old and alone, and if you're there all day, what you want is a relationship, you want company. And I think the state has abandoned certain people in many, many ways. And certainly in certain counties in Ireland, I'm very familiar with County Clare where I'm from, because I have this experience with my own mother, we fought tooth and nail not to have a private provider when we were supplying care. And I do want to say something when people talk about full time carers, somebody who's done it for a long time. You have to have a lot of commuting carers, commuting from Dublin, commuting from Corp, commuting all over the country. We did it, my sisters and I, for weekends on ad nauseum. Up at night, up at Sunday night, up on Saturday night, somebody has to be turned, you have to be there. There's no, I don't know how, that's not counting the census. It doesn't exist. But it is a very big national issue for people who are doing it. But yes, on your micro, the respite services, absolutely. You get the grant, it's now 1800. But it's so small. It's tiny. It doesn't remotely cover a lot. Many of which are ancillary costs that you have to cover, like washing, like if you have constant washing of sheets and ESB bills and energy bills and heat in the house and all those kinds of things. There are enormous costs to having, like you've just said, about the cost of being at home. So I think it's an enormous issue. I absolutely agree that there needs to be some kind of home care package that is driven by the needs of people, not driven by making money. Thanks, Kathleen. Thanks for raising that point about commuting carers. I think it's often lost or overlooked. Zoe? I don't necessarily have a huge amount to say and I'm conscious of time. I suppose one good thing to say is that the respite grant was changed in name a couple of years ago to the carer support grant. And while that's, you know, that was done due to reflect the kind of the changing nature of how carers are using it, because a lot of people were using it as a respite from bills or a respite from extra costs, not necessarily as respite from caring. And yeah, the closing and the access to respite is a really huge issue. I know there's probably not much time to discuss it too much, but yeah, they're very valid points. And there is a clear recommendation. There is. Yeah, absolutely. And I think there's, I think there's a particular opportunity now to actually rethink respite and actually rethink how it's, how it's been done, because we've had two years with pretty much everywhere respite being closed and things are starting to open up again, but the availability is not there even close to what it was, which was still not very much beforehand. So, John, I think you want to come in, but yeah, recommendation seven specifically on respite in the assembly document. Can I say just a bit about respite? It is a big, broad area. Talking about centres that provide respite, residential respite, by and large suits carers of younger people. Carers of older people don't like often residential respite. They would like in-home respite. They'd like to be able to stay at home. So just that is a starting distinction. Another distinction is between what we call regular respite. Everybody should be able to take a break every so often and emergency respite when you need cover. That could be, for a family occasion, it could be because you have to go into a hospital for an operation yourself. Just to acknowledge that in the past 18 months, the HSE began to acknowledge emergency respite as a concept in its own right. We do a lot of trying to deliver it. I would say we are successful in about 50%, maybe 60% of the cases. In other words, there are 40% of the cases where we cannot find suitable respite, either because it is someone who needs a residential space with very clear criteria which just is not available, or because there is not a worker available in a particular area or whatever. But I would say 50% or 60% is better than nothing. Historically, there was no emergency respite. There was a thing called emergency respite and if you booked it a year in advance, you could have it. That is a strange sort of emergency. The other point I want to totally agree with you on the idea of home help. It was an extraordinary move by the HSE to effectively get out of the business of home help and get into the space of personal care, home care. Trying to backfill it now, my suggestion or my idea would be that in looking at overall labour force planning for a home care sector in Ireland, that you could have an interesting training stroke apprenticeship, probably not a formal apprenticeship, but a training model which involves the trainees who are not yet in a position to go out and do one-to-one caring. But they certainly could be in the position to be doing home helping. So as part of a graduated ladder of levels of care, the basic level could be home help. And that is to some extent company keeping and to some extent it is doing small stuff like running to the shops. But Kathleen is right, at the moment the focus is on cleanliness and perhaps a little bit of medication care, although that is quite low. You mentioned mental health and I might have misunderstood it, but I would say there is an issue, there is a big issue in the last couple of years around the mental health of carers. And we have again developed a counselling service, which I must say is proving very effective. Our whole our whole model of caring is caring is it's a good thing. It's actually a rewarding thing. It's challenging. So people cope. They have routines and they kind of go along at a certain level and periodically the caring arrangement changes. Something happens. The person has an extra bit of illness or falls or whatever. There is a strain on the system. Carers go into crisis periodically and our focus then is on trying to bring them down back to a sustainable model. Caring has been or counselling has been really effective around that. But I would also say counselling that is just talk isn't much bloody use. If someone is stressed and needing counselling because they can't afford to pay the bills or because they have to carry their adult stone upstairs because they don't have a downstairs toilet. And these kinds of things, there's no point in talking about that. You've got to do something practical as well. So our intervention, I must say around, it's a holistic intervention around care of wellbeing. It includes counselling and we can measure the effectiveness of it. But if we didn't have the practical responses to go with it, I don't think it would be half as effective. But it's definitely the mental health of carers is a big part. Again, obviously one for weird things. Dumbo thought he could fly because he had a feather in his thing and then he dropped his feather and discovered. We live by having a confidence in ourselves. If carers lose that confidence in their ability to cope, that's it. They're gone. You know, it can't keep it up. Thank you.