Tom Clonan: Will HSE Block Funding for Small Carers?
Tom Clonan asks the Minister whether clause on page 9, paragraph 9(2)(a) of the Bill will allow small home-support providers, who are exempt from regulation, to receive HSE funding. He draws on his family's long experience with HSE carers to show why the clause matters for continuity and choice.
Regulation loophole: Tom Clonan raises a specific concern about paragraph 9(2)(a) on page 9 of the Bill. He warns that exempting people who provide home support to fewer than four clients could create a way for operators to evade regulation by keeping client numbers small.
Family experience: Clonan recounts more than a decade of his family receiving HSE carers and describes how the model of provision can be inconsistent. He praises the carers themselves but explains how changing staff, missed visits and low pay undermine continuity of care for his son.
Brokerage and funding implications: Clonan asks whether the HSE could refuse funding to brokerage-style providers that fall outside the Act's definition - leaving families forced into providers they did not choose. He describes an instance where his family felt compelled to accept a provider for fear of losing supports.
Consequences for choice and continuity: Clonan presses for a clear guarantee that small providers, while potentially exempt from regulation, will not be excluded from state funding. He frames the issue as one of unequal power between families and the HSE and of protecting the right to choose consistent, trusted carers.
Regulation loophole: Tom Clonan raises a specific concern about paragraph 9(2)(a) on page 9 of the Bill. He warns that exempting people who provide home support to fewer than four clients could create a way for operators to evade regulation by keeping client numbers small.
Family experience: Clonan recounts more than a decade of his family receiving HSE carers and describes how the model of provision can be inconsistent. He praises the carers themselves but explains how changing staff, missed visits and low pay undermine continuity of care for his son.
Brokerage and funding implications: Clonan asks whether the HSE could refuse funding to brokerage-style providers that fall outside the Act's definition - leaving families forced into providers they did not choose. He describes an instance where his family felt compelled to accept a provider for fear of losing supports.
Consequences for choice and continuity: Clonan presses for a clear guarantee that small providers, while potentially exempt from regulation, will not be excluded from state funding. He frames the issue as one of unequal power between families and the HSE and of protecting the right to choose consistent, trusted carers.
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Transcript
Minister, you're very welcome as are your officials and I hope you'll be able to address my concerns in the time provided and I just want to echo what Senator Stephenson said. I have a concern about on page 9, at paragraph 9 2a, the person provides a home support service to fewer than four persons. It's on page 9 of the bill and so Senator Stephenson quite rightly points out a concern about, you know, could an unscrupulous operator, you know, get a whole pile of smaller, if you like, care providers, limit them to three clients and in that way try to evade regulation. So that is a concern and I think that that suggestion of an amendment providing that they only, you know, the person who's deemed exempt from the regulator is only providing care to that number of people. But my concern about this and I don't know if you, if your officials can answer this for me, but I'm very, very worried about this clause for a different reason. So just to give you a context, I've been receiving, or sorry, my family has been receiving a number of carers from the HSE for a very long time now, maybe 10 or 12 years, and to echo what Senator Tully said, you know, the experience is mixed. I would echo what you said, Senator Crosslow, that without exception the people who come into our home from all over the world are without exception the most wonderful people. But it is the model of provision that can sometimes lead to inconsistency. So for example, we did have one service provider where you could never know from one day to the other, A, whether somebody would turn up, and B, it was rarely the same person. And then, you know, they wouldn't understand my son's care needs, they would, I'd have to come down. It just was very, very stressful. So that's one thing. So that, if you like, for-profit care providers, and I'm not going to name them because I don't want there to be a suggested or implied criticism of them, but that can be hit and miss. And also because of the money that they take from the HSE, they keep a certain amount for themselves, and those carers tend to be paid very little. And what we have all the time with our son is that he gets a wonderful carer, they really gel, and then, because they're only being paid 12 or 13 euro an hour, they inevitably get a better offer of work. And they say, I'm really sorry, but I have to move on. And so that continuity is denied. So I just want to say this. In all of those years, there is a very unequal power relationship between families and the HSE. I'm not talking about the carers, but with the HSE themselves, the people who open the funding gates. And across all of the regional health areas, they're all different. They're all capricious. They all have their own little kingdoms. They all have their own little rules. And I've had them say to me, you're not getting that funding. I said, why not? And I said, because I say so. And because we don't have a legal right to any of these things, it's very hard to push past that. So in relation to the brokerage model of care provision, where, let's say, a company like At Home Instead, where the client gets to pick and choose their carers who are then coming in and providing a service, but they wouldn't come under the definition of the Act, because they would likely be dealing with just two or three clients. Would this legislation give the HSE... Yeah, so the brokerage model, where... Yeah, so would the HSE be able to say, no, we're not giving you funding for that service provider because they're not amenable to regulation, and it would be kind of irresponsible of us to release public funds to a carer in that situation. That's something I really need to get an answer on, because if that were the case, that confines all of us then to using a model that we don't want. Like, for example, most recently, when funding was cleared for supports for my adult son, his preference was to go with the care provider that had been given to him through the higher education thing for going to university. And the HSE just said, no, in our CHO, they just said, no, you can't do that. You'll take this company or you'll take nothing. And, like, so for fear of losing the funding, we just had to accept it. And they have been fine, but it's not the service of his choosing. So I just wanted to... Could you clarify that for me? I understand that people providing less than three or less than four are exempt from the regulations, but can you guarantee that they will actually, notwithstanding that, be allowed to receive state funding to provide the very valuable services that they do? Thanks for your patience on that. Thank you.