A dedicated unit has been established within the Department of Health to progress the development of a new statutory homecare scheme as a matter of urgency, according to Helen McEntee, Minister of State for Mental Health and Older People.
She said the Department had commissioned a review by the Health Research Board of the approaches to the regulation and financing of formal home care services in four European countries – Germany, Netherlands, Scotland and Sweden – which would inform the debate.
This had shown that there were several principles included in regulated home care in these countries such as standards, transparency, consultation, choice, equity, and sustainability.
These principles were implemented through legislation, policy, strategy, service planning and financing.
Standards in home care are based on best practice which was generally agreed between stakeholders, and implemented through an accreditation, training, monitoring, and inspection process. Monitoring agencies also investigated complaints. Standards in formal home care services used transparent performance indicators and public reporting in order to ensure that users could make an informed selection of home care provider.
Consultation was a major principle in regulated home care and was 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 helped to facilitate the consultation process.
In addition, most countries and their citizens explicitly agreed that home care was preferable to residential care where possible. The wider approach of having a basket of services which individuals could select services to meet their needs rather than a one size fits all approach also enhanced consultation and promotes user choice.
Patient choice is an ideal in many strategies and was implemented through choice of services, choice of funding approach (personal budget or service provision) and choice of provider. Choice of provider was facilitated through access to publicly available quality reports.
Equity was another principle that ran through access to formal publicly funded home care and was implemented through standardised health needs assessment, services provision based on need and means adjusted payments.
The Minister said the review had shown that sustainability was 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 was introduced by increasing tax-based funding, raising the threshold for access to formal home care so that only people with the highest level needs were cared for, introducing or increasing co-payments, and charging full costs for services where people could afford to pay. Personal budgets were also used to control costs.
The foremost cost in home care was paying for trained carers. Nevertheless, controlling costs in formal home care could result in reduced pay for trained carers, reduced hours of care, or the use of untrained carers who would 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.
