For most people, their home is a very special place. It is where they may have been living for a long time, which they have made their own through years of care, decoration, and organisation with every room containing posessions which evoke special memories, be they pictures, ornaments, books, and items related to their hobbies and pasttimes. It is where people feel comfortable and at ease, in a neighbourhood where their friends and neighbours are close by.

Home is not a place that people are in a hurry to move away from.

When a person is no longer as mobile as they used to be and can no longer perform the normal duties associated with shopping, keeping themselves and the home clean, cooking meals, dressing themselves etc. then help is needed. In some situations, other family members may be able to help out if they reside in the same home or close by. At a certain point, however, it may be necessary to bring in some professional home care. This is not an all-or-nothing arrangement. It can range from someone calling in one or more times per day to help with specific tasks, to round-the-clock care if required.

What can a person needing such home care, or their families do when they need to arrange for such care in the home? What supports are available? What information is available? What are the options? These points are addressed below.

Keeping the person needing homecare help in their home, as long as is practical, is usually their preference, and from a financial perspective, less costly than a nursing home. However, individual cases and preferences will vary, and families should discuss the various options with their relative needing care, in a calm manner before decisions are made. It can be difficult for a person, used to independent living, to accept that they need help. Forcing help upon them will only build up resentment and a state of non-cooperation. Families should point out the options, encourage the person to see the need for and benefits of home care, and perhaps start off with a trial period to see how it goes.

Always look for ways to keep the person in the control loop. Ask for their suggestions, what would they want? In terms of meals, for example, give them a say in meal planning and what is on the plate. Similarly, give them the deciding vote in terms of what clothes they wish to wear and as much control as possible in terms of how they spend their time.

Homecare Options

There are typically three options open to individuals or their families seeking homecare help:

• Employ someone privately
• Use the services of a homecare provider business
• Apply for a HSE Homecare Package

Employ someone privately

With this option, the individual requiring care, or a family member, employs someone to give the required home care. In such circumstances it is important to document the agreed work schedule, what hours, what days, what tasks and the renumeration to be paid. The employer needs to keep in regular contact with the carer, giving feedback and receiving reports on the work done, medication issued and any notes on the state or changes in care needs of the individual.

Use the services of a homecare provider business

A number of homecare provider businesses have been established in recent years and provide homecare as a service. This arrangement is somewhat easier to administer for the individual/family than directly employing somebody, but may be more expensive. Its advantages include:

• The homecare provider can usually provide a substitute carer on days where the usual carer is ill or on leave.
• There is flexibility in terms of growing/shrinking the level of care given.
• There are company standards and procedures in place governing how the carers are to perform their duties. The provider trains its staff to follows these standards and procedures and there is supervision in place to check that the required quality of care is given.

Apply for a HSE Homecare Package

The Health Service Executive (HSE) is the State agency responsible for for providing all of Ireland’s public health services in hospitals and communities across the country.

A HSE Homecare Package is a set of services, provided by the HSE, to assist an older person in their own home. The services may include:

• Home help hours (to assist with meal preparation, bathing, dressing, cleaning etc.)
• Nursing services
• Therapy services (e.g. physiotherapy, respite care, speech & language therapy).

Highlights:

• It is typically aimed at supporting older people (aged 65 years and older), but applications for people under this age may be considered, depending on need.
• They are provided at no cost to the individual, and neither a medical card nor an income assessment is required.
• A Care Needs Assessment will be made as part of processing the application. This will consider the overall health of the applicant, the level of care currently being received and the extra level of care required. It is typically conducted by a HSE appointed health care professional (e.g. a public health nurse,  a physiotherapist etc.). It notes the ability of the applicant to perform the tasks of daily living, e.g. bathing, dressing, moving around, shopping etc. It may also include a physical examination. The applicant will receive a copy of the report.
• The applicant may request their Doctor (GP) to write a letter in support of the application and include it when applying. This letter should outline how a Health Care Package would benefit the applicant.
• The resources available to the HSE to provide these packages is limited. Therefore what is granted to the applicant under this scheme, if anything, may fall short of the full home care need, as the applicant would see it. It may be necessary to seek additional homecare using some of the other options outlined above.

For more information, and for a Home Care Package application form, see HSE Home Care Packages.