Pensioners could be asked to pay €5 an hour towards homecare under a new home support scheme, the ESRI has said in a Department of Health-commissioned review of funding options.
The review, published on Wednesday, examines a range of co-payment options that could support homecare in the way the Fair Deal scheme supports nursing homes.
This ESRI review only covered homecare funding options for over-65s due to limited data availability for younger groups, the report said.
However homecare is also available through the HSE for all adults following assessment of their needs.
A homecare scheme was proposed in the Sláintecare report (2017) and included in the 2020 programme for government.
Age Action warned that unintended consequences could arise from charging people and it urged the Government to talk to older people before deciding how to fund homecare.
Public homecare is currently free, with an option to pay for extra private hours. Under-65s can also be assessed for free home support, depending on need.
Among the options discussed by the ESRI is a flat-rate contribution of €5 per home support hour. It found this “would raise up to one-fifth of the total cost of the scheme”.
However, it said this type of payment was regressive and falls more heavily on low-income people.
It found means-tested contributions protect pensioners on lower incomes, with the minimum or living wage potentially set as the threshold.
Two kinds of ‘caps’ were considered: capping financial contributions to help control costs for people with high needs, and capping weekly hours for the scheme at 60. Taking the value of a person’s house into account was not considered, the report states.
The ESRI also advised a new data system would be required if co-payments are introduced to include needs, usage, and people’s means.
Claire Keane, senior research officer, said there would be increased demand on homecare. “While the expansion of current schemes could help tackle this, it will come at an increased cost for the State,” she said.
User contributions, taking account of ability to pay and need, could help fund an expanded scheme and can be designed in a way as to protect those on lower incomes and with high care needs.
Minister for mental health and older people Mary Butler said: “This research will form an important part of the evidence base for the development of a sustainable funding model for home support services in the context of our ageing population.”
Age Action said there was overwhelming support for homecare from older people contacting the organisation.
Age Action senior public affairs and policy specialist Nat O’Connor said while they are still studying the details, they welcome progress to a homecare scheme.
“There is overwhelming support for homecare from older persons who contact Age Action on the topic,” he said.
He said the scheme must be rights-based, giving the choice to people of living independently for as long as possible.
“The ESRI is correct that any major public scheme has to be sustainably funded,” he said. “But we would be concerned to make sure the funding model isn’t going to take away people’s capacity for independent living by taking too much of their money.”
He said means-testing can be deeply problematic.
“They should talk to older people around the country, hit the road,” he said.
We know two out of three older persons are not on the internet, they need to go out and talk to people who are care-