0. Report Structure
This report sets out to examine current and potential forms of support for female carers of the elderly and people with disabilities. Chapter one outlines the background to the work, while Chapter two sets out the Joint Committee’s recommendations.
The complete result of the work done by the researcher engaged by the Joint Committee is included in this report.
1. Introduction and Background to the Study
Background to the preparation of Consultant’s Report
1.1.In a society where lifespans are being extended and where there is an increasing emphasis on non-institutional care, women are increasingly being placed in the role of carers for the duration of their working lives.
The Joint Committee was concerned that a support infrastructure should be in place for those who provide such care.
This report represents the result of the research commissioned by the Joint Committee on such a long-term support framework.
1.2.The complete results of the work done by the researcher as presented to the Joint Committee is included in this report. The Joint Committee considers it to be a comprehensive and valuable examination of the provision of current and potential forms of support for female carers of older people and people with disabilities.
Joint Committee’s Recommendations
1.3.The Joint Committee lists its recommendations in Chapter 2. The Joint Committee urges that Government and other relevant organisations examine these with a view to their implementation as soon as possible. The Joint Committee wishes to emphasise its intention to monitor developments in this area.
1.4.The Joint Committee wishes to thank its researcher, Mr. Mel Cousins, for his valuable input to its deliberations on this topic and his preparation of the annexed study.
2. Recommendations of the Joint Committee
The Joint Committee recommends that a White Paper on Policy on Caring and Carers must be drawn up as a matter of urgency. There is a clear need for a government policy statement on care provision over the next ten to fifteen years, which must be underpinned by a comprehensive definition of community care and full financial commitment and which must detail exactly how and by whom care is to be provided and funded. The White Paper should be based on existing and forthcoming reports such as the Carer’s Charter, the Year Ahead and the Health Strategy and should indicate a clear commitment to providing Community care services which compliment rather than substitute for informal care. The key issues which should be addressed in the White Paper are:
(i) funding and resourcing for care services
(ii)how care needs can be reduced
(iii)how the supply of informal carers can be increased
(iv)provision of appropriate supports to carers in the community.
2.The Joint Committee recommends that policy should fix clear goals in relation to caring and carers, including the support to be provided to carers. Monitoring of these goals should be done on an ongoing basis with formal reviews at five year intervals to take into account changing circumstances.
3.Funding and Resourcing Community Care
The White Paper should set out a clear policy on an appropriate balance between the three different sources of funding and resources which exist at present:
(i)voluntary contributions of the services of carers and carer’s support groups;
(ii)financial contributions from the persons requiring care and their families;
4.The Joint Committee recommends that national guidelines should be introduced by the Department of Health in relation to eligibility and charges as set out in the Health Strategy.
5.In view of the unequal burden placed on a comparatively small group of frequently elderly, predominantly female carers, the Joint Committee recommends that various means of broadening out care and responsibilities among members of the family of the person requiring care and throughout the wider community should be investigated.
6.Public funding of community care services is justified on the basis of social justice and should be increased. The Joint Committee recommends that alternative methods of funding care provision should be examined by the Departments of Health and Finance, such as measures to facilitate private health insurance towards the cost of long-term care and equity release schemes enabling the realisation of the value of their home by persons requiring care in order to generate a cash income.
7.Reducing the Need for Care
Health policy should be tailored to reduce the need for care by
(i)developing preventative healthcare and health promotion programmes (the health services have a key role to play in this area)
(ii)providing accessible housing (e.g. Developing lifetime adaptable housing and small sheltered housing schemes by both voluntary organisations and local authorities)
(iii)providing assistive technology (e.g. installation of simple devices such as grab handles and use of computer technology)
(iv)ensuring an adequate income for older people and people with disabilities in line with their specific needs.
8.Increasing the Provision of Care
In view of the increasing participation of married women in the paid labour force and of women in general in part time paid employment, the Joint Committee recognises that a key issue in ensuring a supply of carers in the coming fifteen years will be measures to reconcile work and family responsibilities. Recent Employment Equality Agency and National Economic and Social Forum reports recommend the introduction of more flexible and family-friendly forms of work such as job redistribution, flexi-time, working from home and job-sharing. The Joint Committee recommends that the Social Partners should examine how these measures could be put in place in the context of these reports.
9.The Joint Committee recommends that the specific measures identified in a recent report from the European Foundation for the Improvement of Living and Working Conditions to facilitate persons caring for older people and people with disabilities should also be examined.
10.The Joint Committee recommends that the possibility of negotiating measures relating to caring leave and support measures for carers should also be actively explored by the Social Partners within the context of the recently issued EU Directive on Parental Leave.
11.The Joint Committee urges employers in Ireland to introduce a number of workplace initiatives to respond to the growing needs of carers among their staff.
12.In view of the economic advantages of adopting such initiatives, the Joint Committee recommends that the initiatives be included in national agreement negotiations.
13.The Joint Committee recommends that full access to all employment and training schemes should be given to carers who have been out of work due to caring responsibilities. The Department of Enterprise and Employment and FÁS should ensure such access in order to facilitate a return to work.
14.The Joint Committee acknowledges the importance of care for older people and people with disabilities as a potential source of new employment in the social economy as has been identified in the EU White Paper on Growth, Competitiveness, Employment. The Committee recommends that organisations creating employment in this area be given adequate support and funding by state agencies.
15.The Joint Committee recommends that simplified procedures should be developed and streamlined by the Department of Social Welfare, the Department of Enterprise and Employment and the Revenue Commissioners for the employment of carers of older persons or persons with disability.
The Joint Committee recommends that carers and the organisations which represent them should be involved in the planning and delivery of services through membership of planning and advisory groups at national level by the Department of Health and at local level by the Health Boards, in order to improve integration and development of overall community care services along the lines of the approach adopted in the Soroptomists’ pilot project in County Clare. (Carer’s Charter in Action Project).
17.The Joint Committee recommends that the Department of Health and the Health Boards provide additional funding to voluntary organisations such as the Soroptomists and the Carers Association which provide direct services to carers. It is clear that investment in this area would be highly cost effective.
18.The Joint Committee recommends that the existing respite care fund for carers should be expanded to cover other caring services.
19.The Joint Committee recommends that a review of the operation of the fund should be conducted by the Department of Health to ensure efficient and equitable administration of the fund.
20.The Joint Committee recommends that each Health Board employ a Development Officer for carers, initially on a 2 year pilot basis with the designated role of supporting carers and helping to develop and coordinate services. These appointments should be funded by the Department of Health and should draw on the experience of the Carer’s Charter in Action Project in Co. Clare.
21.The Joint Committee recommends that the specific guidelines established by the UK Department of Health and Social Security regarding consultation of carers about the temporary discharge from institutional care and provision of temporary institutional care should be examined with a view to implementing them in Ireland.
22.The Joint Committee recommends that reform is needed of community care services provided or controlled by the Health Boards, and that improvements be made in the following areas:-
(i)provision of respite care
(ii)provision of day centres with adequate facilities
(iii)provision of accessible public transport services
(iv)provision of training for carers so as to allow greater access to the above services.
The Joint Committee considers that there should be full access to the services listed above, notwithstanding the presence of a carer.
23.The Joint Committee recommends that the homehelp service be improved and expanded with changes being made in the following areas:-
(i)the establishing of national minimum standards in relation to rates of pay and conditions of employment
(ii)people should not be disqualified from entitlement to home help service because of the presence of a carer.
24.The Joint Committee recommends that the Department of Health should extend the domiciliary care allowance to all children from the time of diagnosis upto the age of eighteen years who satisfy the relevant qualification criteria and who do not qualify for the new disability allowance.
25.The Joint Committee recommends that people in residential special needs schools should be entitled to payment in respect of the domiciliary care allowance for each full week period that the child is not in residential care.
26.The Joint Committee recommends that the Department of Health review the domiciliary care allowance with regard to the degree of disability and age of the child and the travel costs involved.
27The Joint Committee recommends that the Carer’s Allowance should be made payable in respect of carers of all persons requiring full time care. This can be achieved by removing the means test and other qualification criteria relating to the residence and employment status of the carer on a phased basis over the next 5 years.
28.The Joint Committee recommends the grant of full paid P.R.S.I. contributions in respect of carers who have had to give up work due to caring responsibilities.
29.The Joint Committee recommends that the cost of those contributions be met from the Social Insurance Fund.
30.The Joint Committee recommends that the tax allowance of £7,500 for the employment of a carer should be available to the full range of family members contributing to the employment of a carer for an older person or a person with disability.
31.The Joint Committee recommends that the Revenue Commissioners start a promotional campaign publicising the existence of this tax allowance in view of the fact that only 400 people avail of it at present.
32.The Joint Committee recommends that simplified procedures should be developed and streamlined by the Department of Social Welfare, the Department of Enterprise and Employment and the Revenue Commissioners for the employment of carers of older persons or persons with disability.
33The Joint Committee recommends the application of the same level of means testing for medical cards and benefits for persons requiring full time care as is applied in the case of mentally handicapped persons.
34.The Joint Committee recommends the improvement and development of support services in the Community for elderly persons and persons with disability who are being cared for in the Community.
35.The Joint Committee recommends the establishment of a Helpline service by the Department of Health for carers and persons requiring care.
36.The Joint Committee recommends the establishment by the Department of Health of a counselling service for carers and parents of disabled children.