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Tóibín: Clinically discharged patients ‘trapped in hospitals’ due to lack of step-down supports

Aontú’s Peadar Tóibín has told a Dáil debate on Home Care that the state is spending up to €170 million on providing hospital beds to clinically discharged patients who are being forced to remain in hospital due to a lack of step-down supports. 

Figures show that up to 6,000 people in Ireland are waiting for a carer, some in hospital and either unable to return home, or moved to a nursing home, because they cannot remain in their own homes without support.

The Meath West TD said that research undertaken by his party on the issue exposed a health service that is “dysfunctioning at great costs to patients and to the state”.

The Aontú leader said: “This year Aontú researched the number of medically discharged patients who should be discharged from hospitals but are being forced to stay in hospital because of a lack of suitable step-down supports. 

“The information that Aontú found out was incredible and shows a health service that is dysfunctioning at great cost to patients and to the state”.

Deputy Tóibín said that his party established that on any given day, there were as many as 536 patients in Ireland who no longer needed to remain in hospital but were still occupying a hospital bed due to a lack of home care and additional step-down supports which would allow them to return home. 

He said this situation “is shockingly damaging for the hundreds of patients directly affected” and also “incredibly damaging” to those who are sick but cannot access a hospital bed when needed.

Mr Tóibín continued: “The HSE advised in 2019, that the average daily running cost of an in-patient hospital bed across acute hospitals is €878 per night. If there are 536 people in hospital beds that don’t need to be [there], that means it’s costing the state €470,608 or €½ million a night to provide beds for those who don’t need them.  

“If these figures are repeated over each night of the year and we have no reason to suspect that they are not, there is as much as €171m being spent in providing beds for clinically discharged beds,” he said.

Speaking in the Dáil, he said such a situation was “phenomenal”, even for a health service executive which routinely provides “a master-class in dysfunction”.

“That’s phenomenal Minister. Even for the HSE which often provides a master classes in dysfunction, that €171m would be spent on hospital beds for people who don’t need them,” he said.

“Imagine how far that €171m would go in terms of Home Care and other step-down facilities where it would actually have a beneficial outcome for patients?”

He added that the human cost inflicted by the situation is “unquantifiable”, highlighting how some patients remained in hospital for more than a year, with one patient who had been clinically discharged forced to stay in hospital for a period of 18 months to two years.

“Seventeen of the patients I investigated were in hospital despite being clinically discharged, for between 6 and 12 months. Ten of the patients Aontú learned of were clinically discharged more than a year and one for 18 months to two years. The human cost of this is unquantifiable. 

“The monetary cost is €640,000 for one person to provide a bed that they did not need.  This has been going on for years and as far as I know no one has ever been held to account for the problem. Minister, for the sake of the patients who awake every morning trapped in a hospital, will you provide the necessary funding to ensure that step down facilities and treatment pathways are provided in a timely manner?”

The comments come as frustration mounts among the thousands of older people in Ireland waiting on homecare, as the system grapples with preparation for a new funding scheme which seeks to make homecare as accessible as nursing homes.

In late October, the Workforce Advisory Group on Home Carers and Nursing Home Healthcare Assistants claimed a carer shortage “militates against the reorientation of care into the community to which the Government is committed under Sláintecare”. The working group called for a greater number of homecare hours to be delivered by the HSE rather than through outsourcing as part of the answer to the current crisis.

Unattractive, badly paid and undervalued were among some of the terms used by the working group in a report published in September. The report called for a fundamental change in how homecare is viewed.

The cross-departmental Strategic Workforce Advisory Group was established by Minister of State for Mental Health and Older People, Mary Butler, in March this year. The Group was charged with examining strategic workforce challenges in publicly and privately provided front-line carer roles in home support and nursing homes and with making recommendations to address such challenges.

“Care-working has a poor reputation: it is considered unattractive, poorly remunerated, and under-valued,” the report outlined, while also highlighting a lack of young people in the profession, stating:

“The existing workforce is ageing: HSE data indicates that, in September 2021, 63% of home-support workers were aged 55 or over. This will result in a significant decrease in experienced staff over the coming years”.

Action can’t come quick enough, with 970 people in Cork and Kerry alone waiting on homecare in September. The role, which includes washing and feeding elderly people, as well as offering chat and conversation, is invaluable, and provides older people with the retention of a sense of dignity that could otherwise lose.

Minister of State for Older People, Mary Butler, recently highlighted the crisis. Speaking at the Home and Community Care Ireland annual conference last month, Ms Butler said that the national shortage of carers is the most urgent issue facing homecare at present.

The conference heard it was time to stop clapping for carers, and instead working to implement practical support, with the current demand for home support hours at an “unprecedented” level.

“No issue is more urgent than the nationwide shortage of care workers,” the Waterford TD said adding:

“From January to July of this year, the State has provided 12.4m hours of home support, an increase of 8% compared to last year.” 

She said the Covid pandemic showed the value of people being able to receive compassionate care in their own homes.

“We need to do more than just fill vacancies for carers,” she said. “In the context of our ageing population, many of whom have complex care needs, we must recognise that carers often need support of multi-disciplinary teams”.

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