Terms and conditions for homecare workers, who often tend to people during their most vulnerable times, have improved in recent decades. However, there are still blind spots in a sector that will be asked to carry much of the load as Ireland ages.
In 1984, a healthcare worker could expect to make about £2 an hour – about €4.50 an hour in today’s money, according to the Central Statistics Office. There was no holiday pay and no sick pay. Their duties in those days largely consisted of housework for a couple of hours a day. Geraldine McNamara, a healthcare support assistant who started working that year, has seen significant changes.
From 1997, the homecare workers were formally recognised as HSE staff, where they did public work. They were given an 11-hour per week contract, granted holiday and sick pay, a raise to £3 an hour and made eligible for pension entitlements. However workers sometimes faced lengthy periods of unemployment.
In the intervening years, McNamara said that the pay for a HSE healthcare support assistant had risen to a maximum of about €15.50 an hour, “but our job has changed, which required upskilling”.
“Now instead of doing housework, we do personal care – washing, showering, changing pads, helping with walking or hoisting – or even helping when they’re dying,” she says. They have also been trained in other skills, like defibrilator use. Since 2011, thanks to a European Court of Justice ruling, the HSE has paid mileage to homecare workers. Those in the private sector generally earn less, between minimum wage and €10 per hour, in the main, according to Siptu.
Stumbling block
The HSE has introduced a rostering system for the roughly 6,000 healthcare support assistants it employs – the idea being that there would be less latency for workers who will not face periods of unemployment. However, frontline workers say the implementation of this new system has been uneven. “We’re going in the right direction, but there has been a stumbling block with co-ordinators not having the IT system or manpower to implement rosters,” says Katherine Dowling, who also works as a healthcare support assistant. The worth of a homecare professional to the healthcare sector at large is often underestimated, according to Dowling
A homecare support assistant job evaluation exercise is also under way by the HSE, which may lead to pay and conditions being improved. In the private sector, Siptu believes that pay and progression scales are not as clearly defined as in the public sector.
Marie Sherlock, the union’s head of equality and policy, says homecare and nursing home workers have clearly defined wage scales in the public sector, while nursing home staff have received pay increases under the public service agreements.
Sherlock said that some private sector companies operating in the homecare sector “are attempting not to cover mileage expenses for staff”, while there is also a “downward pressure on call times” – the amount of time a carer will spend with a client – in the private sector. “Many companies have 15-minute visit times, sufficient only to check if medication has been taken or the individual is up and dressed,” she said. The HSE’s minimum visit time is 30 minutes.
Quality assurance
Siptu says it is concerned by the potential shortfall of homecare workers to meet demographic demands. “There is little State planning for this massive increase in service demand. There is insufficient quality assurance with regard to some of these services provided by the private sector, and with the HSE stopping the approval of homecare packages, the reliance on the private sector is only going to grow,” Sherlock said.
The Government and the HSE say homecare hours have not been frozen or cut, but campaigners argue that there is clear evidence the State is not meeting demand.
Last year, the Migrant Rights Centre of Ireland (MRCI) wrote to Minister of State for Mental Health and Older People Jim Daly, asking him to address “the increase in the number of undocumented care workers employed directly by families in the private home setting to provide care”.
“This increase is an inevitable consequence of poor labour migration policy and the absence of an employment permit for the sector since 2009 despite population ageing and increasing demand for care workers.” The MRCI has unsuccessfully lobbied the Government to remove care workers from the list of professions that are ineligible for employment permits.
The MRCI has said there is a growing cohort of migrant homecare workers, who are sometimes exposed to haphazard or exploitative employment practices. One such worker is Mercy, a Filipino woman who came to Ireland about five years ago. She says unregulated workers in the sector are “overworked and underpaid”. Mercy pays half her wages to share a room in a house, and has not seen her children since she came to Ireland.
“We want the Government to ensure employment equality legislation for all homecare workers regardless of immigration status,” she says.