By Carol Power and Caroline Crowley, UCC
In Ireland, most people prefer to age in their own homes. Many rely on home care supports to enable them to fulfil this wish, but there are not enough care workers to meet the demand. Almost 6,000 people are waiting on care that has been approved by the HSE, including new clients and those who have been approved for additional hours.
This unmet demand for home care is likely to worsen as Ireland’s population ages. By 2051, the 70+ age-group is projected to double to almost 1.2 million, while the 85+ age-group will quadruple to 304,900. This calls for innovative solutions to support older people to live independently with access to high-quality home care.
Over the past 20 years, the HSE has become increasingly a commissioner rather than a provider of home care services. Only 38% of publicly funded home care is provided directly by HSE staff, while 62% is provided by for-profit and non-profit organisations contracted by the HSE. The introduction of competitive tendering has favoured large care company chains, with the number of home care hours provided by for-profit companies outnumbering the non-profit sector by seven to one.
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From RTÉ Radio 1's Late Debate, how can the State help carers looking after a loved one?
Workforce recruitment and retention are key challenges to delivering home care, with retirements due to an ageing workforce, poor pay and conditions, precarious contracts, employment competition from other sectors, and lack of career development opportunities. In our recent research, we heard from care workers who had experienced such poor pay and conditions in for-profit companies, leading to high levels of stress and burnout. They reported how their expertise was ignored by top-down management structures and how highly pressurised schedules led to 'conveyor-belt care’, where each older person represented a set of tasks to be 'ticked off’.
This is failing both the care worker and the person receiving care. As a society, we need to value and appropriately reward care work. Our research explores the model of care co-operatives, which offer older people and family carers not just access to care and support but also a say in how their care is provided.
Care co-operatives are owned, governed and operated by the people who give and receive care, and other interested stakeholders. They are designed for service to members rather than to make a profit. Financial surpluses are generally reinvested in the co-operative or as agreed by members, rather than for the profit of external investors. They are numerous in Italy and Canada, and have also emerged in France, Spain, Poland, Finland, Sweden, the UK, the US and Japan.
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From RTÉ Radio 1's Saturday with Colm Ó Mongáin, discussion on the home care headache that won't go away with carer Kieran Kenneally, Home and Community Care Ireland's Joseph Musgrave, Minister of State at the Dept of Health & Older People Mary Butler, Labour senator Anna Hoey and Independent TD Michael McNamara
Usually set up as multi-stakeholder co-operatives, which include care receivers, family carers, care workers and others in the community, they often work in partnership with local authorities responsible for social care. They can also be worker co-operatives, which are owned and run by care workers.
While still rare in Ireland, the Great Care Co-op in Dublin is one example of a worker-led co-operative using innovative work practices to provide better work and better care. The GCC emerged out of the Migrant Rights Centre Ireland in response to the negative experiences of migrant workers. According to Aoife Smith, co-founder of the GCC, "it was very clear that the model was broken, that it wasn’t working for carers, it wasn’t working for families, and it wasn’t working for individuals."
After several years’ research, the GCC began trading in Dalkey, Co. Dublin in 2020. It is currently expanding, creating local hubs in Dublin 4 and Bray, Co. Wicklow. Workers operate in self-managed teams, devise their own schedules and work with clients to provide ‘whole person’ care that suits their needs. Workers are also represented on the board of the co-operative. The GCC started with private paying clients and now provides services for the HSE too.
From The Great Care Co-Op, why we established the co-up
While general awareness of co-operatives in Ireland may be low, 3.6 million people are actually members of the co-operative that is their local credit union. Since the late 1950s, credit unions have spread to every community. Because they put members' needs at the top of their agenda, they have become trusted locally-based providers of financial services.
Could similar organisations help to solve Ireland’s worsening home care crisis? For care co-operatives to be part of the solution to Ireland’s care needs, the State must work with them to support their development and integration into the care system. However, co-operatives are autonomous and independent organisations and cannot be set up by the State or its institutions. They must be formed voluntarily by groups of care workers or communities with a strong desire and commitment to developing co-operatives.
We need a new care system that values and rewards care, and respects the rights of older people, family carers and care workers
The first step is to raise awareness and stimulate interest among stakeholders. Trade unions, age advocacy and carer advocacy groups, local authorities, local development companies and community groups could play a key role here.
Many campaigners advocate for personal budgets so that older people and people with disabilities can exercise their right to choose appropriate support and who provides it. This would allow emerging co-operatives to grow their business by becoming a preferred provider based on their distinctive approach.
As the Commission on Care for Older People begins its work, the co-operative model should be considered as central to a new care system that values and rewards care, and respects the rights of older people, family carers and care workers.
This research wads funded by the Irish Research Council's New Foundations scheme and was conducted in collaboration with Age Action.
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Dr Carol Power is a lecturer at Cork University Business School and the Centre for Co-operative Studies at UCC. Dr Caroline Crowley is a Researcher in the Centre for Co-operative Studies in the Cork University Business School at UCC. She is a former Irish Research Council awardee.
The views expressed here are those of the author and do not represent or reflect the views of RTÉ
