Older people in Ireland may have no choice but to move out of their own homes, because they cannot access the care and support services they need to continue living independently.

That is according to Sage Advocacy, which provides support to older people, vulnerable adults and healthcare patients.

The organisation said a national crisis is unfolding that could result in older people having to leave their homes against their will because of a shortage of available carers.

Joan Fisher, 83, is her husband Robin's main carer. Born in Dublin, she moved the UK in her late teens/early 20s where she trained as a nurse.

She met and married Robin there before buying a house to retire in Ireland in 2013. They are over 40 years married.

In 2014, Robin suffered a stroke, but he was still mobile and strong.

Prior to Covid-19, he got ill and ended up in hospital for several weeks, from where Joan took him home where he is confined due to limited mobility.

While his wife is his primary carer, Robin, who is 1.82m tall and weighs over 100kgs, is also supposed to receive 21 hours of home care.

Joan points out that they are assigned two carers for two hours in the morning.

However, if one comes, that is still classed as two hours and if one comes in the afternoon for a half an hour, she said that is classed as an hour.

"So, that's three hours a day, you work that out seven days a week, that's 21 hours, but the actual time spent in the house is not like that," she said.

"I would regret if I put him in a nursing home"

She does not want to consider a nursing home, despite being advised on several occasions to do so.

"I love my husband", she said. "And he would do the same for me. Also, in a way you promise to look after somebody, and you only get one opportunity in life to do the right thing.

"And if you don't take it, you can sit and regret for the rest of your life that you didn't do it. And I would regret if I put him in a nursing home."

Their wedding pictures have pride of place on the wall in their dining room and despite all the challenges her husband now faces, including his speech. Daily they are inter-twined at every opportunity.

It is clear Joan wants them to enjoy the remaining time they have together, and she is not alone.

There are an increasing number of families who want to see older members of the family live at home, but there is also an increasing number that are not getting assigned carer hours.

While help and support can come from different sources such as the HSE Home Support Service, independent carers or private companies, it appears that a recruitment crisis and a shortage of staff to provide these services is having an impact nationwide.

The Department of Health has acknowledged that the Covid-19 pandemic has led to an unprecedented challenge across the health service and none more so than in older persons services.

In a statement, it said that while there have been challenges in the delivery of home support hours, particularly during the third wave of the pandemic, significant progress has also been made.

It points out that provisional information indicates that at end of August this year, over 13.2 million home support hours had been provided to 53,905 people which is about 2 million more hours compared to the same period last year.

It goes on to say that approximately 478 people were waiting for funding approval, representing an 88% reduction compared to the same period in 2020.

'Homecare is full in many parts of the country'

That is all good news, according to Joseph Musgrave, the CEO of Home and Community Care in Ireland.

However, he said the department was warned by HCCI two years ago that without a workforce plan, they were going to run out of staff.

"And that's what we're seeing now," he said.

"Homecare is full in many parts of the country. In Galway, our members are having to wait up to three months before they can take new clients and that's spread across the country.

Joseph Musgrave

"Simply put, the carer hours are there, but there aren't enough carers to fulfill those hours, regardless of whether they're hired by a private operation or the Health Service Executive."

The Department of Health said the HSE would continue to work towards increasing home support provision, however it acknowledged that challenges remain in relation to capacity across both direct and indirect provision.

"There can be delays between funding approval and delivery of home support hours, largely due to staffing issues, with particular local areas experiencing increased pressures," it said.

A Strategic Workforce Advisory Group with involvement of key stakeholders, including representatives from the sector, education and government, has been established by the Minister with responsibility for Older People Mary Butler.

The group will provide a forum for "practical action and collaboration" aimed at addressing the skills needs of the sector including recruitment, retention, pay and conditions, skills development and sustainable employment into the future.

However, Sage Executive Director Sarah Lennon said action is required immediately because people are desperate for carers and to support them in their homes now.

"As lockdown is beginning to end and people are re-emerging, for a lot of families they're still feeling trapped. They're still feeling locked in their own homes.

"They don't have the care and support they need to get up in the morning, get out into their community, the same as the rest of us are starting to enjoy."

Sarah Lennon

Many older people are now having to rely on family and friends to provide essential day-to-day care and support, according to Sage.

The Programme for Government commits to the introduction of "a statutory scheme to support people to live in their own homes, which will provide equitable access to high-quality, regulated home care".

The Department of Health said it was in the process of developing such a scheme and it is intended that it will provide equitable and transparent access to high-quality services based on a person's assessed care-needs.

Back in Drogheda, Joan says she cannot do much more than take one day at a time.

"I don't think about the future. I don't want to think about when both of us are 90," she said.

"I don't think either of us will survive that long. I just live from day-to-day really, you know, because that's the only way you can cope."