Home support services in Ireland: Exchequer and distributional impacts of funding options

A new statutory scheme for the provision of home support services is currently being developed by the Department of Health. Research has shown that access to home support services varies across the country. The new scheme aims to tackle this issue to ensure equitable access to home support services nationwide and is part of wider reform of Ireland’s health and social care systems as envisaged in the Sláintecare report and Department of Health action plans.

Publicly funded home support services in Ireland are currently provided free of charge for recipients, unlike long-term residential or nursing home care, which involves a contribution from residents. In 2019, the HSE’s Older Persons’ Services provided care to 53,000 people at a cost of €440 million. It is anticipated that demand for home support services may increase under the new scheme, for example if unmet demand is met or if the new scheme results in more people being able to remain in their own home, substituting away from long-term residential care. Any increased demand would result in an increased cost, which may also rise as the population ages. This report examines the possible introduction of co-payments for home support services. We focus on the likely Exchequer impact of a range of different funding scenarios along with the distributional, poverty and inequality impacts of such charges. Due to data limitations, and the fact that the majority of home support services are provided to older age groups, we focus on those aged 65 years and over. Regarding co-payments we examine the impact of flat-rate charges for users, regardless of means, as well as co-payments for home support recipients above a variety of income levels. The tapering of payments is also examined to ensure that individuals just over a specific income threshold would see co-payments gradually increasing as their income rises. We also consider the capping of co-payments so that those needing a high number of home support hours would not potentially face very high costs.