The recent news that Bluebird Care Ireland has been sold, means that four of Ireland’s top home care providers have now changed hands in recent times. This is a worrying trend, that home care in Ireland is becoming increasingly dominated by investment funds, with more and more private funding from outside the country becoming involved in the sector.
Home Instead in recent years was sold to Swiss/Austrian investors, who are presently in the process of buying back locally owned franchised offices and moving to a more centralised corporate structure which would facilitate a further sale to private equity in the next few years.
Irish Home Care, another large player was also sold earlier this year, going from a family run business to a private equity backed corporate entity, while Comfort Keepers were sold several years ago to one of the world’s largest companies, Sodexo.
All these deals have been happening because these investors are anticipating the introduction of a statutory right to home care in Ireland. They are also probably hopeful, that any regulation that is brought in will copper fasten their positions as dominant providers, by imposing a one size fits all regulatory system, prioritising overburdensome systems, processes and form filling, instead of great outcomes. The more formidable and complicated the regulatory standards, the higher the barriers for entry for other models such as social enterprises, carer co-operatives and micro providers. This means these large corporate providers, who are set up to tick boxes and fill in forms, can milk the system under the cloak of safeguarding.
What is starting to happen in the Irish home care market is reminiscent of what has happened in the UK social care sector, with a concentration of large corporate providers leading to a race to the bottom on price and quality, so much so that many of these large operators are now looking to exit the social care sector all together, leaving many vulnerable people in precarious situations, in their wake.
A regulatory system shouldn’t be a used as a way to protect the Status Quo but rather it should be a lever to foster innovation and great outcomes with as wide a ecosystem of provision models as possible, in order that families and carers have choices. Families and their needs are incredibly varied and the idea that one all-encompassing regulatory system can fit all, is fanciful.
The introduction of real personal budgets and direct payments, are probably the best way to combat the power of these corporate providers by placing choice and trust firmly in the hands of families and people needing care. The UK, in it’s 2014 Care Act, gave everyone who was receiving support from the State, the right to opt for a direct payment, where they had control over how and with who, funds were spent.
Personal budgets and direct payments mean these corporate providers have to be on their best behaviour or else families can look elsewhere for support. It also means they have to look after their carers well or else carers could migrate to other models of home care provision, including working directly with families themselves. With personal budgets and direct payments, no longer are large corporate providers the sole conduit for State funds.
Home care provision in Ireland is hugely lucrative for the limited list of approved corporate providers and will be even more so when regulation and a statutory scheme are introduced.
Unless measures are taken to open up the market to real competition from other models such social enterprises, carer co-operatives and micro-providers, more and more funds will leak to corporate bottom lines, with many of them being foreign, rather than to where it has most benefit for families, frontline workers.
The fact is, care quality is rarely improved by State funds flowing to corporate profits but it does improve measurably, when those funds create happy, well rewarded frontline workers.