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When I served as a councillor, I was often contacted by families in rural areas desperate for help securing domiciliary care for elderly relatives. These were not people seeking special treatment — just the basic support needed to help their loved ones stay at home safely. Again and again, I saw the same pattern: no available staff, missed visits, constant turnover, and exhausted family carers trying to fill the gaps. When I contacted social workers, I was met with the same frustrated answers! “We just don’t have the staff/capacity to handle the demands!” Years later, those same issues persist. Only now, the system is even closer to breaking point. Across Northern Ireland, more than 300 domiciliary care agencies are registered to provide home-based support to thousands of older and vulnerable people. Yes, you read that right!! Over 300. Just check out the RQIA website to confirm. The majority are independent or voluntary providers, commissioned by our five Health and Social Care Trusts. In theory, this network allows people to live independently and with dignity in their own homes. In practice, it operates on the goodwill of underpaid workers and the determination of families who refuse to give up. Most care workers in Northern Ireland earn between £12 and £14 per hour. Many are not paid for travel time, despite spending long stretches on rural roads between clients. These are people doing deeply personal, often emotionally demanding work — washing, feeding, dressing, and comforting those who can no longer manage alone. For comparison, the Homecare Association has calculated that to deliver care responsibly — paying staff the Real Living Wage of £12.60 per hour, covering travel, training, insurance, and overheads — the minimum sustainable rate would need to be £32.84 per hour. Yet Trusts typically pay agencies around £20 per hour. That gap of roughly £10 per hour isn’t absorbed by bureaucracy — it’s absorbed by the workforce. By people, mainly women, who love what they do but can’t afford to stay in the job. Nowhere is this crisis felt more acutely than in rural Northern Ireland. Recruiting and retaining care staff in areas like Mid Ulster, Fermanagh, or the Glens is a constant struggle. Long distances, high fuel costs, and tight visit schedules make it practically impossible for agencies to cover every call. Families are often left waiting — or told there’s simply no one available. The result? Older people being admitted to hospital because there’s no care at home. Others left isolated and anxious, their independence slipping away through no fault of their own. The Department of Health’s published their latest Winter Plan last week, under duress it would seem, if we listen to some members of the Health Committee! The plan rightly emphasises “care closer to home” and improved “patient flow” to keep hospital beds free. The logic is sound — treating people in their own communities reduces pressure on hospitals and improves quality of life. But here’s the uncomfortable truth: none of that is achievable without a functioning domiciliary care system. Patient flow doesn’t improve if frail older people can’t be discharged because no home care package exists. Care closer to home means nothing if there are no carers left to deliver it. And this isn’t an issue that suddenly appears each November like a seasonal surprise. Every year, we produce a new “Winter Plan” that revisits the same old problems — staff shortages, delayed discharges, blocked beds — as if they’ve crept up on us for the first time. We know these are structural problems, not seasonal ones, yet we treat them like annual inconveniences. It’s as if we forget, every year, that winter inevitably comes. Northern Ireland’s population is ageing faster than ever. By 2031, one in four people here will be over 65 — a demographic shift that will double the demand for domiciliary and community care within a decade. Put simply, more people potentially needing home care, fewer people to deliver that care! It’s not rocket science. Senior policy makers should not need a writer on Slugger to highlight this reality. Yet there is no corresponding workforce strategy, no sustainable funding plan, and no long-term model to support this rising need. This isn’t a short-term “winter pressure.” It’s a permanent structural challenge that will only deepen as our population ages. Good domiciliary care saves the health system millions every year. By keeping people well and supported at home, it prevents admissions, speeds up discharges, and reduces emergency pressures. Yet this vital part of the system remains chronically underfunded and undervalued. We would never tolerate such neglect in hospitals or GP services — but somehow, when it comes to care in the home, we’ve accepted that “good enough” is good enough. This is about more than economics. It’s about what kind of society we want to be. The people receiving care today are the same ones who built our communities — who worked, raised families, volunteered, paid taxes, and served in countless ways. They deserve more than the bare minimum. And those providing care — overwhelmingly women, often part-time, often juggling family responsibilities — deserve fair pay, proper training, and the dignity of a valued profession. Fixing domiciliary care in Northern Ireland requires courage and vision: fair funding that reflects the real cost of care, including travel time and fair wages; professional recognition so that care work is treated as a skilled career, not a stopgap; targeted incentives to attract and retain staff in rural communities; and genuine integration between health and social care to make “care closer to home” more than a slogan. None of this is radical — it’s simply what a compassionate, functioning system should deliver. Many years ago, I had the privilege of being part of, I think the first, Citizens Assembly in the north. The topic……”Domiciliary Care….” Everything I have discussed above was discussed over 2 weekends in Belfast. The key line there…..”many years ago..” it’s not a new problem! We cannot claim to value older people while underfunding the care that sustains them. We cannot talk about dignity while tolerating poverty pay. Domiciliary care is not peripheral to our health system — it is the foundation that allows it to function. The people who deliver it, and those who rely on it, deserve better than the status quo. If we truly believe in a compassionate Northern Ireland, this is where we start: by valuing care, funding it properly, and treating both carers and clients with the respect they have long earned.
