The growth of private home care providers in Europe: The case of Ireland

Abstract

Private for‐profit home care providers have grown unevenly in Europe and through varied processes. Yet, more research focusing directly on private providers is needed to identify and explain European patterns in their growth and in their modes of operation. This paper examines the case of Ireland, where private providers have grown significantly in recent years and transformed the national landscape of domiciliary care. First, it is shown that the amount of public funding received by private providers increased from €3 million in 2006 to €176 million in 2019, in contrast to amounts allocated to non‐profit and public providers that have increased only slightly. Second, those trends are explained through policy analysis and by drawing on in‐depth semi‐structured interviews (n = 12) with private home care providers and government officials who have been central to the privatization of care. The paper gives a direct voice to key figures in private home care, and through a critical reading of interview materials, argues that the neoliberal nature of the Irish state has driven the growth of private provision, in particular, through policies of competitive tendering and fiscalization. Providers' own lobbying activities have also played a role, albeit a secondary one. Ireland has traditionally followed a laissez‐faire, family‐based system comparable to Southern European countries. Its experience is thus directly relevant to that region, but further research should also compare and contrast the development of private providers operating in other European long‐term care regimes.

Demand for the Statutory Home Care Scheme

“…Until recently, care provided through the home help scheme was provided mainly by State-employed home helps or personal care attendants or through a large number of voluntary agencies. However, in more recent years, the for-profit sector has become a bigger component of both public home support as well as providing privately purchased home support (Mercille and O'Neill, 2020).…”

“…Traditionally, care provided through the home help scheme was provided mainly by State-employed home helps or personal care attendants or through a large number of voluntary agencies. In more recent years, the for-profit sector has been a larger supplier of both public and privately purchased home care (Mercille and O'Neill, 2020). There is evidence of the system incrementally shifting toward greater marketisation since the introduction of the HCP in 2006, with the role of for-profit organisations becoming more pronounced (Mulkeen, 2016).…”

“…Public home support in Ireland relies significantly on private providers (Mercille and O'Neill, 2020;Mulkeen, 2016). This is not solely an Irish phenomenon (Kiersey and Coleman, 2017), and not unique to the home support sector (for example a majority of NHSS residents live in private nursing homes (Collins, 2019)).…”

“…Due to limited available data, it is difficult to split non-HSE home support provision between voluntary organisations and for-profit organisations. Recent research has found that there is a 4:1 split between for-profit and voluntary organisations in public home support expenditure (Mercille and O'Neill, 2020 While most home support is provided by non-HSE staff, the share varies across regions in Ireland. While we do not have information on regional variation in private home support, Figure 7.2 illustrates the breakdown of public home support by HSE and non-HSE staff across regions in 2019.…”

Ireland's takeover of private hospitals during the COVID-19 pandemic

“…The Irish health system contains complex interactions between public and private funding and delivery (Burke et al ., 2018 b ; European Commission, 2019 ; Independent Review Group, 2019 ; Mercille, 2018 a , 2019 ; Mercille and O'Neill, 2020 ; Turner and Smith, 2020 ). Nowhere is this more obvious than in the hospital sector.…”